• Cancer

    TUESDAY Q & A: Baseline risk assessment gives patients better understanding of skin cancer risk

DEAR MAYO CLINIC: My physician recommended that I be screened by a dermatologist for a baseline risk assessment. What is this, and is it necessary? I use sunscreen regularly and have skin that normally does not burn. Am I still at risk for skin cancer?

ANSWER: Anyone can get skin cancer. So it is a good idea for everyone to get a baseline risk assessment from a dermatologist. This assessment can give you a better understanding of your risk for developing skin cancer. It also can help determine how often you should see a dermatologist for checkups in the future.

There are three major types of skin cancer: melanoma, basal cell cancer and squamous cell cancer. Basal cell skin cancer is the most common kind of cancer worldwide. Squamous cell skin cancer is the second most common. Although less common than the other two, melanoma is a more serious type of skin cancer that can be difficult to treat if it is not caught early.

Many skin cancers do not cause obvious symptoms. The only indication people often have of skin cancer is a new growth on the skin or a skin change. Occasionally, skin cancer may be painful to the touch or bleed when lightly bumped.

The lack of symptoms makes timely checkups with a dermatologist critical in catching skin cancer early — when it is easier to treat. That’s where a baseline risk assessment comes in. The best time to have one is near the end of puberty, usually in the late teens. At the assessment, a dermatologist examines your skin and reviews your skin cancer risk factors. Based on your risk, you are given a recommendation on how often you should have follow-up appointments.

As you mention, skin type does play a role in skin cancer risk. People with fair skin who burn easily are at higher risk. But keep in mind that people with darker complexions can get skin cancer, too. The fact that you don’t typically burn is no guarantee you won’t get skin cancer.

Where you live makes a difference. Exposure to ultraviolet, or UV, rays from the sun is a risk factor for skin cancer. The closer you live to the equator, the stronger the UV rays. So, for example, someone living in Florida may be at higher risk for skin cancer than someone living in Maine, simply due to location. In addition, UV rays are stronger at higher elevations. That means people who live at sea level may have a lower skin cancer risk than those who live in the mountains.

Your amount of sun exposure contributes to your risk, as well. There is evidence that people who had multiple blistering sunburns as children are at high risk for developing melanoma. In addition, there is increasing evidence that sun exposure as an adult is important, as well.  Therefore everyone should take steps to protect themselves from the sun. Wear sunscreen on a regular basis. Avoid the mid-day sun. Wear protective clothing and a hat with a wide brim.

Finally, genetics are important, too. People who have a family history of skin cancer are more likely to develop skin cancer than those who do not. During a baseline assessment, the dermatologist will ask questions about your family history to help determine your risk. With this in mind, you may want to learn more about the history of skin cancer in your family before your appointment.

The assessment helps determine how often you need to see a dermatologist. Some people at high risk for skin cancer need to be seen every three to six months. Others who are at low risk may only need to check in every other year. The frequency all depends on your individual situation. After your assessment, talk to your dermatologist about the best schedule for you, based on your skin cancer risk factors. Anokhi Jambusaria-Pahlajani, M.D., Dermatology, Mayo Clinic, Jacksonville, Fla.