While it is true that darker skin types are at a lower risk for developing skin cancer and have some natural melanin protection from solar radiation, this false sense of security leads to a lack of education and sun protection practices that are important for all skin types. In a study of Hispanics and Blacks, solar radiation exposure seemed to play a large role in the development of melanoma in both of these groups1. Education on sun protection and skin cancer risk should be offered and an annual skin cancer screening should be performed by a dermatologist for all people.
The American Academy of Dermatology’s How to Perform a Self Examination
• Examine your body front and back in the mirror, then right and left sides with arms raised.
• Bend elbows and look carefully at forearms, upper underarms and palms.
• Look at the backs of your legs and feet, the spaces between your toes and on the sole.
• Examine the backs of your neck and scalp with a hand mirror. Part hair for a closer look.
• Finally, check your back and buttocks with a hand mirror
It is estimated by the World Health Organization that as many as 60,000 people a year worldwide will die from too much sun, predominantly in the form of malignant skin cancer. Forty-eight thousand deaths are attributed to malignant melanoma and 12,000 from other forms of skin cancer. Of these cancers, 90 percent are caused from ultraviolet light from the sun2. In the United States alone, more than 1 million new cases of skin cancer will be diagnosed3. One out of five Americans will develop some form of skin cancer during their lifetime4. You can improve your clients’ chances by taking the time to learn about skin cancer, especially for skin of color.
According to the American Cancer Society, cancer “occurs when cells in a part of the body begin to grow out of control.” The name of the cancer is attributed to the part of the body where the cells began to grow out of control. For example, an out of control growth of cells in the skin is named skin cancer. Just as an out of control growth of cells in the lungs is named lung cancer. Or as an out of control growth of cells in the breast is called breast cancer. These out of control cells behave differently and respond to different treatments. These out of control cells have the ability to break away from the initial part of the body where they started to grow and spread through the blood or lymph system to other parts of the body, this is known as metastasis, the spread of cancer. Should the cells begin to grow out of control after an initial diagnosis and successful treatment of cancer leaving the body free of cancer, this regrowth is labeled as a recurrence.
There are two primary categories of skin cancer, nonmelanoma and melanoma. Nonmelanoma is the most common skin cancer and is usually identified as basal cell or squamous cell. One percent of nonmelanoma skin cancer is of other types. If detected early, both basal and squamous cell carcinomas have a better than 95 percent five-year rate.
Basal cell carcinoma begins at the lowest layer of the epidermis. Three of four skin cancers are basal cell carcinoma. Often developing on sun exposed areas of the skin, it is slow growing. It does not tend to spread to distant body parts, although it can reoccur in the same or in different parts of the body. Basal cell carcinoma often appears flat and firm. It can be pale, pink, red or translucent in color. It may be blue, brown or black and may ooze or crust. It is often a shiny, waxy area that may bleed after injury. It may have one or more irregular blood vessels and may be depressed in the center.
Squamous cell carcinoma begins in the upper layer of the epidermis. Two out of 10 skin cancers are squamous cell carcinoma. This type of skin cancer can begin with a scar or skin ulcer. It can occur in the genital area. If occurring in the genital area, it is often linked to a virus causing genital warts. It invades the fatty tissues and is more likely to spread to lymph nodes or distant body parts. Squamous cell carcinoma often appears as a growing lump, a rough surface, a flat, reddish patch. Bowen Disease is a squamous cell carcinoma in situ, a benign tumor that is the earliest form of squamous cell carcinoma. It appears reddish and with great exposure to the sun is a risk factor.
Basal and squamous cell carcinomas can be detected with a skin cancer screening and monthly self checks (see sidebar 2 on page 56.). Warning signs of nonmelanoma skin cancer include new growths or a spot that grows and does not heal within three months. Prevention of nonmelanoma skin cancer can be practiced with sun safety (see sidebar). The causes of nonmelanoma skin cancer include ultraviolet radiation exposure variables, virus infection, chemicals, genetics, long term or severe skin problems, skin disease, a weakened immune system or prior diagnosis of skin cancer. Human papillomavirus (HPV) is a virus infection that is a known cause of nonmelanoma skin cancer. As are certain chemicals like arsenic and industrial tar, coal, and certain oils which are known to cause nonmelanoma skin cancer. Some individuals are sensitive to sunlight chromosomes and are therefore genetically at risk for nonmelanoma skin cancer as are individuals with long term or severe skin problems who have compromised skin. One example is xeroderma pigmentosum which affects the skin’s ability to repair sun damage of the skin.
Melanoma begins in the melanocyte cells which create the brown pigment, melanin, which helps differentiate skin color. It is the second most common cancer in women aged 20-29.
Heavy exposure and severe sunburns in childhood are believed to be the greatest environmental contribution to melanoma7. Ultraviolet radiation alone is not the only cause of melanoma. A large mole count, especially the presence of an atypical mole, dysplastic nevi, is a risk factor. Awareness of the ABCDE’s of melanoma moles is important in your practice and for your clients’ knowledge. Skin type (Fitzpatrick I and II) and family history are also risk factors. As are personal history of skin cancer, like basal cell carcinoma and squamous cell carcinoma which place an individual in the higher risk factor group for melanoma development. A weakened immune system as a result of chemotherapy, diseases like lymphoma or HIV and excessive sun exposure are also considerations for greater awareness of melanoma and the risk factors.
In general, outdoor exposure time, for example, an avid gardener who works outside will be more susceptive to ultraviolet radiation damage as opposed to an accountant working inside a dark office building with little or no ultraviolet radiation exposure. Tanning bed use is another factor as is geographic location, for example living in West Palm Beach, Florida versus Chicago, Illinois. Lastly, a history of skin cancer makes an individual more prone to being diagnosed again.
It’s time to take responsibility for skin health. Be skin safe, be sun safe. You can help your clients practice skin safety by performing a skin analysis that includes a skin cancer awareness and mole check. Observe the appearance and changes in size, shape, color, and texture. Be aware of bleeding, oozing, and scaling. Have your client visit a dermatologist that you have partnered with for a skin cancer screening. Andrea DeSimone, New York Licensed Aesthetician, says, “it’s wonderful when aestheticians take the extra time to keep track of their client’s skin so the client feels more taken care of… the client knows you’re on top of it for them and they return to you for this level of attention and care.”
If in doubt, a dermatologist can perform a biopsy. There are a number of biopsy methods available: shave, punch, incisional and excisional, and lymph node. A shave biopsy involves shaving off a layer of skin. A punch biopsy uses a cookie cutter type of tool to remove a sample of the skin. An incisional or excisional biopsy is a surgical removal of skin. Incisional only removes a portion of the skin and an excisional removes all of the skin in question. A lymph node biopsy is used to determine if the cancer has spread and either a fine needle aspiration (FNA) is used with a syringe like tool for small tissue removal or the lymph node is removed in its entirety. From the biopsy it can be determined if the concern is indeed skin cancer or not. If staging is pertinent, it is often determined at this time as well. Staging is a classification of the severity of the cancer, ranging from 0 to IV, IV being most serious. Basal cell carcinoma is rarely staged unless it is very large for it does not tend to spread. Squamous cell may spread so this type of staging classification is often used.
Benign skin tumors are rarely cancer and do not tend to become cancer. However, they are an indication that the skin is damaged and regular checks are especially important of damaged skin. Actinic keratosis also known as solar keratosis is a type of benign skin tumor. It is a precancerous problem that indicates too much sun exposure. It appears as small, rough spots, pink, red, or flesh colored. In most cases it appears on the face, ears, back of hands, and arms. It is slow growing and the primary symptom is a patch or patches on the skin that can turn into cancer and should be carefully checked for changes.
As the skin care professional, you can educate your clients on how to protect themselves and the risk factors and considerations associated with skin cancer. Dr. Marcia Glenn, Founder and Director of Odyssey MediSpa, Marina del Rey, CA, encourages her patients to examine their skin monthly and pay particular attention to their moles. She suggests women take the time to do both their skin self exam and their breast self exam at the same time.
As the skin care professional, build your awareness and build your retail sales by offering sun protection products that include both a UVA and UVB protecting ingredient with a minimum Sun Protection Factor (SPF) 15. Ensure ease of sun smart practices by having each client leave your business with a sun protection product. Gift yourself and your clients with the power of this knowledge. Learn more and build your business as a skin cancer aware skin care professional. Practice skin safety, practice sun safety!
The American Academy of Dermatology’s Be Sun Smart Program
Sun exposure is the most preventable risk factor for skin cancer. You can have fun in the sun and Be Sun SmartSM. Here’s how to do it:
• Generously apply sunscreen to all exposed skin using a Sun Protection Factor (SPF) of at least 15 that provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply every two hours, even on cloudy days, and after swimming or sweating.
• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses,
• Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 4 p.m.
• Use extra caution near water, snow, and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.
• Protect children from sun exposure by applying sunscreen.
• Get vitamin D safely through a healthy diet that includes vitamin supplements. Don’t seek the sun.
• Avoid tanning beds. Ultraviolet light from the sun and tanning beds causes skin cancer and wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
• Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.
1. Hu S, Ma F, Collado-Mesa F, Kirsner RS. UV Radiation, Latitude, and Melanoma in US Hispanics and Blacks. Arch Dermatol. 2004;140:819-824.
2. World Health Organization, 2006, Global Burden of Disease from Solar Ultraviolet Radiation.
3. American Cancer Society’s 2006 Facts and Figures.
4. American Cancer Society’s 2006 Facts and Figures.
5. Wong CS, Strange RC, Lear JT. Basal cell carcinoma. BMJ.
6. National Cancer Institute, SEER database, 1996-2000.
7. Niendorf KB and Tsao H. Cutaneous melanoma: family screening and genetic testing. Dermatol Therapy. 2006;19:1-8.
Author’s disclaimer, for clarity and without implying definition or political use, the author has chose to use the term skin of color and ethnic skin to represent the same subject. Many terms are available.
Austine Mah is an Asian American who successfully works with skin of color, especially her own. She is an accomplished methodologist and facilitator, dedicated to advancing the understanding of therapeutic skin treatments through continuing education. Technically knowledgeable, Austine extends her commitment to excellence and awareness from treatment room to home care. She regularly consults, educates and writes for the aesthetic industry. Learn more about Austine at www.austinemah.com.