The Skin

A shield against heat, light, injury and infection, the skin is the body's largest organ. Weighing about six pounds, the skin regulates body temperature and stores water, fat and vitamin D. The skin is made up of two main layers: the outer epidermis and the inner dermis.

The epidermis, which is the outer layer of the skin, is made up mostly of flat, scaly cells called squamous cells. Under the squamous cells lay round cells called basal cells. The deepest part of the epidermis also contains melanocytes. These cells produce melanin, which gives skin its color.

The dermis contains blood vessels, lymph vessels, hair follicles and glands. Some of these glands produce sweat, which helps regulate body temperature. Other glands produce sebum, an oily substance that helps prevent the skin from drying out. Sweat and sebum travel to the skin's surface through small openings called pores.

Skin Safety Tips

Just as the skin helps protect the body, it also needs protection from factors that can cause it harm. Taking the following precautions can prevent many cases of skin cancer:

Use Sunscreen

Studies have shown that using a sunscreen with Sun Protection Factor (SPF) 30 or higher can prevent skin cancer. If you are going to get any sun exposure, it is best to wear sunscreen. It is easiest if you put it on when you get up in the morning. Put it on your face, hands and arms and those areas that are going to be exposed to the sun, including your lips, the tips of your ears and the backs of your hands and neck. You need to use about an ounce of sunscreen to adequately cover your entire body. Also, be sure to re-apply your sunscreen periodically if you stay outside for a while.

Skin Sunburn

Reapply sunscreen after swimming or exercising. Apply sunscreen to young children before they go outdoors, and teach older children and teenagers how to use sunscreen to protect themselves. Remember, only one serious sunburn in childhood can cause melanoma (and other skin cancers) many decades later. A little sunscreen and common sense can prevent our children from growing up with an increased risk of skin cancer.

Wear Protective Clothing

Wear a broad-brimmed hat and long-sleeve shirt, as well as other clothing that protects you from the sunrays if you're going to be outdoors. Do not forget sunglasses that block out both UVA and UVB rays.

Avoid the Sun During Peak Hours

After 10 a.m., try to stay in the shade and out of the direct sunlight until 3 p.m. The sun is most intense at noon. Thus, the most damage is done at that time. Try to schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy. You absorb UV radiation year-round, and clouds offer little protection from damaging rays. If you go to the beach, use a beach umbrella to help reduce the amount of time directly in the sun.

Avoid Tanning Beds

Avoid using tanning beds. Like the sun, they expose you to ultraviolet radiation. Several studies now demonstrate a significant increase in skin cancers in people who use tanning beds. From our own clinical experience, there are now a lot of young people, usually young women in their teens and early twenties, who develop melanoma. When we ask them if they have ever gone to tanning beds, the answer is "yes" 100% of the time!

Be aware of sun-sensitizing medications

Some common prescription and over-the-counter drugs - including antibiotics, certain cholesterol, high blood pressure and diabetes medications, birth control pills, nonsteroidal anti-inflammatories such as ibuprofen (Advil, Motrin, others) and the acne medicine isotretinoin (Accutane) - can make your skin more sensitive to sunlight. Ask your physician or pharmacist about the side effects of any medications you take. If they increase your sensitivity to sunlight, take extra precautions.

Check your skin regularly and report changes to your physician

Examine your skin often for new skin growths or changes in existing moles, freckles, bumps and birthmarks. Using a mirror, check your face, neck, ears and scalp. Examine your chest and trunk, and the tops and undersides of your arms and hands. Examine both the front and back of your legs and your feet, including the soles and the spaces between your toes.

How To Do a Skin Self-Exam

The best time to do a skin self-exam is after a shower or bath. You should check your skin in a well-lit room using a full-length mirror and a hand-held mirror. It's best to begin by learning where your birthmarks, moles and blemishes are and what they usually look and feel like.

Check for anything new:

A new mole that looks abnormal
A change in the size, shape, color or texture of a mole
A sore that does not heal

Examine yourself from head to toe. Remember to check all areas of the skin, including the back, the scalp, between the buttocks and the genital area.

Examine your face, neck, ears and scalp. Use a comb or blow dryer to move your hair so you can see better or have a family member or friend check through your hair because this is difficult to do yourself.
Look at the front and back of your body in the mirror, then raise your arms and look at your left and right sides.
Bend your elbows and carefully inspect at your fingernails, palms, forearms (including the undersides) and upper arms.
Study the back, front and sides of your legs. Also look between your buttocks and around your genital area.
Closely examine your feet, including the toenails, the soles and the spaces between the toes. It's easier to do this sitting down.

By regularly checking your skin, you will become familiar with what is normal for you. It may be helpful to record the dates of your skin self-exams and to take notes about the way your skin looks. If you find anything unusual, see your physician immediately.

Benign Skin Conditions

Moles and Melanocytes

Nevi, or more commonly known as moles, are growths on the skin. These growths occur when cells in the skin, called melanocytes grow in a cluster with tissue surrounding them. Moles are usually pink, tan, brown or flesh-colored.

Moles are very common. Most people have between 10 and 40 moles. Until about age 40, a person may develop new moles from time to time. Moles can be flat or raised. They are usually round or oval and no larger than a pencil eraser. Many moles begin as a small, flat spot and slowly become larger in diameter and raised. Over many years, they may flatten again, become flesh-colored and go away.

Melanocytes also are spread evenly throughout the skin and produce the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes produce more pigment, causing the skin to tan, or darken.

Dysplastic Nevi

About one out of every ten people has at least one unusual mole. These aytpical moles are called dysplastic nevi and are more likely than ordinary moles to develop into a type of skin cancer called melanoma. Because of this, moles should be checked regularly by a physician or nurse, especially if they look unusual, grow larger, change in color, outline, or change in any other way.

Skin Cancer

There are three forms of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. Skin cancer is an abnormal growth of a group of cells in the surface of the skin. Those cells can be basal cells, which is the most common form of skin cancer. When caught early and treated well, basal cell skin cancer is very curable.

Squamous cell carcinoma is the second most common type of skin cancer. Generally, this type of skin cancer is very curable. Only rarely will squamous cell carcinoma spread to other parts of the body, usually if it is neglected for a long time.

The third form of cancer - melanoma - originates in melanocytes, the cells that produce the pigment melanin that colors out skin, hair and eyes. Those cells develop into melanomas when too much sun exposure is applied to them. Melanoma is the most serious of the skin cancers. Fortunately, it is curable if caught early.

Melanoma

Melanoma is the most serious type of skin cancer. Each year in the United States, more than 53,600 people are diagnosed with melanoma. The chance of developing it increases with age, but this condition affects people of all ages. It can occur on any skin surface. In men, melanoma often is found on the area between the shoulders and the hips, often called the trunk of the body, or the head and neck. In women, it often develops on the lower legs. Melanoma is rare in African Americans and others with dark skin. When it develops in dark-skinned people, it tends to occur under the fingernails or toenails or on the palms of the hands or soles of the feet.

Melanoma occurs when melanocytes, the cells that make pigment, become malignant. When melanoma starts in the skin, the condition is called cutaneous melanoma. Melanoma also may occur in the eye, which is called ocular melanoma or intraocular melanoma. Rarely, melanoma can occur in the meninges, digestive tract, lymph nodes or other areas where melanocytes are found.

When melanoma spreads, cancer cells may show up in nearby lymph nodes. If the cancer has reached the lymph nodes, it may mean that cancer cells have spread to other parts of the body such as the liver, lungs or brain. In such cases, the cancer cells in the new tumor are still melanoma cells, and the condition is called metastatic melanoma, not liver, lung or brain cancer.

Melanoma: Who's at Risk?

While the exact causes of melanoma remain unknown, research has found the following risk factors for melanoma:

Dysplastic nevi, which are more likely than ordinary moles to become cancerous. Dysplastic nevi are common, and many people have a few of these abnormal moles. The risk of melanoma is greatest for people who have a large number of dysplastic nevi. The risk is especially high for people with a family history of both dysplastic nevi and melanoma.
Many (more than 50) normal moles: Having many moles increases the risk of developing melanoma.
Fair skin: Melanoma occurs more frequently in people who have fair skin that burns or freckles easily than in people with dark skin. Those at risk usually have red or blond hair and blue eyes.
Personal history of melanoma or skin cancer: People who have been treated for melanoma, basal cell carcinoma or squamous cell carcinoma are at increased risk of getting melanoma.
Family history of melanoma: Melanoma can be hereditary. Having two or more close relatives who have had this disease is a risk factor. About 10 percent of all patients with melanoma have a family member with this disease.
Weakened immune system: People whose immune system is weakened by certain cancers, HIV or drugs given following organ transplantation are at increased risk of developing melanoma.
Severe, blistering sunburns: People who have had at least one severe, blistering sunburn as a child or teenager are at increased risk of melanoma. Sunburns in adulthood are also a risk factor for melanoma.
Ultraviolet (UV) radiation: Experts believe that much of the worldwide increase in melanoma is related to an increase in the amount of time people spend in the sun. UV radiation from the sun causes premature aging of the skin and skin damage that can lead to melanoma. Artificial sources of UV radiation, such as sunlamps and tanning beds, also can cause skin damage and increase the risk of melanoma. While research has shown these are risk factors, many people who do get melanoma have no known risk factors.

Melanoma Signs and Symptoms

Be alert to any kind of change in a mole.

The four most common and most significant signs of change are a mole or skin area that:

Changes in size
Changes in color---typically gets lighter and/or darker
Itches
Bleeds

Most melanomas have a black or blue-black area. Melanoma also may appear as a new mole. It may be black, abnormal or "ugly." Melanomas can arise in a mole that has been present for your entire life, or can start in as a new mole or dark pigmented area on the skin. In more advanced melanoma, the texture of the mole may change. For example, it may become hard or swollen. Melanomas may feel different from regular moles. More advanced tumors may itch, ooze or bleed. However, melanomas usually do not cause pain.

Remembering your "ABCDEs" can help you remember what to watch for:

Aysmmetry -- The shape of one half does not match the other.
Border-The edges are often jagged, uneven, distorted or atypical in outline; the pigment may spread into the surrounding skin.
Color-The color is uneven. Shades of black, brown, and tan may be present. Areas of white, gray, red, pink or blue also may be seen.
Diameter-There is a change in size, usually an increase. Melanomas are usually larger than the eraser of a pencil (1/4 inch or 5 millimeters).
Evolution-anything that changes over time.

Melanomas can vary greatly in how they look. Be aware of any mole or abnormality of the skin that does not heal over time. We see more and more patients with melanomas that present in atypical ways. Often, patients report a red, raised area that looked like a "pimple" or "cyst" that just does not heal over time and gets worse. Although this is not the typical presentation of melanoma, this certainly can happen.

If you have a question or concern about something on your skin, see your physician.

Detecting Skin Cancer

The good news is nearly 85% of all patients who get melanoma are cured. Most melanomas are caught early, before they can spread to lymph nodes or other places. This is because of the increased awareness of patients that a changing or irregular mole needs to be evaluated by a doctor and the good job of many primary care physicians and dermatologists in early diagnosis of melanoma. However, if left untreated, skin cancer can spread to other parts of the body. That is why routine screenings are so important.

Coupled with a yearly skin exam by a doctor, it is important to perform self-examinations of your skin every three months to detect the early warning signs of skin cancer.

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