Could it be skin cancer?
Skin cancer is most often diagnosed in people over age 40, however the events that set it in motion usually occur decades earlier. The threat increases with repeated exposure to the sun, especially sunburns and tanning.
A wide spectrum of solar energy strikes and injures our skin, but ultraviolet radiation (UVA and UVB) is the most dangerous. UVB radiation concentrates in the skin’s surface and spawns cell mutations that are the seeds of skin cancer. For decades, UVB light was considered the main skin cancer culprit, and much of our prevention efforts targeted this range of light.
However, the UVA light range aids and abets UVB’s effects by penetrating deeply into the skin and disabling the immune cells that are meant to fight and repair UVB’s damage. UVA light is especially treacherous because it passes through the atmosphere, windows and most sunscreens with relatively little filtering.
The resulting broken immune defenses, plus clumping surface mutations, change skin from smooth and springy to raised and ragged. The result is moles. Dark pigments stain the surface, tumor cells tap into blood vessels, and a waxy or crusty substance creeps over the skin. The mole and surrounding area may itch or bleed. Or, it may act like normal skin.
There is much overlap in appearance and behavior between moles that will never become cancerous to ones that have already turned. Having cared for many patients in the skin cancer hotspots of Northern Australia and New Zealand, I’ve seen menacing tumors mimic harmless growths and vice versa. The clear lesson is to have any concerning or changing mole examined by an experienced doctor.
Not all moles need to be removed. A thoughtful doctor will balance cancer risks with preserving healthy skin and avoiding scars and surgical complications. A digital camera is one of my most useful tools for meeting this goal. Coupled to a secure electronic health record and frequent re-evaluation, recording and comparing time-sequenced images help separate moles that should be removed promptly from those that can be closely watched. Stored images of treated skin help monitor any recurrences of more serious skin cancers.
Most skin cancers can be safely removed before causing major harm, but delaying treatment leads to more difficult or repeated surgery. Small cancers or pre-cancer moles can be destroyed with super-cooled nitrogen. This avoids cutting the skin, surgical scars and follow-up visits for suture removal. It is much less expensive than cutting out moles.
In nearly all cases, removing or destroying skin cancer cures it. Treatments in my outpatient clinic typically take 10-20 minutes to excise a skin cancer or to destroy several pre-cancer growths. Exceptions to this include melanoma-type skin cancers and cancers that are adjacent to highly sensitive or mobile tissues such as eyes, lips and noses.
Rather than resorting to cutting out developed skin cancers, it’s better to prevent them. There is much encouragement to use sunscreens, and I agree with it. However, sunscreens are only part of the skin cancer prevention story. I think of them as an umbrella with holes: as long as it is not raining hard or your time outside is short, you will not get wet.
Living and working in Vietnam for years with its year-round, intense radiation shower, I learned it’s much more effective to prevent sun exposure the Vietnamese way: avoid daytime solar radiation; if you do go outside, wear a wide-brimmed hat (not a baseball or trucker hat); use gloves to protect your hands and fingers (common sites where skin cancers develop) when bicycle or motorcycle riding; and rely upon clothing for the bulk of sun blocking.
Aside from wet cotton, almost all clothing is a hundred times more effective than chemical sunscreens; it doesn’t need frequent re-application; it won’t dribble into your eyes if you sweat; and doesn’t contain questionable chemicals.