What One Derm Wants You to Know About Advanced Non-Melanoma Skin Cancer—No Matter Your Skin Color
Maritza I. Perez, MD, FAAD, a professor of dermatology in Connecticut, performs 36 skin-cancer surgeries a week, 12 per day for each of the three days she sees patients. She’s become all too familiar with Mohs surgery—the precise outpatient procedure that involves removing cancerous tissue, layer by layer, until all the margins are clear. “During my 30-year career as a Mohs surgeon, I’ve treated 700 to 750 cases per year,” she says.
While Dr. Perez loves her job, she knows that with better awareness, many of these cases might have been avoided. “People talk about melanoma because it’s the number-one skin condition that kills people,” she says. But non-melanoma skin cancer (NMSC), like basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (CSCC), are far more common. According to the latest data, more than 5.4 million NMSC cases are diagnosed each year among 3.3 million people in the U.S. (If that math seems off, that’s because some people have more than one case.)
There are also misconceptions about who’s at risk for NMSC and why, according to Dr. Perez: “This lack of information leads to some patients having advanced cancers by the time they’re diagnosed, instead of early ones that are easily treatable.” This is why she has partnered with Regeneron to help people get real about skin cancer, by raising awareness of the potential impact of advanced NMSC.
Below, she outlines what she believes everyone, no matter their skin color, should understand about NMSC, and what they can do to protect their skin and lower their risk of developing one of these cancers, which can become potentially life-threatening if it advances or spreads to other parts of the body.
Not all skin cancer is caused by UV rays
BCC and CSCC constitute the overwhelming majority of NMSC—80 percent and 20 percent, respectively, of total cases. The common culprit behind both is exposure to the sun’s ultraviolet (UV) rays and to artificial UV sources like tanning beds. These rays can damage the DNA in skin cells, triggering cancer-causing mutations. But there are predisposing factors, too, says Dr. Perez, including chronic inflammation and chronic scarring, as well as human papillomavirus (HPV), which has been found to be a risk factor for CSCC.
Caucasians, particularly those with fair complexions, have the highest skin-cancer risk, but NMSC strikes individuals of every ethnicity and skin tone. And by the time many people of color are diagnosed, the cancer is often at a later stage, when the prognosis is worse. One reason for the delay is that people of color may not be taking as many precautions, according to a study from the Centers for Disease Control & Prevention. The majority of Black and Hispanic people who participated in the study said they perceived themselves to be at low skin-cancer risk due to their “darker skin tone,” with few reporting regular sun-protection behaviors.
It doesn’t just show up where the sun shines
Unlike some types of cancer, skin malignancies are visible to the eye. Unfortunately, their appearance can vary widely. “BCC may present as a pearly pink or red bump that may have broken blood vessels around it,” says Dr. Perez. But it might also look like a scaly patch, a flat scar, or a sore that bleeds and crusts over. BCC lesions are typically found in sun-exposed areas of the body, such as the head, face, neck, and backs of the hands.
CSCC also has many guises, appearing as a firm red nodule, a scaly red plaque, a wart-like growth, or a sore that doesn’t heal. And while it’s also most likely to pop up in sun-exposed skin, this type of cancer can find its way to less predictable areas as well, like the palms of hands, the soles of the feet, the groin, and under the nails.
Having darker skin can also make skin cancer harder to spot. A red or pinkish lesion stands out against pale skin, Dr. Perez points out. “But in people of color, a BCC and CSCC growth can show up as a translucent or skin-colored bump, which is less noticeable,” she says.
As if all that didn’t complicate things enough, the locations of CSCC lesions can vary more for people of color, too. “A main cause of mutations in immunosuppressed people include HPV, and specially in people of color, chronic inflammation and chronic scarring processes,” explains Dr. Perez. “So you need to look for other origins, like the fingers and nail beds, between the toes, in the perianal and genitalia areas, and other areas usually covered by clothing.”
Early detection is everything
NMSC is rarely life-threatening, but that doesn’t mean it shouldn’t be a serious concern. “BCC is usually a slow-growing skin cancer, and it rarely metastasizes,” Dr. Perez says. However, in about 1 percent of cases, it can become advanced and penetrate deep into skin and surrounding tissues, or spread to other parts of the body. “I’ve had young patients with big lesions and metastatic disease.”
And while it’s rarely deadly, having one BCC lesion has been shown to increase your risk for other types of cancer, including melanoma. “Most patients start with an isolated lesion in the skin,” Dr. Perez says. But if it gets to the “locally advanced” stage—meaning the cancer is lodged in the deeper structures of the skin—it becomes much more difficult to manage. “If it advances more toward the lymph nodes and other organs, that’s when we talk about metastatic disease.”
Early-stage skin cancers can be removed using procedures performed in a dermatologist’s office, such as scraping, freezing, or surgical removal. If the NMSC is large, or in a highly visible area such as the face, your dermatologist may recommend Mohs surgery, which limits scarring. If a BCC or CSCC becomes advanced then a multidisciplinary team of doctors may be convened, including a medical oncologist and surgeon, who can help develop a treatment plan that may consist of systemic treatment or a therapy that activates the immune system against the cancer.
Prevention is key
It’s far preferable to avoid these procedures entirely by protecting yourself from early and advanced stages of NMSC in the first place. “You have to make yourself your own advocate in preventing skin cancer,” Dr. Perez says. Luckily, a few simple lifestyle changes can reduce your lifetime risk. For starters, of course, practice sun safety. Everyone—no matter your age, race, or skin color—should avoid prolonged and intense sun exposure and steer clear of tanning beds. Dr. Perez advises seeking shade when outdoors, and wearing a broad-spectrum sunscreen with SPF 30 or higher, along with hats, sunglasses, and other protective clothing.
Take a thorough look at your skin
Beyond that, at-home skin assessments are a crucial first step in screening for skin cancer, in the same way breast self-exams are supplemental to mammograms. In fact, the American Academy of Dermatology reports that almost half of melanomas are detected during self-exams.
Stand in front of a full-length mirror in a well-lit room to examine your skin, from your scalp to the soles of your feet (including those aforementioned areas where the sun doesn’t shine). Take note of any new growths, changes in pre-existing spots, thickened patches, or sores that don’t heal. Inspect your nail beds for anomalies in texture or color, or the appearance of streaks or lines. It’s also important to see your doctor. The Skin Cancer Foundation recommends that you see a dermatologist once a year, or more often, if you are at higher risk of skin cancer, for a full-body, professional exam.
If you find a spot that bleeds occasionally or seems otherwise suspicious, it should be evaluated by a dermatologist ASAP. Dr. Perez adds: It may be nothing, but if it isn’t, you’ll have a far better chance of heading it off at the pass.
Visit LetsGetRealAboutSkinCancer.com to learn more about non-melanoma skin cancer, including some of its features in people of color, and to take a pledge to see a dermatologist for a skin check.
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