Skincancer is the most common type of cancer. Non-melanoma skin cancers are the most prevalent type, with over 3 million cases diagnosed annually in the US. Melanoma is less common but more aggressive, accounting for most skin cancer deaths. Risk factors include fair skin, sun exposure, and family history. Skin cancers are typically diagnosed through visual examination by a dermatologist and confirmed with a biopsy. Treatments depend on the cancer type and stage but may include surgery, chemotherapy, radiation, and immune therapy. Early detection and treatment are key to improving skin cancer outcomes.

1. Overview
Skincancer isthe most commontype of cancer, probablymakingupmore than half of all diagnosed
casesof cancer,according to the AmericanCancerSociety(ACS).The incidence of skincanceris
risingdramaticallyinthe UnitedStates.More than three millioncasesof non-melanomaare
diagnosedeachyear,leadingtoabout3,000 deaths.Andthe ACSestimatesthatin2012, there will
be 76,250 newcases of melanomaand9,180 deathsfromthe disease.Infact,between40 percent
and 50 percentof people inthe UnitedStatesoverage 65 will developnon-melanomaskincancer.
Thistype of cancer ishighlytreatable whendiagnosedinitsearlystagesandisusuallyrelativelyeasy
to diagnose.
The majorityof lifetime sunexposureoccursbefore age 20, andskincancer can take 20 yearsor
more to develop.Infact,veryyoungchildrenwhoexperienceasfew astwo to three severe
sunburnsare believedtohave anincreasedriskof developingskincancerlaterinlife.That’snotto
say youshouldignore your riskof developingskincancer.Youneedtobe concernedaboutskin
cancer, whetheryoursunbathingdaysare overoryou still spendtime pursuingthe perfecttan.
The Structure of Skin
The skinis the largestorganin yourbodyand is the body’sfirst defenseagainstdisease and
infection.Italsoprotectsyourinternal organsfrominjuries.The skinregulatesbodytemperature,
preventsexcessfluidlossandhelpstoremove excesswaterandsaltfromyour body.
Skiniscomposedof twolayers:the epidermis(theoutermostlayerof skin) andthe dermis(the
lowerlayer).The epidermisitself hasfourlayers:the stratumcorneum, the granularlayer,the
squamouscell layerandthe basal cell layer.Keratin(dead,dense proteincells) makesupthe
stratumcorneumor outer layerof the epidermis—the skinlayerthatcan be seenandfelt.
The granular layermovesthe deadkeratincellstothe surface of the epidermis.The squamouscell
layerproduceskeratinforthe stratumcorneumand alsotransportswater.The basal cell layeristhe
lowestlayerof the epidermis.Thisiswheresquamouscellsare producedandwhere the cellsthat
produce melanin,orskinpigment,reside.
The dermisisthe deeperlayerof skin.Itisa diverse combinationof bloodvessels,hairfolliclesand
sebaceousglandsoroil glands.The proteinscollagenandelastinarefoundinthe dermis.They
provide supportandelasticitytothe skin.The sun’srayseventuallybreakdowntheseproteins.With
age,the skinnaturallybeginstowrinkle andsag.

2. The subcutaneouslevel,orsubcutis,isalayerof fatty tissue thatprovidesnourishmenttothe
dermisandupperlayersof skin.Italso conservesbodyheatandcushionsinternal organsagainst
trauma. Bloodvessels,nerves,sweatglandsanddeeperhairfolliclesare foundhere.
Typesof SkinCancer
There are twomaingroups of skincancer: non-melanomaskincancer,the mostcommontype of
skincancer,and melanoma(sometimesreferredtoas“malignantmelanoma”) skincancer.
Accordingto the ACS,basal cell carcinomamakesup 80 percentof non-melanomaskincancers,and
squamouscell carcinomasaccountfor about20 percent.Together,these twotypesaccountfor
about95 percentof all newcasesof skincancer. Overthree millioncasesof non-melanomaskin
cancer are diagnosedeveryyearinthe UnitedStates.Menhave a higherriskthanwomenof
developingtheseskincancers.
Melanomaisthe leastcommon,but mostaggressive,of the three typesof skincancer.Itoriginates
inthe skin’smelanocytes—the cellsthatproduce pigment,ormelanin.
In 2012, the ACSestimatesthat76,250 new cases of melanomawill be diagnosedinthe United
States—about4percentof all diagnosedskincancers.Butmelanomaaccountsforabout75 percent
of skincancerdeaths.One persondiesof melanomaalmosteveryhour(every62minutes).
RiskFactors
Anyone candevelopskincancer,butpeople withfaircomplexionsare more susceptibleto
precancerousconditionsandskincancerthanpeople withdarkerskintones. That’sbecausedarker
skinhas more melanin,whichprovidessome natural protectionagainstthe sun’sdamagingrays.In
additiontofairskin,otherriskfactorsfor skincancer include:
a personal historyof skincancer
a tendencytofreckle orburn easily
lotsof sunexposure throughoutyourlife

3. manysunburnsas a childor adolescent
familyhistoryof the skincanceror conditionsthatare more likelytodevelopintoskincancer
chronic,non-healingscarring
radiationtherapy
exposure totoxicmaterials,suchasarsenic,coal tar or creosote
exposure tocertainsubtypesof humanpapillomavirus(genital warts) especiallyinpeoplewith
compromisedimmunesystems
takingimmunosuppressantdrugs(afteranorgan transplant,forinstance)
Diagnosis
Healthcare professionalsare able toevaluate manyskinabnormalities.A primarycare physician
shouldbe the firsthealthcare professionalyousee if younotice somethingsuspiciousonyourskin.
Thenyou mightconsultwithadermatologist,aphysicianwithextensive traininginskincare andskin
disorders,particularlyskincancer.
The firststepin detectingabnormalitiesthatmaybe skincancerbeginswithyou.Examine yourskin
once a monthforany suspiciouschanges.Lookforchangesincolor,size andsurface texture of a
mole.Soresthatwon’theal mayalsoindicate cancerousor precancerousconditionsof the skinthat
needattention.
Actinickeratoses.Thisprecancerousconditiontypicallyoccursinpeople withalonghistoryof sun-
damagedskin.Lesions appearasrough,crustybumpson the back of the hands,lips,face,scalpor
neckthat may itchor feel tenderonsun-exposedskin.Theymaybe pinkorwhite.If untreated,
these bumpsmaydevelopintoskincancer.Theyaffectmore than10 millionAmericansandare
usuallymore prevalentinpeopleover40 andin sunnierclimates.However,theymayshow up
earlierinpeople whohave usedtanningbedsorsunlamps.
Basal cell carcinoma.Basal cell carcinomashow upas flat,firm, pale areasor as small raisedpinkor
redpearlybumpsthat maybleedafterminorinjury.These bumpsorgrowthsmayappearanywhere
on the bodyregularlyexposedtothe sun,suchas the headandneck.Theyare slow growingand
rarelyspreadto otherparts of the body.But theycan extenddeepintothe skin,causingsignificant
local damage.Approximately80percentof all skincancer casesdiagnosedannuallyare basal cell
carcinoma.Thisform of skincancer has a highcure rate.However,if leftuntreated,basal cell
carcinomacan resultindisfigurement.

4. Squamouscell carcinoma.The secondmostcommonnon-melanomaskincancer,squamouscell
carcinoma,appearsas nodulesoras red,scalypatches,typicallyonthe ears,the face,the lipsand
mouth.These patcheseventuallydevelop intolarge masses.Accordingtothe SkinCancer
Foundation,more than700,000 casesof thistype of cancer are diagnosedeachyear,leadingto
about2,500 deaths.Thistype of skincancer isslightlymore likelythanbasal cell carcinomato
spreadto otherparts of the body.Butit isalso highlytreatable.
Melanoma:Melanomacan developfromapreexistingmole oronclear,smoothskin.Unlike a
noncancerousmole,melanomaisirregularlyshapedorhasirregularborders,andisblack,brownor
tan. Melanomaisrare inchildhoodandadolescence,butitisone of the more commoncancers in
youngeradulthoodandmiddle age.Itisespeciallyprevalentinlate middle andolderage.The legis
the most commonsite inwomen,andthe trunkis the mostcommonsite in men.Earlydiagnosisis
keyto improvingthe prognosisinthispotentiallyfatal disease.
It isimportantto rememberthe “ABCs”of melanoma.The AADhasdevelopedaneasy-to-use
methodtoevaluate yourskinformelanoma.Lookfor:
Asymmetry:One half of the spotisnot shapedlike the otherhalf.
Borderirregularity:Poorlydefined,ragged,blurred,notchedor“scalloped”border.
Color:Shadesof tan, brown,black,andsometimesred,whiteandblue,varyacrossthe mole.
Diameter:The spotislargerthan six millimeters,aboutthe diameterof a pencil eraser.However,in
recentyears,healthcare professionalsare findingmore melanomasbetweenthree andsix
millimeters.
Evolving:The mole orskinlesionlooksdifferentfromthe restor ischangingin size,shape orcolor.
Excessive sunexposure causesthe majorityof melanoma.A familyhistoryof the diseaseisalsoa
majorrisk factor.Individualswithafamilyhistoryof melanoma,orwhohave hadmelanomainthe
past,may needtosee a dermatologist regularlyinadditiontoperformingself-examinations.Talkto
your dermatologistabouthowoftenyoushouldbe professionallyscreened.Tolearnhow to
effectivelyperformaself-examination,visitThe SkinCancerFoundation.
Othertypesof skincancer: Lesscommontypesof skincancer, whichtogethermake uponly1
percentof all cancers,include:

5. Kaposi’ssarcoma.Thisformstarts inthe bloodvesselsof the dermisandsubcutaneouslayersand
can affectinternal organs.Priortothe middle 1980s,this skincancerwas veryrare.But since it often
afflictspeopleinfectedwiththe humanimmunodeficiencyvirus(HIV) andacquired
immunodeficiencysyndrome (AIDS),ithasbecome more common.
Sarcomas.These are cancersthat form inthe cellsof yourconnective tissuesbutoccasionallythey
begininthe dermis.Angiosarcoma,abloodvessel cancer,isone example.
Cutaneouslymphomas.These skincancersoriginate inthe skin’slymphocytes,whichare immune
systemcellsfoundinthe bone marrowandblood.The mostcommoncutaneouslymphomais
cutaneousT-cell lymphoma,alsocalledmycosisfungoides.
Adnexal tumors.These are typicallybenigntumorsthatoriginate inthe hairfolliclesandsweat
glands.Occasionallytheycanbe malignant.
Merkel cell carcinoma.Thisrare cancer beginsinthe skin’sneuroendocrinecells.Itfrequently
returnsaftertreatmentandcan spreadto internal organsandlymphnodes.
DiagnosticTests
To determine if yourskinabnormalitiesare skincancer,yourdermatologistmayperforma biopsy:
takinga sample of skinto examine underamicroscope.Afterreceivingalocal anesthetic,youmay
feel some minordiscomfort—asmallneedlestick,burningandpressure.There are fourprimary
typesof biopsies:
Shave biopsy.The toplayersof skin,the epidermisandapart of the dermisare shavedoff ina thin
slice.
Punchbiopsy.A deeper,cylindrical core sample of the skinlayersandpartof the fat layeristaken.
Incisional biopsyandexcisional biopsy.A wider,deepersampleof all yourskinlayersistaken,then
the skinissuturedwithstitches.Incisional biopsiesremove aportionof the tumorand excisional
biopsiesremove the entiretumor.
Biopsiesof cancerthat hasspread.In some cases,biopsiesof areasotherthanthe skinmaybe
necessary.Tofindoutif—andwhere—askincancerhasspread,yourhealthcare professional may
use one or more of the followingtests:
Fine needleaspirationbiopsy.Usingafine needletoremove verysmall tissuefragments,fineneedle
aspiration(FNA) biopsymaybe usedtobiopsylarge lymphnodesnearamelanomatofindoutif the
melanomahasspread.
Surgical (excisional) lymphnodebiopsy.If alymphnode’ssize suggestsmelanomahasspreadbutan
FNA biopsydoesn’tfindanymelanomacells,yourhealth care professional mayremove the enlarged
node througha small skinincisiontotake a closerlook.

6. Sentinal lymphnode biopsy.Sentinal node biopsyistypicallyperformedformelanomasbeyond
Stage 0. Dye isinjectedintothe skinatthe site of the tumorto identifythe one orseveral “sentinel”
lymphnodesinthe regionthat“cleanse”thatarea of the skin.These few lymphnodesare then
removedandcarefullyexaminedforevidenceof cancer.If positive,afull lymphnode dissectionis
usuallyperformed.
To determine howwidespreadamelanomais,yourhealthcare professional usesasystemto
describe itssize andpervasiveness.The mostcommonsystemiscalledthe “TNM”systeminwhich:
T stands forthe “tumor”—notingthe size andhow farithas spread withinthe layersof the skinand
nearbytissue.
N denotestumorthathas spreadto lymphnodes.
M standsfor metastasize,inwhichthe cancerhas spreadto distantorgans.
Usingthis system,melanomasare groupedaccordingtostage.The stagesare:
Stage 0. The melanomaonlyinvolvesthe epidermis.Alsocalledmelanomainsitu.
Stage I. Thisstage tumor isbetween1.0and 2.0 mm andmay or not be ulcerated.Itappearsto
affectonlythe skinandhas not beenfoundinlymphnodesordistantorgans.Thisstage has a five-
yearsurvival rate of 86 percentto95 percent.
Stage II. A tumor withanythicknessgreaterthana stage I tumor that appearsto affectonlythe skin
and has notbeenfoundinlymphnodesordistantorgans.Thisstage has a five-yearsurvival rate of
about40 percentto67 percent.
Stage III.A melanomathathas spreadto lymphnodesnearthe skinwhere itoriginallybegan.This
stage has a five-yearsurvival rate of about24 percentto68 percent.
Stage IV.A melanomathathas spreadwell beyondthe originallyaffectedskinandthe nearbylymph
nodes.Ithas metastasizedtovital organsorto distantareasof the skinor distantlymphnodes.This
stage has a five-yearsurvival rate of 15 to 20 percent.
Treatment
There are several treatmentsyourdermatologistmayprescribeforactinickeratoses(precancerous
lesions) orskincancer:
For precancerouslesions:

7. Topical chemotherapy,whichusesdrugslike fluorouracil(5-FU) tokill precancerouscells
Cryotherapy,whichinvolvesfreezing precancerswithliquidnitrogen
Scraping(curettage),whichinvolvesscrapingoff damagedcells
Chemical peeling,duringwhichone ormore chemical solutionsare appliedtothe area
Photodynamictherapy,whichinvolvesapplyingachemical thatmakesthe skinmore sensitive to
lightandthenusingan intense lasertodestroydamagedskincells
Laser therapy,whichusesaspecial lasertoremove the actinickeratosesandaffectedskin
Dermabrasion,aprocedure thatremovesaffectedskinwitharapidlymoving brush
For non-melanomaskincancers:
Topical chemotherapy,whichusesdrugslike fluorouracil(5-FU) tokill precancerouscells
Cryosurgery,whichinvolvesfreezingprecancerswithliquidnitrogen
Photodynamictherapy,whichinvolvesapplyingachemical thatmakesthe skinmore sensitive to
lightandthenusingan intense lasertodestroydamagedskincells
Immune response modifiers,ordrugsthat boostthe immune response againstthe cancer,causingit
to shrinkanddisappear
Curettage andelectrodessication.A sharpinstrumentresemblingavegetable peelercalledacurette
isusedto scrape awaythe cancer, and an electriccurrentorneedle burnsthe bordersof the site
where the tissue wasremoved.
Simple excision.The canceriscut from the skinalongwithsome of the healthytissue aroundit.This
may scar your skin,sosometimesskinistakenfromanotherpartof yourbodyand graftedoverthe
area where the cancerwas removed.
Mohs micrographicsurgery.Thissurgical techniquehasa highfive-yearcure rate,whichapproaches
98 percent.The procedure,whichisusuallyperformedinthe surgeon’soffice onanoutpatientbasis,
removesthe cancerand as little normal tissueaspossible.The surgeonthenusesamicroscope to
examine the bordersof the removedtissue toensure nocancercellsremain.
Laser surgery.A relativelynewtechnique,lasersurgeryusesabeamof lighttovaporize cancercells
insquamouscell carcinomainsitu,whichinvolvesonlythe epidermis,andverysuperficialbasal cell
carcinomas.Thistreatmentiscurrentlynotwidelyused.
Lymphnode surgery.If the lymphnodesneara non-melanomaskincancerare growinglarger,those
nodesmaybe biopsiedorremovedandexaminedunderamicroscope forsignsof cancer.This
procedure ismore involvedthanskinsurgeriesandusuallyrequiresgeneral anesthesia.

8. Skingraftingandreconstructive surgery.If asurgicallyremovednon-melanomaskincancerwas
large,the nearbyskinmaynot stretchfar enoughtoclose the wound.Ina case like this,healthyskin
may be takenfromanotherpart of the bodyand graftedoverthe woundto helpwithhealing.
For melanomas:
Surgery.Most melanomasare surgicallyremovedwithalayerof healthysurroundingskin,the sizeof
whichisbasedon the thicknessof the melanomatumorunderthe microscope (determinedduring
the biopsy).A specifictype of surgerycalledMohssurgeryissometimesusedtotreatill-defined
shallowmelanomatumorsinthe headandneck area.
Lymphnode dissection.Duringthisprocedure,the surgeonremovesall of the lymphnodesinthe
regionof the melanoma.Once adiagnosisof melanomaismade,the physicianwill examine the
lymphnodesclosesttothe melanoma,eitherbyphysical examinationorimagingtests.If the nearby
lymphnodesfeel abnormalanda fine needle aspirationorexcisionalbiopsyrevealsthe melanoma
has spread,a lymphnode dissectionwill mostlikelybe done.
Immunotherapy.Immunotherapyusessubstancesproducedbythe bodyorsimilarsubstances
producedina laboratoryto stimulate the immunesystemtohelpthe bodyfightcancer.This
treatmentistypicallyusedformelanomasthatare verythickor whenlymphnodesare involved.
Specifictherapiesinclude ipilimumab(Yervoy),interferonandinterleukin-2(IL-2).Sideeffectsof
these treatmentsinclude headache,chills,fever,fatigueandmuscle aches.
Oral or injectedchemotherapy.Chemotherapyisthe use of medicinestoslow orstopthe growthof
cancer cells.Inthe case of melanoma,chemotherapyistypically usedformetastaticdiseaseto
shrinktumors.The most commonchemotherapydrugusedformelanomaisdacarbazine (DTIC).The
drug temozolomide(Temodar),anoral pill,mayalsobe given.Itacts similarlytoDTIC.Physicians
give chemotherapyincycles,withaperiodof treatmentfollowedbyaperiodof rest to allow the
bodyto recover.Each cycle typicallylastsfora few weeks.Sideeffectsof these drugsinclude nausea
and vomiting.
In severe casesof melanomathatare confinedtoanarm or leg,a type of chemotherapycalled
isolatedlimbperfusionmaybe done.Duringthissurgical procedure,bloodflowtothe arm or legis
separatedfromthe restof the body,anda highdose of chemotherapyisinjectedintothe limbfora
short periodof time.
Prevention
About90 percentof all skincancers couldbe preventedbyprotectingyourselffromthe harmful rays
of the sun,especiallyfrom10 a.m.to 4 p.m.

9. Sunlightconsistsof twotypesof ultraviolet(UV) raysthatdamage skin—UVA andUVBrays. UVC
rays, anotherspectruminsunlight,are alsopotentiallyharmful,butthe ozone layerblocksmostof
themfromreachingthe earth.UVA and UVB rays are presentall yearand are hazardous,whether
theyare director reflected.Whenthe sun’sultravioletradiationreachesthe surface of the skin,the
skinreactsby producingmelanin—otherwise knownasatan—toprotectitself.
UVB rays are the maincause of sunburnandskincancer. Thistype of sunlightintensifiesduringthe
summeranddamagesskinmore quicklythan UVA rays. The epidermisabsorbsmostof the intensity
of UVB rays.
UVA raysare milderthanUVB rays,but because theirwavelengthsare longer,theypenetrate
deeperthroughthe skin’slayers.UVA raysalsopenetrate throughglassandare presentoncloudy
daysand all year round,evenearlyandlate inthe day.UVA rays contribute towrinklingof the skin
and immunosuppression,aswell asthe developmentof skincancer.
UVA raysalso are usedin tanningbooths.There,theynotonlyinflictthe same type of skinandeye
damage as the sun,theymay be as much as 12 timesstrongerthannatural sunlight,dependingon
the bed.UVA raysalso can passthroughwindow glass,unlike UVBrays.
To screenfor skincancer,ask yourhealthcare professional toexamine yourskincarefullyaspartof
a routine cancer-relatedcheckup.Youshouldalsoexamine yourownskinforabnormalities,
preferablyonce amonth.If youfindanythingsuspicious,make anappointmentwithyourhealth
care professional.
Minimize Total Sun Exposure
For the bestprotectionfromthe sun’sharmful rays:
Stay inthe shade wheneveryoucan.
Limitthe time youspendinthe sun.
Avoidthe sunbetween10a.m. and4 p.m.,whenitsrays are strongest.
Be aware that the sun’sultraviolet(UV) rays can reflectoff water,sand,concrete andsnow,andcan
reach belowthe water’ssurface,aswell asburnonan overcastday.

10. Wear a large-brimmedhatandsunglassestoprotectyourscalpand eyes.
Wear a cool,long-sleevedshirtandlongpantswitha tight weave (ormade of material especially
designedforsunprotection) wheneverpossible.
Selectabroad-spectrumsunscreen,whichprotectsagainstbothUVA andUVB rays. Applysunscreen
withan SPFof 30 or higher15 to 30 minutesbefore sunexposure,withcarefulattentiontosun-
exposedareassuchasthe face,handsand arms.
ApplylipbalmwithanSPFof 15 or higherto protectsun-sensitive lips.
Reapplyaboutan ounce (the size of a shotglass) of sunscreenatleasteverytwohours,more
frequentlyif you’ve beenswimmingorsweating.
Be particularlycautiousif you’re takinganantibioticorothermedicationthatcanmake your skin
more sensitive tothe sun.
Don’tforsake the sunaltogether.Instead,followthese stepstogreatlyreduce yourriskof
developingskincancer.
Sunscreens
Nothingisas effective atreducingyourriskof skincanceras avoidingthe sunorusingphysical
“screens”suchas umbrellas,broad-brimmedhatsandlong-sleevedshirts.However,sunscreens
shouldalsobe an importantpartof your skinhealthroutine wheneverskinwillbe exposedtothe
sunbecause theyabsorbultraviolet(UV) rays.
The Food andDrug Administration(FDA) putnew sunscreenlabelingrulesintoeffectin2012 to help
youchoose your sunscreenwisely.Here’s whattolookfor:
Broad spectrum.The regulationsestablishastandardtestfor over-the-countersunscreenproducts
to determine whichmaybe labeled“broadspectrum.”Productsthatpassthe testwill protect
againstbothUVB and UVA radiation.AlthoughUVBprimarilycausessunburn,bothformsof UV rays
can cause sunburn,skindamage andskincancer.
SPF.Sunscreenproductsthatpass the FDA test mustprovide asun protectionfactor(SPF) of 15 or
higher.The higherthe SPF,the greaterlevel of overallprotection.A productratedSPF30 is designed
to provide approximately30timesmore protectionthannothing.WearingsunscreenwithSPF30
allowsyoutobe inthe sun 30 timeslongerwithoutburningthanif youhad noprotection,butno
sunscreencancompletelypreventburning.A sunscreenwithSPF30 or greatershouldbe usedall
yearfor all skintypes.The FDA has proposeda regulationthatlimitsthe upperendof SPFlabelingto

11. “SPF 50+” because there isnotadequate datato prove that productswithSPFvalueshigherthan50
provide additional protectionoverthose withSPF50.
Water resistance.Claimsonthe sunscreen’sfrontlabel musttell how muchtime youcanexpectto
getthe declaredSPFlevelof protectionwhile swimmingorsweating,basedonstandardtesting.Two
timeswill be permittedonlabels:40 minutesor80 minutes.Manufacturerswill notbe allowedto
claimthat sunscreensare “waterproof”or“sweatproof”andmaynot identifytheirproductsas
“sunblocks.”
Applicationinstructions.Sunscreenscannotclaim“instantprotection”(oranysimilartermthat
impliesyouare protectedassoonas youput the sunscreenonyourskin) or protectionformore
than twohourswithoutreapplication,unlessthe manufacturersubmitsdataandgetsapproval from
the FDA.
The newregulationsapplytosunscreensinthe formof oils,creams,lotions,gels,butters,pastes,
ointments,sticksandsprays.The FDA iscontinuingtostudyspray productsto establishlevelsof
effectivenessandtosee if there’sanydangerfromaccidental inhalation.Until thatinformationis
available,if you(oryourkids) preferthe spraysunscreens,be sure touse a lotiononand nearyour
face and applythe spray generouslytothe otherpartsof your body.
Remember,anysunscreen notlabeledas“broadspectrum”or that has an SPFvalue between2and
14 may onlyhelpprotectagainstsunburn(andeventhere,yourprotectionisminimal).These
productsmust carry a “SkinCancer/SkinAgingAlert”toremindyouthatyouare not protected
againstskincancer or earlyskinaging.
If you developarashor othertype of allergicresponse toasunscreen,trya differentbrandorform
(lotionvs.oil,forexample) tosee if youcanbettertolerate it.Sunscreenscontaininghigherlevelsof
SPFtendto stay on the skinlonger.Gelswashoff more easilyandneedtobe reappliedmore
frequently,butmaybe preferable if youare acne-prone orhave sensitiveskin.
Facts to Know
The most seriousconsequence of sunexposure isskincancer.
Skincancer isthe most commontype of cancer.
Skincancer can take 20 years or more to develop.
Anyone candevelopskincancerandprecancerousconditions,althoughpeople withfaircomplexions
tendto be more susceptible thanpeople withdarkerskintones.

12. AlthoughAfricanAmericansare diagnosedwithmelanomalessoftenthanwhites,theyhave a
higherdeathrate fromthe disease.Accordingtothe SkinCancerFoundation,the overall survival
rate forAfricanAmericansis77 percent,comparedto91 percentinwhites.
The earliestwarningsignof severe skindamage isthe developmentof actinickeratoses—rough,
crusty bumpsonsun-exposedareasthatmayitch or feel tenderwhenexposedtosunlight.Actinic
keratosesaffectmore than10 millionpeople inthe UnitedStatesandare becomingmore common.
There are twomainformsof skincancer: non-melanomaandmelanoma—oftenreferredtoas
“malignantmelanoma.”Several otherveryrare typesof skincancer existbutaccountfor lessthan
one percentof all skincancer cases.
Basal cell carcinomaand squamouscell carcinomaare the mostcommontypesof non-melanoma
skincancer,comprisingabout95 percentof all skincancer cases—approximatelyone millioneach
year,accordingto the ACS.These cancersare slow growingandrarelyspreadtootherparts of the
body.
Melanomaisthe leastcommon,but mostaggressive,of the three maintypesof skincancer.The
AmericanCancerSocietypredictsthatthere will be about76,250 casesof melanomadiagnosedin
2012. Melanomaaccountsfor about4 percentof all diagnosedskincancers—butitaccountsfor
about75 percentof skincancerdeaths.
The sun’sUVA rays contribute towrinklingandburningof the skin,aswell astothe developmentof
skincancer.UVA rays are alsousedintanningboothswhere theymaybe upto 12 timesstronger
than natural sunlight,dependingonthe bed.
KeyQ&A
Are tanningbedssaferthanthe sun?No.Tanningbedsuse UVA rays.Theymaynot onlyinflictthe
same type of skinandeye damage as the sun,but mayalso be as much as 12 timesstrongerthan
natural sunlight.AlthoughUVA raysare milderthanUVBrays—the maincause of sunburnand sun
cancer—UVA wavelengthsare longerandtheypenetratedeeperthroughthe skin’slayers.UVA rays
contribute towrinklingthe skin,aswell astothe developmentof skincancer.
If someone inmyfamilyhashad skincancer,doesthisincrease myriskfordevelopingthe
disease?Yes.Althoughsunexposure isresponsibleformostcasesof melanoma,afamilyhistoryof
the disease canalsobe a riskfactor. You are especiallyatriskif othermembersof yourimmediate
familyhave hadmelanoma.People withatypical moles(nevi)are alsoat higherriskfordeveloping
melanoma.Individualswithafamilyhistoryof melanoma,orwho have hadmelanomainthe past,
may needtosee a dermatologistregularlyinadditiontoperformingself-examinations.Talktoyour
dermatologistabouthowoftenyoushouldbe professionallyscreened.
Are dark-skinnedpeopleimmune toskincancer?No.Anyonecandevelopskincancer,although
people withfaircomplexionstendtobe more susceptible toskincancerandprecancerous
conditionsthanpeople withdarkerskintones.Inadditiontofairskinandlighthair,riskfactors for
skincancer include:atendencytofreckle orburneasily;lotsof sunexposure throughoutyourlife;

13. sunburnsas a childor adolescent;familyhistoryof the disease;historyof radiationtherapy;chronic
scarring fromdiseasesorburns;andexposure totoxicmaterialssuchasarsenic.
What type of SPF shouldIlookfor ina sunscreen?Manygroups,includingthe AmericanAcademyof
Dermatology,recommendusingbroad-spectrumproductswithasunprotectionfactor(SPF) of 30 or
more.
ShouldIavoidthe sun altogether?No.Sunlightis ourprimarysource of vitaminD,importantfor
buildingstrongbone andotherhealth-relatedissues.Sunlightisn’tentirelybad,buttanning(and
long-termexposure)is.Learnhowtoprotect yourskinwheneveryou’re outside.
Doessunscreenpreventsunburn?Whilesunscreenhelpsminimize damagingsunburns,itdoesn’t
completelypreventburning.The bestpreventionisstill tominimizethe total amountof sun
exposure yourskinreceives.Thisincludesavoidingthe sunbetween10a.m. and4 p.m.,whenits
rays are strongest;wearingalarge-brimmedhatandsunglassestoprotectyourscalpand eyes;
coveringothersun-exposedpartsof yourbody;stayinginthe shade whenpossible;andlimitingthe
time youspendinthe sun.
My skinissensitive andacne-prone, andsunscreenirritatesit.Whatcan I do?If you’re prone to
rashes,try differentbrandsandtypesof sunscreenuntil youfindone thatdoesn’tcause arash.Gels
washoff more easilyandneedtobe reappliedmore frequentlythansunscreenlotionsorcreams,
but theymaybe preferableif youare acne-prone.Discussyouskinreactionswithyourhealthcare
professional,perhapsadermatologist,forothersuggestions.
It’sbeenyearssince I’ve tannedmyskin.DoI still needtoworryenoughaboutskincancerto do self-
exams?It’simportanttorememberthatyouraverage lifetime sunexposureriskoccursbefore age
20, and that skincancercan take 20 yearsor more to develop.Infact,veryyoungchildrenwho
experience asfewastwoto three severe sunburnsare believedtohave anincreasedriskof
developingskincancerlaterinlife.Soexamine yourskinonce amonthforanythingunusual.
I’ve neverhadmolesbefore,butIjustnoticedabrownspot onmy skin.ShouldIbe
worried?Althoughmelanomatypically beginsinoraroundan existingmole,itcanalsoappear
withoutwarningonclearskin.Youshouldbringyourconditiontothe attentionof your
dermatologistforfurtherevaluationandanaccurate diagnosis.