May is Skin Cancer and Melanoma Awareness Month

Skin cancer is among the most common forms of cancer to appear in the United States today, and as people living in the CNMI, under the equatorial sun, it's even more important for us to actively protect ourselves from the dangers of skin cancer.

Photo by Tara Winstead, taken from Prexels.com

What is Skin Cancer?

Our bodies are made up of a combined trillions of cells which make up our blood, bones, and organs. The human skin is the largest, and most exposed, of the body's organs -- consisting of billions of cells. In our lifetime, these cells typically age and replace themselves with new cells as they die. However, cancer occurs when these old, or abnormal, cells do not die. In some cases, these abnormal cells can continue to replicate, leaving less space for healthy cells to play their part in the body. This can make it difficult for the body to function the way you'd expect.

As the skin is the largest organ and does not have a protective layer around it, it is more exposed to the elements than most of the body. This means that there are more things which can harm the skin, and start this process of abnormal cell growth. This is called skin cancer, and it comes in three forms: squamous cell carcinoma, basal cell carcinoma, and melanoma. The following sections will provide more information on each type of skin cancer, risk factors for developing skin cancer, and what you can do to decrease your risk of developing skin cancer.

Squamous Cell Carcinoma (SCC)

Squamous cells make up the outermost layer of the skin. These cells are small, thin,

and are constantly shedding. If something prevents these cells from shedding as they die, the abnormal cell growth may form squamous cell skin cancer (or carcinoma). Approximately 2 out of every 10 skin cancer diagnoses is squamous cell carcinoma.

Diagram designed by Freepik: <a href='https://www.freepik.com/vectors/human-skin'>Human skin vector created by brgfx - www.freepik.com</a>

What Causes Squamous Cell Carcinoma?

Squamous cell carcinoma is less common than basal cell carcinoma (described below), but the rates of diagnoses have been rising at a steadier rate. It occurs when something triggers abnormal changes to the squamous cells. This can include:

1. Exposure to ultraviolet (UV) radiation, either from spending time in the sun or a tanning bed without protecting your skin with sunscreen;

2. Skin pre-cancers, such as actinic keratosis;

3. History of skin cancer (of any type) or human papilloma virus (HPV);

4. A weakened immune system that stems from illness or certain medications which suppress the immune system;

5. Chronic infections or skin inflammations, such as scars and burns; or

6. Aging (especially in fairer skinned people).

What Does Squamous Cell Carcinoma Look Like?

While squamous cell carcinomas will look different for everyone, you can use the images on the Skin Cancer Foundation's Skin Cancer Pictures page to gain insight into what abnormal growth could look like.

For the most part, squamous cell carcinomas can manifest as:

• Scaly red patches on the skin,

• Open sores,

• Wart-like blemishes that are rough or thicker than surrounding skin, or

• A raised growth, that usually has a central depression (hollow spot).

In any of these manifestations of squamous cell carcinomas, they can be (and are often) accompanied by: bleeding, crusting over, or rapid increase in size. This will likely persist for weeks and any new or abnormal growths should be checked by a medical professional.

Basal Cell Carcinoma (BCC)

As indicated in the diagram below, the basal calls make up the middle layer of the epidermis (the surface layer of the skin). Basal cells have the dual purpose of renewing

both the basal cell layer and the squamous cell layer, as well as ensuring cell adhesion (keeping the skin in a continuous layer). Basal cell carcinoma is the most frequently diagnosed form of skin cancer, and despite it's slow-growing nature, can become serious if left untreated for too long.

Diagram designed by Freepik: <a href='https://www.freepik.com/vectors/human-skin'>Human skin vector created by brgfx - www.freepik.com</a>

What Causes Basal Cell Carcinoma?

Like squamous cell carcinoma, basal cell carcinoma is the result of damage to the skin cells triggering abnormal behavior. Knowing the causes can help you understand if you should seek a professional opinion. These causes can include:

1. Exposure to ultraviolet (UV) radiation, either from spending time in the sun or a tanning bed without protecting your skin with sunscreen;

2. History of skin cancer (of any type) or human papilloma virus (HPV);

3. Chronic infections or skin inflammations, such as scars and burns; or

4. Aging (especially in fairer skinned people).

What Does Basal Cell Carcinoma Look Like?

While basal cell carcinomas will look different for everyone, they commonly occur in places that are frequently exposed to UV radiation, such as your: face, ears, scalp, chest, back, and shoulders. Be mindful of the following when performing a self-skin exam at home:

• Open sores that don't heal: such sores may bleed or crust over. They might even appear to heal, but come back again.

• A reddish patch: these may or may not cause discomfort, itch, crust, or hurt.

• A shiny new mole: these may be pearly-white, clear, pink, red, white, tan, black, or brown. Inspect new moles that appear on your body for shininess, as basal cell carcinomas may be mistaken for normal moles.

• A pink growth: this will be raised, can have a hollow center, and may develop its own surfacing blood vessels with enough time.

• A scar-like area: this may indicate an invasive BCC. If you do not know where a scar came from and it appears shiny and taught, without clearly defined borders, seek medical attention.

In you notice any new or abnormal growths, have them checked by a medical professional.

Melanoma

Melanoma is the term for cancer of the melanocytes. Melanocytes are the located beneath the basal cells in the epidermis and are responsible for creating the pigment

that gives your skin its color. Because this layer is deepest in the skin and is more likely to spread (or metastasize) than SCC or BCC, melanoma is the most life-threatening form of skin cancer. Melanoma can be found anywhere melanocytes are, including the skin, nail beds, eyes, and linings of the sinuses, anal canal, or vagina.

Diagram designed by Freepik: <a href='https://www.freepik.com/vectors/human-skin'>Human skin vector created by brgfx - www.freepik.com</a>

What Causes Melanoma?

Melanoma occurs when a melanocyte becomes cancerous, similar to the processes described above for basal cell and skin cell carcinomas. Factors involved in the development of melanoma include:

1. Exposure to ultraviolet (UV) radiation, either from spending time in the sun or a tanning bed without protecting your skin with sunscreen;

2. Having many moles (especially those which are larger than the tip of a pencil eraser, or any atypical moles);

3. History of skin cancer (in yourself or your family);

4. Chronic infections or skin inflammations, such as scars and burns;

5. Aging; or

6. Fair skin, as melanoma appears more frequently in individuals with fair skin, light eyes, and blonde or red hair.

What do Melanomas Look Like? A melanoma may not appear as obviously as basal cell or squamous cell carcinomas. This is partly because 20-30% appear in existing moles, and the rest may appear as normal moles on the body. While performing a self-skin exam, note the ABCDE's of Melanoma and be on the lookout for The Ugly Duckling.

ABCDE's of Melanoma:

• Asymmetry - most melanomas differ from the common mole in their lack of symmetry. If you drew a line down the center, a melanoma is not likely to have matching halves.

• Border - Common moles tend to have smooth borders, while a melanoma's boarders are likely to be uneven or have notches.

• Color - Most benign moles on your body tend to be the same shade of brown. Colors ranging from black to light tan can indicate an early-stage melanoma. As they grow or metastasize, red, white, or blue may be visible in the mole.

• Diameter or Dark - If you have a mole that is larger than the tip of a pencil's eraser (1/4 inch or 6 mm). It is also common for melanomas to be significantly darker than the rest of the moles on your person.

• Evolving - A solid indicator of a melanoma is its evolution. If a mark on your skin (even if you have had it for a long time) begins to change in color, diameter, shape, or elevation, this could be a warning sign of melanoma.

The Ugly Duckling:

Most people are used to seeing their moles. And most moles on a person look similar; they are generally a uniform color and size. A melanoma, however, would look like the ugly duckling compared to the rest of one's moles. It might be a different size, color, shape, or appear jagged and asymmetrical. These 'ugly ducklings' should serve as a warning, and if you have doubts, contact your primary care physician to have it examined.

How to Protect Yourself

With all skin cancers, the procedure for how to protect yourself remains the same. In the case of the CNMI, it can be impossible on some days to avoid exposure to the sun, so make sure you do the following to stay sun-safe!

1. Keep it covered - If you plan to go out in the sun, wear clothing to cover the skin as much as possible. This includes hats and breathable long-sleeved shirts.

2. Lather up - Wearing sunscreen is an important step to staying sun-safe. SPF stands for Sun Protection Factor, which means that if you used SPF 30, for example, and applied it as instructed, it would take 30 times longer for you to start experiencing sunburn than if you didn't have it on.

3. Say no to tanning beds - While this isn't an issue in the CNMI, when traveling abroad, there are better ways of maintaining your beautiful CNMI glow. Saying no to tanning beds is strongly linked to decreased risk of developing skin cancer.

4. Constant skin self-checks - Perform regular self-checks of your body for moles and abnormal growths on your skin. Should you find any, seek a professional medical opinion.

5. Ask your doctor - Should you find any moles or growths which cause doubt, don't wait to schedule an appointment with your doctor. The key to treating skin cancer - especially melanoma - is early detection. The earlier the detection, the less time a carcinoma or a melanoma has to grow and metastasize. In the event that the warning signs do mean that cancer is present, treatment is much more successful when caught early.