Skin Cancer: What Every Texan Needs to Know About the Warning Signs Hiding in Plain Sight

One in three Texans will develop some form of skin cancer in their lifetime. That's not a distant statistical abstraction — it's your neighbor, your coworker, or you. Nationally, about 5.4 million basal cell and squamous cell skin cancers are diagnosed each year, and an estimated 212,200 melanoma cases were projected for 2025 alone. Yet skin cancer remains one of the most preventable — and most survivable — cancers in medicine, provided you catch it early and understand what you're looking at when you check your own skin.

Texas ranks eighth-highest in the nation for ultraviolet (UV) radiation exposure, and that UV load drives more than 90 percent of melanoma cases. As summer arrives and outdoor time increases, understanding the warning signs of skin cancer isn't optional — it's essential primary care.

The Three Types of Skin Cancer You Need to Know

Skin cancer isn't one disease. It's a family of conditions with very different behaviors, prognoses, and appearances.

Basal Cell Carcinoma (BCC)

Basal cell carcinoma is the most common skin cancer — and the most common cancer of any kind in humans. It accounts for roughly 80 percent of non-melanoma skin cancers. BCC typically appears as a pearly or waxy bump, a flat flesh-colored or brown scar-like lesion, or a bleeding or scabbing sore that heals and then returns. It grows slowly and rarely spreads to distant parts of the body, but it can be locally destructive if left untreated, eroding into underlying tissue and bone.

BCC most commonly appears on sun-exposed areas: the face, ears, neck, scalp, and shoulders. However, it can occur anywhere on the body.

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma is the second most common skin cancer. It often appears as a firm red nodule, a flat lesion with a scaly or crusted surface, or a new sore or raised area on an existing scar or ulcer. SCC is more aggressive than BCC and carries a small but real risk of metastasis (spreading to lymph nodes or distant organs), particularly in immunosuppressed patients.

SCC frequently develops on chronically sun-damaged skin — the face, ears, lips, backs of hands, and forearms. It can also arise within old scars, chronic wounds, or areas of prior radiation exposure.

Melanoma

Melanoma accounts for only about 2 percent of all skin cancers, but it causes the vast majority of skin cancer deaths — an estimated 8,430 Americans in 2025, or nearly 20 deaths per day. The number of new invasive melanoma cases diagnosed annually in the United States increased by 46.6 percent over the past decade (2016–2026), making it one of the fastest-rising cancers in the country.

Melanoma develops from melanocytes (the pigment-producing cells in your skin) and can appear anywhere on the body — including areas that rarely see sun exposure. It is highly treatable when caught early (five-year survival exceeds 99 percent for localized melanoma) but becomes significantly more dangerous once it spreads beyond the skin.

How to Check Your Own Skin: The ABCDE Rule and the "Ugly Duckling" Sign

The most powerful tool for early skin cancer detection costs nothing and takes five minutes: a monthly self-examination.

The ABCDE Rule for Melanoma

According to the American Academy of Dermatology, the ABCDEs of melanoma provide a framework for evaluating any mole or pigmented spot on your body:

The "Ugly Duckling" Sign

Beyond the ABCDE criteria, dermatologists use the "ugly duckling" sign — a recognition pattern based on the observation that a person's normal moles tend to resemble one another. A melanoma often stands out as the mole that looks different from all the others on your body. If you have a spot that doesn't "match" the rest of your moles — different color, different shape, different behavior — that's the ugly duckling, and it deserves medical evaluation.

Signs of Non-Melanoma Skin Cancer

For basal cell and squamous cell carcinomas, watch for:

Who Is at Highest Risk?

While anyone can develop skin cancer, certain factors significantly increase risk.

UV exposure history is the dominant risk factor. Cumulative lifetime sun exposure drives basal cell and squamous cell carcinomas, while intermittent intense exposure (blistering sunburns, especially in childhood and adolescence) is strongly associated with melanoma.

Fair skin, light hair, and light eyes confer the highest risk. People who burn easily and tan poorly have less melanin protection against UV damage. However, skin cancer can and does occur in people of all skin tones — it's simply diagnosed later (and at more advanced stages) in patients with darker skin.

Indoor tanning dramatically increases risk. According to the CDC, indoor tanning exposes users to high levels of UV radiation that damages skin cell DNA. About 900,000 high school students and 7.8 million American adults still use tanning beds — a practice the World Health Organization classifies as a Group 1 carcinogen (the same category as tobacco and asbestos).

Immunosuppression raises skin cancer risk five- to one hundred-fold, particularly for squamous cell carcinoma. This includes organ transplant recipients on anti-rejection medications, patients on chronic immunosuppressive therapy for autoimmune conditions, and people living with poorly controlled HIV.

A history of sunburns — particularly five or more blistering sunburns between ages 15 and 20 — increases melanoma risk by 80 percent, according to the Skin Cancer Foundation.

Family history of melanoma in a first-degree relative (parent, sibling, or child) approximately doubles your personal risk.

The Texas Sun Factor

Texas presents unique challenges for skin cancer prevention. The state's southern latitude means UV radiation is intense for a larger portion of the year compared to northern states. In much of Texas, the UV index reaches "very high" (8–10) or "extreme" (11+) levels from April through September — a six-month window where unprotected sun exposure causes cumulative DNA damage to skin cells.

Texans also tend to spend more time outdoors year-round — working, exercising, attending sports events, and engaging in outdoor recreation — which compounds lifetime UV exposure. Add the state's large agricultural and construction workforce, and you have a population with above-average occupational sun exposure as well.

The result: thousands of Texans are diagnosed with melanoma each year, and non-melanoma skin cancer cases continue to climb statewide.

Evidence-Based Sun Protection: What Actually Works

The American Academy of Dermatology recommends a multi-layered approach to sun protection — sunscreen alone is not enough.

Sunscreen: Use a broad-spectrum (UVA + UVB), water-resistant sunscreen with SPF 30 or higher on all exposed skin. SPF 30 blocks 97 percent of UVB rays. Apply generously (most people use far too little) and reapply every two hours, or immediately after swimming or sweating. No sunscreen blocks 100 percent of UV, and higher SPF numbers do not mean you can go longer between applications.

Protective clothing: A long-sleeved, lightweight, tightly woven shirt provides more reliable protection than sunscreen alone. Wide-brimmed hats (3+ inches) protect the face, ears, and neck. UV-blocking sunglasses protect the eyes and delicate periorbital skin.

Seek shade: Between 10 a.m. and 4 p.m. — when UV intensity peaks — shade is your most effective tool. If your shadow is shorter than you are, UV exposure is at its highest.

Avoid tanning beds entirely. There is no safe level of indoor tanning. "Base tans" do not protect against sunburn in any clinically meaningful way.

Be strategic with timing. For outdoor exercise, early morning or evening hours dramatically reduce UV exposure. If outdoor work is unavoidable during peak hours, combine protective clothing with sunscreen on exposed skin and schedule shade breaks.

The USPSTF Screening Controversy — and What It Means for You

In 2023, the U.S. Preventive Services Task Force issued an "I" statement on skin cancer screening for asymptomatic adults — meaning there is insufficient evidence to recommend for or against routine whole-body visual skin examination by a primary care clinician for the general population.

However, this recommendation is frequently misunderstood. It does not mean skin cancer screening is useless or unnecessary. It means that large-scale population studies have not yet definitively proven that mass screening of all adults reduces mortality. The USPSTF explicitly noted that their statement does not apply to people with risk factors (fair skin, family history of melanoma, history of sunburns, atypical moles) or anyone with a suspicious lesion.

What this means in practice: if you have risk factors or notice any concerning changes in your skin, you should absolutely seek medical evaluation. Your primary care physician is trained to assess skin lesions, identify warning signs, and refer appropriately.

When to See Your Doctor

You should seek medical evaluation if you notice any of the following:

Many of these concerns can be evaluated through a telehealth visit — particularly as an initial triage step. By showing your physician a concerning spot on camera, they can assess whether it warrants in-person evaluation, referral to dermatology, or simply monitoring. This is especially valuable for patients in rural areas of Texas where dermatology access is limited.

At Trinity Family Medicine, we offer telehealth visits for patients across all of Texas, starting at $49.99. Whether you need a spot evaluated, want to discuss your personal skin cancer risk factors, or need guidance on sun protection strategies specific to your skin type and medications, you can see a board-certified family medicine physician from home — same doctor every visit. Our doctors have specialized expertise in dermatological diagnostics and can guide you on when imaging, biopsy, or dermatology referral is appropriate.

The Bottom Line

Skin cancer is the most common cancer in America, and Texas's UV environment puts its residents at above-average risk. But the combination of monthly self-examination, evidence-based sun protection, and timely medical evaluation for suspicious lesions makes skin cancer one of the most detectable and treatable cancers in medicine.

Check your skin monthly. Protect your skin daily. And when something looks wrong, don't wait — ask your doctor.

References

Frequently Asked Questions About Skin Cancer