CNN – Opinion
Doctor: What I didn’t know until I got skin cancer
Opinion by Susannah Hills – July 29, 2023
Editor’s Note: Susannah Hills is a pediatric airway surgeon and assistant professor and vice chair of the Department of otolaryngology-head and neck surgery at the Columbia University Medical Center. The opinions expressed in this commentary are her own. View more opinion at CNN.
As a practicing physician, my life revolves around caring for my patients, helping them stay healthy, educating them about diseases and picking up on the signs of health concerns that need to be addressed. A few weeks ago, however, it became painfully obvious that I had missed the signs of my own major health issue.
To my surprise, I was diagnosed with skin cancer on my scalp. The diagnosis of basal cell cancer, and the fact that I ignored it for so long, have really made me pause to reflect on my own health habits and some common misconceptions about skin cancer.
For over a year, I thought I had an irregular patch of skin behind my left ear. It was covered by my hair, so it was easy to ignore. I watched this skin peel and scab. I thought it was eczema, which I have had for many years, put hydrocortisone didn’t help. I finally went to the dermatologist, much later than I should have considering my medical background, and I had a biopsy. Basal cell cancer. Another was found on my neck right after that.
I was bewildered. I thought I had been protecting myself from sun exposure so carefully. I spend most of my waking hours indoors at the hospital and still I wear sunscreen every day. I hardly have time for sunbathing and on those rare occasions when I’m in the sun for an extended time, I try to cover up.
As it turns out, my skin cancer has probably been brewing for decades, the result of genetics and basking in the sun many years ago. Damage from the sun’s UV rays is cumulative, increasing the risk of cancer over time. Just five blistering sunburns among 15- to 20-year-olds can increase the risk of melanoma by 80% and two other skin cancers, squamous cell carcinoma and basal cell carcinoma, by 68%, according to research published in Cancer Epidemiology Biomarkers & Prevention. So, I’m probably seeing effects of my early years at the beach now.
My mother also had multiple skin cancers, so my risk of getting one myself was significantly higher. When there is a family history of skin cancer, the risk of early-onset basal cell cancer is more than doubled, per the journal Cancer Epidemiology, the risk of squamous cell cancer is increased four-fold, according to the journal Dermatologic Surgery, and the risk of melanoma is increased by 74%, as reported in the Journal of the American Academy of Dermatology.
Still, it seemed so strange to me that my skin cancer showed up on my scalp, underneath a covering of hair. Wouldn’t sun-exposed areas like my nose, forehead, or chin be more susceptible?
With a little research, I discovered that 13% of skin cancers involve the scalp, according to an article in the Journal of the German Society of Dermatology. Skin cancer can show up in all kinds of unusual spots — the eyelids, palms of the hands and soles of the feet. And with the popularity of gel manicures, which use direct UV light to the hands and nails, there is increasing risk of skin cancers in the cuticles and beneath the nails.
Skin cancers can also happen in all types of skin. Malignancies are far more common in light complexions, but cancer of skin with darker pigmentation is often caught later, with higher mortality rates. Everyone is at risk.
Now more than ever, developing good sun protection habits is so important because the risk of developing skin cancer is escalating at an alarming rate. It is estimated by the American Academy of Dermatology that one in five Americans will develop skin cancer in their lifetime, and rates of nonmelanoma skin cancer have increased 33% across the globe since 2007, according to JCO Global Oncology. Many experts attribute this trend to factors such as climate change, global warming and increased exposure to harmful UV rays. Despite this mounting risk, our efforts in skin cancer prevention and early detection are woefully inadequate, with too many people failing to get regular skin exams.
It is up to each of us to develop good sun protection habits early and to learn when to seek medical care for unusual skin changes. Irregularities like changes in color, irregular borders of moles and freckles, skin wounds that don’t seem to heal and areas of chronic peeling or scabbing should never be ignored. An exam should be done every year to monitor unusual skin changes, or if you are at higher risk for developing skin cancer.
This summer, protect yourself. Slather on that sunscreen, wear a hat and seek shade whenever possible. And that peculiar patch of skin you’ve been ignoring? Don’t put off getting it checked out any longer. I learned the hard way that anyone can get skin cancer and it can show up where you least expect. The earlier you catch it, the better your odds, so go see your doctor. I’m glad I did.