Learn the ABCs—and Ds and Es—of Skin Cancer

Skin Cancer Screening

The American Cancer Society estimates that one on five Americans will develop some type of skin cancer by the age of 70. The good news: prevention practices can help most people reduce risk, while screening and treatment innovation can raise patients’ chances of successful outcomes.

“With the proper prevention techniques we can reduce the incidence of skin cancer, and with enhanced screening we can detect it in the early stages when it is easier to treat,” says Natalie Spaccarelli, MD, a dermatology oncology expert at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James). She is also the director of the James Pigmented Lesion Clinic and a member of The James Multidisciplinary Melanoma Clinic.

Here’s more info about skin cancer—the most commonly-diagnosed type of cancer.

Skin cancer facts

“The vast majority of skin cancers we see are basal cell carcinomas—the most common form of skin cancer—and squamous cell carcinomas,” Spaccarelli says. “Melanoma is more rare, but is the most well-publicized form of skin cancer, as it’s more likely to metastasize to other parts of the body and be fatal.”

According to the American Cancer Society, more than 5 million people could be diagnosed with basal cell and squamous cell skin cancers this year—around 80 percent of which is basal cell carcinoma—while approximately 96,500 melanoma diagnoses are expected, causing approximately 7,230 deaths.


Exposure to the sun is the primary cause of the vast majority of skin cancers.

“This means you have to be vigilant about sun protection,” Spaccarelli says.

Avoid or limit exposure to the sun during peak hours, which are typically designated as 10 a.m. to 2 p.m, though some extend the range to 4 p.m., and wear a hat and cover your arms and legs whenever possible.

“We’re seeing more people wearing UV-protective clothing, which should be labeled as such,” Spaccarelli says. “A lot of my patients who golf find the long-sleeve shirts very light and comfortable.”

When you do spend some time in the sun, apply a liberal amount of sunscreen that’s at least 30 SPF or higher about 15 minutes before you go outside, and reapply every two hours.

“Make sure to use a sunscreen that provides UVA and UVB protection and is water-resistant,” Spaccarelli says. “If you go into the water, you will likely need to apply sunscreen more frequently—look at the label to see how often the maker recommends applying the sunscreen when getting in the water.”

Learn more about skin cancer from Dr. Spaccarelli on our Cancer-Free World Podcast

Spaccarelli also recommends that parents keep newborns out of direct sunlight for their first six months, and that everyone avoid tanning beds.

“There are no safe tanning beds.”

While prevention practices can help most people avoid skin cancer, some are genetically predisposed, according to Spaccarelli. Also, people who are immunosuppressed are typically more likely to develop skin cancer.


Self-exams and regular visits to primary care physicians and dermatologists are the best ways to detect skin cancer in the early stages. When monitoring specifically for melanoma, Spaccarelli typically advises patients to look for the ABCDEs:

Asymmetry: One half of the spot doesn’t match the other half.

Border: The edges of the mole are uneven or ragged.

Color: The spot has multiple colors, and the color pattern may be changing.

Diameter: The spot is six millimeters—the diameter of a typical pencil eraser—or larger.

Evolving: The spot or mole changes in shape, color or size. (“This is probably the most important aspect of monitoring,” according to Spaccarelli.)

While the ABCDEs are great for raising potentially life-saving red flags, people should make sure to consult experts when they spot skin abnormalities.

“These are not perfect rules, and any new or changing spot on the skin should be brought the attention of a primary care physician or dermatologist,” Spaccarelli says.


In the vast majority of basal cell and squamous cell carcinoma cases, surgically removing the skin cancer and some surrounding tissue is all that’s required. If advanced, these cancers may need additional evaluation and/or treatment.

“It’s the same for the majority of melanoma cases,” Spaccarelli says. “It gets more complicated in the advanced stages of melanoma, when we typically do a biopsy to see if the cancer has spread to the lymph nodes. This will greatly influence the course of treatment, specifically whether the oncologist will recommend systemic treatments like immunotherapy.”

In recent years, great strides have been made in the usage of immunotherapy to treat patients with advanced melanoma, offering benefits in disease-free survival and mortality in responsive patients.

Multidisciplinary Melanoma Care

The James Multidisciplinary clinic offers all newly-diagnosed melanoma patients thorough evaluations of their cancers and treatment option reviews with teams of experts in surgical and medical oncology and dermatology (sometimes all on the same day) leading to quick, comprehensive creations of personalized treatment plans.

“I love being able to pick the brains of this incredible team of specialists and work at a cancer center that is so geared toward patient care and furthering this field in terms of research,” Spaccarelli says.

If you’ve been diagnosed with melanoma, would like a second opinion or would like to speak with a melanoma specialist, please call The James Line at 800-293-5066 or 614-293-5066.