Pale Skin is In

For those of us living in Coastal Virginia, summer signifies fun in the sun. It’s a wonderful time, but it also means we all need to be extra aware of the risk of skin cancer. Dr. William Coker of Associates in Dermatology in Hampton recently answered some important questions about the disease.

Q. What are the biggest misconceptions people have about skin cancer?

A. They think it’s never going to happen to them—it’s going to happen to someone else. If they wait until they have symptoms, usually whatever cancer they have is pretty advanced. People think if it’s not hurting, it’s not a problem. Lots of times people practice denial rather than good sense.

Q. How can a dermatologist identify cancer that a patient wouldn’t know he/she had?

A. It’s a matter of experience. Cancers don’t always look like they do in the books or the newspaper articles. There can be very subtle changes. Some cancers grow very slowly. People don’t notice. I’ve found things the size of a quarter on people’s faces and they never knew they had it.

Q. What are the best things people can do to protect themselves from skin cancer?

A. Minimize sun exposure. The less sun the better. There’s a saying that a good suntan is the first sign of skin cancer.

Q. What are the best sunscreens?

A. Here’s my stock answer: one you use. If some research comes out and says this is the greatest sunscreen in the world but it smells funny and doesn’t feel right, you won’t use it. Use a high number SPF, and use it frequently. Sunscreens are good in that they minimize sun damage and prevent a lot of skin cancer. But they give people a false sense of security. People think they can lie in the sun all day long and won’t get burned or get skin cancer. A good roof is your best sunscreen.

Q. When should you have a baseline skin check?
A. In your early 20s, but earlier than that if you have a lot of moles or have had lots of sunburns.

Q. Explain the three types of skin cancer.

A. If you have to get a skin cancer, get a basal cell carcinoma. It’s relatively easy to treat and doesn’t usually spread. Squamous cell carcinomas are more serious, especially if they occur on an old burn scar, on lips or other membranes. They’re more apt to spread if they occur in those locations. Melanoma is the most serious type. It’s the most likely to spread.

Q. What’s the youngest patient you’ve treated for skin cancer?

 A. I saw a 15-year-old with a basal cell carcinoma on her nose. You can get skin cancers at any age. Melanomas also can pop up in areas that don’t get sun exposure.

Q. Describe the treatments for skin cancer.

A. Basal cell skin cancers that are caught fairly early and aren’t on potentially disfiguring areas can be treated with curettage—a scraping procedure. That’s very successful, especially for patients with small basal cell carcinomas on the back, chest, arms and legs. For larger cancers, we may need to do an incision. For larger cancers, especially on the face, we can do Mohs surgery, where the cancer is removed one layer at a time and immediately examined to see if all cancerous cells are gone.

Q. Are skin cancer cases increasing?

A. Yes. Some studies show a 200 percent increase in rate of melanomas since 1973. We’ve had a burst of them in the office the last couple of weeks, maybe 15 or so. It’s partly because we’re looking for them harder. Technology helps us to diagnose them at an earlier stage. Before, they may not have been diagnosed as early. All that being said, the incidence of melanoma is increasing. 

Q. Is there any good news related to skin cancer?

A. Forty-five years ago, when I started practicing, a melanoma was almost a death warrant. Some people had waited to come in until they had what looked like a big, black grape growing on them. That was bad. Now, we find them earlier. We have a 98 percent cure rate if found in the early stages. The more advanced the melanoma, the more the cure rate drops off.

Q. Any final words?

A. If you have any questions or concerns about your skin, talk to your primary care physician, or see a dermatologist.

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