What Is Skin Cancer 2

What Is Skin Cancer 3

What Is Skin Cancer 4

What Is Skin Cancer 5

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      Introduction

Skin cancer — the abnormal growth of skin cells — most often develops on skin exposed to the sun. But this common form of cancer also can occur on areas of the skin not ordinarily exposed to sunlight.

Of the three major types of skin cancer, basal cell and squamous cell are the most common and make up the vast majority of cases of nonmelanoma skin cancer. Both are slow growing and highly treatable, especially if found early. Melanoma, on the other hand, is a more serious form of skin cancer. It affects deeper layers of the skin and has the greatest potential to spread to other tissues in the body.

All three types of skin cancer are on the rise. The majority of skin cancers can be prevented by limiting or avoiding exposure to ultraviolet (UV) radiation and by paying attention to suspicious changes in your skin. If caught early enough, most skin cancers can be successfully treated.

Signs and symptoms

Skin cancer develops primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it also can form on areas that rarely see the light of day — the palms, spaces between the toes and the genital area.

A cancerous skin lesion can appear suddenly or develop slowly, and its appearance will vary, depending on the type of cancer:

Basal cell cancer (basal cell carcinoma)

This is the most common type of skin cancer, accounting for nearly 90 percent of all cases. It's also the most easily treated and the least likely to spread. Basal cell carcinomas usually appear as one of the following:

A pearly or waxy bump on your face, ears or neck

A flat, flesh-colored or brown scar-like lesion on your chest or back

Squamous cell cancer

Another common type of skin cancer, squamous cell cancer is easily treated, though it is slightly more apt to spread than basal cell cancer is. Most often, squamous cell cancer appears as:

A firm, red nodule on your face, lips, ears, neck, hands or arms

A flat lesion with a scaly, crusted surface on your face, ears, neck, hands or arms

Melanoma

This is the most serious form of skin cancer and the one responsible for the majority of skin cancer deaths. Melanoma can develop in otherwise normal skin or when an existing mole turns malignant. Although it can occur anywhere on the body, melanoma appears most often on the upper back or face in both men and women.

Warning signs of melanoma include:

A large brownish spot with darker speckles located anywhere on your body

A simple mole located anywhere on your body that changes in color, size or feel or that bleeds

A small lesion with an irregular border and red, white, blue or blue-black spots on your trunk or limbs

Shiny, firm, dome-shaped bumps located anywhere on your body

Dark lesions on your palms, soles, fingertips and toes, or on mucous membranes lining your mouth, nose, vagina and anus
Less common skin cancers

Other, less common types of skin cancer include:

Kaposi's sarcoma. This rare form of skin cancer develops in the skin's blood vessels and causes red or purple patches on the skin or mucous membranes. Like melanoma, it's a serious form of skin cancer. It's mainly seen in people with weakened immune systems, such as people with AIDS and people taking medications that suppress their natural immunity, such as people who've undergone organ transplants.

Merkel cell carcinoma. In this rare cancer, firm, shiny nodules occur on or just beneath the skin and in hair follicles. The nodules may be red, pink or blue and can vary in size from a quarter of an inch to more than 2 inches.

Merkel cell carcinoma is usually found on sun-exposed areas on the head, neck, arms and legs. Unlike basal and squamous cell carcinomas, Merkel cell carcinoma grows rapidly and often spreads to other parts of the body.

Sebaceous gland carcinoma. This uncommon and aggressive cancer originates in the oil glands in the skin. Sebaceous gland carcinomas, which usually appear as hard, painless nodules, can develop anywhere, but the majority of them occur on the eyelid, where they're frequently mistaken for more-benign conditions.

Precancerous skin lesions, such as an actinic keratosis, also can develop into squamous cell skin cancer. Actinic keratoses appear as rough, scaly, brown or dark-pink patches. They're most commonly found on the face, ears, lower arms and hands of fair-skinned people whose skin has been damaged by the sun.

Not all skin changes are cancerous. The only way to get a definitive diagnosis is to see your doctor or dermatologist and have your skin examined.

Causes

Where skin cancer can develop
Your skin consists of three layers — the epidermis, dermis and subcutis. The epidermis, the topmost layer, is as thin as a pencil line. It provides a protective layer of skin cells that your body continually sheds.

Squamous cells lie just below the outer surface. Basal cells, which produce new skin cells, are at the bottom of the epidermis. The epidermis also contains cells called melanocytes, which produce melanin — the pigment that gives skin its normal color.

When you're in the sun, these cells produce more melanin, which helps protect the deeper layers of skin. The extra melanin is what produces the darker color of a "tan."

Normally, skin cells within the epidermis develop in a controlled and orderly way. In general, healthy new cells push older cells toward the skin's surface, where they die and eventually are sloughed off. This process is controlled by DNA — the genetic material that contains the instructions for every chemical process in your body. But when DNA is damaged, changes occur in these instructions. One result is that new cells may begin to grow out of control and eventually form a mass of cancer cells.

The role of UV light

Much of the damage to DNA in skin cells results from ultraviolet (UV) radiation found in sunlight and in commercial tanning lamps and tanning beds. UV light is divided into three wavelength bands—ultraviolet A (UVA), ultraviolet B (UVB) and ultraviolet C (UVC). Only UVA and UVB rays reach the earth. UVC radiation is completely absorbed by atmospheric ozone.

At one time scientists believed that only UVB rays played a role in the formation of skin cancer. And UVB light does cause harmful changes in skin cell DNA, including the development of oncogenes — a type of gene that can turn a normal cell into a malignant one. UVB rays are responsible for sunburn and for many basal cell and squamous cell cancers. But UVA also contributes to skin cancer. It penetrates the skin more deeply than UVB does, weakens the skin's immune system and increases the risk of cancer, especially melanoma.

Tanning beds deliver high doses of UVA, which makes them especially dangerous. What's more, occasional exposure to intense UVA puts you at greater risk of skin cancer than spending long hours in the sun does. An initial high dose of UV radiation will severely damage melanocytes, but not destroy them.

When these damaged cells are subjected to further intense bouts of UVA light, they have little capacity to repair their DNA and so are more likely to become malignant.

Other factors that may contribute to skin cancer

Sun exposure doesn't explain melanomas or other skin cancers that develop on skin not ordinarily exposed to sunlight. It may be that heredity plays a role; skin cancer can run in families in rare instances. Skin cancer can also develop from exposure to toxic chemicals or as a result of radiation treatments. But the cause of skin cancer that develops on unexposed skin isn't well understood and is likely the result of a combination of genetic and environmental factors.

Skin cancer

ARTICLE SECTIONS

Introduction

Signs and symptoms

Causes

Risk factors

When to seek medical advice

Screening and diagnosis

Treatment

Prevention

Risk factors

These factors may increase your risk of skin cancer:

Fair skin. Having less pigment (melanin) in your skin provides less protection against damaging UV radiation from the sun or tanning beds. If you have blond or red hair, light-colored eyes, and you freckle or sunburn easily, you're much more likely to develop skin cancer than a person with darker features is.

A history of sunburns. A sunburn is your body's attempt to heal itself from the sun's damaging rays. Every time you get sunburned, you damage your skin cells and increase your risk of developing skin cancer.

People who have had one or more severe, blistering sunburns as a child or teenager are at increased risk of skin cancer as an adult. Sunburns in adulthood also are a risk factor.

Excessive sun exposure. Anyone who spends considerable time in the sun may develop skin cancer, especially if your skin isn't protected by sunscreen or clothing. Tanning also puts you at risk. A tan is your skin's injury response to excessive UV radiation.

Sunny or high-altitude climates. People who live in sunny, warm climates are exposed to more sunlight than are people who live in colder climates. Living at higher elevations, where the sunlight is strongest, also exposes you to more radiation.

Moles. People who have abnormal moles called dysplastic nevi are at increased risk of skin cancer. These moles — which look irregular and are generally larger than normal moles — are more likely than others to become cancerous. If you have a history of abnormal moles, you and your doctor should watch them regularly for changes. Skin cancer is also more prevalent in people who have 50 or more moles — most people have 10 to 40 moles.

Precancerous skin lesions. Having skin lesions known as actinic keratoses can increase your risk of developing skin cancer. These precancerous skin growths typically appear as rough, scaly, brown-to-dark-pink patches.

They're most commonly found on the face, lower arms and hands of fair-skinned individuals whose skin has been sun damaged.

A family history of skin cancer. If one of your parents or a sibling has had skin cancer, you may be at increased risk of the disease. In rare cases, some families are affected by a condition called familial atypical multiple mole and melanoma (FAMMM) syndrome.

The hallmarks of FAMMM include a history of melanoma in one or more close relatives and having more than 50 moles — some of which are atypical. People with this syndrome have an extremely high risk of developing melanoma. For that reason, frequent screening for signs of skin cancer is crucial.

A personal history of skin cancer. If you developed skin cancer once, you're at risk of developing it again. Even basal cell and squamous cell carcinomas that have been successfully removed can recur in the same spot, often within two to three years.

A weakened immune system. People with weakened immune systems are at greater risk of developing skin cancer. This includes people living with HIV/AIDS or leukemia and those taking immunosuppressant drugs after an organ transplant.

Fragile skin. Skin that has been burned, injured or weakened by treatments for other skin conditions is more susceptible to sun damage and skin cancer. Certain psoriasis treatments and eczema creams might increase your risk of skin cancer.

Exposure to environmental hazards. Exposure to environmental chemicals, including some herbicides, increases your risk of skin cancer.

Age. In general, your risk of developing skin cancer increases with age, primarily because many skin cancers are slow to develop and the damage that occurs in the first 10 to 18 years of life may not show up until middle age. Still, skin cancer isn't limited to older people. Basal cell and squamous cell carcinomas are increasing fastest among women younger than 40.

When to seek medical advice

If you notice any suspicious change in your skin, consult your doctor right away. As with most cancers, early detection increases the chances of successful treatment. Don't wait for the area to start hurting — skin cancer seldom causes pain

Screening and diagnosis

See your doctor if you notice a new skin growth, a bothersome change in your skin, a change in the appearance or texture of a mole, or a sore that doesn't heal in two weeks. Your doctor may suspect cancer by simply looking at your skin. But to properly diagnose skin cancer, your doctor or dermatologist will need to take a small sample of your skin (biopsy) for analysis in a laboratory. A biopsy can usually be done in a doctor's office after administering a local anesthetic.

Doctors generally divide skin cancer into two stages:

Local. In this stage, cancer affects only your skin.

Metastatic. At this point, cancer has spread beyond your skin.

Because superficial skin cancers such as basal cell or squamous cell cancers rarely spread, a biopsy often is the only test needed to determine the cancer stage. But if you have a growth that is very large or has existed for some time, your doctor may conduct further tests to determine whether the cancer has spread.

Treatment

Treatments for skin cancers and the precancerous skin lesions known as actinic keratoses vary, depending on the size, type, depth and location of the lesions. Most treatments surgically remove the abnormal cells or destroy them with topical medications. Most require only a local anesthetic and can be performed in an outpatient setting. Sometimes no treatment is necessary beyond an initial biopsy that removes the entire growth. If additional treatment is necessary, your options include:

Freezing. Your doctor may destroy actinic keratoses and some small, early skin cancers by freezing them with liquid nitrogen (cryosurgery). The dead tissue sloughs off when it thaws. The treatment may leave a small, white scar. You may also need a repeat treatment to remove the growth completely.

Excisional surgery. This type of treatment may be appropriate for any type of skin cancer. Your doctor cuts out (excises) the cancerous tissue and a surrounding margin of healthy skin. A wide excision — taking out extra normal skin around the tumor — may be best for melanoma. To minimize or avoid scarring, especially on your face, you may need to go to a doctor skilled in skin reconstruction.

Laser therapy. A precise, intense beam of light vaporizes growths, generally with little damage to surrounding tissue and with minimal bleeding, swelling and scarring. A doctor may use this therapy to treat superficial skin cancers or precancerous growths on lips.

Mohs' surgery. This procedure is for larger, recurring or difficult-to-treat skin cancers, which may include both basal cell and squamous cell cancers. Your doctor removes the skin growth layer by layer, examining each layer under the microscope, until no abnormal cells remain. This treatment is most able to remove skin cancer without taking an excessive amount of surrounding healthy skin, but because it requires special skill, it should only be performed by doctors experienced in this procedure.

Curettage and electrodesiccation. After removing most of a growth, your doctor scrapes away layers of cancer cells using a circular blade (curet). An electric needle destroys any remaining cancer cells. This simple, quick procedure is common in treating small or thin basal cell cancers. It leaves a small, flat, white scar.

Radiation therapy. Radiation may destroy basal cell and squamous cell skin cancers if surgery isn't an option.

?Chemotherapy. In chemotherapy, drugs are used to kill cancer cells. With skin cancer, chemotherapy can be delivered topically by applying creams or lotions containing anti-cancer agents to the skin. This treatment is useful for cancers limited to the top layer of the skin. An example of an anti-cancer drug applied topically for superficial forms of skin cancer or actinic keratoses is 5-fluorouracil (5-FU). Topical drugs can cause a tremendous amount of inflammation and may sometimes leave scars. Chemotherapy can also be used to treat skin cancers that have spread (metastasized) to other parts of the body.

Treatments for skin cancer under study include:

Photodynamic therapy. This treatment destroys skin cancer cells with a combination of laser light and drugs that makes cancer cells sensitive to light. Photodynamic therapy for precancerous skin lesions is currently available by prescription.

Biological therapy (also called immunotherapy). Interferon and interleukin-2 are under study to treat melanoma and nonmelanoma skin cancers. These immunotherapy drugs stimulate your immune system to fight the cancer. Other medications applied to your skin, such as imiquimod (Aldara), enhance your immune reaction to the presence of skin cancer.

http://www.mayoclinic.com/health/
skin-cancer/DS00190