"Three years ago I noticed a very fine light red line under my right eye. I wasn't concerned ... until one day I realized it had been there over a year." Only then did TV weather forecaster Judy Fraser see a dermatologist. The diagnosis was basal cell carcinoma (BCC).
More than three-quarters of the million-plus skin cancers diagnosed in the U.S. each year are basal cell carcinomas. Squamous cell carcinomas (SCCs) account for another 200,000*. Together, these two most common skin malignancies make up over a third of all cancers in the U.S., notes Mark Naylor, MD, University of Oklahoma Health Sciences Center. And yet, not everyone takes them seriously. Doctors call them "nonmelanoma skin cancers" to differentiate them from melanoma, the deadliest skin cancer, and this comparison to melanoma may delude some into considering them trivial despite their huge numbers.
People might see things differently if aware how much damage nonmelanoma skin cancers can cause when not recognized and treated promptly. In Judy Fraser's case, beneath that fine red line was a cancer so thick that when it was removed, a gaping hole was left on her face. She needed a skin graft to close it up. In the end, she looked good enough to face the television cameras again. But the suffering and disruption in her career had been considerable - and needless.
Judy was luckier than some. Quite a number of nonmelanoma skin cancer patients are left needing serious work (surgery, grafts, injectable fillers, etc.) to repair disfigurement. While basal cell carcinomas usually grow slowly and rarely kill, they can destroy lots of tissue if allowed to grow. Some can be surprisingly aggressive. "Since sun exposure is their main cause, the center of the face, eyelids, eyebrows, the area around the eye, the nose, and the lips are particularly high-risk, along with the ears and the area around the ears" reports Timothy S. Brown, MD, University of Louisville, KY.
Squamous cell carcinoma is more dangerous. Most likely to arise on the ears, nose, temples, and lips, as well as in scars and ulcers, it not only can cause major destruction, but can sometimes spread through the body rapidly and even kill.
All too often, people deny to themselves that they have skin cancer. They wait ... and wait ... and wait .. . and the longer they wait, the larger the growth, and the more likely the chance of significant damage. Squamous cell carcinomas often are preceded by precancerous growths called actinic keratoses, caused by cumulative sun exposure, and anyone who spends time in the sun (or tanning beds) can eventually get them. They are usually easy to treat - a good reason to stop them in their tracks before they can advance to cancer.
Here's another reason: Once you've had one form of skin cancer, your chances are much greater of also developing another form (including melanoma). "Up to half of those who have had one nonmelanoma skin cancer may develop others within five years" says Stuart J. Salasche, MD, University of Arizona Health Sciences Center, Tucson. Legendary comedian Harvey Korman, for example, has had multiple actinic keratoses and about 20 basal cell carcinomas and squamous cell carcinomas. While he can joke about them, he knows they are no laughing matter. "Whenever I've had an squamous cell carcinoma, I've thought of the possible dreadful outcomes - they might spread throughout my body. I still get terrified."
Fortunately, skin cancers are the easiest cancers to find. They're right there on your skin. So inspect your skin from head to toe each month. If you spot something odd, visit a dermatologist pronto. And have a professional skin exam yearly. If you've had a skin cancer, you need frequent lifetime checkups. As Dr. Brown puts it, "Increased vigilance and more aggressive treatment can reduce disfigurement as well as recurrent and metastatic disease."
To avoid skin cancer altogether, practice sun protection. Never sunburn, and never seek a tan. "Whenever I see anyone baking in the sun," says Harvey Korman, "I go right up and say, 'How can you do that? Don't you know what can happen to you?'"
Now that you've read this, don't you?
From the Sun & Skin News, Vol. 22, No. 3, 2005
*Since this article was published, incidence has risen to over a million new cases of BCC, and 250,000 new cases of SCC a year.