Skin Cancer

The number of cases of skin cancer is rising each year in the United States. According to the American Cancer Society (ACS), exposure to ultraviolet (UV) rays is believed to be the biggest culprit. That's why it's so important to protect your skin (Read about "Skin") from excessive sun exposure. It's also important to check your skin regularly for warning signs of skin cancer. If caught and treated early, skin cancer CAN be successfully treated.

Types of Skin Cancer

Although skin cancer (Read about "Cancer: What It Is") can develop on any part of the body, it's most commonly found on areas that are often exposed to the sun. The National Cancer Institute (NCI) and ACS say there are different types of skin cancer:

• Basal cell cancer, the most common, is relatively slow-growing in many cases. It begins in the lowest layer of the epidermis, called the basal cell layer. It can first appear as a waxy bump or a flat lesion.
• Squamous cell cancer is also slow-growing but it can metastasize or spread to other body parts. It begins in the middle portion of the epidermis. This type of cancer can also start as a pearly bump or a flat lesion. It may be crusted as well.
• Malignant melanoma is the most dangerous type. It originates in the melanocytes, or pigment producing cells of the skin. It starts as a pearly or dark bump or as a small lesion with irregular borders. About a third of the cases start in moles that suddenly change appearance or start to bleed. (Read about "Moles/Nevi")
• Other nonmelanoma skin cancers account for less than one percent of nonmelanoma skin cancers, according to ACS. These less common skin cancers include:
  • Kaposi's sarcoma, which usually starts within the dermis but can also form in internal organs. The tumors consist of bluish-red or purple lesions. This cancer occurs in people with compromised immune systems (Read about "The Immune System"), such as those with HIV infection or AIDS (Read about "HIV / AIDS"), as well as transplant recipients who are on immune-suppressing drugs. (Read about "Transplants")
  • cutaneous lymphoma, a type of lymphoma (Read about "Lymphoma") that begins in the skin.
  • skin adnexal tumors, rare tumors that start in the hair follicles or sweat glands, and are usually benign. Skin adnexal tumors can be found on skin throughout the body, including the eyelids. (Read about "Eye Cancer")
  • sarcomas, which usually start in tissues deep beneath the skin, but can develop in the skin as well.
  • Merkel cell carcinoma, a rare cancer that develops on or just beneath the skin and in hair follicles, and usually appears as firm, shiny skin lumps. It is very aggressive, so early detection and treatment are essential.

There is another condition, actinic keratosis (AK), which appears as rough, red or brown scaly patches on the skin. AK is known as a precancerous condition because it sometimes develops into cancer. Like skin cancer, it usually appears on sun-exposed areas but can be found elsewhere. The National Institutes of Health say AK's may start as small, red, flat spots then grow larger and become scaly or thick, like a wart. Most AKs form on the face or back of the hands, but can appear elsewhere.

When examining your skin for changes or growths, the American Academy of Dermatology says there are "ABCD" warning signs to be aware of:

• Asymmetry - one half of a growth does not match the other half.
• Border irregularity - the edges are ragged, notched or blurred.
• Color - the pigmentation is mottled or not uniform.
• Diameter - the width is greater than six millimeters (about the size of a pencil eraser).
• Evolving - a mole or growth that looks different or is changing in its size, shape, or color

In general, any unusual change in the skin, especially a new growth or sore that doesn't heal, can be a warning sign of skin cancer, and should be checked promptly by your physician. Any growth of a mole should be of concern too. When caught early, your chances for successful treatment are much higher. (Read about "Cancer Check-ups")

Who's at risk

Since sun exposure is most commonly linked to skin cancer, people who have a history of frequent sun exposure as well as sunburns are at a higher risk of the disease. NCI says fair skinned individuals, especially if they have blond or red hair and blue eyes are more at risk, as are people with a family history (Read about "Family Health History") of skin cancer.

Since the effects of sun exposure add up, the National Institute on Aging says our risk of developing skin cancer also increases as we get older. (Read about "Age and Skin") And people with a large number of moles can have a higher risk of developing skin cancer. Anyone in a high-risk group should take extra precautions against skin cancer and talk with their doctor about regular screenings.

Treatment options

Treatment for AK's and skin cancer depends on the size of the growth, the type of skin cancer, the cancer's location and its depth. Treatment for skin cancer usually involves some type of surgery or removal with topical medications, according to NCI. Sometimes a combination of methods is used. Options include:

• Surgery - NCI says many skin cancers can be cut from the skin. In fact, the cancer is sometimes completely removed at the time of the biopsy (Read about "Biopsy"), and no further treatment is needed.
• Curettage and Electrodesiccation - In this procedure, the cancer is scooped out with a curette, an instrument with a sharp, spoon-shaped end. The area is also treated with an electric current from a special machine is used to control bleeding and kill any cancer cells remaining around the edge of the wound.
• Mohs' Surgery - The purpose of this technique is to remove all of the cancerous tissue and as little of the healthy tissue as possible. In addition, this method is used to remove large tumors, those in hard-to-treat places, and cancers that have recurred. The cancer is shaved off one thin layer at a time. Each layer is checked under a microscope until the entire tumor is removed. NCI says this method should be used only by doctors who are specially trained in this type of surgery.
• Cryosurgery - Extreme cold may be used to treat precancerous skin conditions, such as actinic keratosis, as well as certain small skin cancers. In cryosurgery, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.
• Laser Therapy - Laser therapy uses a narrow beam of light to remove or destroy cancer cells.
• Radiation - NCI says skin cancer responds well to radiation therapy (also called radiotherapy), which uses high-energy rays to damage cancer cells and stop them from growing. Doctors often use this treatment for cancers that occur in areas that are hard to treat with surgery.
• Topical therapy - Anticancer drugs in a cream or lotion can also be applied to the skin.

Reconstructive surgery may also be part of treatment for skin cancer. (Read about "Plastic Surgery") In addition, melanomas or other cancers that have spread beyond the skin may require radiation therapy, immunotherapy and/or chemotherapy. (Read about "Cancer Treatments")

Prevention

The American College of Preventive Medicine (ACPM) says the key way to help avoid skin cancer is to avoid excessive sun exposure, especially during the peak burning hours between 10AM and 3PM. If you have to be outdoors, use hats and protective clothing, and ask your pharmacist to recommend a waterproof sunscreen with an SPF of at least 15. Some people are allergic (Read about "Allergies") to certain sunscreen ingredients, so ask a healthcare professional for advice if this could be a problem for you or your family.

Children need sun protection as well. According to ACPM, roughly 80 percent of a person's sun exposure occurs before age 21. Sunscreens are usually recommended for children older than six months. Ask your pediatrician for specific advice about protective measures best suited for your infant or toddler. (Read about "Children and Sun" "Sunscreen")

Another issue to be aware of is certain medications - for example, some antibiotics (Read about "Antibiotics") or diuretics - and even some herbal supplements like St. John's Wort (Read about "Herbal Precautions") can make skin more sensitive to the sun's rays. Ask your doctor about this potential side effect of your medications, and take extra precautions.

Remember, though, that while sunscreens can help you avoid sunburn, they may not offer as much protection against the risk of skin cancer. Regardless of age, your best protection against skin cancer is avoiding excessive sun exposure.

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is