I arrived at my building’s outpatient unit at 1:38pm. Although my appointment was at 1:40pm, I still gave myself a huge pat on the back for being “early,” which, technically, I was. A few signatures later, I was handed a paper gown of fairly decent quality and was instructed to wear it, opening to the back, after removing everything except my skivvies. There I was, sitting on the examination table, feeling quite vulnerable. And then I looked down. Crap! My legs were still in hibernation state. Even though doctors aren’t supposed to judge, I just didn’t see how this could fly under the radar. My only hope was that someone much more hairy had already been examined, setting some arbitrary threshold that would place me under the “I’ve seen worse” category. Before my mind drifted into a state where I imagined every possible uncomfortable doctor-patient exchange, the doctor entered the room. It was a dude. I was a bit disappointed but there was nothing I could do about that. It was apparent that I was slightly embarrassed and his attempt at making small talk did not help to dispel the awkwardness of having to let him scan every inch of my skin, including my you know what areas, for abnormalities. But, I knew that this exam could save my life.
Skin cancer is the most common cancer in humans and comes in several flavors, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. BCC is the most commonly acquired skin cancer, accounting for nearly 80% of skin cancers reported. As it’s name implies, BCC develops in the basal layer of the epidermis and often presents as a pearly, flesh colored nodule, usually on areas that get sun exposure (head, neck, arms). SCC, which arises in the squamous cell population of the epidermis, is the second most common type of skin cancer, affecting approximately 200,000 people each year, and often resembles a scaly patch surrounded by a red halo of inflamed skin. While sun exposed areas are more vulnerable, SCC can occur anywhere on the body (including genetalia) and, if not detected in a timely fashion, can spread to other areas in the body. The nastiest version of skin cancer is the potentially (and often) fatal melanoma. Either developing in a pre-existing mole or spontaneously appearing as a new dark spot on the skin, melanoma claims the life of one person per hour in the United States alone (including the life of my great uncle, Hank).
There are a number of misconceptions when it comes to skin cancers, such as the notion that people of color are less vulnerable. While an increase in the amount of the skin pigment called melanin does provide more protection from the sun, the skin cancer survival rate for people of color is considerably lower than that of Caucasian people. This has mainly been attributed to a delay in detection, highlighting that everyone needs to undergo regular skin cancer screening procedures. Also, it is commonly thought that early signs of skin cancer should be painful. However, there are no symptoms associated with the development of most skin cancers and, other than visual signs, early skin cancer lesions can feel like normal skin.
The best bet is to be aware of the skin cancer risk factors, including sun exposure, family history, medical history, and number of moles, so that you can better protect yourself. Also, using water-resistant sunscreen containing both UVA and UVB protection (SPF 30 or greater), seeking shade whenever possible, and avoiding tanning beds, are great tactics for skin cancer prevention. Even if you follow all the rules, be sure to give yourself a periodic self-examination. Furthermore, get screened by a professional on an annual basis. Visit the American Academy of Dermatology to locate the free skin cancer screenings in your area.
Remember, even though you might have to bare your body to some random dude (with credentials), early detection is the key for survival. Plus, it’s all over in 5 minutes or less. I’d trade that for a healthy lifetime any day.