Skin cancer is the most common of all human cancers. In 2022, about 100,000 people in the U.S. are expected to be diagnosed with some type of the disease. About 7,650 are expected to die.
Cancer occurs when normal cells undergo a transformation and grow and multiply without normal controls. Here are the cancer basics: There are three major types of skin cancers:
basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and
melanoma. The first two skin cancers are grouped together as non-melanoma skin cancers. Other unusual types of skin cancer include Merkel cell tumors and dermatofibrosarcoma protruberans. Here
are the basics on skin cancers: 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: Recent studies show the number of
skin cancer cases in the U.S. growing at an alarming rate. Fortunately, increased awareness on the part of Americans and their health care providers has resulted in earlier
diagnosis and improved outcomes. ContinuedSkin Cancer CausesUltraviolet (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:
The following people are at the greatest risk of skin cancer:
Basal cell carcinomas and squamous cell carcinomas are more common in older people. Melanomas are one of the most common cancers in younger people, especially in people ages 25 to 29. The risk of melanoma rises with age. Skin Cancer SymptomsSkin cancer symptoms depend on the type of skin cancer that has developed. A basal cell carcinoma (BCC) usually looks like a raised, smooth, pearly bump on the sun-exposed skin of the head, neck, or shoulders. Others signs include:
A squamous cell carcinoma (SCC) is commonly a well-defined, red, scaling, thickened bump on sun-exposed skin. It may ulcerate and bleed, and left untreated, may develop into a large mass. The majority of malignant or cancerous melanomas are brown-to-black pigmented lesions. Other signs of a cancerous melanoma include:
ContinuedThe following easy-to-remember guideline, "ABCDE," is useful for identifying malignant melanoma:
When to Seek Medical Care for Skin CancerMany people, especially those who have fair coloring or have had extensive sun exposure, periodically check their entire body for suspicious moles and lesions. Have your primary health care provider or a dermatologist check any moles or spots that concern you. See your health care provider to check your skin if you notice any changes in the size, shape, color, or texture of pigmented areas (such as darker or a change in areas of skin or moles). If you have skin cancer, your skin specialist (dermatologist) or cancer specialist (oncologist) will talk to you about symptoms of metastatic disease that might require care in a hospital. Exams and Tests for Skin CancerIf you think a mole or other skin lesion has turned into skin cancer, your primary care provider will probably refer you to a dermatologist. The dermatologist will examine any moles in question and, in many cases, the entire skin surface. Any lesions that are difficult to identify, or are thought to be skin cancer, may then be checked. Tests for skin cancer may include:
If a biopsy shows that you have malignant melanoma, you may undergo further testing to determine the extent of spread of the disease, if any. This may involve blood tests, a chest X-ray, and other tests as needed. This is only needed if the melanoma is of a certain size. ContinuedSkin Cancer TreatmentSkin cancer treatment for basal cell carcinoma and squamous cell carcinoma is straightforward. Usually, surgical removal of the lesion is adequate. Malignant melanoma, however, may require several treatment methods -- depending on the size of the tumor -- including surgery, radiation therapy, immunotherapy, and chemotherapy. Because of the complexity of treatment decisions, people with malignant melanoma may benefit from the combined expertise of the dermatologist, a cancer surgeon, and an oncologist. Skin Cancer Care at HomeHome treatment is not appropriate for skin cancer. These conditions require the care of a dermatologist or specialist in skin cancers. Be active in preventing and detecting skin cancer on yourself and others. Perform regular self-examinations of your skin and note any changes. Medical Treatment for Skin CancerSurgical removal is the mainstay of skin cancer treatment for both basal cell and squamous cell carcinomas. For more information, see Surgery. People who cannot undergo surgery may be treated by external radiation therapy. Radiation therapy is the use of a small beam of radiation targeted at the skin lesion. The radiation kills the abnormal cells and destroys the lesion. Radiation therapy can cause irritation or burning of the surrounding normal skin. It can also cause fatigue. These side effects are temporary. In addition, topical chemotherapy creams have been FDA approved for the treatment of certain low-risk nonmelanoma skin cancers. Patients with advanced or many basal cell carcinomas are sometimes prescribed oral pills to block the growth of these cancers. Side effects include muscle spasms, hair loss, taste changes, weight loss and fatigue. In advanced cases of melanoma, immune therapies, vaccines, or chemotherapy may be used. These treatments are typically offered as clinical trials. Clinical trials are studies of new therapies to see if they can be tolerated and work better than existing therapies. Surgery for Skin CancerSmall skin cancer lesions may be removed through a variety of techniques, including simple excision (cutting it away), electrodesiccation and curettage (scraping the tumor and then burning the tissue with an electric needle), and cryosurgery (freezing the area with liquid nitrogen). Larger tumors, lesions in high-risk locations, recurrent tumors, and lesions in cosmetically sensitive areas are removed by a technique called Mohs micrographic surgery. For this technique, the surgeon carefully removes tissue, layer by layer, until cancer-free tissue is reached. Malignant melanoma is treated more aggressively than just surgical removal. To ensure the complete removal of this dangerous malignancy, 1-2 cm of normal-appearing skin surrounding the tumor is also removed. Depending on the thickness of the melanoma, neighboring lymph nodes may also be removed and tested for cancer. The sentinel lymph node biopsy method uses a mildly radioactive substance to identify which lymph nodes are most likely to be affected. ContinuedAfter Skin Cancer TreatmentMost skin cancer is cured surgically in the dermatologist's office. Of skin cancers that do recur, most do so within three years. Therefore, follow up with your dermatologist as recommended. Make an appointment immediately if you suspect a problem. If you have advanced malignant melanoma, your oncologist may want to see you every few months. These visits may include total body skin exams, regional lymph node checks, and periodic chest X-rays and body scans. Over time, the intervals between follow-up appointments will increase. Eventually these checks may be done only once a year. Skin Cancer PreventionYou can reduce your risk of getting skin cancer by following these guidelines:
Skin Self-Exams Monthly skin self-exams improve your chances of finding a skin cancer early, when it has done a minimum of damage to your skin and can be treated easily. Regular self-exams help you recognize any new or changing features.
Check all areas of your body, including "hard-to-reach" areas. Ask a loved one to help you check if there are areas you can't see.
If you are at high risk for developing skin cancer, ask you doctor about oral nicotinamide, a vitamin B3 supplement taken twice daily in pill form that can decrease the rate of new squamous cell and basal cells by almost 25%. ContinuedSkin Cancer OutlookAlthough the number of skin cancers in the U.S. continues to rise, more skin cancers are being caught earlier, when they are easier to treat. Thus, illness and death rates have decreased. When treated properly, the cure rate for both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) approaches 95%. The remaining cancers recur at some point after treatment.
In most cases, the outcome of malignant melanoma depends on the thickness of the tumor at the time of treatment.
Skin Cancer Support Groups and CounselingLiving with skin cancer presents many new challenges for you and for your family and friends. You will probably have many worries about how the cancer will affect you and your ability to "live a normal life," that is, to care for your family and home, to hold your job, and to continue the friendships and activities you enjoy. Many people with a skin cancer diagnosis feel anxious and depressed. Some people feel angry and resentful; others feel helpless and defeated. For most people with skin cancer, talking about their feelings and concerns helps. Your friends and family members can be very supportive. They may be hesitant to offer support until they see how you are coping. Don't wait for them to bring it up. If you want to talk about your concerns, let them know. ContinuedSome people don't want to "burden" their loved ones, or prefer talking about their concerns with a more neutral professional. A social worker, counselor, or member of the clergy can be helpful. Your dermatologist or oncologist should be able to recommend someone. Many people with cancer are profoundly helped by talking to other people who have cancer. Sharing your concerns with others who have been through the same thing can be remarkably reassuring. Support groups for people with cancer may be available through the medical center where you are receiving your treatment. The American Cancer Society also has information about support groups throughout the U.S. For More Information About Skin CancerNational Cancer Institute, Cancer Information Service (CIS) Skin Cancer Foundation www.skincancer.org Skin Cancer Web LinksFor information about clinical trials in skin cancer treatment, visit the National Institute of Health's Clinical Trials database. For other valuable information, visit the following websites: Skin Cancer PicturesMedia file 1: Skin cancer. Malignant melanoma.
Media file 2: Skin cancer. Basal cell carcinoma. Media file 3: Skin cancer. Superficial spreading melanoma, left breast. Photo courtesy of Susan M. Swetter, MD, Director of Pigmented Lesion and Cutaneous Melanoma Clinic, Assistant Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System.
Media file 4: Skin cancer. Melanoma on the sole of the foot. Diagnostic punch biopsy site located at the top. Photo courtesy of Susan M. Swetter, MD, Director of Pigmented Lesion and Cutaneous Melanoma Clinic, Assistant Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System.
Media file 5: Skin cancer. Melanoma, right lower cheek. Photo courtesy of Susan M. Swetter, MD, Director of Pigmented Lesion and Cutaneous Melanoma Clinic, Assistant Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System. Continued
Media file 6: Skin cancer. Large sun-induced squamous cell carcinoma (skin cancer) on the forehead and temple. Image courtesy of Dr. Glenn Goldman.
Which is more serious basal cell or squamous cell carcinoma?Though not as common as basal cell (about one million new cases a year), squamous cell is more serious because it is likely to spread (metastasize). Treated early, the cure rate is over 90%, but metastases occur in 1%–5% of cases.
Which grows faster basal cell or squamous cell carcinoma?Squamous Cell Skin Cancer Growth Rate: Squamous cell cancers, while still slow-growing, are known to grow more rapidly than basal cell cancers. And, unlike basal cell cancers, there is an increased risk of squamous cell cancers spreading to other areas of the body – like the local lymph system – if left untreated.
Is squamous cell carcinoma more aggressive than basal cell carcinoma?Although squamous cell carcinoma can be more aggressive than basal cell cancer, the risk of this type of cancer spreading is low—as long as the cancer is treated early, Dr. Leffell says. He notes that the lesions must be treated with respect because they may grow rapidly and invade deeply.
Does basal cell carcinoma turn into squamous?One type of skin cancer called basal cell carcinoma begins in the basal cells, which make skin cells that continuously push older cells toward the surface. As new cells move upward, they become flattened squamous cells, where a skin cancer called squamous cell carcinoma can occur.
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