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WHAT IS IT?
The term cancer covers more than a hundred diseases that share one trait: In all of them, cells grow out of control and destroy healthy tissue. Skin cancer affects the cells in the outer layers of your skin. There are three types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and the most serious, malignant melanoma.
About a million Americans get skin cancer each year. It’s the most common type of cancer in the United States. Worse, the number of people with malignant melanoma is growing rapidly in this country.
The good news: Most skin cancers aren’t a threat to your health. They grow slowly, and that means they can be caught and treated before they spread to cause cancer in other parts of the body. And because the most common cause of skin cancer is damage to skin cells from too much sunlight, this type of cancer is very easy to prevent. All you have to do is protect yourself from the sun’s harmful rays.
WHAT IS HAPPENING?
Skin has three layers: the epidermis, the dermis, and the hypodermis. The top layer-the epidermis-is most easily damaged by the sun; this is the layer where skin cancer begins.

The epidermis contains three kinds of cells: flat surface cells called squamous cells; round cells called basal cells; and cells that give your skin its color, called melanocytes. Most of the time, these cells grow, divide, and replace themselves in an orderly way. But sometimes a cell will change-mutate-and grow and reproduce out of control. Since your skin has billions of cells, such changes may be common. Most of the time, your immune system gets rid of mutated cells before they can multiply and become a cancer. Sometimes, though, your immune system may miss a few. Most often this occurs when there are too many damaged cells for it to handle-the result, most often, of too much sun.

Skin cancer can start in any of the three types of cells in your epidermis, but about 96 percent of all skin cancers are basal cell or squamous cell cancers-or nonmelanoma skin cancers.

Basal cell carcinoma most often appears on the face, neck, and hands, but it can show up anywhere. It grows slowly and can invade surrounding healthy tissue but rarely spreads to other parts of the body.

Squamous cell carcinoma is most often found on the face, lips, or rim of the ear. It grows more quickly than basal cell cancer, and can form large masses. If left untreated, it can spread to other parts of the body.

Malignant melanoma begins in the melanocytes, the cells that make you tan. It is much less common-about 4 percent of all skin cancers are melanomas-but it is also much more dangerous. Melanoma can spread easily, or metastasize, to other parts of the body. If left untreated, it can be fatal.
WHAT CAUSES IT?
Many things can increase your risk of skin cancer. Some, such as age, race, and family history, are beyond your control. You can do plenty about how much sun you get, though.

THINGS YOU CAN’T CHANGE

Age
Most people who get skin cancer are over age 50 because the damage to your skin from the sun builds up for years before it results in cancer. That’s why it’s so important to protect your skin from the sun throughout your life.

Family
Researchers think that some melanomas are caused by a genetic problem passed from parent to child, called familial melanoma. It’s unclear whether the risk for other types of skin cancer also runs in families.

Skin color
You’re at greater risk if you have light skin, blond or red hair, and freckles. If you have brown skin, your risk is lower than for those with fair skin, but you can still get skin cancer.

Dysplastic nevi (atypical moles)
Dysplastic nevi are moles that are unusual in appearance. They are usually larger than common moles, with fuzzy borders or a fried-egg appearance with clear borders. They range in color from tan to dark brown.

Having dysplastic nevi raises your risk for melanoma. The more dysplastic nevi you have, the greater your risk.

If you have large moles or many moles-more than 50-you should see a dermatologist to get checked for dysplastic nevi. Even if you think you see just one dysplastic nevus, you should get checked-this doubles your risk for melanoma.

THINGS YOU CAN CHANGE

Time in the sun
Too much sun is the major cause of all types of skin cancer. The more you’re in the sun, the greater your risk. People who work outside and people who sunbathe often are most at risk. The sunlight you get today isn’t the only problem, though. If you had at least one blistering sunburn as a child, or if you spent lots of time in the sun as a child, you are more likely to have skin cancer later in life.

Diet
Too much of the wrong kind of fat might hasten skin cancer. In one study, skin cancer patients who cut their fat calories to about 20 percent had fewer precancerous patches after two years than subjects who continued to eat fatty foods. If you’re at risk for skin cancer, reduce the amounts of animal fats, hydrogenated fats like those in some margarines, and omega-6 fatty acids (in safflower and sunflower oils) in your diet. But don’t make the mistake of cutting all fat from your diet. Omega-3s, the type found in many fish, are thought to be good for your skin.

Exposure to certain substances
Some substances, such as coal tar, can cause skin cancer. Coal tar is used in some creams to treat psoriasis, a skin disease. Exposure to arsenic can also raise your risk for skin cancer.
WHAT YOU CAN DO FOR YOURSELF
You can do a lot to prevent skin cancer or to catch it early, when it’s easy to treat. If you already have skin cancer, there’s much you and your doctor can do to cure it and to keep it from coming back.

Perform regular self-exams
Give yourself a complete skin check at least once a month. Use a full-length mirror and a handheld mirror to check every inch of skin.

Look for anything new-a sore that doesn’t heal, a birthmark or mole that has changed shape or color, or an area that looks like a scar.
Don’t skip hard-to-see areas. Use a handheld mirror to check your back and the top of your head.
If you see any changes in moles or new sores or scaly spots, call your doctor. The sooner skin cancer is found, the better.
Limit your time in the sun
The best way to cut your risk for skin cancer is to stay out of the sun as much as you can, and above all to avoid sunburns. That doesn’t mean you have to avoid the sun all the time, though. In fact, a little sun helps you stay healthy-when skin is exposed to the sun, it makes vitamin D, which you need for healthy bones and teeth. But 10 to 15 minutes of sunlight most days is all anyone needs. After all, you can get plenty of vitamin D from your foods. Good sun sense means making smart choices about when you’re in the sun and for how long.

If you must be outside, avoid spending time in the sun between 10 a.m. and 2 p.m. standard time, and between 11 a.m. and 3 p.m. daylight savings time. This is when the rays are strongest.
Watch out for reflected sun. Snow, sand, concrete, and water all bounce harmful rays.
Protect yourself even if it isn’t sunny. Ultraviolet (UV) rays (which can cause skin cancer) can make their way through haze, light fog, and low clouds.
Be most careful if you live in a Sun Belt state such as Texas, Florida, or Arizona. Your risk of skin cancer also rises as you get closer to the equator. Lots of sun at high altitudes is also hard on your skin.
Stay out of tanning salons. Many tanning devices emit high levels of UV rays.
If you must be in the sun, protect yourself.

Wear a long-sleeved shirt, long pants, and a hat. The best shirts are made of tightly woven cloth in bold colors. You can still get sunburned through thin T-shirts and other light clothes, especially if they’re wet.
If your risk for skin cancer is high, try the new UV protective clothing-which contains materials that absorb UV radiation-providing an SPF of 30 or even higher.
Wear a hat that has at least three inches of brim all around. Baseball hats and visors don’t provide full coverage.
Sunscreen can lower your risk of skin cancer.

If you’re going to be out in the sun, use a sunscreen with a sun protection factor-SPF-of 15 or higher. The SPF shows how much added shielding a sunscreen or article of clothing gives you. If you sunburn after 30 minutes in the sun with no sunscreen, an SPF 15 lotion will keep you from burning 15 times longer than that-about 7 1/2 hours.
Use a sunscreen with an SPF of at least 15. If you burn easily or live or travel close to the equator or at high altitudes, use a sunscreen with an SPF of 30 or higher.
Choose a sunscreen that blocks both UV-A and UV-B rays (both can damage your skin cells).
If you swim or sweat a lot, look for a sports sunscreen designed for active people that won’t wash off right away.
Get into the habit of reapplying sunscreen every two to three hours even if the label on your sunscreen says it’s good for all day.
Eat right
Eating well is important when you’re being treated for cancer-or even if you’re just trying to reduce your risk. If you have cancer, some foods may upset your stomach. Choose foods that appeal to you and don’t cause stomach problems. Also, eat smaller, more frequent meals so you’ll get a steady supply of energy.

Avoid fatty meats, whole dairy products, and other foods with a lot of fat. Eat a variety of foods, especially whole grains, fruits, and vegetables. These are high in fiber, loaded with vitamins, and low in fat. The fiber helps speed toxins out of the body. The vitamins and other active compounds called phytochemicals-phyto for plant-boost the body’s defenses. Some studies also suggest that eating lots of very well done meat can increase your risk for cancer, so you should try to avoid it.

Vitamin and mineral supplements can help, though they won’t replace healthful eating. Choose a multivitamin that provides the recommended daily allowances of a broad range of vitamins. Vitamins C and E are especially important. These antioxidants may well help protect you against cancer (and heart disease). If you have cancer, talk to your doctor, nurse or dietician before you take any supplements. Large amounts of some vitamins and minerals can work against your treatment.

Exercise
Any kind of regular exercise, as part of your weekly routine, can help prevent cancer and other diseases. It reduces stress and helps keep you calm. And it tunes up your immune system.

You don’t need to aim for extreme fitness to be healthy. But do combine a variety of activities: some aerobic exercise-the kind that raises your heart rate and brings out a little sweat-for your heart and lungs, plus some activity to strengthen and limber your muscles and joints. The biggest benefits for overall health come with the first step-going from no exercise to some. If you haven’t done much for a long time, start by being a little more active each day. For instance, take the stairs instead of the elevator. Then work up to more aerobic activities such as brisk walking. Experts suggest 20 to 30 minutes a day, most days a week. For flexibility and strength, many people like yoga. Lifting weights is an important part of any exercise plan.

If you’re being treated for cancer, talk with your doctor about the best kinds of activity for you.

Get support
If you have skin cancer, get support. Studies show that women in cancer support groups have less pain, are less depressed, and survive longer than patients who aren’t in support groups. You can talk with others who know what you’re going through. You’ll learn more about recovery and treatments and make some new friends.
WHAT YOUR DOCTOR CAN DO FOR YOU
If you have skin cancer, treatment will vary depending on your age, your overall health, the type of cancer you have, and whether it has spread.

Your doctor will check the mole or area of skin that doesn’t look normal. If the doctor suspects cancer, he or she will remove some skin for examination. This is called a biopsy. If your diagnosis is cancer, the doctor may give you more tests to find out if the cancer has spread, and if so, where.

Simple surgery is usually all that’s needed to take care of basal cell and squamous cell skin cancers, since these cancers rarely spread. In fact, if you’re diagnosed with one of these cancers, your doctor will more than likely be able to remove the entire tumor during the biopsy.

If, on the other hand, you have melanoma, your doctor will judge from the biopsy what your treatment should be. If he or she suspects the cancer has spread to other parts of your body, treatment may include chemotherapy or biotherapy (see “Latest Developments”).

Following are some of the therapies your doctor may use to treat your skin cancer.

Curettage and electrodesiccation
The doctor scoops out the cancer with a curette (an instrument that looks a little like a grapefruit spoon). Then he or she treats the area with an electric current to kill any remaining cancer cells.
Cryosurgery
The doctor uses liquid nitrogen to freeze and kill the cancerous tissue. The dead tissue later flakes away.
Mohs technique
The doctor shaves off one thin layer of the cancer at a time. He or she checks each layer under a microscope for cancer cells, and keeps shaving off layers until only healthy skin cells remain.
Laser surgery
A laser is used to burn away the cancer cells.
Radiation therapy
A technician uses high-energy rays to damage cancer cells and stop them from growing. Radiation therapy affects only the cells in the treated area. Treatments may have side effects, though, including diarrhea, loss of appetite, tiredness, “sunburn” where the rays are aimed, and muscle soreness. Once treatment is over, the side effects should pass.
Chemotherapy
Drugs are used to stop the growth of cancer cells. Your doctor may put you on topical drugs (drugs applied directly to the skin) or give you drugs to take orally or by injection. Those taken by mouth or injection may cause nausea, vomiting, and hair loss. Once treatment is over, these side effects should pass.
Photodynamic treatment
The doctor gives you an injection of a drug that makes cancer cells very sensitive to light. Then the doctor focuses light from a laser on the cancer cells. A chemical reaction occurs that results in the cancer cells being killed. You must keep the treated area away from light for six or more weeks after treatment. Side effects may include nausea and vomiting. Your eyes may also be very sensitive to light for a while.