Skin Cancer

Skin cancer at a glance

• Skin cancer is the uncontrolled growth of abnormal skin cells.
• This is the most common form of cancer.
• The three main types are basal cell carcinoma, squamous cell carcinoma and melanoma.
• Overexposure to ultraviolet rays from the sun is a risk factor for developing this cancer.
• Symptoms include skin growths and mole abnormalities.
• There are several treatment options that aim to remove the cancerous cells with minimal scarring.

What is skin cancer?

Skin cancer is the uncontrolled growth of abnormal skin cells. According to the Skin Cancer Foundation, a diagnosis occurs more often each year in the United States than all other cancers combined, with an estimated 4.3 million cases of basal cell carcinoma alone. Skin cancer is responsible for more than 3,000 deaths annually.

Types of skin cancer

These cancers are divided into three major types.

Basal cell carcinoma affects the bottom layer of the epidermis and is the most common form. A slow-growing cancer, basal cell carcinoma occurs in areas of the body that get the most sun, typically the head and neck areas. This is usually the easiest form of cancer of the skin to treat.

Squamous cell carcinoma affects the top layer of the epidermis and is usually easy to detect early. Similar to basal cell carcinoma, this type of cancer most often occurs in sun-exposed skin like the ears, lips, face and hands. However, it is more aggressive than basal cell carcinoma and may spread if left untreated.

Melanoma cancer occurs in the skin cells that create pigment called melanocytes. According to The American Melanoma Foundation, melanoma is less common but causes the vast majority of all skin cancer-related deaths, making it much more dangerous than other cancers of the skin.

Less common forms are Merkel cell carcinoma, skin lymphoma and Kaposi sarcoma.

Causes and risk factors

Skin cancer occurs when mutations happen in the DNA of skin cells, causing the cells to grow excessively and form a mass of cancer cells. Despite affecting different parts of the skin, most cancers of the skin have similar risk factors, including the following.

• Prolonged exposure to ultraviolet (UV) rays. UV rays are a kind of invisible radiation, which can come from the sun, sunlamps or tanning beds to penetrate and damage skin cells.
• Over 40 years of age. Older people have a higher risk of these cancers due to possible long-term exposure to the sun.
• A family history of skin cancer. If someone in a person’s family has had this cancer, he or she may have an increased risk.
• A history of sunburns. Experiencing severe sunburns as a child or teenager increases one’s risk of developing cancers of the skin as an adult.
• People with many moles have more collections of benign melanocytes that may have increased risk of developing into skin cancer.
• A fair complexion. Less pigment in the skin results in less protection from damaging UV radiation.
• Living in sunny or high-altitude climates. Living in sunny areas increases long-term exposure to the sun. Higher-altitude climates that are closer to the sun experience stronger UV rays.

Skin cancer symptoms

Basal cell carcinoma may appear either as a raised, pearly or waxy pink bump, oftentimes with a dimple in the middle, or as a flat, flesh-colored or brown scar-like lesion.

Squamous cell carcinoma may appear as a firm, red nodule or a flat lesion with a scaly, crusted surface.

Melanoma may appear as an irregular or asymmetrical mole or growth. Typically, a mole is a benign collection of melanocytes but a mole may be suspected of melanoma if it has:

• Asymmetrical shape.
• Border irregularities.
• Color that isn’t consistent.
• Diameter larger than 6 millimeters.
• Evolving size or shape.

Detection and diagnosis

Skin cancer begins in the top layer of the skin called the epidermis. In constant contact with the environment, this thin, protective layer of skin cells is continually being shed and reproduced. Being familiar with the skin will help people detect skin cancer symptoms. Unusual skin growth or sores that don’t go away may be indications of a non-melanoma skin cancer. Changes in an existing mole, abnormal moles, or appearances of new growths may be indications of skin cancer.

Consulting an oncologist or dermatologist for a screening and diagnosis can determine if skin growths are cancerous. A sample, or biopsy, of skin will be taken from the growth and then sent to a lab where it will be tested for cancer cells.

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Treatments & associated risks

Patients have several treatment options to consider that aim to remove the cancerous cells with minimal scarring. Risks for the surgical types of treatments below include bleeding and infection.

• Excision involves numbing the area and cutting the cancerous cells out.
• Curettage and desiccation includes scraping the cancerous cells away and using electricity to kill any other cancer cells.
• Cryosurgery kills cancer cells by freezing them with liquid nitrogen; risks include redness, blistering and swelling.
• Radiation therapy uses X-rays to destroy cancer cells over a several week time period; risks include irritation, peeling, change in skin color and hair loss in the area.
• Mohs surgery is a layer by layer removal of the cancer cells and is typically used for large or sensitive areas of the body, an older malignancy or one that has returned, even after treatment.
• Creams and pills may be suggested to treat basal cell carcinoma; risks include irritation at the site of treatment.

Prevention

Most skin cancers are preventable. People can reduce their risk by protecting their skin.

• Avoid midday sun. This is when the rays are the strongest.
• Wear sunscreen. A broad-spectrum sunscreen with SPF (sun protection factor) of at least 15 reduces exposure to harmful UV radiation and should be applied year-round.
• Wear protective clothing. Hats, sunglasses, photoprotective clothing and long sleeves can provide an extra layer of protection for the skin.
• Avoid tanning beds. Emitting UV rays, tanning beds increase one’s risk.
• Be aware of sun-sensitizing medications. Ask a doctor or pharmacist to determine if any medications increase light-sensitivity, and take the appropriate precautions to stay out of the sun.
• Check skin regularly. Examine skin conditions regularly to detect changes early on. Schedule an appointment and share any changes with a healthcare provider.