What Is Skin Cancer

What Is Skin Cancer 2

What Is Skin Cancer 3

What Is Skin Cancer 5

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      What is Skin Cancer?

Cancer develops when DNA, the molecule found in cells that encodes genetic information, becomes damaged and the body cannot repair the damage. These damaged cells begin to grow and divide uncontrollably. When this occurs in the skin, skin cancer develops. As the damaged cells multiply, they form a tumor. Since skin cancer generally develops in the epidermis, the outermost layers of skin, a tumor is usually clearly visible. This makes most skin cancers detectable in the early stages.

Types of Skin Cancer

Three types of skin cancer account for nearly 100% of all diagnosed cases. Each of these three cancers begins in a different type of cell within the skin, and each cancer is named for the type of cell in which it begins. Skin cancers are divided into one of two classes - nonmelanoma skin cancers and melanoma. Melanoma is the deadliest form of skin cancer.

The different types of skin cancer are:

Basal cell carcinoma (BCC): The most common cancer in humans, BCC develops in more than 1 million people every year in the United States alone. About 80% of all skin cancers are BCC, a cancer that develops in the basal cells - skin cells located in the lowest layer of the epidermis. BCC can take several forms. It can appear as a shiny translucent or pearly nodule, a sore that continuously heals and then re-opens, a pink slightly elevated growth, reddish irritated patches of skin, or a waxy scar. Most BCCs appear on skin with a history of exposure to the sun, such as the face, ears, scalp, and upper trunk. These tumors tend to grow slowly and can take years to reach ½ inch in size. While these tumors very rarely metastasize (cancer spreads to other parts of the body), dermatologists encourage early diagnosis and treatment to prevent extensive damage to surrounding tissue.

Squamous cell carcinoma (SCC): About 16% of diagnosed skin cancers are SCC. This cancer begins in the squamous cells, which are found in the upper layer of the epidermis. About 200,000 cases are diagnosed ever year. SCC tends to develop in fair-skinned middle-aged and elderly people who have had long-term sun exposure. It most often appears as a crusted or scaly area of skin with a red inflamed base that resembles a growing tumor, non-healing ulcer, or crusted-over patch of skin. While most commonly found on sun-exposed areas of the body, it can develop anywhere, including the inside of the mouth and the genitalia. SCC may arise from actinic keratoses, which are dry, scaly lesions that may be skin-colored, reddish-brown or yellowish-black. SCC requires early treatment to prevent metastasis (spreading).

Melanoma: Accounting for about 4% of all diagnosed skin cancers, melanoma begins in the melanocytes, cells within the epidermis that give skin its color. Melanoma has been coined “the most lethal form of skin cancer” because it can rapidly spread to the lymph system and internal organs. In the United States alone, approximately one person dies from melanoma every hour. Older Caucasian men have the highest mortality rate. Dermatologists believe this is due to the fact that they are less likely to heed the early warning signs. With early detection and proper treatment, the cure rate for melanoma is about 95%. Once its spreads, the prognosis is poor. Melanoma most often develops in a pre-existing mole or looks like a new mole, which is why it is important for people to know what their moles look like and be able to detect changes to existing moles and spot new moles.

Other nonmelanoma skin cancers: All other skin cancers combined account for less than 1% of diagnosed cases. These are classified as nonmelanoma skin cancers and include Merkel cell carcinoma, dermatofibromasarcoma protuberans, Paget’s disease and cutaneous T-cell lymphoma.

Causes

Sun exposure is the leading cause of skin cancer. According to the American Cancer Society, “Many of the more than 1 million skin cancers diagnosed each year could be prevented with protection from the sun’s rays.” Scientists now know that exposure to the sun’s ultraviolet (UV) rays damages DNA in the skin. The body can usually repair this damage before gene mutations occur and cancer develops. When a person’s body cannot repair the damaged DNA, which can occur with cumulative sun exposure, cancer develops.

In some cases, skin cancer is an inherited condition. Between 5% and 10% of melanomas develop in people with a family history of melanoma.

Who Gets Skin Cancer?

Skin cancer develops in people of all colors, from the palest to the darkest. However, skin cancer is most likely to occur in those who have fair skin, light-colored eyes, blonde or red hair, a tendency to burn or freckle when exposed to the sun, and a history of sun exposure. Anyone with a family history of skin cancer also has an increased risk of developing skin cancer. In dark-skinned individuals, melanoma most often develops on non-sun-exposed areas, such as the foot, underneath nails, and on the mucous membranes of the mouth, nasal passages, or genitals. Those with fair skin also can have melanoma develop in these areas.

Skin Cancer Rates Rising

While Americans now recognize that overexposure to the sun is unhealthy, the fact remains that most do not protect their skin from the sun’s harmful rays. As a result, skin cancer is common in the United States. More than 1 million nonmelanoma skin cancers are diagnosed each year, and approximately one person dies from melanoma every hour.

If current trends continue, 1 in 5 Americans will develop skin cancer during their lifetime. Melanoma continues to rise at an alarming rate. In 1930, 1 in 5,000 Americans was likely to develop melanoma during their lifetime. By 2004, this ratio jumped to 1 in 65. Today, melanoma is the second most common cancer in women aged 20 to 29.

Prevention and Early Detection Key

Sun protection can significantly decrease a person’s risk of developing skin cancer. Sun protection practices include staying out of the sun between 10 a.m. and 4 p.m. when the rays are strongest, applying a broad-spectrum (offers UVA and UVB protection) sunscreen with a Sun Protection Factor (SPF) of 15 or higher year-round to all exposed skin, and wearing a protective clothing, such as a wide-brimmed hat and sunglasses when outdoors.

Since skin cancer is so prevalent today, dermatologists also recommend that everyone learn how to recognize the signs of skin cancer, use this knowledge to perform regular examinations of their skin, and see a dermatologist annually (more frequently if at high risk) for an exam. Skin cancer is highly curable with early detection and proper treatment.

What Skin Cancer Looks Like

The most common warning sign of skin cancer is a change to your skin. This change can take many different forms, including:

• Translucent pearl-shaped growth

• Mole that has begun to grow, bleed, and/or itch

• Mole with any of these features: Asymmetrical (if lesion were folded in half, the two sides would not match), Borders irregular, Color varies, or Diameter greater than 6 mm (size of a pencil eraser). While melanomas are usually greater than 6 millimeters in diameter when diagnosed, they can be smaller.

If you notice a mole different from others, or one that changes, itches, or bleeds even if it is smaller than 6 millimeters, be sure to see a dermatologist.

• Brown or black streak underneath a nail

• Sore that repeatedly heals and reopens

• Smooth, waxy lesion

• Cluster of slow growing, shiny or scaly lesions that are pink
or red

To help you recognize the many different forms that skin cancer may take, the links below take you to pages that describe the most common types of skin cancer and show several photographs of each.

If you notice a lesion on your skin that resembles any of examples shown on these pages, see a dermatologist. Don’t delay. The cure rate for skin cancer is 95% only when it is detected and properly treated in the early stages.

Prevention

Most skin cancer can be prevented by practicing sun protection, according to numerous research studies. Research also shows that not only does sun protection reduce one’s risk of developing skin cancer; sun protection also may decrease the likelihood of recurrence.

Even if you have spent a lot of time in the sun or developed skin cancer, it’s never too late to begin protecting your skin. The American Academy of Dermatology (Academy) recommends that everyone protect their skin by following these sun protection practices:

Sun Protection Practices

1. Avoid deliberate tanning. Lying in the sun may feel good, but the end result is premature aging (wrinkles, blotchiness, and sagging skin) as well as a 1 in 5 chance of developing skin cancer. Tanning beds and sunlamps are just as dangerous because they, too, emit enough UV radiation to cause premature aging and skin cancer. If you like the look of a tan, consider using a sunless self-tanning product. These products do not protect skin from the sun, so a sunscreen should be used.

2. Get vitamin D safely through a healthy diet that includes vitamin supplements. Don’t seek the sun.

3. Generously apply sunscreen to all exposed skin every day. The sunscreen should have a Sun Protection Factor (SPF) of at least 15 and be broad-spectrum (provides protection from ultraviolet A (UVA) and ultraviolet B (UVB) rays).

Dermatologists worldwide agree that the Australians’ use of the word “slop!” accurately describes how sunscreen should be used. Most people do not apply enough sunscreen to help protect against harmful ultraviolet (UV) radiation. One ounce, enough to fill a shot glass, is considered by the Academy to be the amount needed to cover the exposed areas of the body properly. So when applying sunscreen, remember to “slop!” it on.

Here are a few more tips:

• Don’t forget your ears, nose, neck, hands, and toes. Many skin cancers develop in these areas. Protect your lips, another high-risk area, with lip balm that offers sun protection with an SPF of 15 or higher.

• Sunscreen should not be used to prolong sun exposure. Some UV light gets through sunscreen.

• Sunscreens should be applied to dry skin 15-30 minutes before going outdoors, and reapplied every two hours.

• Be sure to reapply sunscreen after being in water or sweating.

• Sunscreen does not make sunbathing safe.

4. Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses, where possible. This is what Australians call the “slip!” and “slap!” of sun protection. When you will be out in the sun, be sure to slip on protective clothing, such as a shirt, and slap on a wide-brimmed hat. Here’s why:

• Clothing protects your skin from the sun’s harmful rays. The tighter the weave, the more sun protection provided. In fact, clothing plays such an important role in sun protection that clothing designed specifically to protect against the sun as well as laundry additives created to boost clothing’s protective function are available. Your dermatologist may be able to provide you with more information about these products.

• A wide-brimmed hat shades your face and neck from the sun’s rays. Wide-brimmed means the brim circles the entire hat and shades both the face and neck.

5. Seek shade when appropriate. The sun’s rays are strongest between 10 a.m. and 4 p.m.

6. Use extra caution near water, snow, and sand as they reflect the damaging rays of the sun. This can increase your risk chance of sunburn.

7. Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

More Good Reasons to Practice Sun Protection

Aside from skin cancer, the sun’s UV rays also cause:

• Premature aging: Signs of premature aging include wrinkles, mottled skin, and loss of skin’s firmness.

• Immunosuppression (weakening of the body’s ability to protect itself from cancer and other diseases)

• Cataracts and macular degeneration: Macular degeneration, for which there is no cure, is the leading cause of blindness in people aged 65 and older.

Diagnosis and Treatment

With early detection and proper treatment, skin cancer is highly curable. The average cure rate when detected and treated in the early stages is 95%. Even melanoma, the most deadly form of skin cancer, when limited to the outermost layers of the skin yields a 95% cure rate.

How Skin Cancer Diagnosed

A person’s ability to recognize the signs of skin cancer and perform regular self-examinations are key to early detection. Any time skin cancer is suspected, the lesion should be examined by a dermatologist.

Dermatologists detect skin cancer through a visual examination of the skin and mucous membranes. If malignancy (cancer) is suspected, a biopsy will be performed. This involves numbing the area and removing the lesion, or part of it, for microscopic examination. A biopsy is the only way to definitely tell if skin cancer is present.

Since a skin biopsy is generally a quick and simple procedure, it is usually performed in a dermatologist’s office or outpatient setting. The type of biopsy performed depends on the type of skin cancer suspected, where on the body the tumor lies, and the tumor’s size. The different types of biopsy procedures used include:

• Excisional biopsy – The entire tumor along with a margin of tissue that is not a visible part of the tumor is removed. An excisional biopsy is the preferred method for removing lesions suspected to be melanoma.

• Incisional biopsy – A portion of the lesion is removed during an incisional biopsy, which is usually performed when the lesion is large. A scalpel; a hollow, circular scalpel-like instrument called a “punch” (punch biopsy); or a razor (shave biopsy) is used to remove the sample.

The removed sample is examined under a microscope to determine if cancer cells are present and if so which kind. If an excisional biopsy was performed, the physician examining the sample also should be able to determine how deeply the cancer has penetrated the skin.

Frequently, the removed sample is sent to a laboratory to be examined by a dermatopathologist, a medical doctor trained in both dermatology and pathology, who uses this expertise to microscopically examine tissue in order to diagnose skin conditions. Dermatopathologists provide expertise in diagnosing difficult cases.

In addition to removing the tumor or part of it, the dermatologist also will ask the patient some questions, which usually include when the lesion first appeared, symptoms, and the patient’s history of sun exposure.

Treatment Options
If the biopsy reveals skin cancer, your dermatologist will discuss treatment options. Treatment for skin cancer varies according to the type, location, extent, aggressiveness of the cancer, and the patient's general health.

The goals of treatment for skin cancer are to remove all of the cancer, reduce the chance of recurrence, preserve healthy skin tissue, and minimize scarring after surgery.

Skin Examinations

Two types of skin examinations are used to detect skin cancer:

• Self-examination

• Examination by a dermatologist (or other physician)

Self-Examination

Skin cancer has a 95% cure rate when detected early, and a key to early detection is regular self-examinations of your skin. Everyone, not only those with an increased risk of developing skin cancer, should perform regular skin examinations. Examining your skin for suspicious moles and other lesions could save your life.

To perform a self-examination, you will need a:

• Full-length mirror

• Handheld mirror

• Well-lit room that offers privacy

Examining your skin consists of standing in front of a full-length mirror to visually examine your body for signs of skin cancer and using a handheld mirror to view areas that cannot be seen without a second mirror. It is important to visually inspect your entire body as skin cancer can occur anywhere, not only on areas frequently exposed to the sun. Be sure to check your back, scalp, underarms, genitalia, palms, soles, and areas between the toes and fingers. When examining your scalp, it may help to systematically part the hair to check the entire scalp. An illustrated guide that shows how to examine your skin is shown on the right.

What to look for. You should become familiar with your birthmarks, blemishes, and moles so you know what they look like and can spot changes. As you examine your skin, look for changes in the size, color, shape, or texture of a mark on your skin. Signs of skin cancer include:

• Sore that never fully heals

• Translucent growth with rolled edges

• Brown or black streak underneath a nail

• Cluster of slow-growing, shiny pink or red lesions

• Waxy-feeling scar

• Flat or slightly depressed lesion that feels hard to the touch
Pay special attention to moles, especially one that has recently changed, bleeds, or itches. When looking at moles, keep in mind the ABCDs of Melanoma Detection:

Asymmetry – Does one half of a mole look different from the other?

Border Irregularity – Is the edge (border) of the mole ragged, notched or blurred?

Color – Does the mole have variety of hues and colors within the same lesion?

Diameter – What is the size of the mole? While melanomas are usually greater than 6 millimeters (about the size of a pencil eraser) in diameter when diagnosed, they can be smaller. If you notice a mole different from others, or which changes, itches, or bleeds even if it is smaller than 6 millimeters, you should see a dermatologist.

If you find a suspicious lesion. Any lesion that resembles one described above or that you believe may be skin cancer should be examined by a dermatologist immediately. Don’t delay in contacting a dermatologist; skin cancer has a high cure rate when detected early, and early treatment may help minimize the surgical scars.

Examination by a Dermatologist

Dermatologists also visually examine the skin to detect skin cancer. Sometimes a dermatologist will use a dermoscope, a handheld microscope-like device, to examine a patient’s moles. In some cases, photographs also may be taken and used in follow-up examinations to help spot changes. If a dermatologist finds a lesion that appears to be skin cancer, the lesion will be removed and examined under a microscope (biopsy). A biopsy is the only way to confirm a skin cancer diagnosis.

Anyone who has had skin cancer or has an increased risk of developing skin cancer should be examined by a dermatologist regularly.

Regular dental, ophthalmologic, and for women, gynecologic check-ups should include an examination for pigmented lesions and other signs of skin cancer on the respective areas of the body.

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