Skin cancer and Benign Skin Lesions in Athletes

Long Term Consequence of Outdoor Sports Participation

Jul 17, 2008

Participants in outdoor sports are at increased risk for sun damage to the skin. Both benign and malignant lesions may result.

Athletes that participate in outdoor activities are at risk for skin lesions from long term sun exposure. The most common benign skin lesion secondary to sun exposure is actinic keratosis, a pre-cancerous lesion. Malignant skin lesions include basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Athletes that participate in outdoor sports should limit sun exposure, use high Sun Protection Factor (SPF) sunscreen, and have regular screening checkups from a Dermatologist.

Actinic Keratosis - Actinic Keratosis (AK) is a benign, but pre-cancerous skin lesion due to long term sun damage. AKs that appear today are generally the result of sun exposure twenty or more years earlier. AKs vary in size, from a few millimeters in diameter, to over 3 centimeters across. Lesions also vary in color, (light or dark tan, red, or pink). AKs are generally scaly or rough to the touch, and an individual may present with several lesions simultaneously.

Diagnosis and Treatment – AK lesions are suspected based on their typical appearance and location, such as the face, forehead, ears, bald scalp and forearms. The diagnosis is usually confirmed by a biopsy, obtained by excising a thin layer of the lesion under local anesthesia. Once the diagnosis is confirmed, the lesion is either fully removed with a scalpel (excision), or with cryosurgery (local freezing of the lesion by application of liquid nitrogen). Alternatively, topical creams, applied to the lesion over several months, can be used to treat AKs. Creams such as Aldera, Solarez, and Efudex have all been shown to be effective treatment for AK lesions.

Squamous Cell Carcinoma – Squamous Cell Carcinoma (SCC) is the second most common malignant lesion of the skin, also resulting from long term sun exposure and damage. SCCs present as pink, rough, scaly patches, similar in appearance to Actinic Keratosis. Some SCCs will present as a bump with ulceration and bleeding (which is not seen in AK). SCC lesions may be confined to the superficial layer of the skin (carcinoma in situ, or Bowen’s disease) or can penetrate the deeper skin layers (invasive SCC). If left untreated, SCC can spread to other organs (metastatic SCC).

Diagnosis and Treatment – The diagnosis of SCC is established by skin biopsy. Treatment of localized disease includes excision, cryosurgery, or radiation therapy. Treatment of metastatic disease consists of either surgical resection, chemotherapy, radiation therapy, or a combination of these therapies.

Basal Cell Carcinoma – Basal Cell Carcinoma (BCC) is the most common form of skin cancer. It is generally the result of long term sun damage of the skin, although there is a predilection for the disease within some families. BCCs present as a firm nodule, clearly growing within the deeper layers of the skin, rather than just in the superficial layers. Color and shape of BCC lesions vary. The most common appearance is that of a firm nodule, that may ulcerate and bleed. This type of skin cancer rarely metastasizes, but lesions may be locally destructive if left untreated.

Diganosis and Treatment – The diagnosis of BCC is made by biopsy of the lesion. Once the diagnosis of BCC is established, treatment is surgical removal. Other forms of treatment include radiation therapy, topical/local chemotherapy, and cryotherapy.

Malignant Melanoma – Malignant Melanoma is the least common, but most lethal form of skin cancer. Melanoma involves malignant transformation of the pigment producing cells in the skin (melanocytes). Long term UV ray exposure from the sun or indoor tanning beds increase risk. There is also some familial predilection for developing the disease. Melanomas are generally pigmented (colored) lesions, with a variety of colors noted. The borders of the lesion are irregular, and may change over a short period of time. The lesions may also enlarge. Melanomas can be very aggressive, and if not treated early, will metastasize widely throughout the body.

Diagnosis and Treatment – Diagnosis is made through biopsy. Treatment of melanoma is excision of the lesion. Once melanoma has spread beyond the skin, there are very few treatment options available, although surgery and radiation therapy may be used for local control of disease.

The copyright of the article Skin cancer and Benign Skin Lesions in Athletes in Sports Medicine is owned by Steven M. Cohen. Permission to republish Skin cancer and Benign Skin Lesions in Athletes in print or online must be granted by the author in writing.