Doctor shares insights into treatment, prevention

Assistant professor at Penn State makes statement for Cancer Awareness Month

LEWISTOWN — Skin cancers are those that are directly related to sun exposure, said Doctor David Shupp, dermatologist and assistant professor with Penn State Hershey Medical Center. With two more weeks left in Cancer of the Sun Awareness month, Shupp wanted people to know that, despite some forms being fatal, skin cancer is mostly preventable.

“We’re not sure what causes most cancers, (but) we know what causes skin cancer — sun exposure,” Shupp said.

The best prevention against skin cancer is limiting sun exposure and protecting against it, starting as young as possible.

“The earlier in life you can protect against sun exposure, the less likely you’ll be at risk,” Shupp said.

Wearing protective clothing and hats and reducing mid-day, outdoor activities are two effective prevention methods, as is using sunscreen. Shupp acknowledged that recent reports allege that chemicals from sunscreens have been detected as elevated in the blood, but said that this raises more questions than answers.

“Until we know more, we (should) continue to use sunscreen,” Shupp said, adding that physical sunscreens, with zync-oxide and titanium-dioxide, are not likely to seep into the blood stream from the skin.

The three most common types of skin cancer people receive from too much sun exposure are basal cell carcinoma, squamous cell carcinoma and melanoma, Shupp said. According to www.skincancer.org, more than 4 million cases of BCC are diagnosed in the U.S. each year and include warning signs such as a persistent, nonhealing sore, a reddish patch or irritated area, frequently occurring on the face, chest, shoulders, arms, or legs or a pink growth with a slightly elevated, rolled border and a crusted indentation in the center.

BCC is the least aggressive form and rarely metastasizes, Shupp said.

SCC has an intermediate aggressiveness, with approximately 2,000 deaths each year, Shupp said. According to www.skincancer.org, “SCCs often look like scaly red patches, open sores, warts or elevated growths with a central depression; they may crust or bleed. They can become disfiguring and sometimes deadly if allowed to grow. More than one million cases of squamous cell carcinoma are diagnosed each year in the U.S., which translates to about 115 cases diagnosed every hour.”

Melanoma is the most aggressive form of skin cancer, ranked in the top 10 cancer-related deaths in the country, Shupp said. According to www.skincancer.org, “an estimated 192,310 cases of melanoma will be diagnosed in the U.S. in 2019. Of those, 95,830 cases will be noninvasive … confined to the … the top layer of skin … and 69,480 cases will be invasive, penetrating the epidermis into the skin’s second layer.”

Melanoma is a dark and pigmented growth, Shupp said, most commonly known as a mole and is diagnosed with ABCDE; Asymmetry, Border, Color, Diameter and Evolving. If the mole is asymmetrical, has an irregular border, has multiple colors, is more than six millimeters in diameter and changes in any way over a short period of time, it is more than likely melanoma, Shupp said.

Those who are diagnosed with pre-cancerous skin changes can treat the lesions with topical creams or freezing them with liquid nitrogen, but will need surgery if the cancer progresses, Shupp said. Surgical procedures include shaving the lesion, then treating the base with cautery and currettment, or cutting the lesion out with a scalpel and stitching up the wound. The most preferred treatment method is Mohs, Shupp said. According to www.skincancer.org, “Mohs micrographic surgery is considered the most effective technique for treating many basal cell carcinomas … and squamous cell carcinomas.”

Shupp said the procedure starts with removing a small area of the cancer and analyzing it under a microscope. The procedure is repeated until no cancer remains, making it the most tissue-sparing and most precise treatment, Shupp said.

As with all cancers, if any form of skin cancer advances or metastasizes, chemotherapy is the next likely form of treatment, Shupp said.