Skin cancer is the most common cancer in the United States, with researchers estimating that more than 3 million Americans are diagnosed with the two most common types of skin cancer every year. While most people know that skin cancer can develop on sun-exposed areas of the body, like the face, neck or arms, there are some more unusual places where the disease might surface.
“Skin cancer can pop up in places you might never think to check, like your scalp or the bottoms of your feet,” says Aleksandar Sekulic, M.D., Ph.D., the medical director of dermatology for City of Hope® Cancer Center Phoenix, and physician-in-chief for TGen. “This is why a head-to-toe skin check – by you yourself or a dermatologist – is so important. And don’t skip the ‘hidden’ areas!”
In this article, Dr. Sekulic shares some of the places skin cancer might hide, including:
- Skin cancer on the scalp
- The soles of the feet
- Under the nails
- Behind the ears
- The genitals
- Skin cancer on the lip or mouth
- The eyes
- Skin cancer treatment advancements
If you or a loved one has been diagnosed with a form of skin cancer and would like a second opinion, call us 24/7 at 877-834-8941.
1. Skin Cancer on the Scalp
Many of us don’t think much about the effect of the sun’s ultraviolet rays on our scalp, making it an often-overlooked area of the body when it comes to screening for skin cancer.
“It is important to check your scalp for signs of skin cancer, especially if your hair is thinning or if you have been parting your hair the same way for years,” Dr. Sekulic says.
All kinds of skin cancers can affect the scalp, including basal cell carcinoma, squamous cell carcinoma and melanoma. Although skin cancer on the scalp is not as common as on other areas of the body, it’s important to check for any signs of changes to the skin in this location.
Here’s how:
- Perform a self-examination of the scalp in a room with bright light and the help of a mirror.
- Ask a partner or family member to examine the scalp for you.
- Ask your hairstylist if he or she sees any changes to the skin on your scalp or notice any new moles or lesions.
What should you look for when screening for skin cancer? When it comes to assessing your moles and spotting a possible melanoma, which is most often pigmented (brown or black), dermatologists recommend following the ABCDE rule:
- Asymmetry: Half of the mole is different than the other half.
- Border: The edges of the mole or irregular or blurry.
- Color: The mole is uneven in color, or has shades of brown, tan and black.
- Diameter: The size of the mole is greater than 6 mm across, or about the size of a pencil eraser.
- Evolution: Any change in an existing mole, or development of a new mole
Patients who notice any of the ABCDEs should make an appointment with a skin doctor as soon as possible.
However, other common skin cancers are typically not pigmented and may appear as a skin colored or pink to red bump, sometimes scaly, or resembling a sore that does not heal.
“If a spot is new and not going away after several weeks of applying a moisturizer, or if you have a spot that bleeds without an injury, have your dermatologist check it,” Dr. Sekulic says. “One quick visit can make all the difference.”
2. The Soles of the Feet
The soles of the feet may not seem like an obvious place to check for signs of skin cancer. But one skin cancer type in particular — acral lentiginous melanoma — can affect this area, as well as the palms of the hands and the skin beneath the fingernails and toenails.
Acral lentiginous melanoma is not common, but it’s the most frequently diagnosed skin cancer in people with black or darker-colored skin. It most often looks like a brown, gray or black dark spot on the skin of the foot.
While melanoma is the most aggressive form of skin cancer, if it’s detected early, the prognosis for most patients is very good.
“When caught early, most patients only need a minor outpatient procedure to remove the tumor. In some cases, doctors may check nearby lymph nodes to be safe, but after that, it’s typically just regular skin checks and sun protection,” says Dr. Sekulic. “The key is catching it before it spreads.”
3. Under the Nails
A subtype of acral lentiginous melanoma called subungual melanoma can appear underneath the nails on your fingers and toes. Signs of skin cancer underneath the fingernails or toenails include:
- A dark or black streak that goes from the top of a nail to the cuticle
- A change in the color of the skin underneath the nail
- Dark skin on or around the nail
- A nail that has split down the middle or comes away from the nail bed
While some of these signs may also be caused by non-cancerous conditions, it’s always best to have a dermatologist examine any changes to the nails or nail beds that don’t go away over the course of several weeks.
4. Behind the Ears
Another spot to check for signs of skin cancer is behind the ears. This is because the ears are often exposed to the sun – and because people often forget to apply sunscreen to this small but important area. Most skin cancers found behind the ears are either basal cell carcinomas or squamous cell carcinomas. A self-examination of this part of the body can be hard, so it is often best to ask a spouse or close family member to check for you, looking for any of the ABCDEs of skin cancer.
One extra reason to check behind and around your ears: This skin and the tissues in this part of the body are structured in a way that may make it more likely that skin cancer may spread into the tissue underneath the skin or to other parts of the body, if it’s not found early.
5. The Genitals
Although skin cancer isn’t commonly found in the genital area, it is diagnosed in a small number of patients each year. Most people who develop skin cancer in the skin around the genital area have squamous cell carcinoma, and if identified and treated at the early stage, the prognosis is usually very good.
A self-exam is the best way to keep an eye out for any changes to the skin on or around the genitals. But it can also be helpful for women to ask their obstetrician or gynecologist to check for any signs of skin cancer during their routine appointments. For men, a primary care doctor or dermatologist may be able to help.
6. Skin Cancer on the Lip or Mouth
A rare form of skin cancer called oral malignant melanoma can develop on the lips or inside the mouth. While it isn’t common, it is important to be aware of it and include inspection of the mucosa in the mouth when checking your skin at home or as part of a dental health check-up.
A common skin cancer, squamous cell carcinoma can occur on lips, particularly the lower lip that gets more sun exposure. Like most other types of cancer, protection from the sun’s ultraviolet rays is important to reduce the risk.
7. The Eyes
Several types of skin cancer can also affect the eyes:
- Basal cell carcinoma and squamous cell carcinoma are more commonly found on the eyelid or the skin surrounding the eye.
- Melanoma can develop on the skin around the eye or in the middle layer of tissue in the eyeball, which contains the iris and the muscles that control it.
If melanoma develops in the eyeball, it may also be called ocular melanoma or uveal melanoma. This is typically assessed when performing eye exams in the office.
“You don’t need to hide indoors – just be sun-smart. Make shade, clothing and sunscreen part of your everyday routine,” Dr. Sekulic says. “Your skin is your body’s largest organ. Taking care of it is a gift to your future self.”
Skin Cancer Treatment Advancements
The good news when it comes to skin cancers like melanoma is that early detection and removal typically lead to excellent overall outcomes in most people.
Historically, there were very few effective options for melanoma and other skin cancers that have spread throughout the body. Fortunately, that has been changing rapidly in the last 10 to 15 years.
“There’s good reason for optimism when it comes to melanoma treatment today. In the past decade, we’ve seen a true revolution,” Dr. Sekulic emphasizes.
Some exciting advances in skin cancer treatment include:
- Targeted therapies, which are medications that are tailored to the specifics of a patient’s diagnosis in order to make treatment more effective
- The use of more immunotherapy options, which boost the body’s own immune system to help fight cancer
- Better screening techniques, including artificial intelligence-assisted imaging for diagnosing skin cancer
As the weather warms up, so too should your sun-protection efforts. Some easy ways to limit exposure to the sun’s ultraviolet rays include:
- Wearing a wide-brimmed hat and sunglasses with ultraviolet protection
- Staying in the shade whenever possible
- Choosing lightweight, long-sleeved shirts and pants when going out in the sun
- Using sunscreen with a high sun protective factor (SPF) and reapplying it every two hours
- Checking your skin every month
- Seeing a dermatologist every year, especially for older adults
“The bottom line is that ultraviolet damage is cumulative, and a little prevention now can spare you a lot later,” says Dr. Sekulic. “Skin cancer is common, but also highly preventable, and when caught early, it’s one of the most treatable cancers out there.”
If you or a loved one has been diagnosed with a form of skin cancer and would like a second opinion, call us 24/7 at 877-834-8941.