Skin Cancer

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Introduction

What is skin cancer?

The skin is the largest organ of the body. It provides protection, helps regulate body temperature, and plays a role in sensation. It is also the most common site of cancer. Each year about two million people in the United States are diagnosed with skin cancer (Source: AAD).

The most common skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell carcinomas are often smooth and shiny, may be skin-toned or slightly darker, and may be raised with a central dimple. Squamous cell carcinomas may also be shiny, but they tend to be scalier and may have flat, reddish patches. The appearance of melanomas is often described as ABCD, where A stands for asymmetrical, B stands for borders, which are often irregular, C stands for color, which may be black, brown, tan, or even blue, red, or white, and D stands for diameter, which is often larger than 6mm.

The risk factors for developing any of these three types of skin cancers are similar, and include fair skin and excessive sun exposure. The use of tanning beds also contributes to the development of these cancers.

Both basal and squamous cell cancers are usually easily treatable with simple removal and typically do not spread to distant sites (metastasize). Melanoma is a more aggressive and dangerous type of skin cancer. If it is not detected and treated early, melanoma has a high risk of spreading and can be fatal.

Skin cancers can be serious. Seek prompt medical care if you notice any suspicious changes in your skin including sores that don’t heal, have a shiny, raised appearance or a scaly appearance, or bleed easily. Prompt medical care should be sought for any skin changes that are asymmetrical, have irregular borders, are changing in appearance or color, or are greater than 6 mm in diameter.

Symptoms

What are the symptoms of skin cancer?

Skin cancer may present as an irritated area of skin that won’t heal. Basal cell cancers are often raised with rounded edges and may have a central dimple. Squamous cell cancers tend to be scaly. Melanomas are often pigmented and asymmetrical with irregular borders and features. They also tend to be larger than 6 mm.

Common symptoms of skin cancer

Common symptoms of skin cancer include:

  • Area with a shiny, pearly or waxy appearance
  • Asymmetrical bump or spot on the skin
  • Borders that are irregular
  • Color changes resulting in a black, brown, tan, blue, red, pink or white area
  • Nonhealing scab or ulcer
  • Noticeable blood vessels in or near an area of skin change
  • Raised area with rounded edges, possibly with a central dimple
  • Scaly area of skin
  • Scar-like appearance in an area that has not been injured
  • Skin sore that may bleed and crust over but does not go away
  • Shift in appearance of a mole or other skin lesion
  • Spread of a skin abnormality to a larger area

Symptoms that might indicate a serious condition

Skin cancer, especially melanoma, can be a serious condition that should be evaluated without delay. Seek prompt medical care if you, or someone you are with, have any of these serious symptoms:

  • Area of skin change that is larger than 6 mm in diameter
  • Area of skin that turns red, black, brown, tan, blue or white
  • Bump or discoloration of the skin that has irregular borders
  • Bump or discoloration of the skin that is asymmetrical
  • Skin change that seems to be spreading
  • Skin sore that bleeds easily
  • Skin sore that does not heal
  • Swollen regional lymph nodes
Causes

What causes skin cancer?

While the specific cause is not known, skin cancer is more common in fair-skinned individuals with a history of sun exposure or tanning-bed use. Other risk factors have also been identified.

What are the risk factors for skin cancer?

A number of factors increase the risk of developing skin cancer. Not all people with risk factors will get skin cancer. Risk factors for skin cancer include:

  • Certain genetic conditions

  • Compromised immune system due to such conditions as HIV/AIDS or taking corticosteroids or medications for organ transplant

  • Exposure to certain chemicals or radiation

  • Exposure to excessive UV radiation (sunny climates, high altitudes)

  • Fair skin

  • Family or personal history of skin cancer

  • Multiple moles on the body or abnormal moles (dysplastic nevi)

  • Personal history of a blistering sunburn as a child

  • Personal history of a bad burn

  • Precancerous lesions such as actinic keratosis

  • Radiation exposure

  • Sun exposure

  • Tanning bed use

Reducing your risk of skin cancer

You may be able to lower your risk of skin cancer by:

  • Using sunscreen year round

  • Avoiding tanning beds and excessive sun exposure

  • Beware of medications that cause sensitivity to the sun

  • Prompt diagnosis and treatment of precancerous skin lesions

  • Protecting your skin with a hat, long sleeves, and pants 

  • Routine all-over skin checks by you and your doctor

Treatments

How is skin cancer treated?

Treatment of skin cancer begins with seeking regular medical care throughout your life. Regular medical care allows a health care professional to provide early screening tests. Regular medical care also provides an opportunity for your health care professional to promptly evaluate symptoms and your risks for developing skin cancer.

Goal of cancer treatment

The goal of skin cancer treatment is to permanently cure the cancer or to bring about a complete remission of the disease. Remission means that there is no longer any sign of the disease in the body, although it may recur or relapse later.

Common treatments for skin cancer

Common treatments for skin cancer include:

  • Chemotherapy to attack cancer cells

  • Cryotherapy to freeze off cancers

  • Curettage and electrocautery to scrape and burn off cancers

  • Immunotherapy to enhance the immune system’s ability to fight cancer

  • Laser therapy to remove lesions

  • MOHS surgery ( a specific form of skin cancer surgery designed to remove as little healthy tissue as possible)

  • Participation in a clinical trial testing promising new treatments for skin cancer

  • Photodynamic therapy, in which light is used to activate chemicals that attack cancer cells 

  • Surgery to remove cancer

  • Topical cream to treat superficial cancers

Complementary treatments

Some complementary treatments may help some people to better deal with skin cancer and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

Hospice care

In cases in which skin cancer has progressed to an advanced stage and has become unresponsive to treatment, the goal of treatment may shift away from curing the disease and focus on measures to keep a person comfortable and maximize the quality of life. Hospice care involves medically controlling pain and other symptoms while providing psychological and spiritual support as well as services to support the patient’s family.

What are the potential complications of skin cancer?

Basal cell carcinoma rarely spreads to other areas of the body, but it can continue to spread along the skin to involve larger and larger areas. Left untreated, squamous cell cancer is somewhat more likely to spread to other areas of the body and can spread locally to involve larger and larger areas of the skin. Melanoma is the most dangerous of the skin cancers, since this cancer may spread to lymph nodes and internal organs.

Complications of skin cancer include:

  • Adverse effects of treatment

  • Cosmetic disfigurement

  • Local or distant (metastatic) spread of the disease

  • Recurring cancer after treatment

  • Secondary cancer (metastatic cancer), such as brain or lung cancer

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 6
  1. Fact sheet: Preventing and detecting skin cancer. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002414/
  2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013; 63:11.
  3. Skin cancer: Diagnosis, treatment, and outcome. American Academy of Dermatology. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/skin-cancer/diagnosis-treatment
  4. Ferri FF (Ed.) Ferri’s Fast Facts in Dermatology. Philadelphia: Saunders Elsevier, 2011.
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