Skin cancer is the most commonly diagnosed cancer in the United States, and most cases are preventable. Skin cancer greatly affects the quality of life, and it can be disfiguring or even deadly.[rx,rx–rx] Medical treatment for skin cancer creates substantial health care costs for individuals, families, and the nation. The number of Americans who have had skin cancer at some point in the last three decades is estimated to be higher than the number for all other cancers combined,[rx,rx,rx] and skin cancer incidence rates have continued to increase in recent years.[rx,rx]
Types of Skin Cancer
- Kaposi sarcoma – This rare form of skin cancer develops in the skin’s blood vessels and causes red or purple patches on the skin or mucous membranes. Kaposi sarcoma mainly occurs in people with weakened immune systems, such as people with AIDS, and in people taking medications that suppress their natural immunity, such as people who’ve undergone organ transplants. Other people with an increased risk of Kaposi sarcoma include young men living in Africa or older men of Italian or Eastern European Jewish heritage.
- Merkel cell carcinoma – Merkel cell carcinoma causes firm, shiny nodules that occur on or just beneath the skin and in hair follicles. Merkel cell carcinoma is most often found on the head, neck, and trunk.
- Sebaceous gland carcinoma – This uncommon and aggressive cancer originates in the oil glands in the skin. Sebaceous gland carcinomas — which usually appear as hard, painless nodules — can develop anywhere, but most occur on the eyelid, where they’re frequently mistaken for other eyelid problems.
Skin Type
Skin cancer risk varies by skin type, which is classified by how likely a person is to tan or burn. The six skin types of the Fitzpatrick skin type classification system are shown in [rx] Sunburn often is used as a proxy outcome measure in skin cancer prevention studies because it takes into account the person’s skin type, as well as the intensity and duration of UV exposure. Although anyone’s skin can be damaged by UV exposure, people with skin types I and II are at the highest risk of burns, damage from UV radiation, and skin cancer.
- A large brownish spot with darker speckles
- A mole that changes in color, size or feels or that bleeds
- A small lesion with an irregular border and portions that appear red, pink, white, blue or blue-black
- A painful lesion that itches or burns
- Dark lesions on your palms, soles, fingertips or toes, or on mucous membranes lining your mouth, nose, vagina or anus.
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Fitzpatrick Skin Type
| Skin Type | Description |
|---|---|
| I | Always burns, never tans, sensitive to ultraviolet (UV) exposure. |
| II | Burns easily, tans minimally. |
| III | Burns moderately tans gradually to light brown. |
| IV | Burns minimally always tans well to moderately brown. |
| V | Rarely burns, tans profusely to dark. |
| VI | Never burns, deeply pigmented, least sensitive. |
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Causes of Skin Cancer
Ultraviolet radiation from sun exposure is the primary environmental cause of skin cancer.[rx][rx][rx] This can occur in professions such as farming. Other risk factors that play a role include:
- Smoking tobacco[rx]
- HPV infections increase the risk of squamous-cell skin cancer.[rx]
- Some genetic syndromes[rx] including congenital melanocytic nevi syndrome which is characterized by the presence of nevi (birthmarks or moles) of varying size which is either present at birth or appears within 6 months of birth. Nevi larger than 20 mm (3/4″) in size are at higher risk for becoming cancerous.
- Chronic non-healing wounds.[rx] These are called Marjolin’s ulcers based on their appearance and can develop into squamous-cell skin cancer.
- Ionizing radiation such as X-rays, environmental carcinogens, artificial UV radiation (e.g. tanning beds), aging, and light skin color.[rx] It is believed that tanning beds are the cause of hundreds of thousands of basal and squamous-cell skin cancer.[rx] The World Health Organization now places people who use artificial tanning beds in its highest risk category for skin cancer.[rx] Alcohol consumption, specifically excessive drinking increase the risk of sunburns.[rx]
- The use of many immunosuppressive medications increases the risk of skin cancer. Cyclosporin A, a calcineurin inhibitor, for example, increases the risk approximately 200 times, and azathioprine about 60 times.[31]
Genetic Factors
- People with certain genetic risk factors are more likely than others to develop skin cancer. Genetic risk factors for skin cancer include having a lighter natural skin color; blue or green eyes; blond or red hair; dysplastic nevi (a type of unusual mole) or a large number of common moles; and skin that burns, freckles, or reddens easily or becomes painful after excessive time spent in the sun.[rx,rx]
- People with red hair may be at particularly increased risk of melanoma.[rx] In addition, those with a family history or personal history of skin cancer, especially melanoma, are at increased risk.[rx–rx] Ultraviolet (UV) light exposure, most commonly from sunlight, is overwhelmingly the most frequent cause of skin cancer.
Other important causes of skin cancer include the following
- Use of tanning booths
- Immunosuppression – This means the impairment of the immune system. The immune system protects the body from foreign entities, such as germs or substances that cause an allergic reaction. This suppression may occur as a consequence of some diseases or can be due to medications prescribed to combat conditions such as autoimmune diseases or prevent organ transplant rejection.
- Exposure to unusually high levels of X-rays
- Contact with certain chemicals-arsenic (miners, sheep shearers, and farmers), hydrocarbons in tar, oils, and soot (may cause squamous cell carcinoma)
The following people are at the greatest risk
- People with fair skin, especially types that freckle, sunburn easily, or become painful in the sun
- People with light (blond or red) hair and blue or green eyes
- Those with certain genetic disorders that deplete skin pigment such as albinism, xeroderma pigmentosum
- People who have already been treated for skin cancer
- People with numerous moles, unusual moles, or large moles that were present at birth
- People with close family members who have developed skin cancer
- People who had at least one severe sunburn early in life
Basal cell carcinomas and squamous cell carcinomas are more common in older people. Melanomas can occur at any age. It is most commonly diagnosed at between 55 and 75 years of age, but about 1/3 occur before the age of 50. For example, melanoma is the most common cancer in people younger than 30. A basal cell carcinoma (BCC) usually looks like a raised, smooth, pearly bump on the sun-exposed skin of the head, neck, or shoulders.
- Small blood vessels may be visible within the tumor.
- A central depression with crusting and bleeding (ulceration) frequently develops.
- A BCC is often mistaken for a sore that does not heal.
A squamous cell carcinoma (SCC) is commonly a well-defined, red, scaling, thickened patch on sun-exposed skin.
- Like BCCs, SCCs may ulcerate and bleed.
- Left untreated, SCC may develop into a large mass.
The majority of malignant melanomas are brown to black pigmented lesions.
- Warning signs include change in size, shape, color, or elevation of a mole.
- The appearance of a new mole during adulthood, or new pain, itching, ulceration, or bleeding of an existing mole should all be checked by a healthcare professional.
The following easy-to-remember guideline, “ABCD,” is useful for identifying malignant melanoma
- Asymmetry-One side of the lesion does not look like the other.
- Border irregularity-Margins may be notched or irregular.
- Color-Melanomas are often a mixture of black, tan, brown, blue, red, or white.
- Diameter-Cancerous lesions are usually larger than 6 mm across (about the size of a pencil eraser), but any change in size may be significant.
Symptoms of Skin Cancer
Check for BCCs where your skin is most exposed to the sun, especially the face, ears, neck, scalp, chest, shoulders and back, but remember that they can occur anywhere on the body. Frequently, two or more of these warning signs are visible in a BCC tumor.
- An open sore that does not heal – and may bleed, ooze or crust. The sore might persist for weeks, or appear to heal and then come back.
- A reddish patch or irritated area – on the face, chest, shoulder, arm or leg that may crust, itch, hurt or cause no discomfort.
- A shiny bump or nodule – that is pearly or clear, pink, red or white. The bump can also be tan, black or brown, especially in dark-skinned people, and can be mistaken for a normal mole.
- A small pink growth – with a slightly raised, rolled edge and a crusted indentation in the center that may develop tiny surface blood vessels over time.
- A scar-like area – that is flat white, yellow or waxy in color. The skin appears shiny and taut, often with poorly defined borders. This warning sign may indicate an invasive BCC.
- A basal cell carcinoma (BCC) usually looks like a raised, smooth, pearly bump on the sun-exposed skin of the head, neck, or shoulders.
- Small blood vessels may be visible within the tumor.
- A central depression with crusting and bleeding (ulceration) frequently develops.
- A BCC is often mistaken for a sore that does not heal.
A squamous cell carcinoma (SCC) is commonly a well-defined, red, scaling, thickened patch on sun-exposed skin.
- Like BCCs, SCCs may ulcerate and bleed.
- Left untreated, SCC may develop into a large mass.
The majority of malignant melanomas are brown to black pigmented lesions.
- Warning signs include a change in size, shape, color, or elevation of a mole.
- The appearance of a new mole during adulthood, or new pain, itching, ulceration, or bleeding of an existing mole should all be checked by a healthcare professional.
The following easy-to-remember guideline, “ABCD,” is useful for identifying malignant melanoma:
- Asymmetry-One side of the lesion does not look like the other.
- Border irregularity-Margins may be notched or irregular.
- Color-Melanomas are often a mixture of black, tan, brown, blue, red, or white.
- Diameter-Cancerous lesions are usually larger than 6 mm across (about the size of a pencil eraser), but any change in size may be significant.
Diagnosis of Skin Cancer
To diagnose skin cancer, your doctor may:
- Examine your skin – Your doctor may look at your skin to determine whether your skin changes are likely to be skin cancer. Further testing may be needed to confirm that diagnosis.
- Remove a sample of suspicious skin for testing (skin biopsy) – Your doctor may remove the suspicious-looking skin for lab testing. A biopsy can determine whether you have skin cancer and, if so, what type of skin cancer you have.
Treatment of Skin Cancer
- Curettage and electrodesiccation (electrosurgery)
- Mohs surgery
- Excisional surgery
- Radiation therapy
- Photodynamic therapy
- Cryosurgery
- Laser surgery
- Topical medications
- Oral medications for advanced BCC
Curettage and electrodesiccation (electrosurgery)
How it works
The dermatologist scrapes or shaves off the BCC using a curette (a sharp instrument with a ring-shaped tip), then uses heat or a chemical agent to destroy remaining cancer cells and seal off the wound. The physician may repeat the procedure a few times during the same session until no cancer cells remain. Typically, the procedure leaves a round, whitish scar resembling a cigarette burn at the surgery site.
When it’s used
Curettage and electrodesiccation can be effective for most small BCC lesions. In these instances, the procedure has cure rates close to 95 percent.
Mohs surgery
How it works
Mohs micrographic surgery is performed during a single visit, in several stages. The surgeon removes tissue around and beneath the tumor site and examines the skin cells under a microscope in an on-site lab, while the patient waits. If cancer cells remain at any of the margins, the surgeon removes another piece of tissue from the precise area where the BCC cells were found. The doctor repeats this process until no cancer cells remain.
When it’s used
Mohs surgery is the gold standard, the most effective technique for removing BCCs, harming minimal healthy tissue while achieving the highest possible cure rate — up to 99 percent on tumors treated for the first time. It is often recommended for BCCs located in areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also used for BCCs that are large, aggressive or growing rapidly and on tumors that have returned, as well as ones with indistinct edges. Get more details about Mohs surgery here.
Excisional surgery
How it works
Using a scalpel, the surgeon removes the entire tumor along with a “safety margin” of surrounding tissue. The margin of skin removed depends on the thickness and location of the tumor. If the lab finds cancer cells beyond the margins, more surgery may be performed at a later date until margins are cancer-free.
When it’s used
For small, early BCCs that have not spread, excisional surgery is frequently the only treatment required. Cure rates are above 95 percent in most body areas, similar to those of curettage and electrodesiccation.
Radiation therapy
How it works
The physician uses low-energy X-ray beams to destroy the tumor, with no need for cutting or anesthesia. Destruction of the tumor may require several treatments over a few weeks or daily treatments for a specified time.
When it’s used
Since the procedure is less precise and produces cure rates of only 90 percent, radiation therapy is primarily used for BCCs that are hard to treat with surgery, and in elderly patients or people in poor health for whom surgery is not advised. For some cases of advanced BCC, especially those involving surrounding nerves, radiation may be used after surgery or in combination with other treatments.
Cryosurgery
How it works
The dermatologist uses a cotton-tipped applicator or spray device to apply liquid nitrogen to freeze and destroy the tumor, which eventually falls off, allowing healthy skin to emerge.
When it’s used
Cryosurgery is effective for smaller, superficial BCCs. It is especially useful for patients with bleeding disorders or problems tolerating anesthesia. The cure rate is between 85 and 90 percent. This technique is used less commonly for invasive BCC because it may miss deeper portions of the tumor, and because scar tissue at the site can make a recurrence harder to detect.
Laser surgery
How it works
The dermatologist directs a beam of intense light at the tumor to target the cancerous cells. Some lasers vaporize (ablate) the skin cancer while others (nonablative lasers) convert the beam of light to heat, which destroys the tumor without injuring the surface of the skin.
When it’s used
Laser surgery is not yet FDA-approved for BCC but is sometimes used as a secondary therapy, especially when other techniques have been unsuccessful.
Photodynamic therapy (PDT)
How it works
The physician applies a light-sensitizing topical agent to the tumor or injects the agent into the tumor and, after allowing a short period of time for absorption, directs a strong blue or red light or laser at the tumor to activate the topical agent, killing cancer cells while sparing healthy tissue. After the procedure, patients must strictly avoid sunlight for at least 48 hours, as UV exposure will increase activation of the medication and may cause severe sunburns.
When it’s used
PDT can be used for some superficial BCCs on the face and scalp but is not recommended for invasive BCC.
Topical medications
Approved medications
5-fluorouracil (5-FU)
Imiquimod
Ingenol mebutate
How they work
These are creams or gels applied directly to affected areas of the skin to treat superficial BCCs with minimal risk of scarring. Imiquimod activates the immune system to attack cancerous cells, while 5-FU is topical chemotherapy that kills cancerous cells.
When they are used
5-FU, chemotherapy approved to treat certain internal cancers, has also been FDA-approved in topical form for superficial BCCs. Imiquimod is now approved for superficial BCCs, with cure rates generally between 80 and 90 percent. Oftentimes tumors diagnosed on biopsy to be superficial will have other invasive areas within the same lesion, making appropriate tumor selection for this treatment intrinsically difficult.
When weighing the pros and cons of treatment options, it’s important to consider that radiation, cryosurgery and topical medications all have one significant drawback in common — no tissue is examined under the microscope, so there is no way to determine how completely the tumor was removed.
Treating advanced BCCs
Approved medications
Two oral medications are FDA-approved for treating adults with very rare cases of advanced BCC that are large, have penetrated the skin deeply or have resisted multiple treatments and recurred.
How they work
Both medications are targeted drugs taken by mouth. They work by blocking the “hedgehog” signaling pathway, a key factor in the development of BCC. In 2012, vismodegib became the first medicine ever approved by the FDA for treating advanced BCC. A second hedgehog inhibitor drug, sonidegib was approved for advanced BCC in 2015.
When they are used
Vismodegib is used for the extraordinarily rare cases of metastatic BCC or locally advanced BCC (tumors that have penetrated the skin deeply or frequently recurred) that either recurs after surgery or cannot be treated with surgery or radiation and has become dangerous or life-threatening. Sonidegib is used in adults with BCC that is locally advanced, penetrating the skin deeply or repeatedly recurring, as well as in cases when other treatments such as surgery or radiation cannot be used.
Due to a risk of birth defects, women who are pregnant or may become pregnant should not use either drug. Couples must use birth control if the woman is capable of becoming pregnant while her partner is taking the medication. Scientists are also investigating several other targeted hedgehog inhibitors as potential treatments for locally advanced and metastatic BCC.
If additional treatment is needed, options may include
- Freezing – Your doctor may destroy actinic keratoses and some small, early skin cancers by freezing them with liquid nitrogen (cryosurgery). The dead tissue sloughs off when it thaws.
- Excisional surgery – This type of treatment may be appropriate for any type of skin cancer. Your doctor cuts out (excises) the cancerous tissue and a surrounding margin of healthy skin. A wide excision — removing extra normal skin around the tumor — may be recommended in some cases.
- Mohs surgery – This procedure is for larger, recurring or difficult-to-treat skin cancers, which may include both basal and squamous cell carcinomas. It’s often used in areas where it’s necessary to conserve as much skin as possible, such as on the nose. During Mohs surgery, your doctor removes the skin growth layer by layer, examining each layer under the microscope, until no abnormal cells remain. This procedure allows cancerous cells to be removed without taking an excessive amount of surrounding healthy skin.
- Curettage and electrodesiccation or cryotherapy – After removing most of a growth, your doctor scrapes away layers of cancer cells using a device with a circular blade (curet). An electric needle destroys any remaining cancer cells. In a variation of this procedure, liquid nitrogen can be used to freeze the base and edges of the treated area.
- Chemotherapy – In chemotherapy, drugs are used to kill cancer cells. For cancers limited to the top layer of skin, creams or lotions containing anti-cancer agents may be applied directly to the skin. Systemic chemotherapy can be used to treat skin cancers that have spread to other parts of the body.
- Photodynamic therapy – This treatment destroys skin cancer cells with a combination of laser light and drugs that makes cancer cells sensitive to light.
- Biological therapy – Biological therapy uses your body’s immune system to kill cancer cells.
Radiotherapy
- Radiotherapy is an effective treatment modality for select patients with NMSC unable to undergo surgery, as efficacy is overall lower than with MMS or SE with predetermined margins. In a meta-analysis by Rowe et al., radiotherapy was found to have an overall 5-year cure rate of 91.3% for BCC, and in a similar study, the 5-year cure rate was found to be 90% for SCC.[rx,rx]
- Adjuvant radiotherapy may be beneficial postoperatively for tumors with perineural invasion or as a palliative treatment when complete margin excision is not attainable due to extensive disease.[rx]
- Radiotherapy has been shown to increase the risk of subsequent BCC and SCC by threefold and should not be considered in younger patients, and is contraindicated in patients with genodermatoses susceptible for developing skin cancer.[rx] Complications include long-term skin atrophy and necrosis.
Curettage and cautery
- Curettage and cautery (C and C) involve removing epidermis and dermis containing tumor tissue with a sharp ring curette instrument prior to charring of the base of the wound with electrocautery. This process can be repeated immediately once or twice and provides an effective treatment of low-risk NMSC. Silverman et al. retrospectively reviewed 2314 primary BCCs treated with C and C and found tumors less than 5 mm provided a cure rate of 91% at 5 years.[rx] However, with increasing diameter, cure rates significantly decreased. A prospective trial reported high cure rates for low-risk BCC with the combination of curettage and then cryosurgery to the wound in place of cautery. At 5-year follow-up of 94 superficial BCC (CBC) treated, only one recurrence was noted.[rx]
- For SCC, Rowe et al. reported an overall 5-year cure rate of 96% in a retrospective study of the published literature.[rx] However, with high-risk SCC, the cure rate is lower, and hence C and C for NMSC is recommended only for low-risk tumors.
Cryosurgery
- Cryosurgery involves the delivery of liquid nitrogen to freeze and then thaw the target tumor tissue, inducing local cellular destruction. Significant variation in the duration of the freeze and the number of freeze-thaw cycles for cryosurgery exists in the literature in the treatment of NMSC. High cure rates have been reported for NMSC. Kuflik reported 99% 5-year cure rate for 415 BCC cases treated with cryosurgery and 100% 5-year cure rate for 132 treated SCC cases.[rx]
- High-risk NMSC is associated with lower cure rates, and cryosurgery is recommended for low-risk BCC. Cryosurgery is not recommended for SCC as these tumors have a potential for metastasis, and a more definitive therapy such as surgery, radiotherapy or C and C (for low-risk SCC) is advocated. Treatment with cryosurgery will also manifest a hypopigmented scar, which may have a cosmetically inferior outcome compared to the other treatment modalities.
Photodynamic therapy
- Photodynamic therapy (PDT) is an effective therapy for CBC or low-risk nodular BCC of less than 2 mm thickness. PDT involves the topical application of 5-aminolaevulinic acid (ALA) or methyl aminolaevulinic (MAL). Following uptake of the drug into the tumor cells preferentially, conversion into protoporphyrin IX (PpIX) occurs. The BCC is then illuminated with 410 nm blue or 630 nm red light with activation of PpIX and production of a cytotoxic reaction for tumor destruction.[rx]
- It is accepted that PDT provides excellent cosmetic results in comparison to other treatment modalities; however, little published evidence is present for a long-term response. The majority of studies report upon 1–2-year follow-up data showing cure rates over 90% for CBC.[rx] Basset-Seguin et al. performed a multicentre randomized study comparing 114 CBC treated with MAL-PDT against 105 CBC treated with a double freeze-thaw cycle of cryosurgery. Five-year cure rates for PDT were found to be 78% and 80% for cryosurgery.[rx] PDT is an excellent choice of treatment for CBC but is not recommended for high-risk BCC or any SCC.
Imiquimod
- Imiquimod is a topical immunomodulator, activating cytotoxic T cell against tumor cells via binding to cell surface toll receptor 7 and/or 8.[rx] Imiquimod is an effective treatment for CBC, though most studies report on short-term follow-up data only. Quirk et al. performed a prospective, open-label multicentre study of 169 CBC treated with 5% imiquimod cream daily for 6 weeks. Five-year follow-up data showed 84% cure rate.[rx] The main side effects of the treatment are erythema, crusting, pain, flu-like symptoms and ulceration which can be severe. Topical imiquimod is not recommended for SCC as recurrence rates are too high.
Topical 5-fluorouracil
- 5-fluorouracil (5FU) is a pyrimidine antimetabolite that inhibits DNA synthesis. Topical treatment has been reported for CBC. Romagaso et al. published a small study of 17 CBC showing 90% histological cure rate at 16 weeks. However, the strength of evidence is lacking and topical 5FU is not the recommended first-line treatment of CBC.[rx]
Risk factors
Factors that may increase your risk of skin cancer include:
- Fair skin – Anyone, regardless of skin color, can get skin cancer. However, having less pigment (melanin) in your skin provides less protection from damaging UV radiation. If you have blond or red hair and light-colored eyes, and you freckle or sunburn easily, you’re much more likely to develop skin cancer than is a person with darker skin.
- A history of sunburns – Having had one or more blistering sunburns as a child or teenager increases your risk of developing skin cancer as an adult. Sunburns in adulthood also are a risk factor.
- Excessive sun exposure – Anyone who spends considerable time in the sun may develop skin cancer, especially if the skin isn’t protected by sunscreen or clothing. Tanning, including exposure to tanning lamps and beds, also puts you at risk. A tan is your skin’s injury response to excessive UV radiation.
- Sunny or high-altitude climates – People who live in sunny, warm climates are exposed to more sunlight than are people who live in colder climates. Living at higher elevations, where the sunlight is strongest, also exposes you to more radiation.
- Moles – People who have many moles or abnormal moles called dysplastic nevi are at increased risk of skin cancer. These abnormal moles — which look irregular and are generally larger than normal moles — are more likely than others to become cancerous. If you have a history of abnormal moles, watch them regularly for changes.
- Precancerous skin lesions – Having skin lesions known as actinic keratoses can increase your risk of developing skin cancer. These precancerous skin growths typically appear as rough, scaly patches that range in color from brown to dark pink. They’re most common on the face, head, and hands of fair-skinned people whose skin has been sun-damaged.
- A family history of skin cancer – If one of your parents or a sibling has had skin cancer, you may have an increased risk of the disease.
- A personal history of skin cancer – If you developed skin cancer once, you’re at risk of developing it again.
- A weakened immune system – People with weakened immune systems have a greater risk of developing skin cancer. This includes people living with HIV/AIDS and those taking immunosuppressant drugs after an organ transplant.
- Exposure to radiation – People who received radiation treatment for skin conditions such as eczema and acne may have an increased risk of skin cancer, particularly basal cell carcinoma.
- Exposure to certain substances – Exposure to certain substances, such as arsenic, may increase your risk of skin cancer.
Prevention
Most skin cancers are preventable. To protect yourself, follow these skin cancer prevention tips:
- Avoid the sun during the middle of the day – For many people in North America, the sun’s rays are strongest between about 10 a.m. and 4 p.m. Schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy. You absorb UV radiation year-round, and clouds offer little protection from damaging rays. Avoiding the sun at its strongest helps you avoid the sunburns and suntans that cause skin damage and increase your risk of developing skin cancer. Sun exposure accumulated over time also may cause skin cancer.
- Wear sunscreen year-round – Sunscreens don’t filter out all harmful UV radiation, especially the radiation that can lead to melanoma. But they play a major role in an overall sun protection program. Use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Apply sunscreen generously, and reapply every two hours — or more often if you’re swimming or perspiring. Use a generous amount of sunscreen on all exposed skin, including your lips, the tips of your ears, and the backs of your hands and neck.
- Wear protective clothing – Sunscreens don’t provide complete protection from UV rays. So cover your skin with dark, tightly woven clothing that covers your arms and legs, and a broad-brimmed hat, which provides more protection than a baseball cap or visor does. Some companies also sell photoprotective clothing. A dermatologist can recommend an appropriate brand. Don’t forget sunglasses. Look for those that block both types of UV radiation — UVA and UVB rays.
- Avoid tanning beds – Lights used in tanning beds emit UV rays and can increase your risk of skin cancer.
- Be aware of sun-sensitizing medications – Some common prescription and over-the-counter drugs, including antibiotics, can make your skin more sensitive to sunlight. Ask your doctor or pharmacist about the side effects of any medications you take. If they increase your sensitivity to sunlight, take extra precautions to stay out of the sun in order to protect your skin.
- Check your skin regularly and report changes to your doctor – Examine your skin often for new skin growths or changes in existing moles, freckles, bumps and birthmarks. With the help of mirrors, check your face, neck, ears, and scalp. Examine your chest and trunk, and the tops and undersides of your arms and hands. Examine both the front and back of your legs and your feet, including the soles and the spaces between your toes. Also, check your genital area and between your buttocks.
Skin Cancer Facts
The skin is the largest organ in the body. Skin cancer is the most common of all human cancers. Some form of skin cancer is diagnosed in more than 3 million people in the United States each year.
Cancer occurs when normal cells undergo a transformation during which they grow abnormally and multiply without normal controls.
- As the cells multiply, they form a mass called a tumor. Tumors of the skin are often referred to as skin lesions.
- Tumors are said to be cancerous only if they are composed of malignant cells. This means that they encroach on and invade neighboring tissues because of their uncontrolled growth.
- Tumors may also travel to remote organs via the bloodstream or lymphatic system.
- This process of invading and spreading to other organs is called metastasis.
- Tumors overwhelm surrounding tissues by invading their space and taking the oxygen and nutrients the normal cells need to survive and function.
Skin cancers are of three major types: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma.
- The vast majority of skin cancers are BCCs or SCCs. While malignant, these are unlikely to spread to other parts of the body. They may be locally disfiguring if not treated early.
- A small but significant number of skin cancers are malignant melanomas. Malignant melanoma is a highly aggressive cancer that tends to metastasize relatively early and aggressively, thereby spreading to other parts of the body. These cancers may be fatal if not found and treated early.
Like many cancers, skin cancers start as precancerous lesions. These precancerous lesions are changes in skin that are not cancer but could become cancer over time. Medical professionals often refer to these changes as dysplasia. Some specific dysplastic changes that occur in skin are as follows:
- Actinic keratosis is a patch of red or brown, scaly, rough skin, which can develop into any kind of skin cancer, but most commonly precede the appearance of squamous cell carcinoma.
- A nevus is a mole, and dysplastic nevi are abnormal moles. These can develop into melanoma over time.
Moles (nevi) are simply growths on the skin. They are very common. Very few moles become cancer.
- Most people have 10-40 moles on their body.
- Moles can be flat or raised; some begin as flat and become raised over time.
- The surface is usually smooth.
- Moles are round or oval and no larger than ¼-inch across.
- Moles are usually pink, tan, brown, or the same color as the skin. Other colors are sometimes noted.
- An individual’s moles usually look pretty much alike. A mole that looks different from the others should be examined by your healthcare professional.
Dysplastic nevi are not cancer, but they can become cancer.
- People with dysplastic nevi often have a lot of them, perhaps as many as 100 or more.
- People with many dysplastic nevi are more likely to develop melanoma, either within an existing nevus or on an area of normal-appearing skin.
- Dysplastic nevi are usually irregular in shape, with notched or fading borders.
- Dysplastic nevi may be flat or raised, and the surface may be smooth or rough (“pebbly”).
- Dysplastic nevi are often large, at least ¼-inch across or even larger.
- Dysplastic nevi are typically of mixed color, including pink, red, tan, and brown.
Recent studies demonstrate that the number of skin cancer cases in the United States is growing at an alarming rate. Fortunately, increased awareness on the part of Americans and their healthcare professional has resulted in earlier diagnosis and improved outcomes.
References
