FAQ About Skin Cancer

1) Other than staying out of the sun for too long and using sunblock, how can the average person prevent skin cancer? I’ve read, for example, that some claim dietary changes can prevent skin cancer. Is there any truth to this?

The most important factor is preventing excessive sun exposure. There is more to avoiding skin cancer than staying out of the sun too long and using sunblock. Sun protection can involve physical items like a broad rimmed hat, swimsuits and shirts that include sun protection, for example from Coolibar and Patagonia (no conflicts of interest). 20 minutes of sun on your arms is typically all a person needs to get Vitamin D production going . As a dermatologist, i would rather a little every day than compressing sun exposure into multiple hours in one day, particularly for a winter vacation to a sunny place in the Caribbean for a light skinned person. A lot of dermatologists feel that a few bad sunburns is bigger risk factor for melanoma than mild chronic exposure. With regards to dietary changes, the available medical studies tend to be small and conflicting. Since Ultraviolet light causes skin cancer in part by oxidation, some dermatologist recommend a diet high in Vitamins C, E and A, zinc, selenium, beta carotene (carotenoids), omega-3 fatty acids, lycopene and polyphenols. However, when taken in isolation, these antioxidants have not been shown to prevent skin cancer and high doses can be toxic. I personally do not recommend diet to prevent skin cancer.

2) How can one perform a self-check for the symptoms of skin cancer? How often should it be done? What should one look out for?

Performing a self-check for the signs and symptoms of skin cancer is imperative for someone at high risk for skin cancer. For most of us, once a year is the minimum recommendation. For someone with a higher risk for developing skin cancer, for example, a personal history of melanoma, doing a self check should be every 1-3 months as recommended by your dermatologist. The more feared form of skin cancer is melanoma which can often be detected by a self-skin exam Firstly, good lighting is important. You will need a fixed mirror as well as a handheld mirror. Think of dividing the body into 12 parts. Scalp, face, neck, chest back abdomen, right arm, left arm, right leg, left leg, buttocks and genitalia. The hardest areas to examine are the back buttocks as well as back of the legs. (my older patients get the joke that you need a mirror unless you are Linda Blair) Don’t forget to check between your toes and bottom of your feet (soles) Melanoma is equal in incidence in the front and back, it can more thicker and more deadly on the back due to the delay in discovering it. (i wrote about this in the year 2000 in Archives of Dermatology, reference available) Sitting in a bathroom to examine the more difficult parts of the body is can be helpful .

3) In general, what are some reasons, one should see a doctor re: possibly having skin cancer? Should you see a dermatologist, an oncologist or another expert?

There is some credence to the ugly duckling sign, that is, observing a spot that is different in appearance from the others or that changes, bleeds or itches should results in a visit to your dermatologist. We often use the ABCD rules, that is asymmetry, border irregularity (think coast of Norway) color variation or jet black, and diameter greater or equal to 6 mm (size of a pencil eraser). Another common reason patients give is, “i have this pimple for 3 months that won’t go away.” A dermatologist spends a 3 year residency specializing in the diagnosis and treatment of skin cancer. More than any other specialty, we are trained in judging the appearance (morphology) of spots on the skin and also determining what does not require treatment. We often use magnification and special handheld equipment like a dermatoscope and digital photography to follow the appearance of a suspicious lesion.

4) Generally speaking, what are the treatment options for skin cancer?

There are many options for skin cancer including surgical and non-surgical options. Most skin cancers are typically removed (excised) under local anesthesia in the doctors office. For some small skin cancers, particularly on the trunk, topical creams like imiquimod and 5-flourouracil cream can be options. Radiation therapy is another option, particularly for an elderly patient who may have a hard time with surgery. Another less invasive option for basal cell and squamous cell skin cancer is electro-dessication and curettage, photodynamic therapy using lasers.