Get Serious About Skin Cancer


wear sunscreen

It’s summer, the time of year for flip flops, swimming pools, and “fun in the sun” – which I am sure many of you will be having in the next few months. Which brings me to the topic of this month’s webinar – skin cancer. Obviously, being out in the sun increases the risk of more people developing skin cancer.

Skin cancer is the most common form of cancer in the United States. More than 3.5 million skin cancers in over two million people are diagnosed annually. One in five Americans will develop skin cancer in the course of a lifetime.

Dr. Howard Zahalsky, ADO Medical director, talked with us about what exactly is skin cancer, its effects and what you can do to mitigate your risks of developing skin cancer.

Why does someone get skin cancer?

There are two main reasons people get skin cancer: the sun and genetics. Some people get a lot more sun than others. For example, someone living near the Activ Doctors headquarters in Miami will see a lot more sun than someone that lives, say, in northern Canada.

Having a bad sunburn, at least one ugly, blistering sunburn in your life significantly increases your risk of developing skin cancer at some point. Now, genetics have a major part to play as well. If you are of Northern European descent, and you move to Florida, you will have a much higher risk of developing skin cancer because you have a fair complexion. That is to say, people with red hair and freckles are at a much higher risk of developing skin cancer than someone of Mediterranean or African descent.

Types of Skin Cancer

Basal Cell Carcinoma

Basal cell carcinoma is the most common type of skin cancer (an estimated 2.8 million are diagnosed annually in the US), but it’s about as “un-cancerous” as you can get. How would we identify this a skin cancer? It has a mother-of-pearl complexion – a little bit shiny, a little bit waxy. You can also see blood vessels running through it, like a baseball.

basal cell carcinoma

basal cell carcinoma
image credit:


By and large, basal cell carcinomas never kill anybody. The good thing about basal cells carcinomas is they never metastasize – they just keep getting bigger and bigger and bigger.

Because they don’t look that dangerous, many people ignore them for long periods of time – to their detriment. Like other cancers, it sends out roots. If you were to cut out just the part that you see, the carcinoma is likely to come back.

When this happens, you actually need to take out quite a large amount of skin to make sure you get it all, which means a seemingly disproportionate big, ugly scar.


Squamous cell

Squamous cell carcinoma (SCC) is the second most common skin cancer with between 200,000 and 250,000 cases reported each year. The difference between this and a basal cell, when it comes to looking at it, is the fact that it ulcerates – it looks like it has a bite taken out of it. These are cancers that are typically found in the head and neck region, in areas that get sunburnt, but also areas that a frequently irritated. For example, if you bite the inside of your cheek, you are at a higher risk of getting a squamous cell carcinoma of you cheek.

squamous cell carcinoma

squamous cell carcinoma
image credit:

An area that we have chosen not included an image for (and you can thank me later) is that it’s possible to get squamous cell carcinoma of the male genitalia – particularly if you are uncircumcised, because the foreskin can get chronically irritated. Squamous cell carcinomas of the penis is called Bowen’s disease.

Squamous cell carcinoma can spread beyond the area of the lesion, and can go to lymph nodes and other parts of your body. Fortunately, it (usually) takes quite a while, and because it looks a little uglier than basal cell carcinomas, they tend to be brought to the attention of medical personal well before it advances to that stage. Again, while you do have to take a lot of skin around the lesion, most of the time just cutting it out is sufficient.



Now this is what everyone really worries about when you’re talking about skin cancer – malignant melanoma. Melanoma accounts for less than 2% of all skin cancer cases, but the vast majority of skin cancer deaths. An estimated 9,940 people will die of melanoma in 2015. There are multiple ways to identify a melanoma because there are multiple things that melanomas do that are unlike other cancer cells: they don’t ulcerate, and unlike basal and squama cells, they don’t raise too far off the surface of the skin. They do spread out, like a stain.


image credit: wikipedia

Things to Look For:

  • Asymmetry: If you draw a line through this mole, the two halves will not match, meaning it is asymmetrical, a warning sign for melanoma.
  • Border irregularity: The borders are not an even, round shape, but irregular and lumpy – like an island.
  • Color: Having a variety of colors, including a number of different shades of brown, tan or black could appear. You may not even be able to tell where the splotch ends and normal skin begins. A melanoma may also become red, white or blue.
  • Diameter: more than ¼” or 6mm across is more likely to be melanoma


Early Detection is Key

These are very, very dangerous lesions. So if you do have a history of bad sunburns, and/or you live in an area with high sun exposure and are fair skinned, get checked over by your regular doctor or even a dermatologist regularly. Because melanoma spreads very quickly, early detection is key.

If you have a melanoma, and it gets more than 4mm (or about ¼”) deep, it is almost guaranteed probably spread to other areas of your body. Melanoma like to move fast – it spreads to your lungs and even your brain, and treatments are very poor once it has metastasized this way. So early detection is key.

Even when you catch it early, because the risk of spread is so high, the amount of skin you have to take is LARGE.  For a ½” melanoma, they have to remove 8-10” of skin to make sure they removed everything.

You got cancer WHERE???

Melanoma also has some nasty habits of hiding and developing in some pretty strange places that can make it hard to find before it’s too late.

Underneath the nail. Called subungual melanoma –  It will start out as what looks like a bruise – a dark area underneath the nail, like a bruise, it will look like you hit your nail on something. Over time it will get bigger, bulge out slightly and may even cause the nail to fall off. By the time you have a melanoma this big, it is likely that it has already started to spread elsewhere. Fortunately, melanoma under the nail is fairly uncommon.

In the back of your eye. Your retina is exposed to sun. All the light that goes into your eye, and into the back of your eye which helps you to see. Over time may develop a small blind spot – you may not even notice it at first. By the time you do notice it, and you go to the eye doctor and they will spot the melanoma. This requires complete removal of the eye, which is devastating, to say the least. But it is one of the slower spreading melanomas, so excision of the eye can be curative.

Things that AREN’T skin cancer

…but kinda look like it.

Actinic keratosis

Actually pretty dangerous, they are premalignant lesions that if left alone have the tendency to become squama cell carcinomas. Lesions with a whitish crust on the top, they are most common on the heads of bald men, but can also appear on the ears, face and shoulders. You can tell if you have actinic keratosis because skin around the area is red, but it feels like there’s white, flaky, crusty scab that you just want to pick off. If left alone, they will turn into cancer. Usually you just get one or two at a time. Treatment is performed by a dermatologist will burn them off with liquid nitrogen. For a large scale, like that one pictured, there is a special “chemotherapy shampoo” that can be used to treat large areas.

It will usually leave you with an ugly rash, but it better than trying to freeze all those lesions one at a time.

Semariac keratosis

Semariac keratosis are big, have variable colors and are somewhat crusty so people often mistake them for melanoma. This thing is that they get BIG. Way bigger than melanoma would ever get. They also have more regular, sharp borders – you can definitely tell where they begin and end. Other than getting bigger, they never do anything dangers- they just look pretty ugly.


The plain, average mole. This is what people come to me the most, wondering if they have melanoma. Let’s go through the checklist – relatively round, regular color, but even though this is darker than most, and it may be something that you want to keep an eye on, if I saw it in the office I would reassure the patient that they did not have melanoma.


They look like little red blisters. Sometimes when people get them, they think they are getting a bad rash or bug bits. These are benign skin lesions that are caused by artieries getting stretched out too much. Really, this is the varicose veins of the artery system. These are benign hemangiomas that if I was them in the office I would do nothing about. It’s hard to treat them. You can treat them with liquid nitrogen, but as they tend to come on in clusters, it can be hard to treat all of them.

How to Protect Yourself from Skin Damage


The best thing you can do to prevent basal cell carcinomas, squamous cell carcinomas and dangerous melanomas is apply sunscreen. It’s not enough to apply it just once in the morning, especially if you are doing anything active swimming. Even waterproof sunscreen should be reapplied regularly, and liberally, throughout the day. Even the wind, blowing sand around at the beach can knock the sunscreen off your skin. I would even recommend sun shirts (They’re not just for fat kids, like they were in my day).

How can Activ Doctors Online work for you

Personal Health Records

With our personal health record, you have your easy secure health record that can be available any time anywhere – any country, any doctors office. Dermatologists like to take pictures of moles so they can track mole growth. Now what happens if you move to a different city? With our PHR, you can take all those picutres with you.

Second Medical Opinion

Does your doctor think you have a dangerous condition? Send those images you used to track the mole to specialists in our network and get a second medical opinion.


All those moles that were really not cancer?  If your doctor participates, set up an e-consulation and you can have him check out the mole without ever having to step into his office. Saving your time, and unnecessary stress when you can’t get an appointment for weeks.

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