The Mature Skin
As we mature, the incidence of skin cancer does rise and that is always our concern
By Jeffrey LaDuca, Ph.D., M.D.
Well now I get it! For years I have seen copies of 55 Plus magazine in my waiting rooms and around town. I always thought, “Well that’s nice, but it doesn’t apply to me.” But now that I have crossed that threshold I totally understand!
I’ve been practicing dermatology in Central New York for almost 25 years. A good number of our patients are 55-plus. Daily, even hourly, I discuss issues with maturing skin (I never say “aging”).
As we mature, the incidence of skin cancer does rise and that is always our first concern.
Thankfully many skin issues that occur with maturity are benign and cosmetic. A number of benign skin lesions can look alarming like and actually mimic skin cancer.
So getting checked is never a bad idea.
Skin Cancer
One in five Americans will develop a skin cancer before the age of 70. And it estimated that 9,500 people are diagnosed with skin cancer every day. And the overall incidence of skin cancer has been rising over the decades.
Basically there are two categories of skin cancer: melanoma and non-melanoma skin cancers. Annually there about 1 million non-melanoma skin cancers diagnosed in the United States and about 200,000 melanoma skin cancers.
Non-melanoma skin cancers are very common; the most common types being basal cell carcinomas (BCCs) and squamous cell carcinomas (SCC’s), with BCCs outnumbering SCCs about 4 to 1.
These types of skin cancers are typically found on sun exposed areas of the head, neck, shoulder, arms and legs and appear as non-healing lesions that may bleed.
BCCs nearly never metastasize (leave the skin), but can grow and be destructive to local areas and cause bleeding and pain. SCCs typically do not metastasize, but can, if large enough, or of an aggressive nature. Once inside the skin they can show up in local lymph nodes, along nerve roots and into other organs such as the lung or liver. Early diagnosis and treatment can minimize pain and scarring and potentially save lives.
Melanoma skin cancers are considered the more serious type of skin cancer. Again, these skin cancers typically show up in sun exposed areas, but we have found melanomas on feet, scalps and on genitals (areas where “the sun don’t shine”).
Typically they are dark moles on the skin surface. Melanoma skin cancers, when caught and treated early, can be almost 100% curable. However, melanomas that invade deeper into the skin have a higher rate of metastatic spread to lymph nodes and other organs. Once there is spread of the melanomas cells, cure rates are reduced. Over the past two decades, treatments for these metastatic melanomas have improved dramatically. But sadly over 8,000 will die of melanoma in 2024.
There are other more rare types of skin cancers that can occur. Recently, with the passing of Jimmy Buffet, Merkle cell carcinoma has been discussed more frequently. This and other rare skin tumors do occur, but at a much reduced frequency. However these rarer skin cancers tend to be ever more aggressive and deadly.
Skin Cancers
Melanoma Skin Cancer
• Superficial spreading: Has not invaded deeper into the skin, low potential to metastasize
• Nodular: Has started to invade into the deeper areas of skin, has potential to metastasize
• Lentigo maligna: Typically on sun exposed skin, very superficial, low potential to metastasize
• Acral lentiginous: on hands or feet, often overlooked, often metastatic
• Amelontic: Does not appear dark in color, often not recognized as skin cancer, can metastasize
Non-Melanoma Skin Cancers
Basal Cell Carcinomas (BCCs)
• Superficial
• Nodular
• Pigmented
• Cystic
• Sclerosing/Infiltrative
Squanous Cell Carcinomas (SCCs)
• Bowen’s Disease or SCC in situ
• Well differentiated
• Moderately differentiated
• Poorly differentiated
Rare types of Skin Cancers:
• Merkle cell carcinoma
• Sarcomas
Risk Factors
Risk factors for skin cancers include fair skin type and light colored hair and eyes. The number of moles that you have can increase your risk of melanoma skin cancer. The ABCDE’s of skin cancer is a great screening tool (see below). Easy sun burning, history of sun burns or blistering sun burns is also a risk factor. And family history is important as well. Some people inherit genes that predispose them to skin cancers. With all this said, patients that tan easily and rarely burn can get skin cancers as well. RIP Bob Marley (died of melanoma on his foot).
Skin Cancer Treatment
“Pre-Cancers”
“Cancer is kind of like pregnant” is what I commonly tell my patients. “You either are or you’re not.”
The same can be said about skin lesions.
Lesions are either cancerous or they’re not. However, sometimes we throw around the term “pre-cancer” because it makes sense.
Examples of “pre-cancers” are actinic keratoses and dysplastic nevi. Actinic keratoses (AKs) are areas of sun damage that have the potential to turn into squamous cell carcinomas. Historically about 1 out of 10 might turn into a skin cancer over time. I think of this like colon polyps which are considered “pre-cancers.” If they are found during a colonoscopy, they are removed so that they don’t become cancerous. Likewise, AKs should be treated so that they don’t have the chance to become cancerous. Dysplastic nevi (DN) are moles that are not “normal”, but not cancerous. They have some atypical cells in them and might turn into a melanoma at some point. DNs are rated as being mildly, moderately and severely atypical. Obviously, the more atypical they are, the more likely they are to turn into a melanoma. Mild and even moderately atypical moles are not particularly dangerous, but could evolve into more atypical lesions over time.
NOT Skin Cancer
There are a number of benign skin lesions that are common in our patients over 50.
Some of these lesions are attributable to sun exposure and “weathering.” And some lesions are genetic…. I often tell my patients that they need to pick their parents better. Nature-vs-nurture: Nature is what we received genetically and nurture is what we did yourselves over the years.
Examples of nature is our genetic components: fair skin, light colored eyes and hair, ability to tan vs burn and numbers of moles. And there are a number of benign skin lesions that “just happen.” Examples of genetic skin lesions are birth marks, seborrheic keratoses, sebaceous hyperplasia and cherry angiomas. Nurture is summer days at the beach and tanning parlors —what we did to ourselves.
• Birth marks which can be pigmented like a mole or vascular. Pigmented birthmarks can be the subject of whole volumes in text books. They can be “small, medium or large” and pose a variable risk of developing into melanomas over a lifetime. Typically size and location dictate the risk. Vascular birthmarks are typically red and fade over time. Examples of these are “stork bites” on the nape of the neck, “angel kisses” on the forehead, or hemangiomas which can occur anywhere on the body at birth or shortly afterwards, grow, and then regress during childhood. These lesions rarely pose any health risk.
• Seborrheic keratoses are a noncancerous skin lesion that appears as a waxy brown, black, or tan growth anywhere on the body (face, chest, shoulders, or back). They are the most common noncancerous skin growths in “mature adults.” Some people may develop one or two some 30 or 40, and some will develop hundreds. They are not related to sun exposure and no treatment is necessary. However if they cause irritation they can be removed.
• Sebaceous hyperplasia is a common, benign condition of sweat glands in adults. Commonly these lesions are found on the nose cheeks and forehead and may be multiple or single. They manifest as yellowish, soft, small papules with a central depression. Sebaceous hyperplasia are benign, with no known potential to turn into skin cancers. However, they can look similar to basal cell carcinomas. They may be associated with lowered immunity in transplantation patients receiving medication.
• Cherry angiomas are small red or purple papules that start to develop on the skin after the age of 30. They can occur anywhere on the body but tend to be more frequent on the trunk. These lesions are harmless however they can be a source of cosmetic concern when located on cosmetically sensitive areas of the face, head, and neck. These lesions can easily be removed with lasers or cautery devices.
There are a number of other benign and cosmetic concerns that occur in mature skin, wrinkles, “age spots,” “liver spots,” easy bruising to name a few. There are a number of options to improve these concerning lesions. But one needs to remember that skin cancers are the more serious skin concern. It is recommended that patients over 50 be screened for skin cancers by a skin specialist.
Depending on your risk factors, screening can be every few years or less. But early recognition and treatment of skin cancers allows for the very best outcomes!
Remember, we want to live long enough to inconvenience our children.
Jeffrey LaDuca, Ph.D., M.D. is a board-certified dermatologist who has been practicing in Central New York for almost 25 years as Reflections Dermatology. He attended LeMoyne College, Roswell Park Cancer Institute, SUNY Upstate and University of Rochester for his training. He has published book chapters, written several medical journal articles, teaches PAs, NPs, and medical students and lectures extensively to medical groups locally, regionally and nationally. And he loves golf. For more information, visit www.skinreflections.com.