When fun in the sun makes for not-so-fun doctor visits

As Coloradans, spending so much time outside in the fresh mountain air, on scenic trails, flowing rivers, and other outdoor places is a top pastime. Although we crave sunshine on our faces, it’s not the friendliest element for our skin.

Skin cancer is the most common type of cancer in the United States, with one in five Americans contracting the disease by age 70, reports the American Cancer Society. And like many other types of cancer, there are different types of skin cancer.

“There are three main types of skin cancer: squamous cell carcinoma, basal cell carcinoma and melanoma,” explained Dr. Travis Mason, a surgical oncologist at Banner Health.

The most commonly observed types of skin cancer are basal and squamous cell carcinomas of the skin, Mason said. Both of these cancers typically begin in the top layer of skin and are often associated with sun exposure.

According to the American Cancer Society, eight out of 10 skin cancers diagnosed are basal cell carcinoma, with about two out of 10 skin cancers progressing to squamous cell carcinoma.

Both basal and squamous cell carcinomas occur in areas that get a lot of sun exposure, such as the ears, neck, scalp, face, hands, shoulders, and back.

Risk factors for basal and squamous cell carcinoma include:

• have light skin
• To be older
• exposure to ultraviolet light
• be male
• exposure to certain chemicals
• radiation exposure
• Previous skin cancer
• Smoking

When diagnosing basal cell carcinoma, doctors usually look for two or more signs, such as:

• An open wound that won’t heal
• A reddish spot or irritated area
• A shiny bump or nodule
• A small pink growth
• A scar-like area
• “Basal cell skin cancer can also look like a raised white, waxy scar,” Mason said.

If basal cell carcinomas are not completely removed, they can recur in the same place. It is very rare for basal cell carcinoma to spread to other parts of the body.

Squamous cell carcinomas can appear as “thick, rough, scaly patches that may crust or bleed,” the Skin Cancer Foundation website explains. This type of skin cancer can also look like a wart or open sores that don’t heal or don’t heal completely.

Although squamous cell carcinomas can be surgically removed or otherwise treated, they are more likely to grow into deeper areas of the skin and/or spread to other areas of the body if left untreated.

Melanoma is a much rarer cancer, about 100,000 new cases a year, but more dangerous because it’s more likely to spread to other areas of the body, Mason said.

Melanoma skin cancer can develop anywhere on the skin but is commonly found on the chest, back, and legs.

“Melanomas usually look like a birthmark, but if they’re not pigmented, they can also look like a white spot,” Mason said.

When it comes to identifying melanoma or the possibility of melanoma, the Skin Foundation suggests using five warning signs, known as the “ABCDEs” of melanoma.

The letter “A” stands for asymmetry. If you drew a line down the middle of the area in question, would both sides be the same? If not, it could mean there is a problem.

The letter “B” stands for Rand. Melanoma borders are usually uneven and may have jagged edges instead of smooth edges.

Color is what the letter “C” represents, and while moles are usually darker than most of the skin, an area affected by melanoma can be varying shades of brown, tan, or black. As the cancer grows, it can sometimes turn red, white, or blue tones.

The letter “D” stands for two things – diameter and darkness. If you see a lesion the size of a pencil eraser or larger, contact your doctor as soon as possible. Also, if a lesion or area is darker than other areas or lesions, this can be a sign of melanoma.

With the last letter “E”, it is important that you know your skin. The letter stands for evolution, which can mean any change in the size, shape, color, or height of a spot on the skin over time. It can also include itching, bleeding, or crusting of an area.

“With all of these criteria, it can be difficult for a patient to self-diagnose,” Mason said. “It takes a lot of experience to see these subtle changes in these skin lesions and birthmarks.”

Mason advises that if you have any questions or see any odd spots on your skin, don’t be afraid to go and have them checked out.

“Dermatologists see thousands of these moles and lesions a year, so they’re very good at spotting them by eye,” Mason said. “They also have a dermatoscope so they can get a really good look with magnification if needed.”

In addition to basal cell and squamous cell carcinoma and melanoma, there are also Merkel cell skin cancer, lymphoma of the skin and Kaposi’s sarcoma – all of which have different identification guidelines.

Harlan Else knows first-hand how skin cancer can affect people’s everyday lives. Else and his wife lived in Colorado Springs for many years before moving to South Padre Island, Texas. He recently moved to Greeley to seek additional medical help for some skin cancer issues.

“I’ve struggled with least invasive skin cancer for at least 25 years,” Else said.

Over the years, Else’s doctor removed any squamous cell carcinoma that developed on and around his head.

In February 2021, Else had a large squamous cell carcinoma removed from the side of his left nose to between his eyes, which refused to fully heal, he said.

“It was different from the past, but I kept saying it would heal and I would go to my doctor every two or three weeks and ask him about it,” Else said. “He ended up saying it was just scar tissue and a cyst — nothing to worry about.”

Uncomfortable with the doctor’s response, Else’s wife contacted their daughter, Wendy Sparks, the chief operating officers of Banner Health in northern Colorado.

Sparks showed a photo of her father to a doctor with Banner and they confirmed that what Else has “wasn’t a cyst or scar tissue, it looked like cancer” and wanted to see Else right away.

Else and his wife made the 1,200-mile drive from South Padre Island to Greeley to see a Banner dermatologist and surgeon for help pinpointing what was going on.

“They looked at me and did some lab work and came back and said they had to operate on me within the next week or 10 days,” Else said. “That got my attention.”

As it turned out, Else had a tumor that led to his eye and then was able to travel all the way to his brain.

Else underwent two surgeries – one to remove the cancer and one to reconstruct the area. To remove the tumor, the surgeon had to cut away about a third of Else’s cheek.

“The first operation took an hour and a half to cut out the tumor and all the edges,” explained Else. “The next day was a five and a half hour surgery where a plastic surgeon put everything back together. I looked kind of rough for 24 hours.”

The rebuilding phases of the process left Else with 110 stitches on her face.

Because the tumor was so large, Else had to be treated with radiation for 33 days.

About three months have passed since the last radiation and Else is doing “fine”, she goes to the cosmetic surgeon every two years and to the dermatologist/surgeon more often.

“I still have stuff popping up on my head. The doctor performed a minor operation on my head to get rid of a patch of squamous cell carcinoma,” Else said. “He told me that I will see him for the rest of my life and that stuff will probably be removed every now and then.”

When it comes to protecting yourself and your family from skin cancer, there are a variety of steps you can take.

The American Cancer Society recommends using the catchphrase “slip, slop, slap and wrap” to protect your skin from UV rays.

The “slip, slop, slap and wrap” tips are:

• Slip on a shirt
• Apply sunscreen
• Put on a hat
• Wrap up a pair of sunglasses

Even if you endured extended tanning sessions as a child due to sunburns or as a teenager to get that bronzed spring break look, you should still protect yourself from further troubles.

“If you feel like you are at high risk because of the amount of sun exposure you got when you were young, your best bet would be to just have your annual skin exam with a dermatologist and use sunscreen regularly, if you’re out in the sun longer than a short amount of time,” Mason suggested. “Even with a higher SPF – 30 or 50 or higher.”

And that applies not only to adults, but also to children and young people. Children and adolescents tend to spend more time outdoors and burn more easily. So before you let kids run out the door, be sure to put on sunscreen and educate them about the dangers of overexposure to the sun.

As with any type of cancer, early detection is the best way to prevent skin cancer from growing or spreading to other areas. By doing self-examinations of your skin and that of your family members once a month, you can see sudden changes in moles, blemishes, freckles, and other features.

For people who are prone to skin cancer or are at higher risk of developing cancer, it is recommended that they have an annual skin cancer screening by a doctor. Dermatologists and even family doctors can screen for skin cancer, make notes of anything they need to keep an eye on, or refer patients to specialists if something on the skin needs further investigation.

“It should just become part of your primary care routine to get screened for skin cancer,” Mason said.

For more information on skin cancer, visit www.skincancer.org.