SKIN CANCER

Skin cancer is the most common form of human cancers, affecting more than one million Americans every year. One in five Americans will develop skin cancer at some point in their lives. Skin cancers are generally curable if caught early. However, people who have had skin cancer are at a higher risk of developing a new skin cancer, which is why regular self-examination and doctor visits are imperative. The vast majority of skin cancers are composed of three different types: basal cell carcinoma, squamous cell carcinoma and melanoma.

BASAL CELL CARCINOMA

Basal cell carcinoma (BCC) is the most common type of skin cancer. It’s also the most commonly diagnosed cancer in the United States. Every year, millions of people learn that they have BCC.

This skin cancer usually develops on skin that gets sun exposure, such as on the head, neck, or back of the hands. BCC is especially common on the face, often forming on the nose. While BCC often develops on skin that has had the most sun, BCC can appear on any part of the body, including the trunk, legs, and arms.

People who use tanning beds also get BCC, and they also tend to get it earlier in life.

This type of skin cancer grows slowly. It rarely spreads to other parts of the body. Treatment is important because BCC can grow wide and deep, destroying skin, tissue, and bone.

Signs and Symptoms
Basal cell carcinoma (BCC) shows up on the skin in different ways. That’s because there are different types of this skin cancer. If you see any of the following on your skin, you should immediately make an appointment to see a dermatologist:

  • Dome-shaped skin growth with visible blood vessels. Often pink or skin-colored, it can also be brown, black, or have flecks of these colors. This BCC grows slowly. It may flatten in the center, ooze, and crust over. It also tends to bleed easily.
  • Shiny pink or red, slightly scaly patch, especially on the trunk. It grows slowly and may be mistaken for a patch of eczema.
  • Waxy feeling, hard, pale-white to yellow or skin-colored growth that looks like a scar. You may have difficultly seeing the edges.

 

BCCs may look like a sore that:

  • Bleeds easily.
  • Won’t heal, or heals and returns.
  • Oozes or crusts over.
  • Has a sunken center, like a crater.
  • Has visible blood vessels in or around it.

Although rare, BCC can feel painful or itch. Usually, the only sign of BCC is a growth on the skin.

Who Can Get and Causes
Anyone can get this common skin cancer, but some people have a greater risk. People with a greater risk of getting basal cell carcinoma (BCC) have one or more of the following risk factors:

Your physical traits

  • Light-colored or freckled skin
  • Blue, green, or gray eyes
  • Blond or red hair
  • An inability to tan

What you’ve done

  • Spent a lot of time outdoors for work or leisure, without using sunscreen or covering up with clothing
  • Frequently used tanning beds

Your medical history

  • If you had one BCC, your risk for developing a second one increases by about 40%
  • Close blood relative had BCC
  • Taking one or more drugs that suppress the body’s immune system. People take these drugs after receiving an organ transplant and to treat a medical condition, such as severe arthritis, lymphoma, or human immunodeficiency virus (HIV)
  • Overexposure or long-term exposure to x-rays, such as patients who received x-ray treatments for acne

Risk of developing many BCCs by 20 years of age
Some people are born with a rare condition that makes them more likely to develop many skin cancers, including basal cell cancers, early in life. BCC can develop by 20 years of age in people who have a rare medical condition known as basal cell nevus syndrome.

What causes BCC?
Unlike many cancers, the cause of BCC is well known:

  • Ultraviolet (UV) rays from the sun or tanning beds cause BCC

When UV rays from the sun or tanning beds hit our skin, these rays damage the DNA in the cells of our skin. The body tries to repair this damage. When the rays repeatedly hit our skin, the body cannot repair the damage.

When the body cannot repair the damage, skin cancer develops. Skin cancer usually develops after years of sun exposure. Around 50 years of age, the risk of developing skin cancer increases significantly.

People much younger than 50 years of age also get BCC. Most of these people are women who use indoor tanning beds. Many of these BCCs could be prevented if the women never used tanning beds.

Diagnosis and Treatment
The only way to diagnose any type of skin cancer, including basal cell carcinoma (BCC), is with a skin biopsy. Your dermatologist can perform this procedure during an office visit.

A skin biopsy should not cause anxiety. To perform a skin biopsy, your dermatologist will remove the entire growth or part of it. Your dermatologist may send this to a laboratory or look at it under a microscope. The findings will be communicated in a biopsy report.

If the biopsy report states that you have BCC, your dermatologist will consider many factors to determine which treatment will be best for you. There are several ways to treat BCC:

  • Excision: This is a surgical procedure that your dermatologist often can perform during an office visit. It involves numbing the area to be treated and cutting out any remaining tumor plus some normal-looking skin around the tumor.Like the skin biopsy, this removed skin is examined under the microscope. This may be done at a laboratory or by your dermatologist. The doctor who looks at the removed skin needs to see whether the normal-looking skin is free of cancer cells. If not, more skin will need to be removed. This is a common way to treat BCC.
  • Curettage and electrodessication: This treatment consists of two steps. First, your dermatologist scrapes away the tumor. Then electricity is used to destroy any remaining cancer cells.
  • Mohs surgery: Named for the doctor who developed this surgery, Mohs (pronounced “moes”) is a specialized surgery used to remove some skin cancers. It offers the highest cure rate for difficult-to-treat basal cell cancers. Your dermatologist will tell you if Mohs is right for you.If Mohs is recommended, this is what you can expect. The surgeon will cut out the tumor plus a very small amount of normal-looking skin surrounding the tumor. While you wait, the Mohs surgeon uses a microscope to look at what was removed. The surgeon is looking for cancer cells.If necessary, the Mohs surgeon will continue to remove a very small amount of skin and look at it under the microscope. This continues until the surgeon no longer sees cancer cells.
  • Cryosurgery: This treatment uses liquid nitrogen to freeze cancer cells, causing the cells to die.
  • Radiation: This treatment usually is reserved for BCCs that cannot be cut out, or when surgery may not be the best choice. A patient may need 15 to 30 radiation treatments.
  • Photodynamic therapy (PDT): This treatment uses light to remove early skin cancers. PDT is a two-step process. First, a chemical is applied to the skin. The chemical remains on the skin for some time so that it can be absorbed. Then the skin is exposed to a special light to kill the cancer cells.
  • Medicated creams: Creams that contain a drug, such as imiquimod or 5-fluorouracil, can be used to treat early BCC. A patient applies the medicated cream at home as directed by his or her dermatologist.
  • Pills: While extremely rare, there are reports of BCC spreading to other parts of the body. Patients who have BCC that spreads may be prescribed vismodegib or sonidegib. This medication also may be prescribed for patients who have advanced BCC that cannot be cut out or treated with radiation.

 

Outcome
Nearly every basal cell cancer can be cured, especially when the cancer is found early and treated.

Learn More By Visiting American Academy of Dermatology

MELANOMA

Melanoma is the most serious type of skin cancer. Allowed to grow, melanoma can spread quickly to other parts of the body. This can be deadly.

There is good news. When found early, melanoma is highly treatable.

You can find melanoma early by following this 3-step process:

  1. Learn the warning signs of melanoma.
  2. Look for the warning signs while examining your skin.
  3. See a dermatologist if you find any of the warning signs.

 

It only takes a few minutes to learn the warning signs. You’ll find everything you need to start examining your skin today on the Body Mole Map.

Signs and Symptoms
Melanoma, the deadliest skin cancer, can show up on your body in different ways. You may see a:

  • Change to an existing mole
  • New spot or patch on your skin
  • A spot that looks like a changing freckle or age spot
  • Dark streak under a fingernail or toenail
  • Band of darker skin around a fingernail or toenail
  • Slowly growing patch of thick skin that looks like a scar

 

Warning signs to look for
Dermatologists encourage people of all skin colors to perform skin self-exams. Checking your skin can help you find melanoma early when it’s highly treatable. When examining your skin for melanoma, you want to look for the warning signs, which are called the ABCDEs of melanoma :

If you find anything that looks like it could be melanoma, immediately make an appointment to see a dermatologist. These doctors are the experts at diagnosing skin cancer. Research shows that dermatologists correctly diagnose melanoma more than any other type of doctor.

Symptoms of melanoma
You can have melanoma without feeling any pain or discomfort. For many people, the only sign is a change to their skin, scalp, or nail. Sometimes, melanoma causes one of more of the following:

  • Itch
  • Pain
  • Bleeding

When checking your skin, you want to make sure you check everywhere.

Who gets melanoma?
Anyone can get melanoma. Most people who get melanoma have light skin, but people who have brown and black skin also get melanoma.

Your risk of getting melanoma increases if you:
Seek the sun, tanning beds, or sunlamps: The sun, tanning beds, and sunlamps emit ultraviolet light (UV). Scientists have proven that UV light can cause skin cancer in people.

Their research also shows you increase your risk of getting melanoma if you:

  • Use tanning beds. Using indoor tanning beds before age 35 can increase your risk of melanoma by 59%, and the risk increases with each use.
  • Had 5 or more blistering sunburns between ages 15 and 20. Research shows this increases one’s risk of getting melanoma by 80%.
  • Live close to the equator. Sunlight is more intense there.
  • Live in a sunny area of the United States like Florida or Arizona.
  • Failed to protect your skin from the sun. People older than 65 may experience melanoma more frequently because of UV exposure they’ve received over the course of their lives. Men older than 50 also have a higher risk of developing melanoma.

 

While exposure to UV light greatly increases your risk of developing melanoma, your other characteristics also play a role. These include:

Having light-colored skin, hair, or eyes or certain moles: The risk of getting melanoma increases if you have one or more of the following:

  • Fair skin
  • Red or blond hair
  • Blue or green eyes
  • Sun-sensitive skin
  • Skin that rarely tans or burns easily
  • 50 or more moles
  • Large moles
  • An atypical mole (mole that looks like melanoma)

Taking certain medications or having some medical conditions: Your risk of getting melanoma increases if you have:

  • Had melanoma or another type of skin cancer
  • Had another type of cancer, such as breast or thyroid cancer
  • A disease that weakens your immune system, such as acquired immunodeficiency syndrome (AIDS)
  • To take medicine to quiet your immune system, such as taking life-saving medicines to prevent organ rejection after transplant surgery

Have a history of melanoma in your family: If a close blood relative has or had melanoma, you have a higher risk of getting melanoma.

What causes melanoma?
Ultraviolet (UV) light causes melanoma. We get UV light from the sun and tanning beds. Scientists have shown that UV light from the sun and tanning beds can do two things:

  1. Cause melanoma on normal skin.
  2. Increase the risk of a mole on your skin turning into a melanoma.

Scientists have also found that some people inherit genes that increase their risk of getting melanoma.

Because UV exposure is the leading cause of melanoma, you can greatly reduce your risk of getting melanoma by taking steps to prevent skin cancer.

How do dermatologists diagnose melanoma?
To diagnose melanoma, a dermatologist begins by looking at the patient’s skin. A dermatologist will carefully examine moles and other suspicious spots. To get a better look, a dermatologist may use a device called a dermoscope. The device shines light on the skin. It magnifies the skin. This helps the dermatologist to see pigment and structures in the skin.

The dermatologist also may feel the patient’s lymph nodes. Many people call these lymph glands.

If the dermatologist finds a mole or other spot that looks like melanoma, the dermatologist will remove it (or part of it). The removed skin will be sent to a lab. Your dermatologist may call this a biopsy. Melanoma cannot be diagnosed without a biopsy.

This biopsy is quick, safe, and easy for a dermatologist to perform. This type of biopsy should not cause anxiety. The discomfort and risks are minimal.

If the biopsy report says that the patient has melanoma, the report also may tell the stage of the melanoma. Stage tells the doctor how deeply the cancer has grown into the skin.

The melanoma stages are:

  • Stage 0 – Melanoma is confined to the epidermis (top layer of skin).
  • Stage I – Melanoma is confined to the skin, but has grown thicker. It can be as thick as 1.0 millimeter. In stage IA, the skin covering the melanoma remains intact. In stage IB, the skin covering the melanoma has broken open (ulcerated).
  • Stage II – Melanoma has grown thicker. The thickness ranges from 1.01 millimeters to greater than 4.0 millimeters. The skin covering the melanoma may have broken open (ulcerated). While thick, the cancer has not spread.
  • Stage III – Melanoma has spread to either: 1) one or more nearby lymph node (often called lymph gland) or 2) nearby skin.
  • Stage IV – Melanoma has spread to an internal organ, lymph nodes further from the original melanoma, or is found on the skin far from the original melanoma.

Sometimes the patient needs another type of biopsy. A type of surgery called a sentinel lymph node biopsy (SLNB) may be recommended to stage the melanoma. When melanoma spreads, it often goes to the closest lymph nodes first. A SLNB tells doctors whether the melanoma has spread to nearby lymph nodes. Other tests that a patient may need include x-rays, blood work, and a CT scan.

How do dermatologists treat melanoma?
The type of treatment a patient receives depends on the following:

  • How deeply the melanoma has grown into the skin.
  • Whether the melanoma has spread to other parts of the body.
  • The patient’s health.

The following describes treatment used for melanoma.

Surgery: When treating melanoma, doctors want to remove all of the cancer. When the cancer has not spread, it is often possible for a dermatologist to remove the melanoma during an office visit. The patient often remains awake during the surgical procedures described below.

  • Excision: To perform this, the dermatologist numbs the skin. Then, the dermatologist surgically cuts out the melanoma and some of the normal-looking skin around the melanoma. This normal-looking skin is called a margin. There are different types of excision. Most of the time, this can be performed in a dermatologist’s office.
  • Mohs surgery: A dermatologist who has completed additional medical training in Mohs surgery performs this procedure. Once a dermatologist completes this training, the dermatologist is called a Mohs surgeon.

    Mohs surgery begins with the Mohs surgeon removing the visible part of the melanoma. Next, the surgeon begins removing the cancer cells. Cancer cells are not visible to the naked eye, so the surgeon removes skin that may contain cancer cells one layer at a time. After removing a layer, it is prepped so that the surgeon can examine it under a microscope and look for cancer cells. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less. Mohs has a high cure rate.

When caught early, removing the melanoma by excision or Mohs may be all the treatment a patient needs. In its earliest stage, melanoma grows in the epidermis (outer layer of skin). Your dermatologist may refer to this as melanoma in situ or stage 0. In this stage, the cure rate with surgical removal is nearly 100%.

When melanoma grows deeper into the skin or spreads, treatment becomes more complex. It may begin with one of the surgeries described above. A patient may need more treatment. Other treatments for melanoma include:

  • Lymphadenectomy: Surgery to remove lymph nodes.
  • Immunotherapy: Treatment that helps the patient’s immune system fight the cancer.
  • Targeted therapy: Drugs that can temporarily shrink the cancer; however, some patients appear to be fully cured.
  • Chemotherapy: Medicine that kills the cancer cells (and some normal cells).
  • Radiation therapy: X-rays that kill the cancer cells (and some normal cells).

Other treatment that may be recommended include:

  • Clinical trial: A clinical trial studies a medicine or other treatment. A doctor may recommend a clinical trial when the treatment being studied could help a patient. Being part of a medical research study has risks and benefits.

    Before joining a clinical trial, patients should discuss the possible risks and benefits with their doctor. The decision to join in a clinical trial rests entirely with the patient.

  • Adoptive T-cell therapy: This treatment uses the patient’s immune system to fight the cancer. Instead of receiving medicine, the patient has blood drawn. The blood is sent to a lab so that the T-cells (cells in our body that help us fight cancers and infections) can be removed. These T-cells are then placed in a culture so that they can multiply.

    Once the T-cells are ready, they are injected back into the patient. Some patients with advanced melanoma have had long-lasting remission with this treatment. This therapy, however, is not widely available.

  • Palliative care: This care can relieve symptoms and improve a patient’s quality of life. It does not treat the cancer. Many patients receive palliative care, not just patients with late-stage cancer.

    When melanoma spreads, palliative care can help control the pain and other symptoms. Radiation therapy is a type of palliative care for stage IV (has spread) melanoma. It can ease pain and other symptoms.

Outcome
This depends on how deeply the melanoma has grown into the skin. If the melanoma is properly treated when it is in the top layer of skin, the cure rate is nearly 100%. If the melanoma has grown deeper into the skin or spread, the patient may die.

Learn More By Visiting American Academy of Dermatology

SQUAMOUS CELL CARCINOMA

Squamous cell carcinoma (SCC) is a common skin cancer in humans. About 700,000 new cases of this skin cancer are diagnosed in the United States each year.

This skin cancer tends to develop on skin that has been exposed to the sun for years. It is most frequently seen on sun-exposed areas, such as the head, neck, and back of the hands. Women frequently get SCC on their lower legs.

It is possible to get SCC on any part of the body, including the inside of the mouth, lips, and genitals.

People who use tanning beds have a much higher risk of getting SCC. They also tend to get SCC earlier in life.

SCC can spread to other parts of the body. With early diagnosis and treatment, SCC is highly curable.

Signs and Symptoms
This skin cancer often develops on skin that has soaked up the sun for years. The face, ears, lips, backs of the hands, arms, and legs are common places for squamous cell carcinoma (SCC) to form. Signs include:

  • A bump or lump on the skin that can feel rough.
  • As the bump or lump grows, it may become dome-shaped or crusty and can bleed.
  • A sore that doesn’t heal, or heals and returns.
  • Flat, reddish, scaly patch that grows slowly (Bowen’s disease).
  • In rare cases, SCC begins under a nail, which can grow and destroy the nail.

SCC can begin in a pre-cancerous growth
Some SCCs begin in a pre-cancerous growth called an actinic keratosis (ak-ti-nik ker-ah-TOE-sis), or AK. In adults 40 and older, it is believed that about 40 to 60 percent of SCCs begin in an AK. Signs and symptoms of an AK include:

  • Small, pink, rough, dry, scaly patch or growth on skin.
  • Rough patch or growth that feels irritated or even painful when rubbed.
  • Itching or burning on a patch of skin.
  • Lips feel constantly dry and have a whitish color or feel scaly.

Who Can Get and Causes
This skin cancer is most common in fair-skinned people who have spent years in the sun. But people of all skin colors get squamous cell carcinoma (SCC). Your risk of developing SCC increases if you have any of the following risk factors:

Your physical traits

  • Pale or light-colored skin.
  • Blue, green, or gray eyes.
  • Blond or red hair.
  • An inability to tan.

 

What you’ve done

  • Spent a lot of time outdoors, for work or leisure, without using sunscreen or covering up with clothing.
  • Used tanning beds or sunlamps.
  • Been exposed to cancer-causing chemicals (e.g., arsenic in drinking water, tar, worked with some insecticides or herbicides).
  • Smoked tobacco.
  • Spent lots of time near heat, such as a fire.

 

Your medical history

  • Diagnosed with actinic keratoses (AKs).
  • Badly burned your skin.
  • Ulcer or sore on your skin that has been there for many months or years.
  • Taking medicine that suppresses your immune system.
  • Infected with human papillomavirus (HPV).
  • Overexposure or long-term exposure to x-rays, such as patients who received x-ray treatments for acne in the 1940s.
  • Received many PUVA treatments.
  • Have one of these medical conditions: xeroderma pigmentosum, epidermolysis bullous, or albinism.

 

Causes
Most SCC is caused by ultraviolet (UV) rays from the sun or tanning beds. Other causes include:

  • Long-term exposure to cancer-causing chemicals, such as when a person smokes tobacco, is exposed to tar, drinks from a water supply that contains arsenic, or uses some insecticides or herbicides.
  • A serious burn.
  • Ulcer or sore on the skin that has been there for many months or years.
  • Some types of the human papillomavirus (HPV).

 

Diagnosis and Treatment
The only way to diagnose any type of skin cancer, including squamous cell carcinoma (SCC), is with a skin biopsy. Your dermatologist can perform this procedure during an office visit.

A skin biopsy should not cause anxiety. To perform a skin biopsy, your dermatologist will remove the entire growth or part of it. Your dermatologist may send this to a laboratory or look at it under a microscope. The findings will be communicated in a biopsy report.

If the biopsy report states that you have SCC, your dermatologist will consider many factors to determine which treatment will be best.

The type of treatment a patient receives depends on how deep the cancer has grown and whether it has spread. SCC is often treated with:

Excision: This is a surgical procedure that your dermatologist often can perform during an office visit. It involves numbing the area to be treated and cutting out any remaining tumor plus some normal-looking skin around the tumor.

Like the skin biopsy, this removed skin is examined under the microscope. This may be done at a laboratory or by your dermatologist. The doctor who looks at the removed skin needs to see whether the normal-looking skin is free of cancer cells. If not, more skin will need to be removed. This is a common way to treat SCC.

Mohs surgery: Named for the doctor who developed this surgery, Mohs (pronounced “moes”) is a specialized surgery used to remove some skin cancers. It offers the highest cure rate for difficult-to-treat squamous cell cancers. Your dermatologist will tell you if Mohs surgery is right for you.

If Mohs surgery is recommended, this is what you can expect. The surgeon will cut out the tumor plus a very small amount of normal-looking skin surrounding the tumor. While the patient waits, the Mohs surgeon uses a microscope to look at what was removed. The surgeon is looking for cancer cells.

If necessary, the Mohs surgeon will continue to remove a very small amount of skin and look at it under the microscope. This continues until the surgeon no longer sees cancer cells.

Radiation: This treatment is usually reserved for SCCs that cannot be cut out, or when cutting may not be the best choice. A patient may need 15 to 30 radiation treatments.

When the SCC is caught early, it may be treated by:

Curettage and electrodesiccation: This treatment consists of two steps. First, your dermatologist scrapes away the tumor. Then electricity is used to destroy any remaining cancer cells. These two steps are repeated.

Photodynamic therapy (PDT): This treatment uses light to remove some very early skin cancers. PDT is a two-step process. First, a chemical is applied to the skin. The chemical remains on the skin for some time so that it can be absorbed. Then the skin is exposed to a special light to kill the cancer cells.

Laser treatment: Lasers can be used to remove an SCC that sits on the surface of the skin. This treatment is only recommended for early SCCs.

Chemotherapy cream: Cream that contains a chemotherapy drug, 5-fluorouracil (5-FU), can be used to treat SCC in the earliest stage.

Outcome
With treatment, most SCCs are cured. Early treatment is recommended. When allowed to grow, this skin cancer can grow deep, destroying tissue and even bone. In some cases, SCC spreads to the lymph nodes and other parts of the body. This can cause serious health problems.

Learn More By Visiting American Academy of Dermatology

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