Skin Cancer
Skin cancer is the most common, and preventable, cancer diagnosis in the U.S. About one in five Americans develop skin cancer in their lifetime. While anyone can get skin cancer, regardless of skin color, gender or age, the risk of skin cancer increases as you get older.
Most skin cancers are caused by damage from the sun’s ultraviolet (UV) radiation. When caught early, skin cancer is highly treatable. According to the American Cancer Society, the survival rate of nonmelanoma skin cancers is nearly 100%. When melanoma, the deadliest form of skin cancer, is caught early, the survival rate is around 99%, but if found in a later stage, that number decreases to 35%.
Signs and Symptoms of Skin Cancer
Skin cancer commonly occurs on areas frequently exposed to the sun, such as the face, nose, scalp, ears, lips, arms, hands, back, chest and calves. Common signs and symptoms include:
- A brown or black colored spot with uneven edges
- A change in the border of a spot, spread of color, redness or swelling around the area
- A flat red spot or a lump that is scaly or crusty
- Itchiness, tenderness or pain from a mole or elsewhere on your skin
- Large areas with oozing or crust
- A mole or other skin growth you haven't noticed before
- A small, smooth, shiny, pale or waxy lump that may bleed
- A sore that doesn’t heal
People at Risk of Skin Cancer
- Had many sunburns as a child
- Have blonde or red hair and blue or gray eyes
- Have fair skin, freckles or skin that burns easily
- Have personal, or family, history of skin cancer
- Have several moles and odd moles
Skin Cancer Diagnosis
The type of skin cancer a person gets is determined by where the cancer begins. For example, if the cancer begins in skin cells called basal cells, the diagnosis is basal cell skin cancer. When cells that give our skin its color become cancerous, melanoma develops. The goal is to catch skin cancer in its earliest stages when it’s most treatable.
Skin Cancer Types
Basal cell carcinoma (BCC) is the most common type of skin cancer. It almost always occurs on skin damaged by the sun or tanning beds and looks like a flesh-colored, pearl-like bump or pinkish patch of skin that's raised. BCC frequently develops in people who have fair skin and may appear like a scab that keeps returning in the same spot. BCC bumps are common on the head, neck and arms. However, they can form anywhere on the body, including the chest, abdomen and legs.
Anyone, no matter their skin color, can get this skin cancer. Although BCC doesn’t generally spread, it does get bigger and deeper over time and become a problem if ignored.
Squamous cell carcinoma (SCC) is the second most common type of skin cancer. SCC is caused by exposure to the sun and tanning beds but also occurs in burn scars (from either heat or radiation treatment) or from chronic ulcers of the skin. It often looks like a red firm bump, scaly patch or a sore that heals and then re-opens. People who have light skin are most likely to develop SCC, but this skin cancer can also develop in people who have darker skin. SCC tends to form on skin that gets frequent sun exposure, such as the rim of the ear, face, neck, arms, chest and back.
In a small number of cases, SCC can spread to the lymph nodes and (rarely) to other organs.
Some people develop dry, scaly patches or spots on their skin called actinic keratoses (AKs). These are precancerous growths, not skin cancer. They're caused by too much sun, especially to areas such as the head, neck, hands and forearms. AKs can turn into a common type of skin cancer, squamous cell carcinoma. People who get AKs usually have fair skin.
Melanoma is the least common of the skin cancers, but cases increase every year, especially in young females between the ages of 18 and 29. This is because of the high rate of tanning bed use in this population. Melanoma is the most serious skin cancer, because it tends to spread to lymph nodes and to other organs, including the brain, lungs and liver. Melanoma is very dangerous and occurs in any place there are pigment-producing cells. Skin doesn’t have to be in direct sun-exposed areas to develop melanoma, but sun exposure does increase the risk. It frequently develops in a mole or suddenly appears as a new dark spot on the skin.
Melanoma stages range from 0-4. Stage 0 means the cancer is confined to the lesion itself. Stage IV means it spread to other areas of the body. Early diagnosis and treatment are crucial, as the thinner the tumor is, the less likely it is to spread. Although there’s a lot of research into treatment of melanoma, surgical removal of the tumor, and any involved lymph nodes, is the most effective practice.
Melanoma is more common in families with a history of abnormal moles or malignant melanoma. Those who've had melanoma have a significant risk of developing other melanomas, so regular skin checks are important. Use the ABCDE rule to check your skin for early signs of melanoma.
ABCDE Warning Signs of Melanoma
- Asymmetry: One half of the spot is unlike the other half.
- Border: The spot has an irregular scalloped or poorly defined border.
- Color: The spot has varying colors from one area to the next, such as shades of tan, brown or black or areas of white, red or blue.
- Diameter: While melanomas are usually greater than 6 millimeters, or about the size of a pencil eraser, when diagnosed, they can be smaller.
- Evolving: The spot looks different from the rest or is changing in size, shape or color.
Skin Cancer Treatment
Most skin cancers found early can be treated successfully. Treatment depends on the type of skin cancer and stage of the disease. Common treatment options include:
- Mohs surgery is a procedure used to treat skin cancer. It involves cutting away thin layers of skin. Each thin layer is looked at closely for signs of cancer. The process keeps going until there are no signs of cancer. The goal of Mohs surgery is to remove all of the skin cancer without hurting the healthy skin around it. Mohs surgery allows the surgeon to be sure all the cancer is gone. This makes it more likely the cancer is cured. It reduces the need for other treatments or more surgery.
- Chemotherapy and Immunotherapy might also be used, either by itself or with radiation, if the cancer has spread too far to be cured with surgery or radiation. An immunotherapy drug is often used first. It’s generally given via IV (intravenous).
- Radiation may be used if a skin tumor is very large or if it’s in an area that makes it hard to remove with surgery. Radiation is also be used for people who can’t have, or don’t want, surgery. Radiation can combine with other treatments, like chemotherapy. Radiation is also be used to help treat skin cancer that spread to lymph nodes or other organs.
- Topical Creams, Gels and Solutions are prescribed for use in patients with numerous or widespread actinic keratoses. The physician applies these creams and gels directly to affected areas of the skin to treat visible and invisible lesions with minimal risk of scarring.
- Photodynamic Therapy is used for widespread AKs located on the face and scalp. A topical agent is applied to make the lesion sensitive to light. After allowing a short period of time for absorption, the dermatologist uses a strong red or blue light which causes a reaction that destroys the AK.
Skin Cancer Prevention
- Always use lip balm with SPF 30 or higher with UVA and UVB protection
- Avoid being in the sun, especially between 10 a.m. and 4 p.m., when sunlight is strongest
- Use the ABCDE rule to check your skin for early signs of melanoma
- Don’t smoke
- Never use tanning beds or sun lamps
- Protect children from the sun to reduce their risk of skin cancer
- Protect your skin from excessive sun exposure year-round, not just in the summertime
- Reapply sunscreen every two hours if you stay in the sun, even on cloudy days
- See your health care provider about any skin changes or to get an annual skin check
- Use sunscreen SPF 30 or higher with UVA and UVB protection (broad spectrum)
- Wear protective clothing, headwear and eyewear
Skin Cancer Screening
Use the ABCDEs of skin cancer. If you see a mole that concerns you, see your health care provider right away. It’s a good idea to have a healthcare provider examine your skin every year. To confirm a diagnosis of skin cancer, a provider will take a sample of the area of concern and send it to the lab to have it assessed under a microscope to confirm the diagnosis. You can also check your own skin monthly or with a partner.
How to Perform a Skin Self-Exam
- Examine your body front and back in a full-length mirror, then look at the right and left sides with your arms raised
- Bend your elbows and look carefully at your forearms, underarms, fingernails and palms
- Look at the backs of your legs and feet, the spaces between your toes, your toenails and the soles of your feet
- Examine the back of your neck and scalp with a hand mirror - part your hair for a closer look at your scalp
- Check your back and buttocks with a hand mirror
- If anything is concerning it is important to talk to your doctor and remember the ABCDEs of skin cancer
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