Prevention, Diagnosis, and Treatment for This Common, Curable Disease in Fruitland, Idaho
The Skin Cancer Foundation estimates that more than two people die every hour from skin cancer. The disease is so common, one in five Americans is expected to develop skin cancer at some point. When it comes to fighting skin cancer, Fruitland, Idaho’s Dr. Carl Thornfeldt and the CT Derm staff take a multi-pronged approach by providing education on risk factors and prevention, performing vital partial or complete body skin checks to aid with early detection, and performing treatments that are proven to have excellent cure rates for this medical condition. Dr. Thornfeldt and his team of providers have experience in treating all six types of skin cancer.
What Are the Most Common Types of Skin Cancer?
Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common form of skin cancer, with about two million new cases estimated in the United States annually over the past five years. An estimated 1,000 people die from BCC each year. The major cause in these cases is from this skin cancer spreading from around the nose, ears, eyes, and scalp into the brain.
Basal cells form the single deepest layer of the epidermis. The job of these cells is to divide, then mature and migrate to the surface to form the protective surface layer, called the stratum corneum. Basal cell carcinomas (BCC) are malignant tumors that arise in this layer due to destruction of protective pigmented cells (melanocytes) by ultraviolet light and airborne pollution. BCCs are usually slow-growing skin cancers and rarely spread internally, but they can cause significant local invasion, destroying key skin features like noses. Risk factors for this skin cancer include age (being older than 40), a family history of BCC, having a light complexion, frequent and prolonged sun or tanning bed exposure, exposure to airborne pollutants like fire smoke, agricultural chemicals, and vehicle exhaust. Diminished immunity due to medications or chronic diseases also puts you at risk for this skin cancer. BCC usually appears as a shiny, pearly bump or spot. It may eventually ulcerate, bleed, or scab. These patches of superficial BCC sometimes look like non-healing dermatitis or psoriasis, but are never fatal and are completely curable. BCC may also seem to heal, when in fact this skin cancer is moving deeper.
Squamous Cell Carcinoma
The second most common form of skin cancer is squamous cell carcinoma (SQCC), with more than 400,000 new cases per year estimated in the United States. It arises in the squamous cells that are maturing cells migrating into the mid and upper epidermis. SQCC kills about 4,000 people a year, primarily due to spreading to lymph nodes, lung, stomach, and intestines. These skin cancers may itch or get sore or feel tender. Like BCC, they may occasionally look like a patch of non-healing dermatitis or psoriasis. These are known as Bowen’s disease or carcinoma in situ and are 100 percent curable and never fatal.
Anyone with years of substantial sun or airborne pollution exposure or a history of high-altitude recreation or occupations, including pilots, can develop squamous cell carcinoma. People with a family history of skin cancer, a light complexion, tanning booth exposure, work that involves exposure to pollution (such as farmers and fire fighters), a weakened immune system from allergies, hay fever, auto-immune and other chronic skin diseases, and bacterial fungus, yeast, and viral skin infections face greater risk. This skin cancer often appears as a red or pink irregular scaly bump or patch that frequently ulcerates, producing a non-healing sore. If you observe any of these or other changes in your skin, consult a trained health care provider immediately.
There is no one best method to treat this type of skin cancer. It depends on body site, as well as its thickness, size, and duration of time you’ve had it. Possible treatment options for this skin cancer include surgery, x-radiation, and prescription creams: imiquimod, 5-fluorouracil, or ingenol. Photodynamic therapy is also highly effective at treating Bowen’s disease like it is for superficial BCC.
Melanoma is the fastest increasing of all fatal cancers, killing 16,000 people in a recent year alone. This skin cancer afflicts people of all ages and all races and is now the leading cause of death for people in their 30s.
Neither of the most common skin cancers, BCC and SQCC, progress to melanoma. Melanoma begins in the cells that give the skin its color, called melanocytes. When they become cancer cells, they rapidly spread through the blood into the lymph nodes then lungs, brain, liver, and stomach and intestines.
Diagnosis of melanoma is often made during a routine medical checkup or during a mole or skin exam. A punch or excisional skin biopsy is the most accurate way to determine if a suspicious growth is melanoma or a “pre-skin cancer” atypical or inflamed mole or nevus. Also available at CT Derm is a handheld polarizing microscope called a dermascope. This allows our providers a deeper look into your skin layers, including the melanocytes at the base of the epidermis, to markedly increase the accuracy of a skin cancer or pre-cancer diagnosis. Any spot with multiple abnormalities on dermascope or the changes mentioned above should be removed with a 1/8-inch margin to eliminate the risk of progressing to melanoma.
The activating factor for melanoma is ultraviolet radiation, which can come from natural sunlight or a tanning booth. The tanning booth rays create a more than fivefold increase in risk of developing this skin cancer. You may be at high risk for this skin cancer if you are exposed to intense sun over short periods of time (also called "weekend tanners"), are fair-skinned, suffered from more than two blistering sunburns by age 18, vacation in the Southern United States or tropical places, or your skin freckles easily. Especially at risk are those with high sun exposure in their childhood or before age 15.
You should also perform routine skin cancer self-examinations every one to two months. Look for any new or changing growths, as up to half of melanomas do not originate from a mole. If you find a mole or growth that does concern you, do not ignore it. Make sure you show it to your skincare provider. Early diagnosis and proper surgical treatment of melanoma has a good chance of saving your life!
When monitoring moles, watch for any growths that follow the ABCDEs of skin cancer: asymmetry, a border that appears scalloped or indistinct, coloration that is mottled or variegated, a diameter greater than a pencil eraser, or evolution in terms of size, shape, appearance, texture, and more. Any of these characteristics can be a warning sign for skin cancer, but the most important sign of melanoma is an “ugly duckling” that looks different than any other spot or growth on your body. A spot growing wider at the base or having any burning, itching, tenderness, or pain for more than two weeks is likely dangerous. Lesions like that must be examined by a professional and removed to be checked under the microscope, not just watched! The most dangerous sites for this skin cancer are head and neck, palms, soles, lips, and eyelids.
Dr. Thornfeldt has also effectively treated the other three types of skin cancer: basosquamous cell, cutaneous T cell lymphoma, and merkel cell cancer, which is the most dangerous of all skin cancers.
What Is Actinic Keratosis?
Actinic keratosis (AK) is the most common sun-related skin growth due to ultraviolet (UV) light, but has been proven to also be due to airborne pollution. Even blue and visible light can also play a role. These growths are premalignant—meaning they are not yet skin cancer—but it is estimated that one in 11 lesions progress to squamous cell carcinoma.
Dr. Thornfeldt developed Epionce to reduce visible AKs as shown in five clinical studies that were 12 to 24 weeks long after he discovered AKs are triggered by a disrupted skin barrier and abnormal inflammation. Certain petrolatum-containing products also reduce visible AKs with daily use. No moisturizers, alpha hydroxy acids, vitamin C, vitamin E, or other antioxidant-containing products have been proven in humans to reduce or remove visible AKs like Epionce has. Vitamin A (retinoids and retinol) seems to make AKs less visible in the first few months, but actually increases the number of AKs and SQCC after 18 months of daily use.
Minimizing Skin Cancer Risk
To reduce your risk of developing skin cancer, start a complete sun protection program. The program that Dr. Thornfeldt recommends includes sunscreen of at least an SPF 30, but preferably SPF 50, applied twice against both UVA and UVB, sun protection clothes that block both UVA and UVB such as Sun Precautions or Coolibar, a tightly woven cloth hat with at least a 4- to 5-inch brim such as SunDay Afternoons, and UV blocking sunglasses. Seek shade, especially if you are not protected. Always avoid the sun during the dangerous hours of 10 a.m. through 4 p.m., or when the UV index is higher than 6.
Although UVA is present whenever the sun is up, protection is needed, since these rays suppress the protective immune system in the skin, markedly increasing your risk of developing premalignant skin cells after midday UVB exposure. There are protective orally ingested supplements, including vitamin C (500 mg), vitamin E (200 IU), ferulic acid (30 to 60 mg), tomatoes, and dark chocolate of greater than 55 percent cacao content. Proven to be protective against sun and tanning booth light damage are green tea extract (EGCG) at 200 mg and Heliocare at one to three pills daily in the morning. Quercetin and a turmeric extract called Meria, Niacinamide, silymarin, and Pycnogenol are also effective protectants against both UV light and pollution-induced damage. Beta carotene provides mild protection.
Remember, there is no safe tan! So using a tanning booth of only UVA prior to vacation does not protect against damaging UVB, blue, and visible light, nor lower skin cancer risk.
What type of sunscreen should I use to lower risk of skin cancer?
Look for FDA-approved, broad-spectrum sunscreens that protect against both UVA and UVB rays to minimize skin cancer risk. Under active ingredients listed on the sunscreen container, look for zinc oxide, titanium dioxide, and homosalate. Avoid the recently documented sunscreen toxins oxybenzone, octocrylene, and octinoxate, especially in children. It is critical to understand that sunscreen ingredients must bind to the stratum corneum, the roof of the skin. Thus, a normal skin barrier is necessary. Yet 70 percent of Americans do not have a normal skin barrier. Dr. Thornfeldt developed Epionce to repair and strengthen this barrier, so use Epionce nightly to maximize the benefit of your sunscreen the next day.
How often and when should I apply sunscreen?
Most people don't apply enough sunscreen to get full coverage. To minimize risk of skin cancer, you should apply adequate sunscreen twice in the morning to clean, dry skin at least 30 minutes prior to going outside. The second coat should be applied approximately 30 minutes after the initial application. This should protect you all day. Also, it is important to re-apply sunscreen after sun exposure longer than four hours and exposure to salt water or heavy perspiration longer than an hour and a half, even if you’re wearing water-resistant sunscreen. For a full-body application, you need one full ounce (the size of a shot glass) of sunscreen. Lotions are more protective than sunscreen sprays or sticks.
What is proper skincare to reduce skin cancer risk for my children in the summer when playing or swimming outdoors?
Apply two layers of sunscreen that is SPF50 or higher with water resistance 30 minutes apart and at least 30 minutes prior to going outdoors or swimming. After swimming, have them rinse off and apply Epionce Medical Barrier Cream or Renewal Body Lotion for barrier-repairing benefits.
What type of hat should I wear when outdoors to minimize skin cancer risk?
Hats are very important in reducing skin cancer risk by decreasing sun exposure to your scalp, face, ears, and neck. Hats should have at least a 4- to 5-inch rim all the way around and have a tight enough weave that you cannot see through it. Look for hats and clothing that contain an Ultraviolet Protection Factor (UPF). There are many options available in stores and on the Internet. Baseball caps are not sufficient to block UV rays from the ears, neck, and cheeks. Dr. Carl calls them “cancer caps.”
What other measures can I take to prevent skin cancer?
Wear UV-blocking sunglasses and UPF-protective clothing. Seek shade when appropriate—remember that the sun's rays are strongest between 10 a.m. and 4 p.m. Use extra caution near water, snow, and sand, since these surfaces reflect the damaging rays of the sun, which can increase your chance of sunburn and skin cancer risk. Never use tanning beds. There is no such thing as a "safe tan." Even occasional tanning bed use as minimal as three times a year triples your risk of developing skin cancer and skin aging.
We recommend many oral supplements, as listed above, to help you keep your skin healthy and looking radiant.
Is there a safe way to tan?
No. A tan is the body's protective reaction to UV damage to the skin.