Now, before you again don warm clothes, is a good time to note how much sun damage you incurred this summer. Are body parts that were not covered darker or more freckled than the skin you were born with? If so, you failed to cover your exposed skin and protect it adequately with sunscreen when out on both sunny and cloudy days.
Eventually, depending on your susceptibility and the extent of unprotected sun exposure, you could wind up with skin cancer, the most common cancer in the US by far. Even if you escape cancer, you will certainly speed the aging of your skin, and by midlife you might have a wrinkled, leathery surface that makes you look older than your years.
But unless you’ve already had one of the common skin cancers or a melanoma, the US Preventive Services Task Force does not recommend a yearly head-to-toe checkup for skin cancer by you or a doctor.
In updated guidelines issued last February and printed in the Annals of Internal Medicine, the task force found insufficient evidence to justify periodic “screening for skin cancer by primary care clinicians or by patient self-examination.”
You may wonder what the harm could be in such a checkup. Haven’t you been repeatedly told that early detection is the secret to preventing a cancer that can threaten your life or well-being?
Research supports such testing for cancers of the cervix or breast. But in assessing whether routine screening for any disease is justifiable, experts must weigh the evidence for both benefits and risks. And the task force, an arm of the US government’s Agency for Healthcare Research and Quality, concluded that there was “a critical gap in the evidence” to assess the risks of routine skin cancer screening.
The task force found no direct evidence that whole-body skin exams by primary care physicians or patients “improves patient outcomes” and that studies were lacking to determine the extent of harm that could come from such screening. The possible risks it listed were “misdiagnosis, overdiagnosis and the resultant harms from biopsies and overtreatment.”
In other words, there is not enough information to say whether the benefits of routine skin cancer screening outweigh the potential risks associated with examining and treating lesions that turn out not to be cancer.
WHEN TO SEE A DOCTOR
This is not to say that if you notice something suspicious anywhere on your skin — like a mole that is changing, a rough spot on a sun-exposed part of your body, or a sore that bleeds or does not heal — you should ignore it, hoping it will disappear on its own. Most dermatologists recommend periodic skin checkups, especially to catch early, curable melanomas, and any such lesion should be brought to a doctor’s attention without delay.
Darius R. Mehregan, chairman of dermatology at Wayne State University School of Medicine in Michigan, agrees that for most adults an annual skin cancer checkup by a physician is not needed. Still, in an interview, Mehregan suggested that patients should do a monthly self-check for the “A, B, C, D and E” of skin cancer starting around age 50.
This means looking for lesions with any of these characteristics: A for asymmetry, B for irregular border, C for multiple colors, D for a diameter greater than 6mm and E for evolving (that is, growing or changing).
Gary N. Fox, who practices dermatology in Defiance, Ohio, a farming area where skin cancers are rampant, also sees little to be gained from routinely screening people who do not have risk factors for skin cancer. But in an interview, Fox emphasized the importance of insisting on a biopsy if someone had a lesion that “causes sufficient patient or doctor concern, even if it has been there for 20 years.”
Furthermore, Fox said, unless the doctor doing the biopsy is very experienced in pathology, the biopsied tissue should be examined by a dermatopathologist, who is specially trained to diagnose skin disease. If there is any doubt about the finding, he said, “another pathologist should look at it since it doesn’t hurt to ask for a second opinion.” Sometimes, he explained, a mole can be hard to distinguish from a melanoma.
Fox also cautioned doctors against freezing a lesion to see if it went away unless there was no doubt about its nature. For example, the common sun-induced lesion called actinic keratosis, in which cancer cells are confined to the top of the skin, can safely be frozen.
But he adds that anyone who has had a number of actinic keratoses should be regularly re-examined, since more are likely to occur and they can develop into an invasive cancer.
LOOKING FOR MELANOMA
Of course, if you have already had one skin cancer — a basal-cell or squamous-cell carcinoma or, more serious, a melanoma — you should be regularly examined as well. For example, Fox said, a person who has had one basal-cell cancer has a 50 percent chance of developing a new one within three to five years. He suggested repeat exams at three to four months, at six to eight months, and again at a year during the first year, and annually thereafter.
Since melanomas run in families, Fox added, anyone with a family history of the disease should start regular skin exams in their 20s. Likewise, Mehregan said, people who have many moles should get an early start on screening because it is difficult for patients to determine when a melanoma arises in a mole.
Fox explained that the main goal was to catch and treat melanoma “in situ” — that is, still confined to the site of origin and not life-threatening. He emphasized that a full skin exam for melanoma should be head to toe: the scalp (with hair parted by a hair dryer on cool setting) and all body surfaces, including the underarms, buttocks, genitals, palms, soles and nails.
However, he said, a check for the ordinary sun-related skin cancers — basal and squamous cell carcinomas — can be limited to sun-exposed body parts: the face, the trunk, the back, the arms, the legs and, in someone partly or completely bald, the scalp.
The best way to avoid skin cancer, these experts said, is to be diligent about sun protection. Wear a tightly woven hat with a wide brim and routinely use a full-spectrum sunscreen with an SPF rating of 30 (above that, there is little additional benefit), even when sitting behind glass or under an umbrella. And apply it generously: Mehregan notes that the SPF rating is based on using a tablespoon of the product for one arm.
Sun-protective clothing can help as well. Reapply sunscreen after sweating heavily or swimming, even if the product claims to be water-resistant.
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