Skin cancer Q&A

The incidence of some types of skin cancer appears to be on the rise, even though the rate for melanoma appears to have stabilized, one expert says. With climate and environmental changes affecting many parts of the world, questions about melanoma, basal cell and squamous cell carcinomas - and, particularly, how to protect oneself against them - are becoming more prevalent.

Robert Friedman, M.D., clinical associate professor in the oncology division of the department of dermatology at New York University School of Medicine, answers some common questions and sheds light on recent developments.

ITK What do we know about skin cancer today that we didn't know a year ago?

ITK Will there be a vaccine for melanoma? Who will be eligible to get it?

Dr. Friedman: There are a number of vaccines, all experimental, in varying types of trials. To date, however, none has proven successful in the long-term treatment of advanced melanoma.

ITK Are all melanomas pigmented?

Dr. Friedman: No. A small percentage are nonpigmented, also known as amelanotic.

ITK Is melanoma definitely linked to sun exposure?

Dr. Friedman: While we don't have the proven linkage as with squamous cell carcinoma, melanoma is unquestionably related, at least in part, to sun exposure.

ITK What is the best way to protect against melanoma?

Dr. Friedman: Sun protection in the form of broad-spectrum sunscreens, wearing protective clothing during sun exposure, and time of day during which exposure takes place all factor into helping protect against melanoma and all skin cancers. Try to avoid long periods of time in the sun, along with avoiding sun exposure as much as possible between the hours of 10 a.m. and 4 p.m.

ITK Has there been an increase in the past decade in other types of skin cancer, such as basal cell and squamous cell?

Dr. Friedman: Yes, both basal cell and squamous cell carcinoma have substantially increased in incidence.

ITK Should everyone, regardless of whether they've ever had any kind of skin cancer, have a body check yearly?

Dr. Friedman: In my opinion, yes. Obviously those individuals with the greatest number of risk factors (past history of skin cancer; atypical nevi; those who are fair-skinned, freckled, have light eyes, family history of skin cancer, etc.) should definitely be screened at least annually. Some high-risk individuals should be seen more frequently.

ITK Are there common sites for these skin cancers? Do the sites vary by gender?

Dr. Friedman: Obviously, sun-exposed areas are at greatest risk - the trunk, extremities, and head and neck. Interestingly, for women, the trunk of the body and legs are the sites most common for skin cancers. In men, it is most often the trunk.

ITK Do melanomas affect a certain population or demographic more than others?

Dr. Friedman: Generally, people with fair skin, light eyes and a tendency to burn rather than tan are most susceptible. The Celtic, Nordic and Germanic populations tend to be more susceptible than darker-skinned individuals. A family history in all races plays an important role.

ITK At what age do actinic keratoses begin to appear? Those are brown spots that often can be confused with "age" spots, right?

Dr. Friedman: These precancerous spots often appear between 40 and 50 years of age - in some fair-complexioned people, even earlier. These are something to bring to the attention of a dermatologist. The key aspects that differentiate them from the brown spots caused by photodamage are that they are pink-brown and often scaly.