Understanding Skin Cancer: Prevention, Diagnosis and Treatment (video/podcast)

Most people love sunny days, and San Diego has plenty of them. However, all that sunshine can increase the risk of skin cancer.

The most common type of cancer, skin cancer affects up to one in five people in the United States, and that number is even higher in areas that get a lot of sunshine. Fortunately, skin cancer can often be detected early, when it is most treatable, and with the correct treatment, survival rates can exceed 90%.

In this video, San Diego Health host Susan Taylor talks with Benjamin Kelley, MD, a dermatologist and skin cancer expert at Scripps Cancer Center and Scripps Clinic, about risk factors, diagnosis, treatment and prevention.

The main cause of skin cancer is exposure to ultraviolet light, with the sun being the greatest source.

“Here in San Diego where we have a lot more sunshine than other places and we love being outdoors, skin cancer rates are up to one in three,” says Dr. Kelley. “We have year-round sun, so that really makes us more susceptible.

Moreover, your skin cancer risk is based on the amount of ultraviolet light exposure you’ve had over your entire lifetime. If you’ve used tanning beds, that exposure counts too.

“It accumulates,” Dr. Kelley explains. “It’s not just what you’ve had in the past few years. This goes all the way back to your childhood up until now.”

Anyone can get skin cancer, but the risk is generally higher among people who have lighter skin tones and lighter eyes (such as blue or green). This is mainly because they’re more susceptible to sunburn, and each burn increases the likelihood of skin cancer. Most vulnerable are areas of the body most often exposed to the sun, such your face, nose, ears, neck and arms.

“And other places like eyelids that we don’t think about that much. A lot of us wear sunglasses, but that doesn’t necessarily mean that we are completely protected because the light can come from above as well,” says Dr. Kelley. “When it’s cloudy out, we don’t necessarily wear sunglasses and the ultraviolet light can come right through the clouds.”

The three most common types of skin cancer are basal cell, squamous and melanoma.

Basal cell cancer makes up about 80% of all skin cancers; it is the most common and most treatable type. The second most common, squamous, is more dangerous but is usually caught early enough to successfully treat. Both basal cell and squamous cancer symptoms look like little bumps on the skin that may progress to spots that are tender, bleeding or do not heal.

Melanoma, the third most common, makes up just 1-2% of skin cancer but can be very dangerous if not detected early. Melanoma skin cancer usually appears as a brown spot or mole on the skin. It may be a new spot or an existing spot that starts to change in color, shape or size.

Treatment for skin cancer mainly depends on the type and location of the cancer and how early it is detected. Very small or precancerous spots on areas that are less cosmetically sensitive, such as the back, may be removed by freezing or cutting.

“Mohs surgery is great for areas like the face where we can very delicately go in and take small layer by small layer of a cancer and check it in real time. This gives us one of the highest cure rates, well over 99%, and it also allows us to keep the defects or the scars much smaller,” explains Dr. Kelley. “We have one of the biggest Mohs surgery units in the world here at Scripps Cancer Center.”

If surgery is not an option, treatment may include radiation or immunotherapy, which activates the patient’s own immune system to attack cancerous cells.

“Thankfully we catch most skin cancers fairly early, so the survival rate can be well over 95%, even for melanoma,” says Dr. Kelley. “The survival rate has increased dramatically.”

Ideally, you can prevent skin cancer before it develops. Dr. Kelley recommends wearing sunscreen with an SPF of 30 or higher, avoiding sunburns and tanning booths, and wearing protective clothing such as hats, sunglasses and long sleeves when outdoors, especially if you burn easily.

If you do notice new or changing spots or moles, see your doctor. Even without symptoms, it’s smart to schedule an annual skin exam.

“If something starts to grow on your skin that you haven’t seen before or that you're somewhat concerned about, that's always a good reason to get checked,” says Dr. Kelley. “But we’re all susceptible to skin cancer here in San Diego, and I think it’s a good idea for most of us to go in at least once a year for a general checkup.”

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