Skin Cancer TYPES OF SKIN CANCER SKIN CANCER STATISTICS

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1 Skin Cancer TYPES OF SKIN CANCER Basal cell carcinoma and squamous cell carcinoma Are the most common forms of skin cancer, and are collectively referred to as non-melanoma skin cancers (NMSC). Arise within the top layer of the skin and can appear on any sun-exposed areas of the body, but are most frequently found on the face, ears, bald scalp, and neck. Basal cell carcinoma frequently appears as a pearly bump, whereas squamous cell carcinoma often looks like a rough, red scaly area or an ulcerated bump that bleeds. Although metastasis from NMSC infrequently occurs, if left untreated, involvement of underlying tissues can lead to disfigurement in the affected area. Melanoma Is the most deadly form of skin cancer. May suddenly appear without warning, but also can develop from or near an existing mole. Can occur anywhere on the body but is most common on the upper back, torso, lower legs, head and neck. Frequently spreads to lymph nodes and most internal organs, making early detection and treatment essential. New, rapidly growing moles or moles that itch, bleed, change color or other surface characteristics are often early warning signs of melanoma and warrant prompt attention. SKIN CANCER STATISTICS Substantially more than 1 million new cases of skin cancer will be diagnosed in the United States this year, more than any other form of cancer. 1 1 in 5 Americans will develop some form of skin cancer during their lifetime. 2 The majority of diagnosed skin cancers are nonmelanoma skin cancer, with ~80% of these basal cell carcinoma and ~20% squamous cell carcinoma. 7 The incidence of melanoma has been steadily increasing for the past 30 years. Since 1992, melanoma has increased 3.1% annually in non-hispanic Caucasians, but in recent years is increasing more rapidly

2 SKIN CANCER in young women (3.8% since 1995) and men age 65 and older (8.8% since 2003). 1, 3 situ (noninvasive) and 68,720 invasive (39,080 men and 29,640 women), and this number continues to increase yearly. 1 1 in 58 individuals will be diagnosed with melanoma during their lifetime. Caucasians and men over 50 years of age are at a higher risk of developing melanoma than the general population. 4 Melanoma is the most common form of cancer for young adults years old and the second most common form of cancer for adolescents and young adults years old. 5 Rates of melanoma are rising faster in year old females than males. 5 One American dies of melanoma almost every hour (every 61 minutes). In 2009, 8,650 deaths will be attributed to melanoma. 1 Approximately 75% of skin cancer deaths are from melanoma. 1 The World Health Organization estimates that as many as 65,161 people a year worldwide die from the effects of too much sun, mostly from malignant skin cancer. 6 Melanoma has a 99% five-year survival rate if detected and treated before it spreads to the lymph nodes. 1 Five-year survival rates for regional (lymph nodes) and distant (other organs/lymph nodes) stage melanomas are 65% and 15%, respectively. 1 Both basal cell carcinoma and squamous cell carcinoma have cure rates approaching 95% if detected early and treated promptly. 1 The estimated total direct cost associated with the treatment of melanoma in 2004 was $291 million. In 2004, the total direct cost associated with the treatment for nonmelanoma skin cancer was $1.5 billion. RISK FACTORS Exposure to ultraviolet light, from the sun and indoor tanning devices, is the most preventable risk factor for skin cancer. Caucasians with fair skin have the highest risk of developing any form of skin cancer, including melanoma. 1 Although basal cell carcinoma and squamous cell carcinoma can occur at any age, the incidence rate increases as you get older. 8, 9 Melanoma can strike anyone, but there is an increased risk for individuals who have: AAD toll-free information number: (888) 462-DERM (3376)

3 Red or blonde hair, or blue or green eyes; Greater than 50 moles, large moles or atypical (unusual) moles; A blood relative (parent, sibling, children, aunt, uncle, cousin) who has had melanoma; A previous diagnosis of either melanoma or nonmelanoma skin cancer. 1, A history of other previous cancers, such as breast or thyroid cancer SKIN CANCER Individuals who have been diagnosed with either basal cell carcinoma or squamous cell carcinoma are at increased risk for the development of future NMSC. 17 PREVENTION OF SKIN CANCER Protection from ultraviolet light may prevent many skin cancers. (See the Sun Safety page) Treatment Early detection of melanoma is essential; there is a direct correlation between the thickness of the tumor and survival rates. 18 Early detection and treatment of NMSC also is important to prevent involvement of the underlying tissues and potential disfigurement. Melanomas are removed surgically - and take out the tumor as well as some of the surrounding tissue. The amount of tissue removed depends on the size and depth of the tumor. Treatments for basal and squamous cell carcinomas include surgical approaches such as excision or Mohs micrographic surgery, electrodesiccation (tissue destruction by heat), and cryosurgery (tissue destruction by freezing), but also non-surgical methods such as radiation therapy, topical agents, and photodynamic (laser) therapy. 7 Additional Information The Academy has designated May as Melanoma/Skin Cancer Detection and Prevention Month. The first Monday in May is Melanoma Monday, which is designated as National Skin Self-Examination Day in order to raise awareness about melanoma and encourage individuals to begin a lifelong habit of regular skin self-examinations. For more information on skin cancer, visit the SkinCancerNet section of the Academy s

4 SKIN CANCER (cont.) SKIN CANCER See your dermatologist for successful diagnosis and treatment of skin cancer. 1. American Cancer Society Cancer Facts and Figures. downloads/stt/500809web.pdf. 2. Robinson JK. Sun Exposure, Sun Protection, and Vitamin D. JAMA 2005; 294: Linos E, Swetter S, Cockburn MG, Colditz GA, Clarke CA. Increasing burden of melanoma in the United States. J Invest Derm. 8 January 2009 doi: /jid Melanoma of the Skin, Cancer Fact Sheets, National Cancer Institute, SEER database, Cancer Epidemiology in Older Adolescents & Young Adults, SEER AYA Monograph Pages World Health Organization, Solar ultraviolet radiation: Global burden of disease from solar ultraviolet radiation. Environmental Burden of Disease Series, N Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in Nat Clin Pract Oncol 2007; 4(8): Alam M, Ratner D. Cutaneous squamous-cell carcinoma. N Engl J Med 2001; 344(13): Rubin AI, Chen EH, Ratner D. Basal-cell carcinoma. N Engl J Med 2005; 353(21): Bower CP, Lear JT, Bygrave S, Etherington D, Harvey I, Archer CB. Basal cell carcinoma and risk of subsequent malignancies: a cancer registry-based study in southwest England. J Am Acad Dermatol 2000;42: Hemminki K, Dong C. Subsequent cancers after in situ and invasive squamous cell carcinoma of the skin. Arch Dermatol 2000;136: Rosenberg CA, Greenland P, Khandekar J, Loar A, Ascensao J, Lopez AM. Association of nonmelanoma skin cancer with second malignancy. Cancer 2004;49: Grenader T, Goldberg A, Shavit L. Second cancers in patients with male breast cancer: a literature review. J Cancer Surviv. 2008;2(2): Satram-Hoang S, Ziogas A, Anton-Culver H. Risk of second primary cancer in men with breast cancer. Breast Cancer Res. 2007;9(1):R Auvinen A, Curtis R, Ron E. Risk of subsequent cancer following breast cancer in men. J Natl Cancer Inst. 2002;94(17): Canchola A, Horn-Ross P, Purdie D. Risk of secondary primary malignancies in women with papillary thyroid cancer. Am J Epidemiol. 2006;163(6): Marcil I, Stern RS. Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer: a critical review of the literature and meta-analysis. Arch Derm 2000; 136(12): Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2001;19(16): AAD toll-free information number: (888) 462-DERM (3376)

5 Sun Safety Sun exposure is the most preventable risk factor for skin cancer. It s never too late to protect yourself and minimize your future risk of skin cancer. You can have fun in the sun and Be Sun Smart TM. Here s how to do it: Generously apply a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. Broad-spectrum provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days, and after swimming or sweating. Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible. Seek shade when appropriate, remembering that the sun s rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade. Protect children from sun exposure by playing in the shade, wearing protective clothing, and applying sunscreen. Use extra caution near water, snow and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn. Get vitamin D safely through a healthy diet that includes vitamin supplements. Don t seek the sun. Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you ve been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it. Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early. Check the Academy s Web site ( for the latest list of sun protective products that meet the stringent, evidence-based criteria of the AAD SEAL OF RECOGNITION. SUN SAFETY ULTRAVIOLET RADIATION and ultraviolet B (UVB) rays. This form of ultraviolet radiation can penetrate window glass, exposing you even when indoors or inside your car. sunburn.

6 cancer. The United States Department of Health & Human Services and the World Health Organization s (WHO) International Agency for Research on Cancer panel have declared ultraviolet (UV) radiation from the sun and artificial sources, such as tanning beds and sun lamps, as a known carcinogen (cancer-causing substance). 1 SUN SAFETY WHAT TO LOOK FOR IN A SUNSCREEN SPF stands for Sun Protection Factor. These numbers refer to the product s ability to provide primarily UVB protection, which helps prevent sunburn. The SPF value does not tell you about the level of UVA protection. The higher the SPF, the more UVB protection, but the level of protection does not increase proportionately with the SPF value. SPF 15 screens out 93% of UVB rays and SPF 30 screens out 97% of UVB rays. While using a higher SPF provides greater UVB protection than a lower SPF, it does not mean that you should stay out in the sun longer. At present, there is no U.S. Food and Drug Administration (FDA)-approved system for rating a sunscreen s level of UVA protection. Look for a sunscreen that provides broad-spectrum coverage (UVA and UVB protection) with an SPF of 30 or higher. Ingredients to look for on the label to ensure broad-spectrum UV coverage include: avobenzone (Parsol 1789) cinoxate ecamsule (Mexoryl SX) menthyl anthranilate octyl mathoxycinnamate octyl salicylate oxybenzone sulisobenzone titanium dioxide zinc oxide The AAD SEAL OF RECOGNITION can help consumers choose products that will provide the sun protection recommended by dermatologists. AAD toll-free information number: (888) 462-DERM (3376)

7 HOW TO USE SUNSCREENS Sunscreen should be applied every day to all exposed skin, not just if you are going to be in the sun. UVA rays can penetrate window glass, leaving you prone to damaging effects if unprotected. Don t reserve the use of sunscreen only for sunny days. Even on a cloudy day, up to 80% of the sun s ultraviolet rays can pass through the clouds. 2 Sunscreens should be applied to dry skin 15 to 30 minutes BEFORE going outdoors. Coat all exposed skin liberally, paying particular attention to the face, ears, hands and arms, and rub it in thoroughly most people apply only 25-50% of the recommended amount of sunscreen. 3 One ounce, enough to fill a shot glass, is considered the amount of sunscreen needed to cover the exposed areas of the body properly. Sunscreens should be reapplied at least every two hours or after swimming or perspiring heavily. Sunscreens rub off as well as wash off, so after drying with a towel, reapply sunscreen for continued protection. Unless indicated by an expiration date, the FDA requires that all sunscreens be stable and at their original strength for at least three years. However, if you are using sunscreen appropriately, a bottle should not last very long. SUN SAFETY 1. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on carcinogens, 11 th ed: Exposure to sunlamps or sunbeds. 2. Global Solar UV index. World Health Organization. UVIguide.pdf. 3. Neale R, Williams G, Green A. Application patterns among participants randomized to daily sunscreen use in a skin cancer prevention trial. Arch Dermatol 2002; 138: