Glenn Goldman, MD, is medical director of Dermatology at The University of Vermont Medical Center. He is also professor of medicine and director of the Dermatology Residency Program at the Larner College of Medicine at UVM.

Glenn Goldman, MD, is medical director of Dermatology at The University of Vermont Medical Center. He is also professor of medicine and director of the Dermatology Residency Program at the Larner College of Medicine at UVM.

Vermont has a very high incidence of skin cancer. In fact, we rank “number one” for melanoma, although that is not an honor.

Why? It’s largely due to our population demographics – we are mostly of Northern European ancestry – and our active outdoor lifestyles. Fortunately, Vermont has excellent treatment of skin cancer. We have a dedicated group of providers who render the highest quality of care. These providers are found both in the community and at the UVM Medical Center. They range from primary care providers to dermatologists and general surgeons with special training in the treatment of skin cancer.

There are two areas where we can make improvement: First is in the recognition of skin cancer at an earlier stage, and the second is with primary prevention. While 97% of Vermont residents have insurance, individuals frequently hold off on notifying their provider about a skin lesion. Skin cancer is most readily treated if it is early in its development. This is particularly true for melanoma and squamous cell carcinoma. Let’s learn more about skin cancer together – here is a guide for you.

How to Spot Skin Cancer

This can be a challenge. Most people have moles, and many patients have an assortment of other benign skin growths. In fact, the vast majority of growths are benign. Newer skin lesions are more likely to be malignant in patients who are fair, with red or blond hair, those who burn easily, and those with blue eyes. While there are many types of skin cancer the main three are basal cell carcinoma, squamous carcinoma, and malignant melanoma.

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is a slow-growing, but destructive skin cancer. BCCs invade local tissues.They do not tend to spread. They usually present as a pearly, slowly growing spot which bleeds on its own. In fact, any new and enlarging growth in a fair individual which has spontaneous bleeding should be considered a BCC until proven otherwise.

Patients who suspect that they might have a BCC should make an appointment with a provider. This is not usually an urgent visit, since the lesions grow very slowly. BCCs are usually readily treated, though some facial lesions require particular attention. Note that BCCs can become quite large and difficult to treat. Overall, BCC causes more morbidity than mortality. The vast majority of people are cured of their lesions.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is a more rapidly-growing skin cancer. SCC usually presents as an enlarging rough, scaly plaque or nodule, and these growths are often painful or tender. They tend to occur almost exclusively in areas of high sun exposure, such as on the arms, shins, scalp or face. Most SCCs are not deeply invasive and can be removed with excision or other suitable means.

Left untreated, SCC can get large and painful rapidly. This type of lesion can also spread locally and to lymph nodes, and early treatment is more important than with BCC. Most patients who have a dangerous SCC are aware that the lesion needs treatment. It is important that their providers recognize that such lesions need immediate care so that this can be arranged.

Melanoma

Melanoma is a malignancy of pigment cells. It is the most common form of skin cancer to spread or metastasize, and the most likely to cause death. Most melanomas are caught early enough to treat them. They usually present as a mole that changes color and enlarges. Unfortunately, these changes can be subtle. A melanoma should be suspected if an old mole starts to change, or if a new growth arises which is irregular, multicolored, changing, or a combination thereof. People who identify a lesion that they think may be a melanoma should contact their health care provider immediately and be seen in a reasonable time frame. By the time melanomas are larger or deeper they have often spread, and this is a challenge to treatment.

How We Treat Skin Cancer — In a Nutshell

Most skin cancers are treated surgically. Treatment of more advanced skin cancers will often include chemotherapy or radiation, but more and more highly-specific, targeted therapies are available. Widely metastatic cancers and very advanced lesions are sometimes cured, and those that cannot be cured can often be controlled for a long period of time. New developments in the treatment of advanced forms of skin cancer continue to roll out and the future in this area promises continued success.

How We Can Prevent Skin Cancer

Beyond early detection, Vermont could learn from Australia about prevention. It is not enough to treat skin cancer effectively. It is important to prevent it. Australia has the highest incidence of all forms of skin cancer. It is the only country in the world to successfully implement a nationwide campaign to limit the damage from skin cancer. Australians have rallied around sun protection and sun avoidance, and this has resulted in a decrease in the incidence of skin cancer.

In Vermont we are making some progress. Tanning beds are illegal to those under 18. Parents are better about protecting their children than they are with their own skin. But, we can go further. The majority of skin cancers occur in patients who have had multiple serious sunburns or who just have repeated, chronic sun exposure. Push comes to shove, there is nothing enjoyable about a sunburn. There is also nothing good about having leathery, thin, fragile, bronzed skin. It is not clear who invented the term “healthy tan,” but there is no such thing. Even those who are not burned are damaging their skin when they tan deeply.

The State of Vermont and the UVM Medical Center are committed to reducing the incidence of skin cancer. We are working with the State’s Skin Cancer Task Force on prevention and detection. Several local TV stations have teamed up with us to get the message out that the sun is a double-edged sword, and that skin cancer is to be taken seriously. With increased education and appropriate resources, I believe that we can address this issue head on and turn the tide.

This is one area in which the State of Vermont does not need to be number one.

Glenn Goldman, MD, is medical director of Dermatology at The University of Vermont Medical Center. He is also professor of medicine and director of the Dermatology Residency Program at the Larner College of Medicine at UVM.

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