A Visual Guide to Skin Cancer and What It Actually Looks Like
Despite everything we know about the importance of wearing SPF, skin cancer rates are on the rise. The most important thing you can do to protect yourself against skin cancer is to take your head-to-toe sun protection routine seriously (more on that later). But also important for lowering your risk is staying vigilant about any suspicious spots.
So, what exactly does skin cancer look like? We asked board-certified dermatologists to break down how to spot something troublesome and keep yourself cancer-free.
The Big 3
When it comes to skin cancer, you'll often hear dermatologists talk about "the big three." "The three most common forms of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma," Anne Marie McNeill, a board-certified dermatologist in California and a spokesperson for the Skin Cancer Foundation, tells Allure. Here's how to spot each one.
Basal Cell Carcinoma
Basal cell carcinoma is the most common form of skin cancer, according to the Skin Cancer Foundation. It estimates 4.3 million cases are diagnosed in the U.S. each year. Though it's fairly common, relatively few people die from basal cell carcinomas — the SCF estimates the annual number of deaths is around 3,000.
"Basal cells can look lots of different ways," says McNeill. Most commonly, they'll look like little red patches or open sores. Sometimes, these spots have a raised border with an indentation in the center, according to the Skin Cancer Foundation. But they can also look more unassuming — like a flat scar, a patch of eczema, or a pearly pimple. "I often tell my patients if they have a spot that looks like a pimple or a sore [that hasn't healed], I want them to come in," McNeil says. "It's probably not a pimple if it hasn't gone away after a month."
Your risk for this type of skin cancer goes up as you get older and get more sun exposure (both cumulative and single, intense burns). Basal cell carcinomas tend to hang out where you get the most sun exposure — on your nose, ears, and face, says McNeill. "I have a lot of women that get them on the chest," she adds. "I also see them a lot right along the hairline," — a spot you might easily be missing when you apply your makeup or SPF, she says. While it's common in people with very fair skin, you can develop one no matter what your skin tone.
As far as cancer treatments go, treating a basal cell carcinoma is a cinch. The shallowest spots can be scraped or burned off, but even the more "invasive" option is typically an easy in-office procedure called, Mohs surgery. This procedure involves your derm removing the tiny tumor one layer of tissue at a time, examining each layer under a microscope so they can be ultra-precise. "The goal of Mohs surgery is to remove the smallest amount of tissue to try to minimize any trace of a scar," McNeill explains.
Having basal cell carcinoma may not seem all that scary. While it is highly treatable, that doesn't mean you shouldn't take it seriously. Studies show that up to 50 percent of people with a basal cell carcinoma have a recurrence within five years, reports the Cancer Treatment Centers of America. "If you've had a basal cell, wear sunscreen every single day and get regular skin exams either every six months or every year," says McNeill. "Chances are you are going to get another one and we want to catch it early."
Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common form of skin cancer — though it is deadlier than the more commonly occurring basal cell. "If left untreated, squamous cell carcinomas are more likely to spread into the lymph nodes and be life threatening," explains McNeill. According to the Skin Cancer Foundation, over 1 million cases are diagnosed in the U.S. each year, resulting in more than 15,000 deaths.
Squamous cell carcinomas can look similar to their more common cousins — a red sore with a raised border. But more commonly, they appear as red, scaly patches or open sores that crust and bleed. They can also look like a wart, McNeill adds. These raised bumps tend to crust and bleed too, according to the Skin Cancer Foundation.
"Just like basal cells, squamous cell carcinomas are the result of UV exposure," says McNeill. So, they typically appear in places that are always in the sun, such as your scalp, face, and neck — even your lips.
Technically, squamous cell carcinomas are most common in people who are older with light skin. But the Skin Cancer Foundation notes two disturbing trends: This cancer is becoming more common in people in their 20s and 30s and in people with darker skin tones. Researchers chalk up the rise, at least in part, to the increased rates of indoor tanning. "People who use tanning beds are two and a half times more likely to develop squamous cell carcinoma than those who don't," the organization states.
Luckily, squamous cell carcinomas are treated fairly easily with the same methods used to treat basal cell. They can metastasize and spread to lymph nodes or other areas of the body, however, so don't think you can slack on getting a cancerous spot treated.
While the first two types of skin cancer tend not to be as serious, melanoma can be life threatening. Though it only accounts for 1 percent of all skin cancers, reports the American Cancer Society, it's the deadliest.
"It's critical to educate yourself about melanomas," Julie Karen, a board-certified dermatologist, tells Allure. "What differentiates melanomas from benign moles is called the 'ABCDEs' of melanoma," she explains.
A stands for asymmetry. "If you have a mole and the two sides don't match, that could be more concerning than a mole that's symmetrical," Karen says.
B is for border. "Most benign moles have perfectly round borders, where melanomas typically have jagged or scalloped borders," Karen explains.
C stands for color, specifically color variation. "If a mole is multiple colors, that's a worrisome sign," McNeill says. "Uniform colors, even if it's very dark, aren't as worrisome."
Generally, melanomas are black or brown but they can also be red or even a blueish purple. (Side note: Some melanomas are actually colorless. Called amelanotic melanomas, these can be harder to detect. Typically, they "look like little pink bumps," says McNeill. If you see a pinkish or whitish spot that's either changing or new, have your derm take a look, she says.)
D stands for diameter. "Melanoma can be small, but if you have a mole that's larger than the size of a pencil eraser, you should watch it a little more carefully because that's more likely to be cancerous than a smaller mole," Karen explains.
Finally, E stands for evolution. "If you have a mole that's changing in size, shape, or color, even if that mole has been previously examined, it's worth having it looked at again," Karen says.
Amelanotic melanomas in particular are super hard to spot — even for trained dermatologists. That's why getting regular skin checks is so important. Typically, doctors recommend going yearly to cover all your bases, "but there are exceptions to every rule," McNeill points out. "There are some melanomas that present very deep, very quickly," she says. Though melanomas are very serious, she stresses they are by no means a death sentence. "If a melanoma is caught early it has a very high cure rate. It's really when melanomas are not caught early that they become deadly," she says. Translation: Have a pro check your birthday suit every year or twice a year if you have a history of skin cancer.
Another thing that makes melanomas scary? They're good at hiding in hard-to-see places like your scalp. In addition to showing up in spots where you get the most sun exposure, they "can crop up in unexpected areas like under the nail, in the genital areas, on the palms and soles, even on the eyelids," says McNeill. "Be aware of that when you do a self-exam."
Sun exposure will up your risk for getting a melanoma, but there's also a genetic component, says McNeill. "Know your family history. If one of your first-degree family members had it," — aka your mom or dad — "that increases your chances significantly," she says.
As a more aggressive cancer, melanomas require more aggressive treatment. If you catch it early (meaning it hasn't rooted deep into the skin), the cancerous tissue can usually be removed using a local anesthetic in your dermatologist's office. "With more advanced cases, we'll do a lymph node biopsy to test whether it's spread," explains McNeill. When that's the case, oncologists get involved to help treat the spread of the cancer.
Spotting Other Types of Skin Cancer
While "the big three" are the most common types of skin cancer, they're not the only ones you should be aware of.
Merkel Cell Carcinoma
"After 'the big three', the next skin cancer you think about is Merkel cell carcinoma," Doris Day, a board-certified dermatologist in New York City and a member of the Skin Cancer Foundation's leadership society, tells Allure. While it's pretty uncommon, about 40 times rarer than melanoma, Day says, it's deadlier. Merkel cell carcinoma kills one in three patients (as opposed to one in nine for melanoma), according to the Skin Cancer Foundation.
This type of cancer is incredibly hard to spot, which explains why it's so deadly. "Merkel cell can be tricky to diagnose because it doesn't always present the same way; it can look like a cyst or just a little red bump and it can occur anywhere on the body," says Day. "This is one of the reasons why it's super important to see a board-certified dermatologist for skin checks."
Merkel cell carcinomas typically don't occur in people under 50, but recent data suggests that could change. As we previously reported, rates of Merkel cell are estimated to be rising six times faster than other types of skin cancer — something seriously concerning to dermatologists, given how aggressive this type of cancer can be. "If a Merkels cell is not treated, it's certainly deadlier than a melanoma," says McNeill.
"Certain metastatic cancers can show up in the skin," says Day. Cancers prone to spreading (such as breast cancer or kidney cancer), can sometimes spread to the skin, causing what might look like a cyst or little red bump.
A type of lymphoma (cancer of the lymph nodes), called CTCL can also show up in the form of skin issues. Though cutaneous T-cell lymphoma isn't technically a skin cancer, it can show up on your skin looking "like eczema," explains Day. Just like eczema, the cancer-induced rash can be itchy and dry, and "the skin has a cigarette-paper quality to it," she explains.
For these types of skin issues, a dermatologist would refer you to a specialist in treating that specific cancer.
How to Stay Skin Cancer-Free
Factors like genetics can influence your risk of getting skin cancer, but the number-one culprit is still the sun. Naturally, the biggest thing you can do is use sun protection — all the time. "You really have to wear sunscreen every single day," stresses Karen. When you're actually at the beach or spending a lot of time outside in the sun's rays, make sure to reapply every two hours, she says.
As much as we love our SPF, Karen stresses sunscreen alone isn't enough. "It should be one component of a smart sun strategy that includes hats, long sleeves, sun protective clothing, and sitting in the shade," she explains.
"If you don't go in the sun, it doesn't guarantee that you'll never get skin cancer, but it does greatly decrease your risk of the big three," Day adds.
Step two: Keep up with yearly skin checks. If you have a history of skin cancer, either personally or in your family, your dermatologist might recommend upping them to every six months. And in the meantime, don't be afraid to see your derm about something that looks weird.
McNeill recommends making an appointment to see your dermatologist if a spot — a weird bump, sore, mole, or pimple that just won't go away — is not healing after a month. "You should not have a pimple or a scab or new bump for a month," she says.
Finally, the experts stress the importance of seeing a board-certified dermatologist, not just any doctor, for suspicious spots. "A board-certified dermatologist does at least three years of residency training just in skin conditions," explains McNeill. Other doctors might not have as much experience in spotting something worrisome — especially the rarer types of skin cancer.
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