The Mole the Merrier: Breaking down skin cancer

Skin cancer is the most common cancer in the United States, accounting for approximately one third of all cancers in the U.S.  Join me in breaking down the medicine behind skin cancer including the various types, preventative measures, and treatment options.

This episode's show notes: Season 1, Episode 2 Show Notes

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Transcript

S1E2

“The Mole the Merrier: Breaking down skin cancer”

Erin Layman Rhoads: [00:00:00]

Hello, and welcome to Medicine in Layman’s Terms. 

Whether you are a patient looking to understand more about your health, a student looking to brush up on common medical terms, or a provider wanting ideas to explain diagnoses to your patients, I invite you to join me every week as we break down basic medicine into layman's terms. I am your host, Erin Layman Rhoads, a certified physician assistant, and let's get started.

[00:00:25]

Meet Allison. Allison is a 45 yo female who is at her annual physical. She works as an elementary school teacher and part time as a dog walker. She also loves gardening and riding her bike. During her visit, her provider finds a small mole on her upper arm which Allison notes did begin changing colors a few months ago. She knows that she has a family of skin cancer but does not know which kind. As her provider arranges a biopsy of the mole, Allison asks more about her risk, the types of skin cancer, and how people develop it. 

[00:00:55]

Briefly, I wanted to thank you all for the downloads, supports and views. Again, there will be a link to YouTube if you want to watch an animated video of the podcast. Feel free to check out our website for show notes, extra resources and the YouTube link. But, without further ado, let’s talk skin cancer. 

[00:01:13]

What is skin cancer?

[00:01:57]

Skin cancer is the most common cancer in the United States, accounting for approximately one third of all cancers in the United States. Per the American Academy of Family Physicians, one in six Americans develop skin cancer at some point during their life. There are multiple different kinds of skin cancer including basal cell carcinoma, squamous cell carcinoma and melanoma. These are listed here in order of most to least common. Basal cell carcinoma is the most common type of skin cancer, and there are approximately 3.6 million cases diagnosed in the United States each year. We are going to focus today on these top three most common kinds of skin cancer but be aware that there are other kinds. 

[00:01:49]

Skin cancer is the uncontrollable growth of abnormal skin cells. It most often develops on skin that is frequently exposed to the sunlight, including the scalp, face, ears, neck, chest and arms. Having lighter skin tones is a risk factor for developing skin cancer, however skin cancer affects people of all skin tones and can occur in areas that are rarely exposed to sunlight, like your genitals or toenails. 

[00:02:12]

To understand skin cancer, it is important to briefly summarize the layers and structure of the skin. The skin is divided into two main layers known as the epidermis and the dermis. The epidermis is the outer (or upper) layer of the skin, while the dermis is the inner (or lower) layer. The epidermis, the outer layer, is made of up different kinds of cells. We will highlight three of those types: squamous cells, basal cells and melanocytes. Squamous cells are thin, flat cells that compose the top layer of the epidermis. Basal cells sit underneath the squamous cells and are more round. Finally, melanocytes occur in the lower parts of the epidermis and make something called melanin. Melanin gives skin its color. I would invite anyone who is interested in examples or diagrams to go to the American Cancer Society as they have some wonderful images and information. The link will be in the information section below or on our website with the show notes. 

[00:03:22]

Quick skin fun fact moment here to liven it up a little! In one year, an adult human generally sheds approximately one million skin cells, adding up to over eight pounds of dead skin. Generally, we she our entire outer skin layer every two to four weeks. 

[00:03:22]

So, what are the symptoms?

[00:03:24]

The appearance of skin cancer often presents differently between people due to varying types of skin cancer, different skin tones, location on the body, etc. The most common sign of skin cancer is a change in the skin. And, this “change” can include a new growth or a change in an old growth - like changing in size, color or if the skin lesion or skin growth suddenly becomes painful and bleeding. 

[00:03:45]

For the next few sections, I want to discuss the skin cancer types separately as they have different appearances, treatments, and patterns. If you recall the three main cell types of the epidermis are squamous cells, basal cells and melanocytes. 

[00:03:51]

When skin cancer arises from those thin, flat outer squamous cells, we call it a squamous cell carcinoma. The appearance may vary but includes red, firm, raised growths, scaly patches or thickened skin growths. When skin cancer arises from the round cells known as the basal cells, we call it basal cell carcinoma. Basal cell carcinomas generally appear as a pearl colored or waxy skin bump. They may also appear as a bleeding sore or red patch. 

[00:04:23]

Finally, when the skin cancer comes from melanocytes, we call it melanoma. It often appears, like the other skin cancer types, on sun exposed area like the face. A mole that changes in appearance is a hallmark feature of melanoma. A very common pneumonic for remembering the warning signs of melanoma are the A-B-C-D-Es of melanoma. 

A.      Asymmetrical: Does one half of the skin growth differ from the other? This could be one side being raised with the other side smooth or one side being darker than the other. 

B.       Border: Is the border smooth or is it jagged?

C.       Color: Is the color the same across the skin growth or is it uneven?

D.      Diameter: Is the skin spot growing or larger than the size of a pea?

E.       Evolving: Has the skin growth suddenly changed? 

[00:05:08]

Melanoma is the most dangerous of the forms of skin cancer that we have discussed today. It can be treated when caught early, however it has the highest metastasis and fatality rates when missed. It is crucial to report any changes or concerning skin growths to your doctor.

[00:05:23]

So, what are the causes? Skin cancer is most commonly due to overexposure to ultraviolet rays, otherwise known as UV rays. This can come from direct sunlight or tanning beds. Too much UV can damage the DNA in cells which can lead to cell abnormalities and out-of-control growth. 

[00:05:39]

What are the risk factors? Although anyone can develop skin cancer, certain characteristics do increase that risk. Some of these characteristics include having a lighter natural skin color, blue eyes, or blonde hair. When we have less pigment in our skin, we have less protection from the UV radiation. Skin that burns or freckles easily, advancing age, and having a personal or family history of skin cancer also increases your risk. 

[00:06:02}]

Diagnosing skin cancer: In today’s case with Allison, her provider noticed a concerning skin growth and decides to biopsy it. A biopsy is a procedure that removes tissue so that the cells can be further tested in a laboratory. The biopsy can reveal what kind of cancer it is as well. 

[00:06:18]

Sometimes if results return as skin cancer, further testing like additional imaging is performed to determine the extent or stage of the cancer. This might also include performing a procedure to remove and test a nearby lymph node. 

[00:06:32]

A cancer’s stage is indicated using the Roman numerals I to IV. Stage I cancers are small and limited to the area where they began. Stage IV indicates advanced cancer that has spread to other areas of the body. When the cancer spreads to another place in the body, we call this metastasis. In skin cancer, metastasis can often occur to the lung. When the cancer is found in the lung tissue, it will have features of the primary cancer type, in this case, skin cells. 

[00:06:59]

So, what are our treatment options? Treatment varies based on staging, size, type and locations. Excisional surgery cuts out (AKA excises) the cancerous tissue as well as some of the surrounding margin of healthy skin. A Mohs surgery, another option for treatment, is generally used for larger cancers and removes the skin growth layer by layer. Each layer is then examined under a microscope and this is repeated until no abnormal cells remain. The benefit of this procedure is that the cancerous cells are all removed without taking an excess of surrounding healthy skin. 

[00:07:32]

Radiation therapy uses high-powered energy beams to kill cancer cells. This is often an option when the cancer cannot be completely removed during surgery. Chemotherapy uses drugs to kill cancer cells. There are creams or lotions containing anti-cancer agents that can be applied directly to the skin. There is also systemic chemotherapy. There are many, many treatment options, and this was a highlight of only a few. 

[00:07:56]

At this point you may be thinking to yourself, “So, should I stay inside?”  Nope. No is the answer here. There are many benefits from sunshine and the outdoors. Being outside offers many ways to stay active like biking, hiking or, if you are like me, beach volleyball. Sunshine and spending time outside has been linked to decreased stress levels and improved mental health. The sun’s UV rays can also stimulate production of Vitamin D which is an important vitamin for bone development and immunity. 

[00:08:22]

It is, however, important to protect yourself and decrease your risk for skin cancer. Use a sunscreen of SPF 15 minimum and remember to re-apply it. Make sunscreen part of your daily routine and wear protective clothing.

[00:08:34]

And that, my friends, is an overview of skin cancer. Join us next week when we talk about heart attacks. 

[00:08:41]

If you want more information or have any questions, feel free to reach out. My Instagram handle is rhoadtopa, R H O A D T O P A. You may also email me at rhoadtopa@gmail.com. Again, the same spelling as the Instagram handle. Feel free to like and subscribe and check out our podcast’s website for today’s show notes and links to the articles mentioned. Have a wonderful week.