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Conquering the most common skin cancer

Cover up, use sunscreen and get checked. Dr. Judith Reichman offers this advice and more on preventing and dealing with basal cell carcinoma.

Q:  I’ve just been diagnosed with basal cell carcinoma and I’m planning to begin treatment. However, I’ll also be going on a tropical vacation in the near future. How worried should I be?

A: You’ve been diagnosed with the most common type of skin cancer.

Just so you know, half of all cancers in the U.S. are skin cancers. More than a million people will be diagnosed every year, and 80 percent of non-melanoma cancers are of the basal-cell type.

Basal cell carcinoma is caused by ultraviolet radiation, especially recreational exposure (i.e. sunbathing, sports activities or that tank top and hatless dress code while on vacation), especially during childhood and adolescence. Unlike other cancers, intense intermittent burning puts you at higher risk than if you’re continually out in the sun. In other words, an outdoor worker is less likely to get this type of skin cancer than someone who spends most of their time indoors or in dark climates, and occasionally gets out, “takes in the rays” and gets sunburned.

You are also more likely to develop basal cell carcinoma if you have fair complexions, red or blonde hair, or light eye color. In most cases, the cancer develops on those body parts that are exposed to the sun, the head and neck (80 percent of all cases), followed by the trunk (15 percent of cases) and then the arms and legs (5 percent).

Having been diagnosed, you now know what the cancer looks like, but for others reading this column (and as a result, I hope, peering in a mirror) let me wax descriptive. Basal cell cancer appears as a raised pearly nodule which often has very fine blood vessels on the surface. The lesion can sometimes crust or peel and on occasion will look like a very large pore or pit which appears on the central portion of the face. Sometimes it contains brown or black pigments. In some cases, it may simply look like an enlarging scar with uneven margins. If you notice something matching any of these descriptions, especially on your face, you should immediately see a dermatologist and have a biopsy performed.

The good news is that this type of cancer generally does not metastasize. If, however, it is left untreated it can spread into adjacent areas. (This may take up to nine years.) Very rarely, it can spread to nearby lymph nodes and become fatal.

Because it is unlikely to metastasize, treatment is usually localized: excision or destruction of the lesion. This can be done surgically; scraping it and cauterizing the edges, freezing it or excising it completely.

One method of removal that causes the least deformity is termed a MOHS micrographic surgery. This is a technique in which small pieces of the tumor are removed, frozen and viewed by a pathologist in the office so that the surgeon can be sure that 100 percent of the tumor is removed. Because this is done microscopic slice by microscopic slice, the amount of excised tissue is minimized, while at the same time ensuring the borders are clear. This type of surgery has the lowest five-year recurrence rate of all available treatments.

If for some reason surgery cannot be performed, especially among patients over 60, radiation is sometimes used.

If you’ve had a basal cell tumor, your chance of having another one in the future may be as high as 50 percent. So make sure that you and your dermatologist carefully inspect your skin, especially on your face, near your scalp, behind your ears and any other place where you could have had bad sunburns when you were younger.

Although we feel that intermittent recreational sun exposure at a young age is mostly to blame for this type of skin cancer, repeating this insult as you get older can make things worse or increase your risk of recurrence.

Dr. Reichman’s Bottom Line: Cover up, use sunscreen (I would suggest SPF 30 or higher if you are in strong sunlight, as we’re certain it protects you from other forms of skin cancer), and get checked on a regular basis. Make sure that children and adolescents in your life — who are at the highest risk — do the same.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .