Skin Cancer

Skin cancer is the most common type of cancer in the United States. Skin cancer often begins as an unusual, uncontrolled growth on the skin. This type of cancer often develops on sun-exposed areas like the face, head, and neck. Still, it can be found on all parts of the body, even areas that are rarely exposed to sunlight. This can include the nails and soles of the feet.  

Skin cancers are usually named after the type of cell that is affected. 

• Commonly diagnosed skin cancer types include: Basal Cell Carcinoma: Basal cell carcinoma (BCC) is the most common type of skin cancer. It starts in the basal, or lowest, layer of the epidermis. The epidermis is the outer layer of skin on the body that you can see and touch. 
• Cutaneous Squamous Cell Carcinoma: cSCC is the second most common type of skin cancer. It starts in the epidermis from the flat squamous cells that lie on top of the basal layer of the skin. It is also known as Squamous Cell Carcinoma of the Skin or Squamous Cell Skin Cancer.
• Melanoma: Melanoma is a type of cancer that begins in the melanocytes. These are cells that make the pigment melanin. Melanin gives our skin its color. 
• Merkel Cell Carcinoma(MCC): Merkel cell carcinoma is a very rare type of skin cancer. MCC is not as common as BCC, cSCC, or even melanoma. It develops in the special nerve cells that lie within the skin.

Some rarer forms of skin cancer include: 

• Sebaceous Carcinoma (SC): SC is a rarer cancer that develops on the skin around the eyelid. 
• Dermatofibrosarcoma protuberans (DFSP): DFSP is a rare type of skin cancer that typically grows slowly. It develops in the middle layer of the skin, called the dermis. 

Skin cancer is easier to treat and cure when it is found early. If the cancer is left untreated or not removed completely, it may come back (recurrence) or begin to spread to nearby areas. Cancer cells can invade nearby healthy tissue or break away from the tumor, enter the blood or lymph vessels and spread to other parts of the body. When this happens, it is called metastatic disease. Melanoma is much more likely than other skin cancers to spread to other parts of the body. If your cancer spreads to the bone, visit our bone metastases page.

Risk factors are things that can increase a person’s chance of developing a disease. While skin cancer is more common among people with light or fair skin tones, people of all skin tones are at risk. 

Signs of skin cancer can show up differently for people of color. This can make it harder for people to notice the signs and symptoms right away. For example, signs of melanoma in people of color may appear under the fingernails and between the toes.

Learning about the types of skin cancer and the signs and symptoms to look for can help you and your healthcare team catch the disease early. When found early, skin cancer can be easy to treat and cure.

Other risk factors include:

• Exposure to sunlight or ultraviolet radiation from tanning booths
• Frequent blistering sunburns, especially early in life 
• A personal history of skin cancer 
• Having more than 50 moles
• Possible genetic factors (i.e., mutations in certain genes or family history)
• History of radiation therapy, certain conditions that suppress the immune system or exposure to high levels of arsenic 

As always, talk with your healthcare provider if you notice anything unusual on your skin, or if you have a sore or patch of skin that won’t heal. Tell your doctor if you notice changes or anything unusual on your skin. Do monthly skin checks – check all the surfaces of your skin and look closely at your moles so that you can tell if they begin to change in shape, size or color.

Know the ABCDE’s of Skin Cancer

• Asymmetry - The shape of one half does not match the other.
• Border - The edges are often ragged, notched, blurred or irregular in outline; the pigment may spread into the surrounding skin 
• Color - The color is uneven. Shades of black, brown and tan may be present. Areas of white, grey, red, pink or blue also may be seen.
• Diameter - There is a change in size, usually an increase.
• Evolving - Changes in size, shape, color or elevation, or any symptoms such bleeding, itching or crusting.

Screening, Diagnosis & Staging

You know your body best. Check your skin and discuss any changes with your doctor. Your doctor will complete a medical history that will include:

• Your past exposure to the sun
• Any exposure to other known causes of skin cancer
• Your personal or family history of skin conditions
• When you first noticed the mark
• If the mark has changed at all in size or appearance

Tests that are commonly used to find skin cancer include:

• Skin exams - A dermatologist will check the skin for bumps or spots that look abnormal in color, size, shape, or texture.

• Skin biopsy - A biopsy is typically needed to confirm a diagnosis of skin cancer. A biopsy is a common procedure to remove a part of an abnormal-looking growth. The area will be numbed with a local anesthetic injected into the skin. If needed, all or part of the growth wil be cut from the skin. A different doctor (called a pathologist, often a dermatopathologist) will look at this tissue under the microscope to check for cancer cells. There are different types of biopsies that may be used depending on the cancer and its location.

  If the disease is more advanced, other diagnostic tests may be added, including CT or PET scans. However, this is done very infrequently.

  On rare occasions, a person’s lymph node(s) may be removed to find out if the cancer has spread, which is called metastasis. The doctor may order other tests such as blood tests, chest x-rays, and imaging scans of the lymph nodes and nerves, liver, bones, and brain. This is also rare.

   

Treatment and Side Effects

The treatment for skin cancer will depend on a number of factors, including:

• The stage of the disease (whether it has spread deeper into the skin or to other areas of the body)
• The type of skin cancer
• The size and location of the tumor
• Your preferences 

Treatment options may include:

• Surgery to remove the cancer cells. Different surgical techniques may be recommended.
• Topical medications that are applied to the skin (when the skin cancer is a type that is known to be very thin).
• Radiation therapy using high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
• Chemotherapy using a drug or combination of drugs to kill cancer cells. These medications may be taken by mouth or given through a vein.
• Immunotherapy using substances made by the body or in a laboratory to activate or trigger the body’s immune system to recognize and fight cancer cells.
• Targeted therapy using new medications designed to target and kill cancer cells without harming healthy cells. Targeted therapies work in different ways. For example, the target may be a specific protein or abnormal mutation in the cell that is promoting cancer growth.
• Clinical trials or studies that test new ways to use or combine drugs or techniques that are already approved or investigate novel therapies. Clinical trials may be a good option for some people. Ask your doctor if a clinical trial is right for you.

Communicating with the healthcare team

Timely cancer treatment is important. Skin cancer is easier to treat and cure when it is found early. Once the cancer spreads to other parts of the body it can be harder to treat. It is important to see the right specialist to treat your stage of cancer at the right time.

Follow-up care

Because skin cancer can come back, be sure to ask your doctor how often to have your skin checked for signs of cancer. Remember to keep any follow-up visits.