As a dermatopathologist (a surgical pathologist with fellowship training and board certification in dermatopathology), I see patients’ skin on a pretty deep level – at up to 1000x under the microscope. I receive skin biopsies and excisions of a wide variety of dermatologic conditions including infections, “rashes,” as well as benign, pre-malignant and malignant neoplasms.
Much of what I diagnose daily are small skin cancers on sun-exposed skin. Because of our nearly constant exposure to UV radiation from the sun here on the coast, we are particularly susceptible to the most common types of cancer – basal and squamous cell carcinoma. These cancers are caused by DNA damage in the epidermis and dermis from cumulative doses of UVB radiation. BCC and SCC are rarely fatal, though they can definitely be locally aggressive. The most anxiety-inducing diagnosis I make is melanoma, especially when it is in a young patient. UV radiation is clearly one of the causes of melanoma, but genetic factors also play a role in melanocyte pathology. Our outdoor lifestyle also leads to skin damage in the form of freckles, “age spots,” and wrinkles due to UVA rays which penetrate deeper into the dermis and subcutis.
Every day, but especially in the summer, sun protection and sun avoidance are important to remember for ourselves and for our patients. A broad spectrum (covering UVA and UVB) sunscreen is essential to protecting ourselves from skin cancers, melanoma and premature aging. As summer approaches and you start seeing more of your patients’ skin, take a moment to notice those skin lesions that may deserve a biopsy. Catching a cancer or even a melanoma while it’s early could make a important difference in outcome.