Spotting Skin Cancer

Think you're not at risk? You may be ignoring the signs.

May 29, 2000 -- When 31-year-old J.T. Fields saw an odd-looking "freckle" growing on the bridge of his nose, he did what comes naturally to men: He ignored it.

J.T. was shocked when the "freckle" turned out to be skin cancer. Thankfully, it was squamous cell cancer, one of two types of non-melanoma skin cancers (the other is basal cell cancer) that have a better than 95% cure rate if detected early.

Like J.T., "most men ignore changes or symptoms in their skin when they first occur," says Christopher Arpey, MD, University of Iowa assistant professor of dermatology. "Men are much more likely [than women] to think a skin abnormality will go away on its own, even if it's itching, bleeding, or hurting."

This certainly rang true for J.T. "I thought it was a zit," he said. "Even when it bled, I thought, 'hmm -- how did I get that bruise?' " In fact, it was almost by accident that he even asked a doctor about it. J.T. went to see a dermatologist for another problem. "While I was there," he said, "I pointed to it and asked him what he thought it was." His doctor took a careful look and calmly told him it was probably skin cancer.

However calmly stated, it's a serious diagnosis. Men are much more likely than women to die from skin cancer or suffer deformities from surgery to remove it. Though men are at only a slightly higher risk of developing skin cancer than women, the real challenge is getting a diagnosis and then getting treatment earlier.

The Big Picture

More than 1.3 million Americans will get skin cancer this year. It's the most common type of cancer among men. Nearly all cases will be basal or squamous cell cancers, which affect the middle and outer layers of the skin. Fewer than 4% (about 45,000 cases) will be the more deadly melanoma, a cancer of melanocytes, the cells that produce the skin pigment called melanin. While there are other factors, such as aging and genetic vulnerability, exposure to ultraviolet rays is a major factor in all three types.

The good news is that skin cancer is very likely to be cured if it's caught in time. But for men, that's a big if. "It's easier for me to convince women to check their skin regularly than men," says Arpey. "Whether it's a Pap smear or a breast exam, women grow up with the idea that they have to check themselves out. Men don't."

Certain types of people are at greater risk of developing skin cancer. Construction workers, farmers, lifeguards, and athletes are especially susceptible. There's a range of six skin types grouped according to level of risk, from high to low. People in the Type I group, "always burns easily, never tans" (such as very pale redheads), are most at risk. There's less risk for those in the Type VI group, "never burns, deeply pigmented" (such as many Africans).

J.T. is Type II, "always burns easily, tans minimally." He's pale with very sun-sensitive skin. If you are like J.T. and spend time outdoors, you ought to be very concerned if you're not taking precautions.

A history of one or more severe childhood sunburns is a signal flare for greater skin cancer risk. Ask J.T. In high school, he fell asleep on the beach and burned his nose so badly that the skin came off in sheets. "My nose looked like grilled cheese for two weeks," he says.

Simple Ways to Lower Your Risk

According to Steven Pearlman, MD, a clinical associate professor of dermatology at Columbia University College of Physicians and Surgeons, taking precautions is easy. "Get out of the sun," he says, "or protect yourself with clothing and sunblock." Ninety percent of skin cancer is caused by getting too much sun exposure. If you have to be outdoors, experts recommend avoiding sun exposure between 10 a.m. and 3 p.m. when the sun is strongest and, if possible, wearing tightly woven clothing so that the sun's rays can't sneak through.

Of course, the best way to prevent skin cancer is to stay indoors, but you can enjoy a few rays by putting the lotion in motion. Always wear sunblock with a minimum SPF (Sun Protection Factor) of 15 on exposed skin if you're going to be outside for more than 15 or 20 minutes, whether it's sunny or not. The ultraviolet rays that damage your skin can easily pass through clouds when it's overcast.

A suntan may make you look good, but enough unprotected exposure to change your skin color can add to your risk of cancer. Even tanning beds should be avoided.

Prevention and early detection go hand in hand. Remember to check your skin on a regular basis for any new or suspicious changes. Look for waxy spots that crust or bleed, or for a mound of tissue or wounded skin that just won't heal. And don't wait for your doctor to notice, like J.T. did. If you see something new or strange, get it checked out. Grilled cheese belongs on your plate, not on your nose.

Michael Alvear is an Atlanta-based writer. Besides WebMD and other publications, his work has appeared in The Los Angeles Times and the Internet magazine Salon.