The Skin Cancer Epidemic ? Men's Health

The incidence of skin cancer in this country has reached nothing short of epidemic proportions with no sign of relent.? Recent analyses based on data from Medicare estimate that the number of non-melanoma skin cancers (NMSC) treated annually in the United States approaches 3,000,000, far exceeding that of all other human malignancies combined.? To put these figures in perspective, this translates to a one in three lifetime risk of developing skin cancer for fair-skinned Americans. The cost to the health care system ranks NMSC fifth among human cancers, which is remarkable given that these are almost always treated in the outpatient setting without expensive hospital, operating room, laboratory, or radiological costs, and without the use of traditional chemotherapy.

Types of cancers

When most people think of skin cancer, they conjure up an image of a big black ugly mole ? an obvious, disfiguring growth that is hard to miss.? In reality, the vast majority of skin cancers are far more inconspicuous. As dermatologists, we divide skin cancer into melanoma and non-melanoma subtypes, together accounting for 99 percent of all cases.

As with other human cancers, those that arise in the skin are named according to the cells from which they originate. While melanoma arises from the pigment-producing cells, called melanocytes, the far more common basal cell carcinoma and squamous cell carcinoma arise from keratinocytes in the epidermis, and together are referred to as non-melanoma skin cancer (NSMC). 95 percent of skin cancers ?are basal cell and squamous cell carcinomas.

Clinically, NMSC presents as a small dome-shaped papule, or a flat scaly pink plaque on sun exposed areas of fair-skinned individuals and occasionally bleed, scab, or ulcerate.? The most common descriptions that patients provide are ?a pimple that just won?t go away,? or, ?a spot that bleeds when I wash my face.?

Contrary to the assumption that northern latitudes are not affected by this epidemic, here at the University of Rochester Medical Center, we see thousands of cancers annually. Our population of farmers, golfers, and snowbirds contributes to an abundance of skin cancer cases.

A wide array of treatment options exist

Surgical management remains the treatment for localized melanoma, with national guidelines that dictate the indicated width of surgical margins needed for tumor removal.? For NMSC, many therapeutic options exist. For small or superficial cancers located on the trunk or extremities, treatments such as curettage and electrodesiccation, photodynamic therapy, cryotherapy and topical immune modulators yield an acceptable cure rate.? However, the majority of NMSC occur on the head and neck, encroaching upon vital structures such as the eyes, nose or lips, and require more delicate surgical removal. For these tumors, intra-operative margin control using Mohs micrographic surgery has emerged as the treatment modality with the highest cure rate. ??With the Mohs technique, the physician acts as surgical oncologist, pathologist, and reconstructive surgeon for each case.? Patients typically spend the majority of the day in the office as the obvious tumor is initially removed under local anesthesia with a very narrow margin (1 ? 2mm) and full peripheral margin analysis is performed while the patient waits in the office.? The sections removed are mapped in meticulous fashion to allow the Mohs surgeon to pinpoint the location of any residual tumor, allowing for maximal preservation of normal tissue and cure rates approaching 100 percent. Once clear margins are obtained, reconstruction can be performed on the same day.

What you can do

Moving forward, there is a tremendous amount we can all do to prevent skin cancer. We have learned a lot from countries such as Australia and New Zealand where rates of skin cancer surpass those in the United States, but have decreased from their peaks as a result of intensified public awareness campaigns.? The school systems there teach about sun protection at the elementary school level and provide students with covered outdoor areas at schools and ubiquitous public service announcements.

As physicians, we have a responsibility to deflate the hype that the sun is a safe and necessary source of vitamin D when oral supplements are readily available and common fortified foods exist.

Lastly, the importance of performing a quick skin check as part of our routine physical examinations cannot be underestimated. Everyone should know how to perform a self-skin evaluation and what to look for. Have suspicious growths or lesions evaluated quickly. A delay in diagnosing tumors can result in larger, more invasive cancers that require more extensive surgical intervention. The growth you have been living with for two or three years may not be a mole but a cancer that will continue to grow in a destructive way ? and your chances of developing additional cancers increases once a NMSC has developed. From scalp to toes, a self-skin evaluation can take less than one minute and potentially prevent the significant morbidity that results from neglected skin cancers.

The University of Rochester Medical Center Department of Dermatology treats thousands of cancers annually, with the Division of Mohs Surgery treating a large percentage of cases diagnosed across the entire Upstate New York area.? If you would like to schedule an appointment or require further information about skin cancer or the Mohs technique, contact 585-275-SKIN (7546) or 585-487-1440.

Sherrif Ibrahim, M.D., Ph.D., is a fellowship-trained surgeon specializing in skin cancers and cosmetic procedures. His research interests include skin disorders related to human papilloma virus (HPV), effects of tanning and new agents for treatment of aging skin. Ibrahim has published several research articles and book chapters. He is a member of American Society for Dermatologic Surgery, Society for Investigative Dermatology and American Academy of Dermatology. Ibrahim recently completed fellowship training in Moh?s micrographic surgery, a delicate procedure to remove melanoma and squamous cell cancers, at the University of California-San Francisco. In his practice Ibrahim offers cosmetic procedures for wrinkles and veins, as well as liposuction and Botox injections. He practices at University Dermatology Associates? offices at 400 Red Creek Drive in Henrietta.

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