When I moved from Boston to Southern California for college, I set my sights on one goal (well, besides getting a degree): getting a tan. I spent four years lying in bikinis on the quad, my skin slathered in baby oil. As I got older, I began protecting my skin more out of fear of wrinkles. But my years of sunbathing had (quite literally) left their mark: I’d developed many moles, which had the potential to develop into skin cancer. Despite this, or perhaps because of it, I put off seeing a dermatologist, my procrastination bolstered by fear and remnants of youthful invincibility.
Finally, last fall, I made an appointment. Three days afterward, I had a melanoma diagnosis.
While my excessive sun exposure was habitual, even “one bad blistering sunburn in a fairer-skin individual with a genetic predisposition could be the tipping point,” says Dr. Richard Torbeck, assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City.
Though I caught my cancerous mole early enough to keep it from spreading to the rest of my body, some people don’t. This year, it’s estimated that around 100,000 cases of invasive melanoma will be diagnosed — meaning melanomas that have been allowed to spread because they weren’t caught earlier by a screening.
Of these, an estimated 7,650 will result in death. While the U.S. Preventive Services Task Force only recommends skin cancer screenings for adults who don’t notice anything amiss, there might be things you don’t catch on your own. It’s just good practice to get regular skin checks. (Plus, the recommendation dates back to 2016 and could be changed soon. )
A common enemy
I quickly became a statistic.
Skin cancer is by far the most common cancer in the United States, with more skin cancer diagnoses made annually than all other cancers combined. A whopping 1 in 5 Americans will develop skin cancer at some point in their lifetime. Almost 10,000 people are diagnosed in the US every day.
But not all of these cancers are melanomas, like mine — in fact, most aren’t. There are three types of skin cancer: basal cell skin cancer, squamous cell skin cancer and melanoma. Basal and squamous cell cancer, sometimes collectively called nonmelanoma skin cancer, are the most common forms of skin cancer, and also the least deadly. Instead of developing through moles, they manifest as discoloration of the skin or even bumps. Melanoma, meanwhile, accounts for just 1 percent of all skin cancers in the US but causes the most deaths related to skin cancer. That said, it has an overall survival rate of 93 percent.
Most skin cancers are caused by sun exposure, but repeated X-rays, scars from burns, exposure to certain chemicals, a weakened immune system and family history can also contribute.
The science of sunburn
Ever sit at the beach for hours, engrossed in a good book, and forget to apply sunscreen? As you read, UV radiation damages the DNA in your skin’s outermost layer. One element most at risk is a vital tumor-suppressing gene.
Dr. Tanya Nino, the melanoma program director at Providence St. Joseph Hospital in Orange County, California, says once the harm is inflicted, there’s no undoing it. “When the DNA is damaged and can’t repair itself, that’s when a skin cell can turn into skin cancer,” she explains.
Your body does try to protect you: When your skin peels after a long, hot day at the beach, it’s actually expelling cells at risk of becoming cancerous. Nevertheless, sun damage builds up over time. The more you burn, the greater your risk of cancer.
If you’re a person of color and don’t get obvious burns, the cancer risk associated with unprotected sun exposure is still there. What’s more, because sun damage is less apparent, skin cancer in people of color tends to be diagnosed at a later stage, which means it can be much deadlier.
Basal and squamous cell cancers are typically linked to daily accumulated sun exposure over time, Nino explains. Melanoma usually stems from more intense, intermittent sun exposure that causes painful sunburn. Interestingly, your age at the time of your sunburns can affect your risk of melanoma.
If you get a bad, blistering sunburn during childhood or adolescence, it doubles your chance of developing melanoma later in life. Another large study found that sunburn in early life is the main driver of melanoma, while sunburns at older ages were associated with other types of skin cancer. Learning this, I couldn’t help but think of the many childhood vacations where I spent evenings slathering aloe over my tomato-red limbs in our hotel room.
The dangers of “ugly duckling” moles
I have a lot of moles. Many of us do. And most of them are harmless. Sun exposure, especially early on, primarily determines how many moles you’ll get, although genetics and hormonal changes (like pregnancy or puberty) can also play a role.
Cancerous moles generally don’t hide what they are. Torbeck explains that dermatologists have a code, the “ABCDEs of skin cancer,” when investigating moles:
- Asymmetry
- Border irregularity
- Color change
- Diameter > 6mm
- Evolution (any changes in the mole)
“We look for the ‘ugly duckling’ sign, or a mole that sticks out from the others in comparison,” Torbeck says. “Some people have multiple odd moles, but if they all look similar, that’s reassuring.”
In my case, my cancerous mole was smack dab in the middle of my back, making it that much easier to ignore. Still, my antenna went up whenever I glimpsed it in the mirror post-shower. I didn’t know about the ABCDEs, but the mole’s dark, wide appearance seemed ominous.
The fallout of an atypical mole
Dermatologists can’t diagnose cancer on appearance alone. If they find a concerning mole, they will conduct a biopsy and send it to an expert who can differentiate between benign and malignant cells.
If the mole is cancerous, as mine was, the next step is excision, or cutting the mole out.
Due to the size of my mole, my doctor had to take a relatively large chunk of skin out of my back, which took an excruciating 45 minutes. However, the experience was well worth it — it got rid of all of the cancer in my body, and there was no reason to believe it had spread.
If the mole is cancerous and the doctor has found that it’s spread throughout your body, the first step is still excision. After that, treatment varies depending on how much and where the cancer has spread, but it could include immunotherapy, chemotherapy, radiation or removal of affected lymph nodes (where melanoma tends to spread first).
Now I try to get a skin check every six months.
Skin cancer is deadly, but only if it’s not caught early. I’m glad I finally went in for an exam. Take it from my experience: The sooner you make your next dermatologist appointment, the better.