What Laura Bush Can Teach You About Skin Cancer

ByMark Abdelmalek, M.d.

Dec. 19, 2006 — -- First lady Laura Bush is just one of the 1.3 million Americans who will be diagnosed with skin cancer this year. Squamous cell carcinoma, which Bush had surgically removed from her right leg in early November, is the second most common type of skin cancer.

ABC News White House correspondent Jessica Yellin reports that the first lady has kept a brisk schedule this month despite the surgery. She has already attended 23 holiday receptions, and she'll be attending her 24th tonight.

Bush was wise to act early. Doctors quickly performed a biopsy and then removed the growth, so she benefited from early detection and treatment.

The first lady's office said the cancer will require no further treatment, and that this is her first experience with the disease.

Skin cancer is the most common type of all cancers. One in five Americans will get skin cancer at some point in their lifetime. But even with so many people affected, there is good news -- skin cancer is almost always curable if caught early.

There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.

Basal cell carcinoma is the most common of the three and hardly ever spreads to other parts of the body, but can grow to large sizes and become locally destructive. It usually occurs on the face and may look like a pink mole, a pimple, or a pearly-colored bump.

Squamous cell carcinoma is most often found on sun-exposed areas and can look like a rough patch of skin or a red scaling bump. If left untreated, squamous cell carcinoma can spread to other parts of the body.

Malignant melanoma, the third most common type of skin cancer, is the most serious type of skin cancer and accounts for 75 percent of all skin cancer-related deaths.

The first lady's squamous cell carcinoma diagnosis shows how important early detection of skin cancer is. Depending on the type of surgery she had, she now has a greater than 95 percent chance of never having to worry about her skin cancer coming back in the same spot.

Still, now that Bush has had one skin cancer, she is at higher risk for getting a second skin cancer during her lifetime and should see her dermatologist every six to 12 months for skin examinations.

"While the vast majority of people who develop this type of skin cancer can be successfully treated usually with surgery alone, squamous cell carcinoma does account for about 2000 deaths a year," said Dr. Frederick Beddingfield, a dermatologic surgeon and assistant clinical professor at UCLA.

Skin cancers know how to do one thing and one thing only -- get bigger. Skin cancers often start out small, but they can grow to become quite large.

Noticing changes in your skin is the most important precautionary measure you can take. A changing or bleeding skin lesion almost always warrants a trip to the dermatologist for evaluation.

Basal and squamous cell carcinomas can occur anywhere on the body, but most often arise in sun-exposed areas of the body -- the face, scalp, hands and legs.

The American Academy of Dermatology recommends that every American perform regular self-skin examinations -- looking for moles and skin lesions that are new, changing color or getting bigger -- and also for sores that just won't heal.

So what should you look out for? Dr. Tim Johnson, the ABC News Medical Editor, said on Good Morning America today that it's smart to be aware of anything that seems abnormal in appearance.

"It can take many different forms or shapes or colors," Johnson said. "Usually it's red, raised, growing, and the edges are irregular."

Any suspicious spots should be checked by a doctor. Taking this crucial step can go a long way in protecting your health.

"The good news is that most of the basal cell and squamous cell cancers are curable if detected early," Johnson said. "They rarely interfere with your life, if treated."

Though the first lady's mother is a breast cancer survivor, it is unlikely that her family history had much to do with her skin cancer diagnosis.

Johnson said the first lady was at a higher risk "not because of the connection with breast cancer, but certainly because she's lived outdoors in the southland, exposed to the sun."

"That's the major cause of these kinds of cancers," he added.

Having five or more sunburns doubles your risk of developing skin cancer, and blistering sunburns in childhood may further increase the risk.

Bush's fair skin type and light-colored eyes put her at higher risk for skin cancer.

Other common risk factors include blond or red hair and a tendency to freckle or sunburn with sun exposure.

Although those with fair skin and light eyes like Bush are most at risk, patients with all skin types, including those with dark skin types, can develop skin cancer.

"People who have had a skin cancer before, have a family history of skin cancer or have many moles are also at higher risk of skin cancer," Beddingfield said.

"Early diagnosis is the key to successfully treating all forms of skin cancers because they can become more difficult to treat and dangerous as they grow," said Beddingfield. "People should seek medical care immediately if they believe they may have skin cancer."

Dermatologists and dermatologic surgeons are specifically trained to diagnose and treat all types of skin cancer. Although surgery is the most common treatment, there are several non-surgical treatment options available for skin cancer, including topical creams and radiation.

"An annual skin examination is a key component of prevention and timely diagnosis," said Dr. Christine Ko, assistant professor of dermatology and pathology at Yale University.

Depending on the type and location of the skin cancer, your dermatologist will help decide what treatment is best for you.

Dermatologists say the number one thing a person can do to prevent skin cancer is protect their skin from the sun's harmful ultraviolet rays.

The American Academy of Dermatology recommends that everyone "generously apply sunscreen to all exposed skin every day" and recommends sun screen with a sun protection factor (SPF) of at least 15.

People should get into the habit of wearing sunscreen all year long -- winter, spring, summer and fall -- and even on cloudy days as 80 percent of the ultraviolet rays make their way through the clouds.

"Everyone should avoid excessive sun and check themselves regularly for possible skin cancers," Beddingfield said.

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