Skin Cancer Archive

In the journals

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While it's important to have any suspicious mole checked for possible skin cancer, a study published online Aug. 29, 2017, by the Journal of the American Academy of Dermatology suggests most melanomas — the deadliest skin cancer — appear as new spots on the skin. The researchers reviewed 38 studies involving 20,126 cases of melanoma and found that 29% of diagnosed melanomas came from an existing mole, while 71% appeared as new spots. Moreover, they discovered that melanomas that grew from moles were thinner and thus less aggressive than other melanomas. In fact, people whose melanoma was associated with a mole had a better prognosis than others.

The study's authors stressed the importance of looking for any new spots on the skin as well as checking moles for changes, like itching or bleeding, and to see a dermatologist if needed. The American Academy of Dermatology encourages everyone to perform regular skin self-exams, and to ask a partner to check hard-to-see areas like the back. You can learn how to do a skin self-exam, and much more, at www.aad.org/public/spot-skin-cancer.

Research we're watching

You probably know to have your skin checked frequently for the signs of melanoma. But you should also be looking out for another, more common type of skin cancer — squamous cell carcinoma. This potentially lethal skin cancer can show up on your skin as a white or pink bump, a non-healing sore, or even a scaly patch. According to the American Academy of Dermatology, cases of squamous cell carcinoma are on the rise, with some 700,000 new diagnoses each year.

"While other skin cancers may be more lethal, they're less common," writes Dr. M. Laurin Council, an assistant professor of dermatology at Washington University in St. Louis. "Squamous cell carcinoma is highly treatable when detected early, so it's important for people to know the signs of this disease and keep a close eye on their skin."

On call

Q. I have a history of skin cancer, so I am careful with my sunscreen application. I recently heard that I should avoid spray sunscreens. Is that true?

A. Sunscreen use is highly recommended to help prevent skin damage from sun exposure. Spray sunscreens are popular because they are easy to apply and help cover hard-to-reach areas like the back and shoulders. However, they do raise a few concerns. One is the chance of inhaling some of the sunscreen ingredients or its propellant. The health risk from this is uncertain, but it may trigger asthma in susceptible men. The FDA has not specifically determined the health risks of inhaling sunscreen sprays, but recently advised not to use them near your face.

Research we're watching

Image: © Igor Gratzer/Thinkstock
In Hans Christian Andersen's classic fairy tale, the ugly duckling stands out from the flock because he's destined to become a swan. In dermatology, the "ugly duckling" is a mole that doesn't look like the rest of the moles on a person's body, and is often suspected to be a melanoma.

A team of French researchers decided to test whether finding an ugly duckling among all of a patient's moles is as effective a way of identifying melanoma as applying diagnostic criteria — like size, shape, color, and irregularity — to each mole separately. For the study, nine dermatologists studied images of 2,089 individual moles from 80 people. The images were presented to the dermatologists two different ways on two different days. On one day, they evaluated each image separately; on another, they looked for the ugly ducklings among the complete set of moles from each patient. They were able to flag the melanomas accurately both times. However, they were able to decrease the number of moles biopsied when they used the ugly duckling system.

Ask the doctors

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Q. I like gel manicures because the polish doesn't chip easily, but I've heard that they may cause cancer. Is this true?

A. The gel polish itself hasn't been associated with an increased risk of cancer. However, lamps and light boxes, which are used to seal the polish during professional manicures, have raised concern. That's because many emit fairly high levels of UVA radiation, which plays a major role in the development of cancer. The level of risk depends on the frequency of manicures. A 2014 study in JAMA Dermatology indicated that the level of UVA exposure associated with a gel manicure every two weeks probably isn't high enough to increase the risk of skin cancer significantly.

Dr. Robert S. Stern, chair of the Department of Dermatology at Harvard-affiliated Beth Israel Deaconess Medical Center , calls them "solar-phobes": people so concerned about getting skin cancer that they stay inside or cover every bit of skin. "They cover up like they were going out into the Arabian Desert ," he says. The marketing of ultrablocking sunscreens and special sun-protective clothing plays into these fears.

There's no getting around the fact that sunlight is hard on your skin. Age gets blamed for wrinkles and rough, dry skin. But the real culprit is a combination of age and sun that dermatologists call photoaging. The short UVB wavelengths that cause sunburn can also damage DNA and suppress the skin's immune system. The longer, more penetrating UVA wavelengths may create highly reactive oxygen molecules capable of damaging skin cell membranes and the DNA inside.

Once you've completed treatment, adjusting to a "new normal" can be challenging.

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Completing cancer therapy can feel like a graduation. You've done some hard work, it's paid off, and you may be ready to celebrate. But saying goodbye to treatment can arouse many of the emotions and uncertainties associated with beginning a new chapter in life.

Dr. Larissa Nekhlyudov is a general internist who works with cancer survivors at two Harvard affiliates, Brigham and Women's Hospital and Dana-Farber Cancer Institute. She acknowledges that cancer survivors have a lot to deal with. "Once you've had your final chemotherapy infusion or swallowed the last pill, you may find yourself facing a new set of challenges—monitoring yourself for signs of recurrence, getting recommended follow-up care, adjusting to the long-term effects of treatment, psychologically adapting to normal life, and working to stay in good health," Dr. Nekhlyudov says.

The best way to prevent skin cancer is to use sunscreen to reduce lifetime exposure to the sun's damaging rays. But some men may not be heeding the gospel of sun protection, according to a report in the Journal of the American Academy of Dermatology.

Analysis of data from a 2013 national survey showed that less than 15% of men, compared with 30% of women, said they regularly used sunscreen on both the face and other exposed areas, such as the back, arms, and legs.

If a growth or mole looks like a melanoma, the doctor will take a biopsy to confirm the diagnosis. This entails removing either a sample of tissue or else the entire growth and some surrounding skin, and examining the tissue under a microscope to determine whether it's cancer. Depending on how deep a melanoma is, additional tissue may have to be removed. In some cases, lymph nodes may be removed, too. A procedure called sentinel node biopsy can show whether the lymph node nearest the tumor contains any cancer cells. If it does, surgery to remove additional nodes right away can improve survival.

In addition to surgery, treatments for melanoma include immunotherapy (which strengthens the immune system against the cancer), chemotherapy, and radiation therapy. Newer, so-called targeted treatments include drugs that target specific genetic changes seem in people with certain forms of melanoma. For example, about half of melanomas have genetic changes (mutations) in a gene called BRAF, which signals melanoma cells to grow and divide quickly. Drugs that inhibit BRAF, such as vemurafenib (Zelboraf ) and dabrafenib (Tafinlar), and related proteins are now available.

A strong sunscreen and sun-protective clothing can help keep you safe this summer and every day of the year.

With summer here, it's time to reach for the sunscreen. But not everyone is convinced that skin protection is a necessity. "Older adults grew up at a time when unprotected skin exposure wasn't a cardinal sin, and many I talk to think a little sun is good for them. But older adults are actually at an increased risk for skin cancer, since their skin is no longer able to repair damage as efficiently as it once did," says Dr. Oon Tan, a dermatologist at Harvard-affiliated Massachusetts Eye and Ear Infirmary.