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Modifiable Risk Factors for Skin Cancers

Protect yourself against the most common cancer in the USA and worldwide.

1 in 5 Americans will develop skin cancer by the age of 70. Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by about 40%.

Risk factors are determinants or variables associated with an increased risk of a disease. Risk factors can be genetic or an aspect of personal behavior, lifestyle or environmental exposure. There are some risk factors over which you have no control. These are known as "irreversible" risk factors. Age, skin color, and family history are some examples. Other risk factors are those that you can change or modify. If you have a high risk of developing a certain type of cancer associated with a proven, modifiable risk factor, behavior change offers great potential for cancer prevention.

UV (ultraviolet) light exposure is one such modifiable, behavioral major risk factor for development of skin cancer. In the United States, skin cancer is the most frequent cancer type, with more than 5.4 million cases identified annually. Most skin cancers are not melanomas. The primary risk factor for melanoma and non-melanoma skin cancers is exposure to ultraviolet (UV) light, including sunlight and tanning beds, with the risk growing with the amount of exposure. It doesn't matter whether your skin is pale, dark, or somewhere in between as anybody can develop skin cancer.

Basal cell cancer and squamous cell cancer are the two most prevalent types of skin cancer.

Basal cell cancers start in the top layer of the skin (epidermis) and are related to sun exposure. These slow-growing cancers usually develop in sun-exposed areas, especially the face, head, and neck. Although basal cell cancer seldom spreads towards other areas of the body, it can infiltrate surrounding tissues. Basal cell carcinoma might reappear in the same location on the skin if it is not entirely eradicated. People who have had basal cell carcinomas on their skin are more likely to acquire new ones in other places of their bodies.

Sun-exposed parts of the body, including the face, ears, neck, lips, and backs of the hands, are common locations for squamous cell cancer. They can develop in scars or in chronic skin sores. They can rarely develop in the genital area as well. Squamous cell cancers can typically be removed completely, but they are more prone than basal cell tumors to spread to other parts of the body and penetrate into deeper skin layers.

A third type is called Actinic keratosis (AK) or solar keratosis. It is a precancerous skin condition caused by too much exposure to the sun. AKs appear as usually small, rough or scaly spots that may be pink-red or flesh-colored. Usually they are multiple, seen on the face, ears, backs of the hands, and arms of middle-aged or older people with fair skin. AKs tend to grow slowly and usually do not cause any symptoms (although some might be itchy or sore). They sometimes go away on their own, but they can come back. Rarely, they may turn into squamous cell skin cancers.

Those who have ever used tanning beds have a 83% increased risk of developing squamous cell carcinoma and a 29 % increased risk of developing basal cell carcinoma.

Melanomas are a type of skin cancer that develops when melanocytes (the cells that give the skin its tan or brown color) start to grow out of control. Melanomas can develop anywhere on the skin, but they are more likely to start on the chest and back in men and on the legs in women. The neck and face are other common sites. Melanoma comprises only about 1% of all skin cancers, but it is responsible for more than 90% of skin cancer deaths. You can also get melanoma on the palms of the hands, soles of the feet, or under the nails. Melanomas in these areas make up a much larger portion of melanomas in African Americans than in whites.

There are 2 types of UV radiation. It is important to protect your skin from both UVA and UVB radiation.

  • Ultraviolet A (UVA). UVA radiation can pass through glass. Research suggests that it may:

  • Cause premature aging and wrinkling of the skin

  • Play a role in causing basal cell carcinoma, squamous cell carcinoma, and melanoma

  • Ultraviolet B (UVB). UVB does not pass through car windows or other types of glass but:

  • Is more closely linked with the development of skin cancer and melanoma

  • Causes sunburn

Keep in mind that the sun's rays-

  • Are strongest between 10:00 a.m. and 4:00 p.m.

  • Can go through light clothing, windshields, windows, and clouds

  • Are reflected by sand, water, snow, ice, and pavement

Ask your doctor about your risk of skin cancer:

  • -Some skin conditions and certain medicines (such as some antibiotics or hormones) may make your skin more sensitive to damage from the sun.

  • -Medicines or medical conditions (such as HIV) that suppress or impair the immune system or its function may increase your risk of skin cancer.

  • -Having scars or skin ulcers increases your risk.

  • -Exposure to a high level of arsenic (a poison that is sometimes found in well water or pesticides) increases your risk.

Regular self checks should be done looking for:

  • Unusual skin growth or sore that doesn’t go away, such as a nodule, rash or irregular patch on the surface of the skin

  • A pale patch of skin or a waxy or pearly white translucent bump on the head or neck, or a brownish scar or flesh-colored lesion on the chest, which may be signs of basal cell carcinomas

  • Firm, rough lumps on the surface of the skin, sometimes developing more like a reddish, scaly patch if a nodule doesn’t form, which may be signs of squamous cell cancer.

  • Red or flesh-colored moles that are raised and grow quickly, which may be a sign of Merkel cell carcinomas which are also a type of skin cancer.

  • Changes in a previous mole (remember ABCD which stands for Asymmetry, uneven Borders, changes in Color and increase in size in a mole/Diameter )

Follow these tips to protect your skin from sunlight:

  • Wear a hat with a wide brim all around that shades your face, neck, and ears.

  • Wear sunglasses that block UV radiation to protect the skin around your eyes.

  • Wear long sleeves and long pants made of tightly woven dark fabrics. Some fabrics are rated with an ultraviolet protection factor (UPF). The higher the rating, the greater the protection from sunlight.

  • Use sunscreen products with a sun protection factor (SPF) of at least 30. Apply the product’s recommended amount to uncovered skin 30 minutes before going outside, and apply again every two hours or after swimming or sweating.

Skin cancer is one cancer you can see. Therefore, knowing what your skin looks like and noting any 'new, strange, or 'changing skin growths is important . Take a look at the checklist (Click here) that will guide you on what to look for in your monthly self-checks. If you see a change, make an appointment with your doctor right away. Your physician can send you to a dermatologist or a skin specialist to further examine any suspicious skin lesions. The next steps usually are either:

Shave biopsy. A tool similar to a razor is used to remove a small section of the top layers of skin (epidermis and a portion of the dermis).

Punch biopsy. A circular tool is used to remove a small core of skin, including deeper layers (epidermis, dermis and superficial fat).

Excisional biopsy. A small knife is used to remove an entire lump or an area of abnormal skin, including a portion of normal skin down to or through the fatty layer of skin.

Early detection is key to prevent spread of skin cancers such as melanoma and to prevent complications from basal and squamous cell skin cancers.

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There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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