Medical professionals and organisations like the American Academy of Dermatology frequently educate their patients on the ABCDEs of melanoma, the most dangerous form of skin cancer ― and for good reason.
“Melanoma is the ‘deadly skin cancer,’ as this type of skin cancer can metastasise,” said Dr. Elaine Kung, a New York-based board-certified dermatologist. Once melanoma metastasises, it can spread to other body parts and internal organs, like the lungs or brain.
But other types of skin cancer, like basal and squamous cell carcinoma, may go undetected. And while they’re not as deadly, they’re more common — and it’s important to treat them seriously.
“In reality, melanoma is actually a very, very small fraction of skin cancers,” said Dr. Jeffrey Hsu, an Illinois-based board-certified dermatologist. “The majority of skin cancers are basal cell carcinoma or squamous cell carcinoma.”
According to the American Cancer Society, basal cell carcinoma accounts for about 8 out of every 10 skin cancer diagnoses and squamous cell carcinoma accounts for about 2 out of every 10 skin cancer diagnoses, whereas melanoma only accounts for 1% of all skin cancer diagnoses.
Skin cancers like basal and squamous cell carcinoma may look like simple skin rashes in their early stages, which leads many patients to miss signs that something is wrong.
Hsu experienced this firsthand with a recent patient, a woman of Asian descent with darker skin who loved the outdoors and would frequently go tanning.
“She started noticing persistent dryness, rashes and a few spots on her chest,” Hsu said.
Although these spots looked like a simple rash, Hsu became concerned when his patient mentioned she had this rash for a couple of years. As these spots were persistent and did not go away despite the many different types of treatment the patient tried, Hsu suspected possible precancerous cells.
“After completing a biopsy, these spots turned out to be squamous cell carcinoma,” Hsu said. His patient was able to receive treatment for her skin cancer before it advanced to later stages.
According to the American Academy of Dermatology, if squamous cell carcinoma is left untreated, it can grow deeper into the skin tissue, injuring blood vessels and nerves in the surrounding area. Although rare, squamous cell carcinoma can metastasise and spread to other body parts. While the risk of basal cell carcinoma metastasising is generally very low, this type of cancer can not only grow deeper into the skin but also into muscle and bone tissues, which can lead to potential disfigurement.
The lack of public awareness about non-melanoma skin cancers and persistent myths that those with darker skin can’t get skin cancer can cause many patients to not be as lucky. Here’s what you need to know.
How do I know if I might have basal cell or squamous cell carcinoma?
“Basal cell carcinomas are often shiny, translucent bumps with ill-defined borders that may bleed easily without trauma. Squamous cell carcinomas are like a tender, rough rhinoceros-like horn growing above a pink scaly patch,” Kung said.
But when these cancers start, they might be mistaken for a persistent pimple, a scaly rash or a scab that just won’t seem to heal.
“Commonly, I’ll have patients describe a spot and say, ‘Oh yeah, I got this pimple. I pick at it, and it just doesn’t go away, and over the years, it’s gotten slightly larger,’” Hsu said.
“Who doesn’t have a pimple here or there? But typically, these things go away within a couple of months,” Hsu said. “If you have a persistent scaly or rough spot that just refused to go away after three months, that’s probably time to receive a professional evaluation.”
Typically, it’s recommended to see a dermatologist if a suspicious spot doesn’t go away on its own after about three months. However, in some particular areas, you may want to visit a dermatologist sooner.
“The skin on the face and scalp tends to heal faster than the skin on the trunk and extremities,” said Dr. Angela Casey, an Ohio-based board-certified dermatologist. Due to the fact the skin on the face heals more quickly, Casey recommended reaching out to your dermatologist if a spot on your scalp or face doesn’t go away after two months.
The dangerous myth that ‘melanated skin can’t get skin cancer.’
Those with lighter skin types who have gotten a nasty sunburn are all too familiar with just how much damage UV light can inflict on the skin. Damage from UV light is what can potentially cause skin cancer to develop. However, not all UV damage is visible to the naked eye.
“Many people of colour mistakenly believe that they can’t get skin cancer because they don’t burn as much,” Hsu said.
“While those with darker skin types do have some ‘built-in’ UV protection rendered by the melanin in their skin, it is not a substitute for the more comprehensive barrier provided by sunscreens and sun-protective clothing and hats,” Casey said.
The belief that those with darker skin can’t get skin cancer can also cause patients not to prioritise visiting their dermatologist for important early skin exams.
“My patients who are of Irish descent are aware that skin cancer ‘runs in the family’ and are more apt to get skin cancer screenings earlier in life,” Kung said.
And it’s in these exams that a dermatologist can diagnose what seemed like an innocuous spot.
“The skin cancers that I have seen in patients with darker skin have generally been more advanced because the symptoms of the skin cancer were brushed off as eczema, inflammation or irritation of the skin,” Casey said. “This highlights the importance of educating the public on the different ways that any skin condition, not just skin cancers, can present in different skin types.”