Why Melanoma Isn’t the Only Kind Of Skin Cancer You Need to Worry About

The Derm Group

Our very own Dr. Marc Glashofer is featured in this important piece which ran in this month’s MEN’S HEALTH.


Think skin cancer, and the word “melanoma” inevitably jumps to mind.

And for good reason: Since melanoma is most prone to spread to other organs in your body, it kills more people than any other form of the disease.

But melanoma makes up only one percent of all diagnosed skin cancers.

“If you add up all of the non-melanoma skin cancers each year, that number is greater than all of the new cases of breast, prostate, colon, lung, and melanoma skin cancers combined,” says Joseph Sobanko, M.D., an assistant professor of dermatology at the Hospital of the University of Pennsylvania. “We’re seeing an epidemic of non-melanoma skin cancer.”

In fact, about 3.3 million Americans are treated for basal and squamous cell skin cancers each year, according to a 2015 study from Brown University.  That equates to over 5 million non-melanoma skin cancers—more than 4 times the amount estimated in 1994. The uptick in cases could be for many reasons.

The first is a plus: Dermatologists are diagnosing more cases since more people are coming in for screenings at younger ages, says Marc Glashofer, M.D., a skin cancer surgeon at the Dermatology Group in West Orange, New Jersey.

We’re also living longer. That means more cumulative years of sun exposure, a risk factor for all skin cancers.

Another reason isn’t so positive. The ozone layer—which helps block damaging ultraviolet (UV) rays that lead to skin cancer—is being depleted more rapidly, Dr. Glashofer notes. This puts all of us at a higher risk for skin woes down the line.

Non-melanoma skin cancers are much less likely than melanoma to spread. However, these skin cancers are still cancer, so spreading always remains a possibility.

Squamous cells carcinomas are more likely to do so than basal cell—they can spread to local areas like lymph nodes or even to other distant parts of the body, says Dr. Glashofer.

What’s more, if you wait years before getting the cancer treated, removal can be disfiguring. It’s especially problematic if the cancer is somewhere cosmetically sensitive like your nose, he says.

And even if you get the cancer removed, you’re not in the clear just yet: If you’ve had non-melanoma skin cancer, you have a 30 to 50 percent chance of developing another one over the next five years, says Dr. Glashofer.

Some new research also suggests non-melanoma skin cancer can put you at risk of developing another kind of cancer later on.

According to a 2014 study from the Geisel School of Medicine at Dartmouth, people who were diagnosed with squamous cell carcinoma were 40 percent more likely to develop a second kind of cancer than those who didn’t have the disease. People with basal cell carcinoma were 18 percent more likely to get diagnosed with a subsequent cancer.

And the risk was even higher when looking at just melanoma—people with basal or squamous cell carcinomas were more than three times as likely to develop melanoma afterwards, it found.

Experts aren’t exactly sure what’s behind the link.

But developing non-melanoma skin cancer might indicate that your body’s DNA and repair mechanisms may not be functioning as robustly as someone who’s never had skin cancer, says Dr. Glashofer.

“Cancer doesn’t start out of nowhere—it starts as a cell that’s bad,” says Dr. Glashofer. “Some people just have the ability to eliminate that cell before it turns into a real issue.”
Most of us know the warning signs of melanoma: A dark spot or mole that’s irregular in shape, itches or bleeds, or changes in color or size, says Andrew Alexis, M.D., chairman of the department of dermatology at Mount Sinai West and Mount Sinai St. Luke’s.

But non-melanoma skin cancers tend to look a little different.

Basal cell carcinomas—which make up about 80 percent of non-melanoma cancers—usually look like little pink, shiny bumps that may have broken blood vessels on the surface, says Dr. Sobanko. Sometimes they can also look like a pale white scar.

Have a “pimple” on your nose that’s not going away and sometimes bleeds? Many men tend to mistake basal cell carcinoma for acne, notes Dr. Glashofer.

In its early stages, squamous cell carcinoma often starts as pre-cancerous rough, scaly spots on the skin that feel like sandpaper. In time, these can turn into red or pink cancerous bumps.

The overwhelming majority of non-melanoma cases are on sun-exposed areas like the head and neck, says Dr. Sobanko. See your dermatologist about any suspicious-looking spot that hasn’t gone away for about two months, says Dr. Glashofer. He or she will evaluate the lesion and decide whether or not to biopsy it. It the test comes back as a non-melanoma skin cancer, the type and location of the lesion will dictate the treatment, says Dr. Sobanko. Generally, if the cancer is your face or neck, you want to minimize scarring, which means conserving as much cancer-free tissue as possible.

In this case, Mohs Micrographic Surgery—a specialized technique that maps out the exact margin of the cancer—produces the smallest wound and a success rate of about 99 percent.

“We can look at the entire lesion and make sure if it does have roots, we know where those roots are,” says Dr. Glashofer. “We can take it out sliver by sliver.”

Small non-melanoma cancers in areas that aren’t as cosmetically sensitive (like your back) can be scraped off with an instrument with a ring-shaped tip and stitched, says Dr. Sobanko. Scraping is a much easier procedure that takes less time.

There are also some FDA-approved topical creams, like Imiquimod, that may work on thin basal cell cancers and—at times—on early stage squamous cell cancer.

“But the risk of the cream not getting it all introduces the risk of recurrence,” says Dr. Sobanko.

Make a broad-spectrum sunscreen your new best friend—and not only for days you hit the beach. You should slather some SPF 30 moisturizer on any time you’re in the sun, whether it’s on a jog or just driving to work, says Dr. Glashofer.

Avoid staying directly in the sun during its peak hours, between 10:00 am and 4:00 pm—that’s when UV rays are the strongest. Instead, carve out time for outdoor activities in the early morning or the hours right before sundown, says Dr. Sobanko.

If you must be outside during primetime, seek shade, and be sure to use protective gear like hats, sunglasses that block UV rays, or even UV-blocking clothing, says Dr. Glashofer.

You should also examine your skin once a month, looking out for any new moles or marks, and anything that has changed in shape, size, or color.

Have your partner check your backside to make sure you’re scanning your entire body, not just what you see in the mirror, says Glashofer.

If you have a history of skin cancer, you should see your dermatologist every 6 months for a total-body screening, says Dr. Glashofer. Otherwise, make sure you’re going once a year.

One more thing: It’s important to remember than not everyone has the same risk for skin cancer. People who light skin and eyes are at a much greater risk of skin cancer than people with darker skin and eyes, says Dr. Sobanko.

That’s because additional pigment in darker skin acts as a sun protectant from damaging rays, which are more easily absorbed by lighter skin, he says.

So if you’re in that category—or are at high risk due to family history or numerous sunburns growing up—it’s especially important you remain vigilant about sun protection techniques.