Skin Cancer

What is skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells and accounts for more than 50 percent of all cancers.

Fortunately, skin cancers — basal cell and squamous cell carcinoma, and malignant melanoma — are rare in children. When melanomas occur, they usually arise from pigmented nevi, or moles, that are large (diameter greater than 6 mm), asymmetric, with irregular borders and coloration. Bleeding, itching and a mass under the skin are other signs of cancerous change. If a child has had radiation treatment for cancer, moles in the radiated area are at increased risk of becoming cancerous.

What causes skin cancer?

Exposure to sunlight is the major contributing factor to developing skin cancer later in life. In particular, blistering sunburns in childhood and adolescence significantly increase the risk of developing malignant melanoma.

Most people receive more than 50 percent of their lifetime ultraviolet (UV) dose by the time they are 20 years old. Limiting exposure to sunlight in children and teens may pay large dividends in preventing cancers later in life.

What are the different types of skin cancer?

There are three main types of skin cancer

Basal cell carcinoma

• Basal cell carcinoma accounts for most of all skin cancers.
• This highly treatable cancer starts in the basal cell layer of the epidermis, or top layer of skin, and grows very slowly.
• Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin -- mainly those areas exposed to the sun, such as the head, neck, arms, hands and face.
• It commonly occurs among people with light-colored eyes, hair and complexion.

Squamous cell carcinoma

• Although less common but more aggressive than basal cell carcinoma, squamous cell carcinoma is highly treatable.
• Squamous cell carcinoma may appear as nodules or red, scaly patches of skin and may be found on the face, ears, lips and mouth.
• Squamous cell carcinoma can spread to other parts of the body.
• This type of skin cancer is usually found in fair-skinned people.

Malignant melanoma

• Malignant melanoma accounts for 5 percent of all skin cancers and accounts for 73 percent of deaths from skin cancer.
• Malignant melanoma starts in the melanocytes cells that produce pigment in the skin.
• Malignant melanoma usually begins as a mole that then turns cancerous. This cancer may spread quickly.
• Malignant melanoma most often appears on fair-skinned men and women, but people with all skin types may be affected.

Distinguishing benign moles from melanoma

Research shows that certain moles are at higher risk for changing into malignant melanoma. Moles that are present at birth and atypical moles have the greatest chance of becoming malignant.

To prevent melanoma, it is important to examine your child's skin on a regular basis and become familiar with moles and other skin conditions so that you can identify any changes.

Recognizing changes in your child's moles by following this ABCD Chart is crucial in detecting malignant melanoma and other cancerous skin growths at their earliest stages of development. The warning signs are:

• Asymmetry: when half of the mole does not match the other half
• Border: when the border (edges) of the mole are ragged or irregular
• Color: when the color of the mole varies throughout
• Diameter: when the mole's diameter is larger than a pencil's eraser

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while others may only show changes in one or two characteristics. Always consult your child's physician for a diagnosis.

What are the risk factors for melanoma?

Skin cancer is more common in fair-skinned people – especially those with blond or red hair who have light-colored eyes. But no one is safe from skin cancer. Almost half of all Americans who live to age 65 will be diagnosed with skin cancer at some point in their lives, according to the National Cancer Institute.

Other risk factors include:

• family history of melanoma
• sun exposure
• early childhood sunburns
• many freckles
• many ordinary moles (more than 50)
• dysplastic nevi

Sun exposure early in life is the major contributing factor to developing skin cancer, and the amount of time spent unprotected in the sun directly affects your child's risk. Research has shown that sunburns early in life increase a child's risk for skin cancer later in life.

Prevention of skin cancer

The American Academy of Dermatology (AAD) has declared WAR on skin cancer by recommending these three preventive steps:

• Wear protective clothing, including a hat with a four-inch brim.
• Apply sunscreen all over your child's body and avoid the midday sun from 10 a.m. to 4 p.m. Keep infants under 6 months of age out of direct sunlight at all times.
• Regularly use a broad-spectrum sunscreen with an SPF of 15 or higher, even on cloudy days.

The following steps have been recommended by the AAD and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer.

• Protect children from excessive sun exposure when the sun is strongest and apply sunscreen liberally and frequently to children 6 months of age and older.
• Apply sunscreen with an SPF of 15 or higher that protects against both UVA (ultraviolet A) and UVB (ultraviolet B) rays. Apply it to all areas of the body that are exposed to the sun.
• Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or sweating.
• Wear clothing that covers the body and shades the face; hats should provide shade for both the face and the back of the neck. Wearing sunglasses will filter as much as 80 percent of the sun's harmful rays, protecting the lids of the eyes as well as the lens.
• Avoid exposure to UV (ultraviolet) radiation from sunlamps or tanning beds.

Remember that sand and pavement reflect UV rays, too – even under an umbrella – and that snow is also a good reflector of UV rays. Reflective surfaces can reflect up to 85 percent of the sun's most damaging rays.

Consult with your child's physician before applying sunscreen to babies under 6 months old.

How to perform a skin examination

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully, and examining your children (and yourself) is usually the first step in detection.

The American Cancer Society suggests the following method of examination:

• Examine your child's body front and back, then the right and left sides, with arms raised.
• Look carefully at your child's forearms, the back of his upper arms, and the palms of the hands.
• Look at the backs of his legs and feet, the spaces between the toes and the soles of the feet.
• Examine the back of his neck and scalp.
• Check his back and buttocks.
• Become familiar with your child's skin and the pattern of moles, freckles and other marks on his body.
• Be alert to changes in the number, size, shape and color of pigmented areas.
• Follow the ABCD Chart when examining moles or other pigmented areas, and promptly consult your child's physician if you notice any changes.