Skin cancer develops over time, often over decades, mainly caused by accumulated damage from exposure to ultraviolet (UV) radiation from the sun or from indoor tanning. Despite increased awareness, all three of the main types of skin cancer are on the rise, and we want you to take them seriously. The most common types are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. It’s hard to pinpoint an exact number of cases, because only melanoma (the least common but most dangerous of the three) has official registries in the U.S. Using the best research available, The Skin Cancer Foundation estimates about 3.6 million BCCs a year in the U.S., about 1.8 million SCCs and about 200,000 melanomas. That’s a lot of skin cancer!
Paradoxically, however, public awareness successes and medical breakthroughs have had an unintended consequence: They have led too many people to conclude that skin cancer is no big deal, that it is a relatively simple medical matter that involves detection, treatment that is only mildly invasive, no recurrence or complications, done.
Today, thankfully, most skin cancer cases are straightforward. But you also need to understand that for a constellation of reasons, many skin cancers do not follow this tidy, predictable script. Yes, a tiny percentage of skin cancers result in death. But many, many more may become messy, complicated, disfiguring and disruptive in unanticipated ways. Hence the Foundation’s hashtag: #SkinCancerIsSerious.
We tapped two top experts, who share crucial lessons from a few of the not-so-tidy cases they’ve treated: Deborah S. Sarnoff, MD, is a clinical professor in the Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine. She is also codirector of Cosmetique Dermatology, Laser & Plastic Surgery LLP in New York City and Long Island, and president of The Skin Cancer Foundation. Matthew Mahlberg, MD, is director of the Colorado Center for Dermatology & Skin Cancer in Denver. Both physicians are fellowship-trained Mohs surgeons.
Lesson 1: “Ignore it and it will go away” is not a viable option.
Dermatologists often see patients who have let a new or persistent bump or spot on their skin go unchecked because “it’s only a pimple,” or “I’ve always had lots of moles — what’s one more?” This reluctance to consult a medical professional about what a patient almost certainly knows is a classic warning sign of skin cancer can have many sources, Dr. Sarnoff notes. Sometimes it’s as simple as fear of having one’s worst suspicions confirmed. “Never underestimate the power of denial,” she says. “I see it all the time. A younger person who has always been healthy, for instance, can’t imagine that something so small could be a serious problem. So the fear that it might be gets tucked away in the denial compartment of the brain.”
People may also drag their feet in consulting a doctor because of their anxiety about the physical pain that could accompany diagnosis and treatment. Body shame is another deterrent. “A patient might put off coming in because the spot is in an embarrassing place, like the groin. And I’ll never stop being shocked by female patients who say, ‘I hate having a dermatologist see all my cellulite and extra flab,’” she says. “Trust me, we aren’t looking at that. When dermatologists check for skin cancers, we’re like hounds sniffing for truffles in a forest. We’re focused on the thing that matters.” Besides, she adds, “good dermatologists always provide a gown that patients can strategically adjust to allow modesty as we check each area.”
Dr. Sarnoff vividly recalls one of her patients, an elderly widow who lived alone, whose adult children decided it was time to move their mother to an assisted living facility. The facility required a thorough physical before a new patient could be admitted. “This woman’s children had not seen their mother undressed in years, so when the doctor was examining her, they were horrified to see this enormous open wound on her shoulder and back,” Dr. Sarnoff says. “Through a decade of weddings and holidays and all sorts of other activities, their mother covered this thing with her clothing, and all the while it kept getting bigger and bigger. And she never confided in a single one of her five children. She knew it was there, but she was in denial. She figured it hadn’t killed her in the 10 years she’d had it, so why rock the boat?”
The lesion turned out to be a large SCC, the second most common type of skin cancer. The tumor required extensive surgery followed by radiation. But this patient was extremely lucky: Her cancer was eliminated, and she has remained healthy.
