President Biden, first lady Jill Biden and I have something in common: We all were recently treated for a basal cell carcinoma (BCC) — the most common type of skin cancer, especially among older Americans.
For me, it began just shy of my 70th birthday when I noticed a tiny, shiny bump on my nostril. My dermatologist took a biopsy, suspecting it was BCC. It was, but it was very small. She reassured me that it was highly curable and rarely spread.
Like Jill Biden, I had the suspicious spot removed with Mohs surgery, a specialized microscopic procedure that carefully removes layers of cancerous skin one by one until only healthy tissue remains. It’s considered the gold standard for preventing recurrence with less scarring. Jill Biden had surgery for a spot near her eye and one on her chest in January, while her husband had a lesion on his chest removed in February.
More than 3.5 million basal cell carcinomas are diagnosed annually in the U.S., according to the Skin Cancer Foundation. Adults over 40 are particularly at risk, said foundation spokeswoman Jane Yoo, a dermatologist and Mohs surgeon in New York City. “One in 5 Americans will develop the disease by age 70.”
Basal cells normally help the skin produce new cells as old ones die off. But long-term exposure to the sun’s ultraviolet radiation can cause these cells to go haywire, producing abnormal cell growth. The good news is that these cancerous basal cells grow slowly and are rarely fatal, but they can be destructive to tissues and disfigure the skin if treatment is delayed, wrote researchers with the Icahn School of Medicine's Department of Dermatology in a 2016 review in The Journal of Clinical and Aesthetic Dermatology.
Unfortunately, as we age, our cumulative years of exposure to the sun’s damaging rays catches up with us — especially because many of us grew up unaware of the danger of skipping sunscreen. And let’s not even mention all those times we sat roasting in the sun in order to look “healthy” and tan.
My mother, a champion golfer who rarely used sun protection, never imagined it would result in multiple bouts of skin cancer in her 70s and 80s.
To catch skin cancer early, when it’s most treatable, go to your dermatologist for an annual full-body check for suspicious spots. You also should regularly check yourself in the mirror. Here’s what you need to know:
What to look for that could be skin cancer
“Examine your skin for anything that’s new, has changed in appearance or looks unusual,” says Yoo. This could include:
- A shiny bump that is pearly or translucent. It can be pink or white on white skin, or tan, brown or black especially in people of color and can be mistaken for a normal mole.
- An open sore that doesn’t heal and may bleed, ooze or get crusty
- A reddish patch or irritated area
- A persistent sore that may appear to heal and then return
- A flat, waxy scar-like area, often white or yellow, with poorly defined borders
Other common skin cancer types include:
- Squamous cell carcinoma, which can first appear as a rough, reddish scaly patch, a wart-like growth, a brown spot or a sore, according to the American Academy of Dermatology
- Melanoma, which is more aggressive and serious. The American Academy of Dermatology recommends checking for changes in color, shape or size of an existing mole, or a new unusual or irregular growth on the skin. This cancer can appear in shades of brown or black and some can be red or pink.
How to protect your skin from sun damage
Avoid direct sun between 10 a.m. and 4 p.m., when UV rays are at their strongest. Wear long-sleeve shirts and pants, says Yoo, and a wide-brimmed hat that covers your scalp and shades your face, neck and ears. UV-blocking sunglasses can shield the eye area.
Sunscreen is now included in many beauty and moisturizer products, which makes it even easier to protect your skin against both cancer and the signs of premature aging, including fine lines, wrinkles and the hyperpigmentation that causes those dark age spots.
Look for sunscreen products that have an SPF of 30 or higher and are water-resistant. Yoo recommends using roughly a shot glass full of sunscreen — about three tablespoons — applied to your whole body about 30 minutes before going outside. Reapply every two hours or immediately after swimming.
What treatment is used to remove BCC?
If your dermatologist sees something suspicious, she will take a small tissue sample and send it to a lab for analysis. If it comes back positive for cancer, your doctor will refer you to a skin cancer surgeon, who will decide the best treatment for your specific case, including Mohs surgery, cutting out the cancerous lesion or radiation therapy.
“Mohs surgery has a 99 percent cure rate for skin cancers that have not been treated before,” says Yoo, and up to 94 percent for skin cancers that recur after previous treatment.
My Mohs surgery needed only one layer to determine there were no underlying cancer cells. I drank coffee, ate snacks and listened to music during the wait for results. The surgeon then did a skin graft for cosmetic purposes, using skin from the underside of my earlobe. Two months later, the spot on my nostril is invisible.
We’ve come a long way from sunburning
I no longer leave the house before applying facial sunscreen, even if it’s cloudy or during the chilly days of winter. At the beach you can find me under the biggest umbrella, reapplying sunscreen and wearing a baseball cap or wide-brimmed hat while I read a novel or do a crossword. I’ll never give up oceans and lakes, but their natural beauty still shines brightly from my view in the shade.
Have any of you ever had skin cancer? Let us know in the comments below.