American Medical Association Family Medical Guide - American Medical Association [761]
• Walk or sit in the shade when you’re outside.
• Try to avoid the sun between 9 AM and 3 PM, when the ultraviolet rays are the strongest.
• Don’t try to get a tan, and don’t go to tanning salons. If you like the look of suntanned skin, apply an over-the-counter self-tanning product. Many of these products include a sunscreen.
Treatment
If you get a sunburn, take aspirin right away to help reduce the inflammation and relieve discomfort. Running cool water on the burned area or applying a cool cloth to the burn can help lower the temperature of the skin and reduce pain.
Basal Cell Carcinoma
Basal cell carcinoma is the most common skin cancer. In basal cell carcinoma, cells just beneath the surface of the skin are damaged and become cancerous, usually from long-term exposure to strong sunlight. Basal cell carcinoma is common on skin areas that are regularly exposed to the sun, such as the nose or the back or, in men, the chest. Unlike many malignant growths, basal cell carcinoma usually does not spread to other parts of the body. If it spreads, it does so over a number of years. A large, untreated basal cell carcinoma can eventually destroy surrounding tissue and cause disfigurement, but death from this cancer is rare.
Symptoms
In basal cell carcinoma, a small, flesh-colored, sometimes pearly lump with enlarged blood vessels appears on the skin (see page 119). The tumor grows slowly and develops a sore (ulcer) with a hard border and a raw, moist center that may bleed. Scabs may keep forming over the ulcer and the area may seem to heal, but the ulcer keeps returning.
Diagnosis and Treatment
If you have a basal cell carcinoma, your doctor will take a small sample from the tumor for examination under a microscope (biopsy). A basal cell cancer can be removed by cutting it out or destroying it with laser surgery (see page 1088), freezing (cryosurgery), burning with a high-frequency electric current (electrocautery), or radiation therapy (see page 23).
In a technique called Mohs surgery (see page 22), progressive layers of skin and surrounding tissue are sliced off parallel to the tumor and examined microscopically for the presence of cancer. The surgeon stops cutting off layers when he or she reaches a layer whose outer margins are free of cancer cells. Mohs surgery diminishes the amount of skin that has to be excised around a skin cancer and cuts down on the degree of disfigurement.
Doctors sometimes recommend a topical cream (fluorouracil or imiquimod) to treat superficial skin cancers in people who may not tolerate surgical procedures well, such as older people or people with a weakened immune system. However, treatment with topical creams is less effective and the cure rate is lower than that for surgery.
In some cases, basal cell carcinoma returns after treatment, usually within about 2 years, and treatment has to be repeated.
Squamous Cell Carcinoma
In squamous cell carcinoma, underlying skin cells are damaged, usually from many years of exposure to strong sunlight. Squamous cell cancers are common on body parts that are constantly exposed to the sun, such as the ears, hands, and mouth. Unlike basal cell carcinoma (see previous page), squamous cell carcinoma can spread to other parts of the body (metastasize) if untreated. You are most at risk of skin cancer if you have lived in a southern latitude or tropical area, worked outdoors for many years, have fair skin, or are middle-aged or older.
Symptoms
In squamous cell carcinoma, a firm, fleshy, hard-surfaced, sometimes scaly lump (see page 119) develops and grows steadily. In some cases, it looks like a wart or an ulcer. A squamous cell carcinoma can double in size in a few weeks.
Actinic Keratoses
Actinic (or solar) keratoses are benign (noncancerous) rough or thick patches of skin (see page 121) caused by overexposure to the sun. In rare cases, actinic keratoses develop into skin cancer, usually squamous cell carcinoma. For this reason, actinic keratoses are removed, usually by laser surgery (see page 1088), freezing (cryosurgery),