Skin Cancer​—A Modern-Day Plague

The Merck Manual states that this is the most common type of cancer in the world. In the United States, 1 out of every 6 to 7 people gets some form of skin cancer. But rates are increasing. According to Dr. I. William Lane in the book The Skin Cancer Answer, “it is now estimated that 50 percent of people who reach the age of sixty-five will develop some form of skin cancer.” Malignant melanoma causes some 7,500 deaths yearly in that country and is on the rise, according to the American Academy of Dermatology. Dark-skinned people have a lower incidence of skin cancer, but they too are at risk.

Why has skin cancer become such a plague? While there may be many relevant factors, such as elevation, latitude, the amount of cloud cover, and the condition of the ozone layer, the main culprit may simply be too much exposure to the sun. Life-styles have changed. Vacations at the beach and outdoor recreation such as mountain climbing and skiing have become more popular and accessible for people with indoor occupations. Fashions have changed. Whereas modesty used to dictate that men and women wear long swimming costumes, swimming suits have become ever skimpier, exposing more of the skin. Skin cancer has increased correspondingly. Did desert dwellers such as the Bedouin, with their long, flowing robes and head coverings, know something that we seem to have ignored?

Skin Cancer​—A Very Real Danger

The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Basal cell and squamous cell carcinomas begin in the outer layer of the skin, which is only 1/25th of an inch thick [1 mm] on the average. These nonmelanoma cancers appear to result from chronic sun exposure, such as that of outdoor workers, and they occur almost exclusively on parts of the body exposed to the sun, such as the face and the hands.a These carcinomas tend to begin as a nodule or a lesion on the skin that enlarges, often bleeds, and does not heal completely. It may spread locally, invading surrounding tissue. About 75 percent of skin cancers are basal cell carcinomas. Although less common, squamous cell carcinoma is more likely to metastasize, or spread, from the primary site to other parts of the body. Early diagnosis is important because while nonmelanomas are the most curable type of skin cancers, they can result in death if left untreated.

Malignant melanomas, which account for only 5 percent of all skin cancers, also begin in the outer layer of the skin. One of the main factors for developing melanoma appears to be intense, intermittent exposure to the sun, such as that received by indoor workers who vacation in the sun. Some 50 percent of malignant melanomas develop from pigmented moles, particularly on the upper back and lower legs.

This type of skin cancer is the most deadly, for if it is not treated early, it can invade the inner layer of the skin, the dermis, where blood vessels and the lymph are located. From there it can quickly metastasize. Says oncologist Dr. Larry Nathanson: “The paradox of melanoma is that it is a highly curable disease when it is treated early. On the other hand, when it is metastatic it is relatively resistant to treatment by drugs or radiation.” In fact, only 2 or 3 percent of patients with metastasized melanoma survive for five years. (See the box on page 7 for early warning signs of melanoma.)

Who are at risk for skin cancer? In addition to people who have had chronic or intense, intermittent exposure to the sun, those with fair skin, light hair and eyes, moles and freckles, and a family history of the disease are especially at risk. Skin cancer is much less likely among people with a darker complexion. Does this mean that the more tanned you are, the less danger there is of skin cancer? No, because although tanning is the skin’s reaction to protect itself from UV radiation, the skin is damaged during the tanning process, and repeated injury increases your risk of skin cancer.

Save Your Skin!

“People are unaware of the very real risk posed by the sun . . . and the damage it can cause to the skin’s DNA. Accumulation of this damage can lead to a skin cancer time bomb.”​—Dr. Mark Birch-Machin, skin-cancer expert.