Skin checks after 60: what to look for and what not to worry about

Skin cancer incidence rises steeply with age, reflecting cumulative ultraviolet exposure accrued mostly decades earlier. The sunburn that matters happened in your twenties; the consequence arrives in your seventies.

Older skin also develops a large number of new marks that are completely harmless, and telling the two groups apart is the useful skill.

The benign things that alarm people

Seborrhoeic keratoses. Extremely common after fifty and the single commonest cause of unnecessary worry. They look stuck on, as though a piece of wax or bark has been placed on the skin, with a slightly greasy or warty surface. Colour ranges from pale tan to almost black — the dark ones cause the most alarm. They are entirely benign. Many people accumulate dozens.

Cherry angiomas. Small bright red domed spots, increasing in number with age. Harmless.

Solar lentigines — flat, uniformly tan, sharply edged patches on sun-exposed skin. Age spots, and benign.

Skin tags, in flexures and around the neck.

Actinic keratoses occupy a middle ground and are worth knowing about. Rough, scaly, sandpapery patches on sun-exposed skin — often felt before they are seen. They are pre-malignant, with a small individual risk of progressing to squamous cell carcinoma, and are usually treated as a field rather than individually.

The three cancers

Basal cell carcinoma is by far the commonest and the least dangerous. It grows slowly, invades locally, and essentially never metastasises — but left alone it can destroy a great deal of tissue, which matters when it sits on a nose or an eyelid.

It rarely looks like the popular image of skin cancer. Typically a pearly or translucent nodule with fine visible blood vessels, sometimes with a rolled edge and a central depression or ulcer. The classic history is a spot that bleeds, scabs, seems to heal, and then does it again. Any lesion that has repeatedly cycled like that for months should be looked at.

Squamous cell carcinoma is faster growing, often a firm scaly or crusted nodule that may be tender, and it does have metastatic potential — particularly on the ear, the lip and in immunosuppressed people. Transplant recipients on long-term immunosuppression have a dramatically raised risk and need regular surveillance.

Melanoma is much less common but accounts for most skin cancer deaths, and outcome depends heavily on thickness at diagnosis.

The melanomas that break the rules

Two subtypes matter disproportionately in older adults and both evade the standard criteria.

Nodular melanoma is symmetrical, uniform in colour, has a regular border, and grows rapidly — failing A, B and C entirely. It presents as a firm raised nodule that may be pink or red rather than pigmented, and it may bleed. Because it grows vertically from the start, it is often thick at diagnosis and accounts for a disproportionate share of deaths. Any new, firm, growing nodule warrants assessment whatever colour it is.

Lentigo maligna is the one most specific to older skin: a slowly enlarging, irregularly pigmented flat patch on chronically sun-damaged skin, usually the face. It grows over years and is easily dismissed as an age spot. The distinguishing feature is that it changes and enlarges, whereas a solar lentigo stays put.

Acral lentiginous melanoma occurs on palms, soles and under nails, is not related to sun exposure, and occurs at similar rates across skin types. A new pigmented band in a single nail, particularly if it widens or extends onto the surrounding skin, needs assessment.

How to check

Whole-body self-examination every few months, with a mirror and someone else's help for the back. Photograph anything you are unsure about with a ruler alongside for scale, and re-photograph in three months — change over time is far more informative than a single look.

Do not forget the scalp, behind the ears, the soles, between the toes and the nails. Bald scalps and ear tops are high-risk sites for squamous cell carcinoma and are easily missed by their owners.

Population-wide screening of asymptomatic adults is not recommended by most bodies, on evidence rather than on cost — it has not been shown to reduce mortality and does lead to overdiagnosis. Regular dermatological surveillance is recommended for higher-risk groups: previous melanoma, many atypical moles, strong family history, immunosuppression, and significant prior sun damage or sunbed use.

Still worth protecting your skin

It is easy to conclude that the damage is done. Two reasons it is not.

Continued UV exposure adds risk on top of what has accumulated, and the interval between exposure and cancer is shorter in already-damaged skin. And older skin burns more readily, repairs DNA less efficiently, and — because of reduced ability to synthesise vitamin D — creates a genuine balance to strike rather than an argument for either extreme.

Shade, a hat with a brim, long sleeves, and sunscreen on the face, ears, neck and hands when out for extended periods. The hands and the ears are the two most commonly forgotten sites, and both are among the commonest sites for skin cancer.