Basal cell carcinoma (BCC) is the most common skin cancer. It is much more common in fair skinned individuals with a family history of basal cell cancer and increases in incidence closer to the equator or at higher altitude. According to Skin Cancer Foundation, there are approximately 800,000 new cases yearly in the United States alone.About two thirds of the carcinomas occur in sun-exposed areas and one third occur in non-sun-exposed areas, emphasizing the genetic susceptibility of the basal cell cancer patients.
BCC typically affects adults of fair complexion who have had a lot of sun exposure, or repeated episodes of sunburn. Although more common in the elderly.It can be destructive and disfiguring. Risk is increased for individuals with a family history of the disease and a high cumulative exposure to UV light via sunlight or, in the past, carcinogenic chemicals especially arsenic.It is rarely life-threatening but if left untreated can be disfiguring, cause bleeding and produce local destruction (eg., eye, ear, nose, lip).
BCCs arise in otherwise normal appearing skin, unlike squamous cell carcinomas (SCCs), which often arise within pre-existing solar keratoses. BCCs can vary in size from a few millimetres to several centimetres in diameter. They usually grow slowly over months or years.
Asymmetrical skin cancers, especially on the left cheek, scalp, arm and hand are being seen with increasing frequency by dermatologists, a team at St. Louis (Missouri) University School of Medicine reported .
At the 65th annual meeting of the American Academy of Dermatology, being held here this week, Dr. Scott Fosko presented data on 898 patients with asymmetrical skin cancers.
Overall, 53 percent of the cancers occurred on the left side of the body. Nearly two thirds (64 percent) of these occurred in men. Fosko said that similar studies conducted in countries where the driver's seat is on the right side of the vehicle had similar distributions of skin cancers on the right side of the head, face and arm.
Basal cell carcinoma, the least aggressive type of skin cancer, was the cause of 608 of the cancers, while squamous cell carcinoma was the cell type in 178 skin cancers. Squamous cell cancers are usually not serious if they are identified early and treated promptly. If not, they can be difficult to treat and cause disfigurement.
"But of interest, we are seeing a particular type of melanoma, lentigo maligna melanoma in situ, that is occurring in younger patients and it can be very aggressive," Fosko told meeting attendees.
Fosko's team conducted a survey of patients with biopsy-proven skin cancers, collecting data on their driving habits, such as whether they tend to drive with the windows up or down, use sunscreen and other related habits.
"We saw trends according age brackets," Fosko said. For example, patients younger than 70 years of age had driven more years and spent more time per week driving than their older counterparts.
Men spent three or more hours more per week driving, while women spent about one hour a week driving. Men spent 91 percent of their driving time in the driver's seat. Drivers spent a considerable amount of time driving with the windows open.
"We have some obvious concerns about this," Fosko said. "Children are starting to drive at a younger age and are driving for longer periods" than previously, making them more susceptible than individuals who begin driving later in life.
The St. Louis investigator said the trend is for cars to be made with larger windows, moon roofs are a favorite accessory and tinted glass is not used on the driver's window. UV protection with tinting only lasts for about five years, Fosko noted.
In addition, "laminating really helps block penetrating ultra-violet rays, especially UVBs, but UVA is not being blocked...A UV shield has been developed but there is little interest (by manufacturers) to use it," Fosko said.
In the meantime, while technology to block UV rays catches on, Fosko recommends driving with the windows up and using sun block.
Those who have had one BCC are at increased risk of developing others within the next year or so. They are also at increased risk of other skin cancers, including melanoma. Early detection means easier treatment, and less scarring.
Protect your skin from the sun. Wear covering clothing and apply broad spectrum sunscreens to exposed skin daily during the summer months. Arrange a complete skin examination from time to time.
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