doctor inspects a patient skin

Skin cancer: 1 in 5 Americans will get it; Here's how you can find out if you are at risk

One in five Americans will develop skin cancer before the age of 70, which makes skin cancer more common than all other cancers combined.

Dr. Kathleen Kroger, a board-certified dermatologist at UTMB Health, said she was drawn to the field of dermatology after her grandfather was diagnosed and later died from metastatic melanoma.

“A big passion of mine is spreading awareness that skin cancer can affect anyone, even in skin of color patients,” she said. “Unfortunately, skin cancers are diagnosed so much later and have a much worse prognosis in patients with darker skin.”

Kroger said one of the most common types of melanoma in Hispanic, Black, and Asian populations is found on the foot, which is where her grandfather’s cancer began. By the time he was diagnosed, the cancer had already metastasized.

Metastasis means cancer has spread to other parts of the body, most commonly to a lymph node first, and then to other organs, Kroger said.

“I see how much skin cancer affects people’s lives and diagnosing it early can make a big difference—it can be so treatable when it’s caught early.”

Dr. Kroger with Patient

One of the ways patients can find skin cancers early is by making a dermatology appointment. To prepare for the appointment, Kroger said she recommends not wearing make-up or nail polish. Patients will also change into a full gown so the doctor can examine all parts of the body.

“We see a range of skin concerns including acne and rashes and conduct full skin checks,” she said. “We are looking from the scalp to toes, even the buttocks and genital region.”

Kroger said if she finds anything concerning in the screening, she tells her patients upfront. A biopsy is needed to confirm whether the skin lesion is cancerous. The biopsy happens under local anesthesia and involves taking a skin sample and sending it to a dermatopathologist. Most patients find out their results in a week’s time.

If the sample is confirmed to be cancer, the next step is discussing the different treatment options. One option is a procedure called electrodesiccation and curettage to scrape the cancerous cells. The second option is to widely excise the cancer, which means the cancerous cells will be cut out with a margin of skin around it. The third option, Mohs surgery—named for its inventor general surgeon Dr. Frederic Mohs—has the highest cure rate of the three. This surgery is performed by a dermatologist who has completed an extra year of training to perform this surgical technique. This method allows the surgeon to examine tissue taken on the day of surgery to ensure all the cancerous tissue has been removed.

Kroger said this surgery is usually reserved for larger skin cancers or cancers in high-risk areas.

Another option patients have is excision by a plastic surgeon. For Cynthia Wong, one of Kroger’s patients, this was the route deemed best for her.

Wong said she had always had a birthmark on her scalp and was warned that her type of birthmark, a nevus sebaceous, had the potential to become cancerous.

“Dr. Kroger looked at my scalp, and she saw a tiny dark, blackish spot and she said that was a problem,” Wong said. “She had me get a biopsy and I got a call that weekend confirming it was positive for basal cell carcinoma.”

Kroger said because the cancer was on Wong’s scalp, it would have been difficult for Wong to check it herself.

Within two weeks, Wong had an appointment with plastic surgery to remove the cancer. She has been in remission for three years and continues to go to annual checkups with Kroger.

“My care was excellent and I was so grateful for Dr. Kroger for really looking closely at that spot and examining it so well—I appreciated that very much,” she said. “Dr. Kroger is just A-plus -plus as far as it goes. The first I ever saw her was when the biopsy was done, and I’ve been seeing her since because I have frequent follow-ups to check on the surgical scar and make sure everything looks good.”

Kroger said studies have shown a decrease in melanoma incidence in patients 30 years old and younger which she attributes to increased education about sun protection. However, for the older populations, Kroger said there’s a chance their skin has already been damaged, as the bulk of harmful sun exposure tends to occur in adolescence. That’s why regular checks are so important for everyone, but especially this patient population. Should they continue to grow skin cancer, their dermatologist should be able to catch it sooner than later.

“All people can get skin cancer, regardless of the amount of melanin in their skin,” she said. “It can change your life to take 15 minutes out of your day to go get a skin exam.”

Visit the linked websites to learn more about UTMB Health, Dr. Kathleen Kroger and the services she provides.

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