A Skin Cancer Q&A with Board-Certified Dermatologist Dr. Smetanick

May is Skin Cancer Awareness Month, a time to elevate attention about America’s most common cancer. Matthew Smetanick, D.O., sits down with us to talk about the cancer that will affect one in five Americans by the age of 70.

Q: What is skin cancer?  

A:  Skin cancer is an abnormal growth of cells from the layers and structures of the skin, often originating from ultraviolet-induced DNA mutations that have originated from years of sun exposure.

Q: What does skin cancer look like?  

A: Skin cancers have various clinical presentations. The more common types of skin cancer (basal cell carcinoma and squamous cell carcinoma) might appear as a skin-colored bump that easily bleeds or a tender, red, or inflamed, scaly bump that never seems to heal. Melanoma may present as a darkly pigmented flat or raised growth that has a color or shape out of context from the other moles and growths on the skin. Some melanomas can actually be ‘amelanotic’ (without pigment) and may appear as a red skin bump that may or may not have any symptoms. 

Q: What should I be looking for to help detect skin cancer?  

A: Let your Dermatologist know about any growths that are persistently red or inflamed, tender, itchy, or bleeding. Skin cancer is not always symptomatic though. It is also important to monitor for any sudden or rapid changes to your current moles and skin spots in terms of color, size, or shape.

Q: How is skin cancer treated?  

A: Surgical removal is often the most optimal management for skin cancer to ensure clear tissue margins and a lower likelihood of recurrence. Depending on the type and severity of skin cancer, other nonsurgical options may be applicable, including radiation therapy, curettage (manual scraping of the skin), and topical and systemic chemotherapy and immunomodulatory agents. 

Q: What types of skin cancer are there?  

A: The three most common skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. BCC is the most common and least worrisome type. SCC and melanoma are usually more serious types of skin cancer that have a higher likelihood of dangerous invasion and metastasis. 

Q: Who is more at risk for skin cancer?  

A: Individuals with fair skin and a history of excessive sun exposure and multiple sunburns are more at risk of skin cancer. Other factors that increase skin cancer risk include tanning bed use, older age, a family history of skin cancer, many moles, radiation exposure, and certain genetic conditions. 

Q: Are there any medical conditions that can increase our risk for skin cancer?  

A:  Patients taking immunosuppressive medications, for organ transplantation and autoimmune conditions, are at a higher risk of skin cancer. Also, certain types of HPV (human papilloma virus) warts may predispose a person to skin cancers such as SCC. In addition, there are various genetic syndromes that predispose a person to early sun damage and development of skin cancers.

Q: What does a Full Skin Exam entail?

A: At the comfort level of the patient, a full skin exam usually means that your Medical Dermatology Provider will examine your hair, nails, and the skin of the scalp, face, nose, ears, neck, trunk and extremities, hands and feet, fingers and toes, and even the buttocks and genitalia. Remember, the skin is the largest organ of the body and moles can develop anywhere, even where there is no sun exposure or sun damage. Dermatologists also examine eyes and eyelids, lips, and even inside the mouth.

Q: What are the most unusual places you’ve detected skin cancer on a patient?

A: Skin cancer is not always found in sun-exposed or sun-damaged areas. In fact, melanomas may occur in parts of the eyes, mouth, and genital skin. We even sometimes find cancers in the nail units and on the palms and soles. Some skin cancers are also found in areas where a patient has had external radiation treatments for conditions such as breast and prostate cancer.

Q: What’s the difference between sunblock and sunscreen?

A: Sunblock is usually comprised of ingredients such as zinc and/or titanium. These minerals reflect ultraviolet radiation and offer great broad-spectrum coverage. Sunblock is usually better for those with sensitive skin types. Historically, sunblocks have not been as aesthetically pleasing as sunscreens, but newer product lines now allow for better miscibility with the skin and some are even tinted to offset the opaque nature of mineral products. Sunscreens are formulated with ingredients that absorb and dampen ultraviolet radiation in the skin and may be more aesthetically pleasing on average. That said, they do not always offer the same degree of protection compared to sunblocks, and there is also a higher risk of skin reactions from their active ingredients.

Q: What is UPF clothing, and how does it work?

A: UPF clothing is specially designed to block, absorb, and reflect ultraviolet radiation using certain types of fabric and weave patterns. Ultraviolet Protection Factor (UPF) is the rating used to indicate how well a fabric can protect against ultraviolet radiation. Clothing with a UPF of at least 30 is generally recommended, but those garments with a UPF value of 50+ are more optimal. There are many retail and online stores now which offer a variety of UPF clothing, including rash guard shirts and brimmed sun hats. Remember to apply sunblock or sunscreen to all other exposed areas, and don’t forget to wear sunglasses and apply a sun protective lip balm as well.

Dr. Smetanick sees patients at Vitalogy Skincare’s Burnet and Marble Falls locations. He diagnoses a wide range of dermatological conditions affecting the skin, hair, and nails. Skilled in the diagnosis and treatment of skin cancer, he often diagnoses conditions that have previously eluded his patients. Affectionately known to many as Dr. Matt, he is deeply committed to the health and well-being of his patients. Get to know Dr. Smetanick and schedule appointments with him here.