This time of the year is a good time to remind ourselves about skin cancer. There are three main types of skin cancer: squamous cell skin cancer, basal cell cancer and melanoma. I will review the most important information about each of these types to help increase your awareness.

Cutaneous squamous cell carcinoma (SCC) is very common. It is the second most common type of all cancers. Occasionally it can be aggressive and cause metastasis. The common areas that may contribute to reoccurrence include cancers that develop around the lips and ears. Immunosuppression, tumor diameter and nerve involvement may also contribute to reoccurrence.

Basal Cell Carcinoma is another common skin cancer, but the lesions are rarely metastatic. On the other hand, they do tend to invade/destroy the surrounding tissue. It is much less common in African Americans, and men are 30% more likely to develop BCC than women. The likelihood of occurrence increases as you get closer to the equator. The likelihood also increases with age, specifically between the ages of 55 to 75. Genetic and environmental risk factors are very important contributors in developing this type of cancer. Frequency and intensity of sun exposure are also big factors. Tanning beds can increase the likelihood of developing BCC. While exposure to psoralen plus ultraviolet light (PUVA) does increase its’ incidence, it is not as high of a risk as SCC. Medications that cause increased sun sensitivity also contribute to developing BCC. Chronic immunosuppression is too a contributor.

Melanoma is the most serious of skin cancers. Patients with stage I disease are likely to be cured. The other stages of Melanoma may develop metastatic disease.

Risk factors include:

1. When the lesion, or a change in the lesion was noticed
2. Personal/Family history of melanoma
3. Severe sunburns in childhood
4. Personal history of cancer-prone syndrome
5. Immunosuppression
6. Prolonged psoralen plus ultraviolet A (PUVA) therapy

Patients tend to have red or blond hair; light eye color; a fair complexion; and increased number of melanocytic nevi.

Important predictors of skin lesions likely to be melanoma are known as the ABCDE criteria (asymmetry, border, color, diameter >6, evolution). In addition, the ABCDE criteria was enhanced to include change (preexisting lesions, modification over time or new lesion, especially in individuals over 40).

It is very important to observe changes of the skin on your feet, hands and nailbeds. Unfortunately these are common areas that patients tend to skip when applying sun screen.

Obviously prevention is key for all of these different cancers. It is best to apply sun screen 20 minutes before being exposed to the sun. Tanning is not recommended. Since it is difficult to recognize skin cancer, make sure that you see a dermatologist for whole body skin checks. This significantly decreases the likelihood of developing any of these cancers.   While we as primary care physicians are trained to detect skin cancers, because of the complexity of some skin cancers and the lack of availability to technology that dermatologists use to help detect these cancers, these exams are best done with a dermatologist who can biopsy any lesions.