Skin cancer can surface in unusual places, so be vigilant in checking

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Published May 14 2015

Conner Fenlon noticed he had a small bald spot on the back of his head, near the top, when he was in high school. He figured it was a sort of birthmark and never gave it much thought.

Then, last year, Fenlon decided to participate in a fundraiser for the Pediatric Cancer Foundation and agreed to have his head shaved. With the area no longer blocked by surrounding hair, friends noticed and commented that it was red and inflamed.

That got Fenlon's attention.

He went to a dermatologist and found out that the bald spot, about the size of two quarters, was imbedded with basal cell skin cancer and would have to be surgically removed.

"To think it was there, and I didn't know what it was," said Fenlon, who is now 25, lives in Tampa and works as a substitute teacher, "it definitely scared me."

The three most common types of skin cancer — squamous cell carcinoma, basal cell carcinoma and melanoma, the deadliest form of skin cancer — are usually found on skin that gets a lot of sun.

About "60 to 70 percent of skin cancers are related to ultraviolet sun exposure," said Dr. Amy Ross, a Morton Plant Hospital dermatologist. That's why most skin cancers are found on the face, head, chest, neck and arms, areas that, especially for Floridians, may get chronic sun exposure.

But skin cancers are also found on areas of the body that get very little or no sun or in areas that most of us neglect to check or never even think to look for something suspicious.

Melanoma is particularly good at hiding. It is most commonly found on the back, where few people routinely check for changes related to skin cancer. According to a new American Academy of Dermatology survey, only 36 percent of respondents examined their backs for signs of skin cancer. Even fewer said they asked someone to help check areas that were difficult to see.

While basal cell and squamous cell carcinomas are often easily found on skin exposed to the sun, melanoma often appears on the bottoms of feet, between the toes, on the palms, under fingernails and toenails, on the scalp beneath a full head of hair, inside the ear, behind the eye on the retina and on the genitals and other intimate parts of the body. When melanoma occurs in someone with a dark complexion, such as African-Americans, it's more likely to be found in an area not exposed to the sun.

Fenlon's skin cancer was surprising because he has always avoided the sun and never goes outside without covering up with clothing and a hat because he hates the feel of sunscreens.

"He was very fortunate to have had his head shaved," said Dr. C. Wayne Cruse, a Moffitt Cancer Center plastic surgeon and surgical oncologist who took care of Fenlon. Cruse said the cancer was caught relatively early and arose from a skin lesion that had probably been on Fenlon's head since birth. The lesion Cruse removed was about the width of a golf ball and was fairly deep. The scar after surgery was about the width of a tennis ball.

"Another year," Cruse said, "and he would have had a much bigger operation." As a result of Fenlon's diagnosis, the Pediatric Cancer Foundation now has experts on hand to inspect the skin of those who have their heads shaved.

Doctors say that most adults should have a total body skin exam at least once a year, especially if they have a history of severe, blistering sunburns as a child, have a family history of skin cancer or have used tanning beds.

Between visits, you should regularly check yourself with the help of a mirror. Look for anything new or unusual on your skin, including pearly or waxy bumps; a firm, red nodule; a flat, scaly crusted lesion; moles and freckles that change in size, color or that bleed or itch; a red, white, blue or blue-black lesion with irregular borders; or a dark spot in an unusual place, such as on your palms, soles, fingers, toes or scalp, or in your mouth or nose.

If found early, many skin cancers are curable. "Unfortunately people will neglect lesions for years and come in to see us when they are bleeding or it's causing some problem they can no longer ignore," Ross said. "Something that we could have cured is now life-threatening or the surgical treatment will be disfiguring, something that never should have happened."

Contact Irene Maher at [email protected]

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