Skin cancer questions
By Richard P. Holm, MD
Q: What are some types of skin cancer?
A: The three major types are basal cell, squamous cell and malignant melanoma. In general, one in five, or 20 percent of people in the U.S. have had or will have some type of skin cancer. In Australia where the sun is intense, two out of three skin cancers are basal cell, one in four are squamous cell, and one in twelve are malignant melanoma.
Q: Should I go to a dermatologist for screening?
A: The dermatologist is the most experienced with skin cancer, but primary care providers can help, too. Realize, however, that the first person to discover skin cancer should be you, along with a partner to look over places you cannot see. Self-screening is especially important for those at high risk for skin cancer.
Q: Who is at high risk for skin cancer?
A: At highest risk would be anyone who has had a bad sunburn or excessive lifetime sun exposure, especially when young, and those with light complexion, freckles, blue eyes, blond or red hair. At higher risk for malignant melanoma are those with many moles, with a prior personal history of skin cancer, and with a family history of malignant melanoma.
Q: Does sunscreen help prevent skin cancer?
A: This is widely presumed to be true but not yet scientifically proven. In fact, some speculate that people who use sunscreen may feel emboldened to expose themselves to more hours of damaging sunlight. Also, using sunscreen to shield skin from sunlight may possibly result in vitamin D deficiency. All that said, it is my opinion there is enough evidence to use sunscreen all year long and, if you live in the northern climates, take 2000 IU of vitamin D daily.
Q: How do I know when to go to the doctor?
A: The ABCDE mnemonic helps in knowing when a skin lesion might be dangerous. A: asymmetry or irregularly shaped; B: border fuzzy not sharp; C: more than one color in it; D: diameter wider than pencil width; and E: lesion evolving or changing. It is common to mistake a benign and safe look-a-like seborrheic keratosis for a possible malignant melanoma. Seborrheic keratosis is light brown to black, raised, and waxy. If one can partially peel or scratch off waxy material with a fingernail, then it is likely a benign keratosis. Malignant melanomas can be either flat or nodular…but never waxy.
No question, if ever you are in doubt, see your doctor.
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