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Skin Cancer

What is skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells. In the U.S. alone, more than 2 million Americans are expected to be diagnosed in 2013 with nonmelanoma skin cancer, and more than 76,000 are expected to be diagnosed with melanoma, according to the American Cancer Society.

What are the different types of skin cancer?

There are three main types of skin cancer, including:

Name

Description

Basal cell carcinoma

Basal cell carcinoma accounts for approximately 80 percent of all skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin, mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. It most commonly occurs among people with light-colored eyes, hair, and complexion.

Squamous cell carcinoma

Squamous cell carcinoma, although more aggressive than basal cell carcinoma, is highly treatable. It accounts for about 20 percent of all skin cancers. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and may be found on sun-exposed areas such as the face, ears, lips, and mouth. However, if left untreated, squamous cell carcinoma can spread to other parts of the body. This type of skin cancer is usually found in fair-skinned people.

Malignant melanoma

Malignant melanoma accounts for a small percentage of all skin cancers, but accounts for most deaths from skin cancer. Malignant melanoma starts in the melanocytes--cells that produce pigment in the skin. Malignant melanomas sometimes begin as an abnormal mole that then turns cancerous. This cancer may spread quickly. Malignant melanoma most often appears on fair-skinned men and women, but people with all skin types may be affected.

Distinguishing benign moles from melanoma

To help find melanoma early, it is important to examine your skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. Certain moles are at higher risk for changing into malignant melanoma. Moles that are present at birth (congenital nevi), and atypical moles (dysplastic nevi), have a greater chance of becoming malignant. Recognizing changes in moles, by following this ABCD chart, is crucial in detecting malignant melanoma at its earliest stage. The warning signs are:

Normal mole / melanoma

Sign

Characteristic

Photo comparing normal and melanoma moles showing asymmetry

Asymmetry

When half of the mole does not match the other half

Photo comparing normal and melanoma moles showing border irregularity

Border

When the border (edges) of the mole are ragged or irregular

Photo comparing normal and melanoma moles showing color

Color

When the color of the mole is not the same all over; you may see shades of brown or black, sometimes with areas of pink, red, white, or blue

Photo comparing normal and melanoma moles showing diameter

Diameter

If the mole's diameter is larger than a pencil's eraser

Photographs Used By Permission: National Cancer Institute

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while others may show few or none. Always consult your doctor for a diagnosis.

What are the risk factors for skin cancer?

Skin cancer is more common in fair-skinned people, especially those with blond or red hair, who have light-colored eyes. Skin cancer is rare in children. However, no one is safe from skin cancer. Other risk factors include:

  • Family history of melanoma

  • Personal history of skin cancer

  • Sun exposure. The amount of time spent unprotected in the sun directly affects your risk of skin cancer.

  • Early childhood sunburns. Research has shown that sunburns early in life increase a person's risk for skin cancer later in life.

  • Many freckles

  • Large or many ordinary moles

  • Dysplastic nevi

  • Male gender

  • An immunosuppressive disorder or weakened immune system (such as in people who have had organ transplants) 

  • Exposure to certain chemicals, like arsenic

  • Radiation exposure

  • Smoking

  • HPV (human papillomavirus)

  • Certain rare inherited conditions, such as basal cell nevus syndrome (Gorlin syndrome), or xeroderma pigmentosum (XP) 

Prevention of skin cancer

The American Academy of Dermatology (AAD) recommends the following steps to help reduce your risk of skin cancer:

  • Wear protective clothing, including a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, when possible.

  • Seek the shade when appropriate, especially when the sun's rays are the strongest, from 10 a.m. to 4 p.m.

  • Regularly use a broad-spectrum sunscreen with an SPF (sun protection factor) of 30 or higher on all exposed skin, even on cloudy days. Sunscreen should be reapplied every two hours and after swimming or sweating.

  • Protect children from the sun by using shade, protective clothing, and applying sunscreen.

  • Use extra caution near water, snow, and sand, which can reflect the sun's rays and increase the chances of sunburn.

  • Avoid tanning beds. The UV (ultraviolet) light from tanning beds can cause skin cancer and wrinkling.

  • Check your birthday suit on your birthday. Look at your skin carefully and if you see anything changing, growing, or bleeding on your skin, see your doctor.

  • Get vitamin D safely through a healthy diet (which may include vitamin supplements.) Don't seek out the sun.

The American Academy of Pediatrics approves of the use of sunscreen on infants younger than 6 months old only if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers most surface areas of skin. However, parents also may apply a minimal amount of sunscreen to the infant's face and back of the hands.

Remember, sand and pavement reflect UV rays even under an umbrella. Snow is a particularly good reflector of UV rays.

How to perform a skin self-examination

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. A skin self-exam is usually the first step in detecting skin cancer. The following suggested method of self-examination comes from the AAD:

(You will need a full-length mirror, a hand mirror, and a brightly lit room.)

  • Examine your body front and back in mirror, then the right and left sides, with your arms raised. Women should look under their breasts. 

  • Bend your elbows, look carefully at your forearms, the back of your upper arms, and the palms of your hands. Check between your fingers and look at your nail beds.

  • Look at backs of your legs and feet, spaces between your toes, your toenail beds, and the soles of your feet.

  • Examine the back of your neck and scalp with a hand mirror.

  • Check your back, buttocks, and genital area with a hand mirror.

  • Become familiar with your skin and the pattern of your moles, freckles, and other marks.

  • Be alert to changes in the number, size, shape, and color of pigmented areas.

  • Follow the ABCD Chart when examining moles of other pigmented areas and consult your doctor promptly if you notice any changes.

Treatments for skin cancer

Specific treatment for skin cancer will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Type of skin cancer 

  • Extent and location of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

There are several kinds of treatments for skin cancer, including the following:

  • Surgery. Surgery is a common treatment for skin cancer. It is used in most treated cases. Some types of skin cancer growths can be removed very easily and require only very minor surgery, while others may require a more extensive surgical procedure. Surgery may include the following procedures:

    • Cryosurgery. Using liquid nitrogen, cryosurgery uses an instrument that sprays the liquid onto the skin, freezing and destroying the tissue.

    • Curettage and electrodesiccation. This common type of surgery involves scraping away skin tissue with a curette (a sharp surgical instrument), followed by cauterizing the wound with an electrosurgical unit.

    • Excision. A scalpel (sharp surgical instrument) may be used to excise (cut away) and remove the growth. The wound is usually stitched or held closed with skin clips.

    • Mohs' microscopically controlled surgery. This type of surgery involves excising a lesion, layer by layer. Each piece of removed tissue is examined under a microscope. Tissue is progressively removed until no tumor cells are seen. The goal of this type of surgery is to remove all of the malignant cells and as little normal tissue as possible. It is often used with recurring tumors (those that come back after treatment).

  • Laser therapy. Laser surgery uses a narrow beam of light to destroy cancer cells, and is sometimes used with tumors located on the outer layer of skin.

  • Radiation therapy. X-rays are used to kill cancer cells and shrink tumors.

  • Photodynamic therapy. Photodynamic therapy uses a certain type of light and a special chemical to kill cancer cells. 

  • Other types of treatment include the following:

    • Chemotherapy. Chemotherapy uses drugs to kill cancer cells.

      • Topical chemotherapy. Chemotherapy given as a cream or lotion placed on the skin to kill cancer cells.

      • Systemic chemotherapy. Chemotherapy administered orally or intravenously (IV) for more advanced cancers. 

    • Immunotherapy. Immunotherapy involves various approaches to boost the body's own immune system, helping it to attack the cancer. Some types of treatment can be applied on tumors or injected directly into them. Other types are used for more advanced cancers and are given as an injection into the vein (IV)

    • Targeted therapy. Some medicines used to treat advanced skin cancers work by targeting specific parts of the cancer cells. These medicines can often be taken as a pill. 

Online Medical Reviewer: Alteri, Rick, MD
Online Medical Reviewer: Stump-Sutliff, Kim, RN, MSN, AOCNS
Last Review Date: 2/10/2013
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