As certified health and exercise professionals, we have a unique opportunity to play a vital role in skin cancer awareness. We frequently see clients in workout clothing – tank tops, shorts, sports bras, etc., allowing us to observe potential warning signs that might otherwise go unnoticed. Since early detection is critical for successful skin cancer treatment, empowering clients with knowledge of skin cancer signs is a valuable service we can provide. Though it is not within our scope to diagnose, we can create awareness.

What Is Skin Cancer?

According to the National Cancer Institute, skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of your skin. The purpose of  skin is to protect body against heat, light, infection, and injury. It also stores water, fat, and vitamin D. The skin has two main layers and several kinds of cells. Skin cancer can occur anywhere on the body, but it is most common in places that have been exposed to more sunlight, such as the face, neck, hands, and arms.

Skin cancer can take many forms. The most common sign of skin cancer is a change on the skin, such as a growth or a sore that won’t heal. Sometime there may be a small lump. This lump can be smooth, shiny and waxy looking, or it can be red or reddish brown. Skin cancer may also appear as a flat red spot that is rough or scaly. Not all changes in your skin are cancer, but you should see your doctor if you notice changes in your skin. Let’s examine some of the most common types.

What Causes Skin Cancer? 

Ultraviolet (UV) Radiation: The Main Culprit

The primary cause of skin cancer is exposure to ultraviolet (UV) radiation, primarily from the sun but also from tanning beds and lamps. UV rays damage the DNA in skin cells, and over time, this damage can lead to mutations that cause cells to grow uncontrollably, forming cancerous tumors. There are two main types of UV rays:

• UVA rays: These rays penetrate deep into the skin’s dermis, contributing to premature aging and wrinkles. They can also damage the DNA in skin cells.
• UVB rays: These rays are responsible for sunburns and are the primary cause of skin cancer. They damage the DNA in the skin’s epidermis, the outermost layer.

The amount of UV radiation a person receives depends on several factors, including:

• Skin type: People with fair skin, blonde or red hair, and blue or green eyes are more susceptible to UV damage and skin cancer.
• Sun exposure habits: Frequent and intense sun exposure, especially during peak hours (10 am to 4 pm), significantly increases skin cancer risk. Sunburns,particularly in childhood, are a major risk factor.
• Tanning beds and lamps: These artificial sources of UV radiation pose a significant risk of skin cancer, similar to sun exposure.

Beyond UV Radiation: Other Risk Factors

While UV radiation is the leading cause, other factors can contribute to skin cancer risk:

• Weakened immune system: People with weakened immune systems due to conditions like HIV/AIDS or medications that suppress the immune system are at higher risk.
• Certain genetic conditions: Some inherited gene mutations can increase skin cancer risk.
• Exposure to certain substances: Long-term exposure to arsenic or certain industrial chemicals can increase skin cancer risk.

Remember, early detection is crucial for successful skin cancer treatment. By incorporating skin cancer awareness into your practice and encouraging regular self-examinations and professional screenings, you can play a vital role in helping your clients maintain good skin health and reduce their risk of skin cancer.

The Big Three: Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma

Skin cancer manifests in various forms, but three main types account for the vast majority of cases:

• Melanoma: The most aggressive form, melanoma often presents as an atypical mole with irregular borders, uneven coloration, and a larger diameter (greater than 6mm). While the ABCDE rule (Asymmetry, Border, Color, Diameter, Evolving) serves as a foundational tool for melanoma recognition, it’s crucial to go beyond this basic framework. Emphasize to clients that any mole or lesion exhibiting changes in size, shape, or color warrants a visit to a dermatologist.

• Basal Cell Carcinoma: The most prevalent form of skin cancer, basal cell carcinoma typically appears as a pearly or waxy bump, most commonly on the head and neck. However, it can occur anywhere on the body. Move beyond the ABCDE rule and stress the importance of self-examination. Instruct clients on proper techniques for examining their entire body regularly, paying particular attention to areas that don’t see regular sun exposure. The “ugly duckling” sign can also be a helpful concept to introduce – any spot that stands out from the surrounding skin, regardless of whether it strictly follows the ABCDE criteria, should be checked by a professional.

• Squamous Cell Carcinoma: Often arising from precancerous lesions (actinic keratosis), squamous cell carcinoma appears as rough, scaly patches or red, firm bumps. Squamous cell carcinoma is a reminder that sun protection isn’t just about preventing melanoma. Encourage clients to incorporate broad-spectrum sunscreen into their daily routine, even on cloudy days, to reduce their risk of developing all types of skin cancer.

Early Detection Saves Lives

By incorporating skin cancer awareness into your client interactions, you can significantly impact their well-being. Here are some actionable steps you can take:

• Visual Aids: Utilize posters or handouts with clear images depicting various skin cancer types. This can significantly enhance client understanding and retention of key information.
• Self-Examination Tips: Instruct clients on proper self-examination techniques,recommending a regular schedule for checking their skin. Provide resources or even offer to guide them through the process during a session if appropriate.
• Professional Checkups: Encourage annual skin cancer screenings by a dermatologist. Early detection is the cornerstone of successful treatment, and regular screenings can help identify potential issues before they progress.

The Power of Partnership

Early detection is the cornerstone of successful skin cancer treatment. By working together, we can empower our clients to be proactive about their skin health and potentially save lives. Remember, knowledge is power. Let’s equip our clients with the knowledge they need to identify and address skin cancer concerns promptly. We can be that first line of defense in the fight against skin cancer.

Determining Personal Risk

There are some techniques and tools that can help you and your clients determine individual risk of developing skin cancer.

Self-Assessment:

• Skin Type: People with fair skin, blonde or red hair, and light-colored eyes tend to have less melanin, the pigment that protects skin from UV rays, and therefore have a higher risk.
• Sunburn History: Frequent sunburns, especially blistering sunburns in childhood, significantly increase skin cancer risk.
• Family History: Having a close relative (parent, sibling, child) with skin cancer increases your risk.
• Moles: A large number of moles (more than 50) or atypical moles (irregular borders, uneven color, larger than 6mm) warrant attention and possible monitoring by a dermatologist.

Risk Assessment Tools:

There are online tools like the National Institute’s of Health “Melanoma Risk Assessment Tool” can provide a preliminary risk evaluation based on questions about your skin type, sun exposure habits, and family history. It’s important to remember that these tools are for informational purposes only and should not replace a consultation with a healthcare professional. Scan Your Skin also offers a similar risk assessment tool.

Professional Consultation:

• Dermatologist Visit: A dermatologist can perform a thorough skin examination, looking for suspicious moles or lesions. They can also discuss your individual risk factors and recommend appropriate screening intervals.

It’s important to emphasize that these methods are not definitive. Skin cancer can develop in anyone, regardless of risk factors. However, understanding your risk profile can help you make informed decisions about sun protection and encourage regular skin self-examinations and professional checkups

Precautions That Will Reduce Risk

“Skin cancer is one of the few diseases which can be minimized if people protect themselves from the sun,.” said Dr.  Lynn Drake,  President, American Academy of Dermatology (AAD). Below are some practical strategies you and your clients can employ.

Sun Protection is Paramount:

• Seek Shade: Whenever possible, especially during peak sun hours (10 am to 4 pm), seek shade under trees, umbrellas, or canopies.
• Sun-Protective Clothing: Cover up with long-sleeved shirts, pants, and wide-brimmed hats whenever possible. Look for clothes with a tight weave that offer good UV protection.
• Sunscreen: Apply broad-spectrum sunscreen with SPF 30 or higher generously and evenly to all exposed skin 15 minutes before going outdoors. Reapply every two hours, or more often if sweating or swimming. Don’t forget areas like the ears, lips, neck, tops of the feet, and the backs of the hands. Make sure you are choosing a sunscreen that doesn’t include chemicals like oxybenzone and homosalate which can disrupt hormone levels, fluid retention, and thyroid function. Non-chemical barrier sunblocks like non-nano zinc oxide are a great choice not only for preventing burns, but for preventing ocean pollution. Just be prepared by the “whiteness” they will lend to the skin! 

The best defense against skin cancer is to completely protect yourself from the damaging and harmful ultraviolet rays of the sun. Often, through early detection, most skin cancers (including melanoma) can be cured. The AAD urges everyone to examine his or her skin regularly. Regularly examine your entire body including your back, your scalp, the soles of your feet, between your toes, even the palms of your hands.

Remember if you notice any changes in the size, color, shape or textures of a mole or any other unusual changes in the texture of your skin, see your dermatologist or personal physician immediately.Beyond sun protection, you and your clients can take other reasonable precautions to lower the risk of skin cancer development.

Beyond Sun Protection:

• Tanning Bed Avoidance: Completely avoid tanning beds and lamps. They emit harmful UV rays that can significantly increase your risk of skin cancer.
• Sunglasses: Wear sunglasses that block UVA and UVB rays to protect your eyes from sun damage.
• Self-Examination: Perform regular skin self-examinations, checking your entire body for any new, changing, or suspicious moles or lesions. Familiarize yourself with the ABCDEs of melanoma (Asymmetry, Border, Color, Diameter, Evolving) but remember that any unusual spot should be checked by a professional.
• Dermatologist Visits: Schedule regular skin cancer screenings with a dermatologist. The frequency may vary depending on your individual risk factors,but typically annual screenings are recommended for adults at high risk.

Develop Sun-Safe Habits:

• Make sun protection a routine part of your daily life, just like brushing your teeth.
• Keep sunscreen readily available in your car, bag, or at home for easy reapplication.
• Educate children about sun safety habits from a young age.

By adopting these strategies, you and your clients can significantly reduce the risk of developing skin cancer.

For more information and access to facts sheets and research, check out the following resources.

• Skin Cancer Foundation: https://www.cancer.org/cancer/latest-news/how-to-spot-skin-cancer.html
• American Canceskin r Society: https://www.cancer.org/cancer/risk-prevention/sun-and-uv/skin-exams.html
• Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/symptoms-causes/syc-20354187
• Scan Your Skin: https://www.scanyourskin.org/risk-prediction-tool/