Here’s a not-so-fun fact that might surprise you: Skin cancer is not only the most common type of cancer in the United States—It’s diagnosed in numbers that surpass all other cancers combined. According to the American Cancer Society, more than 3 million Americans develop skin cancer every year.
Now to the good news: Skin cancer is preventable, can often be caught early (including by the people who have it), and is usually highly treatable and curable. It just takes some know-how—including a familiarity with your own body, so you can tell when something’s amiss.
“I think it’s really important for people to get to know their skin,” Bridget Bryer, MD, an assistant professor of dermatology at the University of Virginia, in Charlottesville, Va., tells SELF. “Skin cancer caught early is such a different story than skin cancer caught late.”
Skin cancer basics
Unprotected exposure to ultraviolet rays, either from the sun or indoor tanning, is responsible for the vast majority of skin cancers. UV light can break the DNA inside your skin cells, which your body then tries to repair. If the damage overwhelms your internal repair mechanism, these cells can end up with some seriously janky mutations that cause them to divide and grow aggressively, leading to a cancerous tumor.
Per the ACS, most skin cancers form in the top layer of the skin (called the epidermis), which contains three main types of cells:
- Squamous cells, which live in the upper part of the skin and are constantly shed and replaced by new cells
- Basal cells, which dwell a little deeper down and replenish the squamous cell supply
- Melanocytes, which produce a pigment (called melanin) that gives the skin its color
The cancer process can begin in any of those cell types, so skin cancer is broken down into three main forms.
Basal cell carcinoma
Basal cell carcinoma
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This skin cancer may not have the name recognition of melanoma (more on that later), but it’s by far the most common type, says Ashley Culbreth, a physician assistant in cutaneous oncology at Moffitt Cancer Center, in Tampa.
In fact, BCC accounts for about 80% of all skin cancers among Americans—making it extra important to know its warning signs. (In fact, it’s the most common type of cancer in humans, full stop.) Admittedly, that can be tricky, since BCC tumors vary in appearance, and often resemble a bunch of garden-variety skin problems, particularly early on. “Sometimes,” Culbreth tells SELF, “people think it’s a pimple that just won’t go away.”
Here’s a rundown of what BCC commonly looks like:
- A small bump, or bumps, that may be brown or glossy black or resemble a mole if you have brown skin, or pink or red (hence the pimple confusion), or translucent and shiny, if you have a lighter skin tone
- A patch of irritated skin that may itch or hurt (or not)
- A pink, brown, or even blue growth with slightly raised edges and a depression in the center, which might house tiny blood vessels that branch out like spokes on a wheel (although those blood vessels might be harder to see if you have dark skin)
- Open sores that may bleed or crust over, and don’t completely heal
- A waxy or scar-like area that’s flat and has indistinct borders
Regardless of how it looks, BCC almost always arises in areas of the skin with the most sun exposure, like the face, neck and arms.
In some cases, says Dr. Bryer, people first notice something’s wrong because they repeatedly have a bit of bleeding from the same spot on the skin—say, when they wash their face. That can signal an early BCC that isn’t obvious to the naked eye, she says.
Fortunately, BCC usually grows slowly and is almost always curable (though people need regular checkups to detect any recurrences). Still, the ACS says, it’s possible for an untreated BCC to invade the bone or other tissues beneath the skin. Treating early BCC is straightforward, Dr. Bryer says: Often a dermatologist can remove the tumor right there in the office, after numbing the skin. Other treatments include cryotherapy (freezing and killing the tumor cells with a cold substance like liquid nitrogen); “light therapy” that uses blue or red light to kill cancer cells; and medications that you apply to your skin.
Squamous cell carcinoma
Squamous cell carcinoma
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This form (pronounced SKWAY-muhs) accounts for around 20% of skin cancers, and it, too, usually arises in the most sun-exposed areas of the body. Often, SCC presents itself as a patch that’s scaly or rough, says Mary Stevenson, MD, a dermatologic surgeon at NYU Langone Health, in New York City.
But like basal cell carcinoma, SCC comes in various guises. Per the American Academy of Dermatology, it may look like:
- A wart
- An open sore, often with raised edges
- A brown spot that looks like an “age spot”
- A sore that develops within an old scar
- A protrusion from the skin that resembles a “rhinoceros horn” (a red flag for a more aggressive SCC)
Sometimes those growths come with symptoms, like itching, pain, or numbness. And while SCC mostly strikes sun-damaged skin, it can begin in unexpected places, like your mouth, nails and genitals.
Just like basal cell cancer, SCC typically grows slowly and is very curable. But without treatment, some SCCs burrow deeper, potentially injuring nerves or blood vessels, or spreading to other parts of the body. The treatment options for early SCC are the same as for BCC; if the cancer has spread, it might require more extensive surgery or drugs taken by mouth or IV.
Melanoma
Melanoma
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Of the major types of skin cancer, melanoma is the rarest, but also the scariest, Culbreth says. It makes up only around 1%of skin cancers, the ACS says, yet it causes the vast majority of skin cancer deaths. That’s because melanoma can spread to various organs if it’s not treated early on. But when it is caught early (and hasn’t spread beyond the skin where it started), the outlook is good: Over 99% of people diagnosed with early-stage melanoma are still alive five years later.
That’s why it’s critical to know how to spot melanoma. Per the AAD, the cancer can develop from an existing mole, or appear as a new growth, with any of these “ABCDE” warning signs:
- Asymmetry: One half of the growth is unlike the other
- Border: It has an irregular or undefined border
- Color: It’s a mix of colors, with varying shades of brown or black, or areas of red, white or blue
- Diameter: Melanomas can be small, but they’re usually bigger than 6 millimeters across (the size of a pencil eraser) when diagnosed
- Evolving: The growth is changing in size, shape or color
Oftentimes, people think melanoma only crops up in moles they’ve had forever. In reality, Dr. Bryer says, it’s more likely to emerge as a new growth; if a new mole pops up at any point after you turn 40, she notes, that’s definitely something to have checked out.
Another “myth,” Dr. Bryer tells SELF, is that melanomas are always raised bumps. “Early melanomas are almost always flat,” she says, “and that’s when we want to catch them.”
Early melanoma, in fact, can often be treated with surgery alone. When it’s more advanced, though, various drug therapies may be necessary. The latest treatments, Culbreth says, are immunotherapy drugs—which bolster the immune system’s ability to fight the cancer.
Who gets skin cancer?
The short answer is “anyone can.” But as we mentioned, a person’s lifetime UV exposure is a critical factor. Plus, certain people are at heightened risk of skin cancer, due to factors like these::
- Having light-colored skin, since melanin (the pigment in skin cells) offers some protection from UV rays, Culbreth notes. People who have skin that freckles or easily burns, or light-colored eyes and red or blonde hair, are at particular risk.
- Having many moles (50 or more), or large or “atypical” ones (jagged borders or multiple colors), is a risk factor for melanoma.
- Genetics: Melanoma can sometimes run in families. About 10% of people with melanoma have a family member who also had it, per the Skin Cancer Foundation.
- A history of skin cancer: If you’ve had one type of skin cancer, you’re at heightened risk of a recurrence or developing another type.
Again, though, skin cancer knows no boundaries, Culbreth stresses, and it can strike people who always tan and never burn. If you are Black or brown, you are at lower risk of skin cancer in general, but, Dr. Stevenson points out, at increased risk of a rare and more aggressive melanoma subtype called acral lentiginous melanoma. It typically appears as dark spots on the feet or hands, she says, or as “streaks” under the nails. (Research has shown that people with darker skin tones are less likely than those with lighter skin tones to survive melanoma and that they are often diagnosed at later stages, when the cancer is more difficult to treat.)
As for age, it does matter, with skin cancer being more common after age 50. But you’re never too young to develop it, and sunburns and exposures in childhood can end up causing the DNA damage that leads to problems later in life. “These cancers are incredibly common, and I treat many people in their 30s and 40s,” Dr. Stevenson tells SELF.
What you can do
Perform skin self-exams.
Take stock of your skin once a month. Look everywhere, using a mirror to help you, Culbreth says. And don’t forget places like your scalp, soles of your feet, between your toes, and your nails. (The ACS has detailed instructions on how to do a skin self-exam, along with images of what skin cancers often look like.) One hack, Dr. Bryer notes, is to snap pictures with your phone, to help detect changes in your skin over time.
Also keep an eye out for any mole or other spot that’s new, changing in appearance, or sticks out from others like an “ugly duckling.” If something looks off, Dr. Bryer says, make an appointment with your dermatologist if you have one; if not, see your primary care provider. (It’s worth noting that no medical groups recommend that healthy people be routinely screened for skin cancer by a doctor, but some dermatologists do, at least for certain patients.)
Protect yourself outdoors.
This one goes for everyone, regardless of skin tone, all three experts say: Skip indoor tanning, and shield yourself from the sun’s rays. Some general advice on how:
- Hang in the shade whenever you can, especially between 10 a.m. and 2 p.m., when the sun is most intense
- Wear broad-spectrum sunscreen. The Skin Cancer Foundation recommends using an SPF of 15 or higher for everyday life, and 30 or higher if you’ll be in the sun for a prolonged time. And be sure to slather enough on, Dr. Bryer stresses: Adults typically need an ounce—a shot glass full, she says—for full body coverage. Reapply after two hours, or after swimming or sweating., whichever is sooner.
- Culbreth adds these pointers: Protect often-forgotten spots like the scalp and the ears (with sunscreen and/or a hat), and remember that the sun’s rays can find you when you’re riding in a car, too.
- Cover up with clothing, like a light long-sleeved shirt, wide-brim hat, and sunglasses. Dr. Bryer says she’s a “huge fan” of sun-protective clothes (which carry an ultraviolet protection factor label). They’re especially useful, she says, if you’re the active outdoorsy type who constantly sweats or swims your sunscreen off.
The bottom line: As common as skin cancer is, it’s also one of the most preventable and treatable cancers. And, Dr. Bryer says, even if you spent your teens and 20s applying baby oil and roasting yourself under the sun, it’s never too late to start protecting your skin.
“I do tell people that what you’re doing now makes a difference,” Dr. Bryer says. “If you’re in your 30s, 40s, you still have so much sun exposure—so much life—ahead of you. It makes a huge difference.”
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