Though summer is in its final days, this is not the time to let up on skin care when it comes to the sun. We talked to Dr. Mary Martini, a dermatologist and head of the dermatology, pigmented lesions and melanoma program at Northwestern Medicine, for information about skin cancer, warning signs and ways to prevent it. Here's an edited version of our conversation.
Q: Who is at risk for skin cancer?
A: Everyone has the potential to make a skin cancer. We may see more skin cancer in fair-skinned individuals, but all skin types can make a skin cancer. The more color there is to your skin, you have some more protection from the sun than a fair-skinned person.
Q: Does age play a factor?
A: We see skin cancer occur as we age because it's (the result of) cumulative damage from the sun or tanning beds and that's why it comes out at a later age. People who use tanning beds often use them at an early age — between 16 and 22 — and tanning bed users are now making skin cancers (particularly melanoma) in their late 20s and 30s. That's a new phenomenon since tanning beds have been around … the younger you expose your skin to tanning beds, the more harmful it is in promoting skin cancer formation.
Q: What are the different types of skin cancer?
A: There are three main types.
Basal cell carcinoma is the least aggressive and it is very much sun-induced. It is often destructive to the skin where it grows but rarely is lethal.
Squamous carcinoma also is sun-induced. It can spread to a lymph node, and if neglected it can grow to the size of a large gum ball.
The third type is melanoma, which occurs in 1 of 50 people. It represents 5 percent of all skin cancers but 80 percent of skin cancer deaths. It can be sun-induced, but there also is a gene that can cause familial melanoma.
Ninety percent of all melanomas are due to environmental damage, and these types of melanomas are on the rise. Melanomas are most common in white men who are 60 and older. They are the most common individuals to get a melanoma, and often in that population they are missed because some men do not go to the doctor or get checked regularly.
The other population that melanoma is missed in is African-Americans and Asians, who can get melanomas on their bottom of their feet (an area that sometimes is not checked).
All of these skin cancers are painless but can spread when they're a millimeter thick. That's why melanoma is so lethal — it is painless and it spreads early.
Q: What are some preventive steps we can take?
A: To prevent skin cancer, we encourage a multistep approach. Sunscreens alone will not totally protect you. Sunscreens block a certain spectrum of light, but they don't block the whole visible light spectrum, so a certain percentage of sun rays are still getting through.
We encourage patients to wear sunscreen and wear some sunscreen clothing such as T-shirts, hats and shirts that have sunscreen in the fabric.
We also tell people if you like to play tennis or golf, the most potent hours (for sun) is midday between 11 a.m. and 3 p.m. We also discourage people from lying out to get a tan or going to tanning beds.
Q: Are there parts of the body that are more affected by skin cancer than others?
A: In men, the most common location is the upper back, the back of the neck and the ears, because those areas get a lot of heavy sun. There are also incidence in the posterior scalp — often hairdressers and barbers will notice moles growing and send customers to the dermatologist.
In women, we see the same areas, but we see more melanoma on the lower leg, the "V" of the chest, the face and the neck.
Q: When should they seek a doctor's care?
A: Early detection is critical. If a melanoma is caught early, the patient will do very well and not have any problems.
If you have a changing mole or a new mole that is growing fast or a bleeding growth that will not heal and is persistently there, you should go to the dermatologist or see your family doctor.
Patients who have more than 50 moles have a slightly higher risk for melanoma. If you have numerous moles and it's getting hard for you to know what's changing, then you should be seeing a dermatologist regularly.
Q: With summer behind us, can we ease up on the sunscreen?
A: In the colder weather, more of us is covered up, so that's good. But in the cold weather, the more brisk the day the more the ozone depletion is affecting us. On a bright, sunny, cold day, your face and neck can get as much radiation as if you were at the beach.
If you're hiking and at high altitude, there's more UV radiation. We tell skiers, hikers and mountain bikers that they need to be just as diligent (as in the summer).