{"id":1991,"date":"2019-05-09T17:38:44","date_gmt":"2019-05-09T17:38:44","guid":{"rendered":"http:\/\/scfredesignpro.wpengine.com\/?p=1991"},"modified":"2023-10-24T16:02:00","modified_gmt":"2023-10-24T16:02:00","slug":"more-than-one","status":"publish","type":"post","link":"https:\/\/www.skincancer.org\/blog\/more-than-one\/","title":{"rendered":"More Than One?","gt_translate_keys":[{"key":"rendered","format":"text"}]},"content":{"rendered":"

If you (or someone you know) has been diagnosed with two or more nonmelanoma skin cancers, you are part of a special group. You are also, unfortunately, at much higher risk of developing further skin cancers. Here\u2019s why \u2014 and what you can do about it.<\/p>\n

In February 2017, Australian actor Hugh Jackman<\/a> posted a photo of his bandaged nose on Instagram, saying \u201cAnother basal cell carcinoma.\u201d This was one of many times he\u2019d required surgery on his nose for this most common form of skin cancer. Imagine how that must feel when your face is shown on giant screens worldwide. Jackman told People <\/em>magazine that he gets his skin checked every three months now because, \u201cMy doctor says I\u2019ll likely have more.\u201d<\/p>\n

If you\u2019re one of the millions of people who have been diagnosed for the first time with either a basal cell carcinoma<\/a> or a squamous cell carcinoma<\/a> (also called BCC and SCC, the major nonmelanoma types of skin cancer), you have better than even odds of getting another. About 60 percent of people who have had one skin cancer will be diagnosed with a second one within 10 years, says a 2015 study in\u00a0JAMA Dermatology<\/em>.<\/p>\n

Your odds increase dramatically if you\u2019ve been diagnosed with a second BCC or SCC (or third, or any other number beyond first). Then you have a 61.5 percent chance of being a repeat customer within just\u00a0two<\/em>\u00a0years. So if you\u2019ve been diagnosed twice, welcome to the high-risk club. Hugh Jackman is in it, and Diane Keaton, and millions of regular folks like me (my tally: 10 BCCs and 1 SCC).<\/p>\n

Risky Business<\/strong><\/h3>\n

\u201cIt\u2019s important for patients to be aware of those statistics, because knowing they\u2019re at higher risk can empower them to take action,\u201d says New York City dermatologist Elizabeth K. Hale, MD, a senior vice president of The Skin Cancer Foundation. \u201cWhile having previous skin cancers may be the greatest risk factor, knowing your other risk factors is also extremely important.\u201d These include how often you\u2019ve been sunburned, for example, and whether you\u2019ve ever used tanning beds.<\/p>\n

Many other factors can put you in this high-risk group, too, like your skin type, genetics and a family history of skin cancer, says Los Angeles dermatologist Ronald L. Moy, MD, also a senior vice president of the Foundation. \u201cWhere did you grow up? How much Irish or English do you have in you? How much sun exposure have you gotten, and how much early exposure as a child?\u201d<\/p>\n

Some patients may think it\u2019s no big deal to be diagnosed with a nonmelanoma skin cancer. For those whose BCC or SCC was detected early and treated right away, it usually isn\u2019t a big deal. If they\u2019re also among the 40 percent of people who won\u2019t develop another skin cancer in the next decade, that\u2019s great news. But for those of us who\u2019ve had more than one, it\u2019s important to understand that these skin cancers\u00a0can<\/em>\u00a0be a big deal. While basal cell carcinomas almost never spread (metastasize), some can be aggressive, grow quite large and even become disfiguring. And squamous cell carcinomas can sometimes metastasize, spreading to lymph nodes or beyond if not treated early.<\/p>\n

\"warning\"

Watch Your Head!\u00a0<\/strong>Men are less aware of the warning signs of skin cancer than women and less likely to use sunscreen. Let\u2019s help change that!<\/p><\/div>\n

Making matters worse, if you\u2019ve had one type of skin cancer, statistics show you are also at risk for the other types, including melanoma<\/a>, which can be life-threatening. The main reason for this risky situation? When your skin is exposed to ultraviolet (UV) rays<\/a> from the sun or from tanning beds, it causes DNA damage in your skin cells. If repair processes in those cells don\u2019t fix all this genetic damage, it can produce mutations that lead to skin cancer. If you\u2019ve had multiple skin cancers, it may signal that you\u2019ve had extensive sun damage, that your immune system is compromised, that your skin just doesn\u2019t repair its DNA very well \u2014 or all the above.<\/p>\n

\u201cI see patients every day who have had multiple skin cancers,\u201d Dr. Moy says. Some patients even get hundreds of them, such as a fair-skinned commercial airline pilot from New Zealand he sees regularly. \u201cWhen you\u2019re on a plane, whether as a passenger, a crew member or a pilot, you\u2019re bombarded with ultraviolet radiation. Some penetrates the windows, and even the fuselage doesn\u2019t protect you completely.\u201d Much DNA repair takes place at night, especially when you\u2019re sleeping. So for those who travel a lot, lose sleep and get jet lag, that nighttime repair may be disrupted, putting them further at risk.<\/p>\n

Make a Commitment<\/strong><\/h3>\n

If you\u2019ve had more than one skin cancer, it\u2019s important to understand and accept that you\u2019re at high risk. Then it\u2019s time to make a lifelong commitment to prevention and early detection. \u201cThat is what makes skin cancer unique,\u201d says Dr. Hale. \u201cPatients can really take ownership. You can\u2019t change your genetic predisposition, but there are plenty of things you can do.\u201d<\/p>\n

Detect Early<\/h3>\n

Finding a dermatologist you feel comfortable with who specializes in skin cancer (and accepts your insurance) is a good first step. Create a regular schedule for skin checks, and talk to the doctor about what to look for on your own skin and when to raise a red flag between regular checkups. For example, precancerous spots called actinic keratoses (AKs) can sometimes develop into SCCs, but you can avoid this by finding and treating them early. \u201cIt\u2019s a matter of keeping up with these precancers and figuring out what we can do to decrease their chance of getting aggressive and progressing,\u201d says Dr. Hale.<\/p>\n

I see patients every day who have had multiple skin cancers,\u201d says Ronald L. Moy, MD. \u201cSome even get hundreds of them.\u201d<\/p><\/blockquote>\n

Similarly, if you\u2019re diagnosed with a BCC or SCC and need treatment such as surgery to remove it, it\u2019s always better to do it when it\u2019s small. \u201cSometimes a patient might say, \u2018If it\u2019s not going to kill me, why are you cutting into my face?\u2019\u201d Dr. Hale says. She explains that even though BCCs grow slowly, they may bleed, get scabby and unsightly, and invade deep into local tissue. Left untreated completely, they can eat through muscle, even bone, and that can make surgery more difficult and more disfiguring. SCCs can attach themselves to local lymph nodes and spread. \u201cIt\u2019s much better to treat an SCC before it becomes a big problem,\u201d says Dr. Hale.<\/p>\n

Protect Consistently<\/strong><\/h3>\n

First and foremost, Dr. Hale tells her patients to wear a broad-spectrum, high-SPF sunscreen every day, rain or shine, all year round. To help motivate people, she often cites three important studies that came out of Australia. For 20 years, the researchers followed adults who went from just recreational sunscreen use to everyday sunscreen use. They found that regular sunscreen use reduced squamous cell carcinoma by 40 percent and helped prevent actinic keratoses when used as directed. Later they determined that it cut melanoma incidence in half. And in 2013, they showed that regular sunscreen use also reduced signs of skin aging and wrinkles by 24 percent.<\/p>\n

Sunscreen alone can\u2019t protect you fully, though. See our\u00a0Daily Sun Protection Guide\u00a0for detailed advice on sunscreen, sun-protective clothing, hats, sunglasses and more.<\/p>\n

Fight the Damage<\/strong><\/h3>\n

Continuing to use sunscreen and other sun protection daily is crucial and will help you prevent skin cancers down the road. \u201cMeanwhile,\u201d says Dr. Moy, \u201cthere are things you can do now to repair some of the skin damage you already have.\u201d<\/p>\n

    \n
  • Nicotinamide:\u00a0<\/strong>Dr. Moy strongly recommends nicotinamide (also called niacinamide), a form of vitamin B3 that enhances DNA repair in damaged skin cells, for many of his patients. A study in\u00a0The New England Journal of Medicine<\/em> showed that a year of treatment with 500 mg of oral nicotinamide twice a day reduced new nonmelanoma skin cancers by 23 percent. The supplements, sold over the counter, also cut precancers by 15 percent. \u201cThis was a very good study and proves that taking a supplement can greatly influence the chance of getting a future skin cancer,\u201d says Dr. Moy. \u201cIt\u2019s so convincing, and there were no side effects in the study.\u201d Dr. Hale agrees. She typically recommends that patients who have had two or more nonmelanoma skin cancers take nicotinamide supplements. \u201cIt\u2019s exciting that there is research showing something else we can do to diminish the chance of skin cancer,\u201d she says. \u201cIt can also reverse some precancerous lesions \u2014 and it\u2019s affordable.\u201d Be sure the label says \u201cnicotinamide\u201d or \u201cniacinamide\u201d and not \u201cniacin,\u201d a different form of the vitamin, which can cause side effects such as flushing. And remember that supplements are not a substitute for sunscreen, hats, long sleeves and other forms of daily sun protection. They work together!<\/li>\n
  • DNA repair enzymes:\u00a0<\/strong>Another area of research that Drs. Hale and Moy are excited about is topical products containing DNA repair enzymes. \u201cI now recommend these not only for patients who have a history of nonmelanoma skin cancers, but also for patients who just have multiple actinic keratoses,\u201d says Dr. Hale. Dr. Moy says he\u2019s seeing good results in his patients: \u201cI had a woman with very bad actinic cheilitis, a type of precancer that forms on the lips. I started her on nicotinamide and a DNA repair enzyme cream, and they stopped the growth and reduced the number of precancers.\u201d These products are sold over the counter, but be sure to look for all three words, \u201cDNA repair enzymes,\u201d on the label or in the ingredients list.<\/li>\n
  • Topical medication:\u00a0<\/strong>Prescription topical treatments, such as imiquimod and 5-fluorouracil, work very well for treating actinic keratoses and some small, superficial BCCs, says Dr. Hale. Patient compliance can be poor, though, when these therapies are used for the extended periods of time needed for treatment, because they come with uncomfortable side effects like redness, swelling and crusting. But for prevention in higher-risk patients, sometimes she prescribes a low dose of imiquimod, for example, to be applied to at-risk areas of skin one night a week \u201cjust to keep the immune system up and regulated to try to attack whatever may come.\u201d Although this use is still off-label (not strictly FDA-approved for the purpose) and the protocol is still being worked out, Dr. Hale says it is something doctors may consider for some patients.<\/li>\n
  • Laser resurfacing:\u00a0<\/strong>Another technique that can help reduce skin damage is laser resurfacing. Often done as an antiaging treatment, it can reduce wrinkles and scars, but it also removes precancerous or genetically mutated cells. A small study in 2006 showed that it resulted in a lower incidence of nonmelanoma skin cancers, and a longer time before developing new skin cancers, compared with the control group. Dr. Moy says doing a laser peel that removes damaged skin cells from the basal layer of skin, where basal cell carcinomas form, allows healthy new skin cells to replace them and heal in about three days. \u201cThat should dramatically decrease skin cancers. I saw a patient recently who had lots of skin cancer on her arms and legs but not a single one on her face. Why? I had done laser resurfacing on her face.\u201d<\/li>\n
  • Photodynamic therapy:\u00a0<\/strong>While this is an approved light-based treatment for AKs (it has some rejuvenating effects, too), Dr. Hale says she also uses it for reducing sun damage in high-risk patients. \u201cI have different protocols I use for different people, depending on their history and skin type, and it\u2019s very effective.\u201d The doctor applies a light-sensitive chemical to the areas at risk, then uses a blue light to activate the areas, which causes precancerous skin cells to slough off and be replaced by healthy new cells. Because of continued sun sensitivity, patients must avoid sunlight for a few days afterward.<\/li>\n<\/ul>\n

    \"Featured
    \n*This article was first published in the <\/em>2017 issue\u00a0of The Skin Cancer Foundation Journal.<\/em><\/p>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"excerpt":{"rendered":"

    If you (or someone you know) has been diagnosed with two or more nonmelanoma skin cancers, you are part of a special group. You are also, unfortunately, at much higher risk of developing further skin cancers. <\/p>\n","protected":false,"gt_translate_keys":[{"key":"rendered","format":"html"}]},"author":2,"featured_media":1992,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5,10],"tags":[],"class_list":["post-1991","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthy-lifestyle","category-skin-cancer-information"],"acf":[],"yoast_head":"\nMore Than One? - The Skin Cancer Foundation<\/title>\n<meta name=\"description\" content=\"If you (or someone you know) has been diagnosed with two or more nonmelanoma skin cancers, you are at higher risk of developing further skin cancers.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.skincancer.org\/blog\/more-than-one\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"More Than One?\" \/>\n<meta property=\"og:description\" content=\"If you (or someone you know) has been diagnosed with two or more nonmelanoma skin cancers, you are at higher risk of developing further skin cancers.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.skincancer.org\/blog\/more-than-one\/\" \/>\n<meta property=\"og:site_name\" content=\"The Skin Cancer Foundation\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/skincancerfoundation\" \/>\n<meta property=\"article:published_time\" content=\"2019-05-09T17:38:44+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-10-24T16:02:00+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.skincancer.org\/wp-content\/uploads\/MoreThanOne-.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"897\" \/>\n\t<meta property=\"og:image:height\" content=\"404\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Julie Bain\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@skincancerorg\" \/>\n<meta name=\"twitter:site\" content=\"@skincancerorg\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Julie Bain\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.skincancer.org\/blog\/more-than-one\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.skincancer.org\/blog\/more-than-one\/\"},\"author\":{\"name\":\"Julie Bain\",\"@id\":\"https:\/\/www.skincancer.org\/#\/schema\/person\/e05673ef4d60255e455764b227bca2fa\"},\"headline\":\"More Than One?\",\"datePublished\":\"2019-05-09T17:38:44+00:00\",\"dateModified\":\"2023-10-24T16:02:00+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.skincancer.org\/blog\/more-than-one\/\"},\"wordCount\":2023,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\/\/www.skincancer.org\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.skincancer.org\/blog\/more-than-one\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.skincancer.org\/wp-content\/uploads\/MoreThanOne-.jpg\",\"articleSection\":[\"Healthy Lifestyle\",\"Skin Cancer Information\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.skincancer.org\/blog\/more-than-one\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.skincancer.org\/blog\/more-than-one\/\",\"url\":\"https:\/\/www.skincancer.org\/blog\/more-than-one\/\",\"name\":\"More Than One? 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