Skin cancer

What is skin cancer?

Skin cancer is the most common cancer in the United States and it is estimated that 1 in 5 Americans will develop skin cancer in their lifetime. In total, about 10,000 Americans are diagnosed with skin cancer every day and many of these new cases are in women. Skin cancer refers to an overgrowth of skin cells, usually basal cells or squamous cells. When these cells overgrow, they form bumps or patches that can grow, change, and bleed. Most skin cancers are caused by ultraviolet light radiation and tanning and can be prevented with sun protection.

The most common skin cancers are basal cell carcinoma and squamous cell carcinoma. Basal cell carcinoma comes from basal cells in the skin, which are the bottom layer of the skin. Squamous cell carcinoma comes from the squamous cells in the skin, which form the “bricks” of the skin.

Melanoma is the most significant skin cancer and arises from the pigmented producing cells of the skin, called melanocytes. Melanocytes are usually spread evenly throughout the skin but can begin to grow abnormally and spread into the upper and lower levels of the skin as a melanoma. Melanoma is a significant cancer and affects 1 in 27 men and 1 in 40 women in their lifetime.

Types of skin cancer

There are several types of skin cancer that arise from the different cells in the skin. The most common skin cancers are:

• Basal cell carcinoma. As the most common skin cancer, basal cell carcinoma usually appears as a pimple or bump on the skin that does not heal. It typically occurs on sun exposed areas. It may grow slowly in size and bleed over time. Basal cell is highly treatable and curable when diagnosed early.

• Squamous cell carcinoma. Squamous cell carcinoma often appears as red, scaly, non-healing patch. It also typically occurs on sun exposed areas. Squamous cell carcinoma is treatable and curable when diagnosed early.

• Melanoma. Melanoma is a significant skin cancer, with a high risk of spread to nearby lymph nodes if not found early. Melanoma usually appear as a dark brown to black patch on the skin, but can also appear pink or brown.

Any bump that is new, changing or bleeding should be evaluated by a dermatologist. Call to make an appointment if you have a bump or lesion of concern.

Who is at risk for skin cancer?

Skin cancer can affect anyone, including those with different skin types. Skin cancer is most commonly associated with tanning bed use, blistering sunburns and overall excessive UV exposure.

Skin cancer is most common in non-Hispanic White individuals and is 30 times higher in this group than in other groups. While skin cancer is more common in this group, skin cancer can be found in individuals with darker skin tones. In individuals with darker skin tones, skin cancer is often diagnosed in later stages, so it is important for an individual to have a new bump or changing lesion evaluated.

While skin cancer commonly occurs in sun exposed areas, it can also occur on the palms and soles, groin, nails, and the lips and mouth. A complete skin examination should include close examination of those areas, along the the rest of the skin.

Skin cancer occurs in men and women, but is more common in women under 50 and in men over 50. This may be related to increased sun exposure and tanning bed use in young women. Melanoma in specific is higher in women in younger age groups but this appears to be improving over time with increased use of sun protection.

Symptoms of skin cancer

Skin cancer can appear anywhere on the body and usually appears as a non-healing, growing bump or patch.

Basal cell carcinoma often appears as a pearly pimple or bump on sun exposed areas and may bleed when touched or irritated.

Squamous cell carcinoma can appear as a red, flaking patch that also bleeds and may grow a thick white crust on top of it. This also occurs in areas of high sun exposure.

Melanoma usually appears as a black or dark brown patch or bump on areas of high sun exposure. Rarely, melanomas can be pink or brown as well. Importantly, melanoma can be genetic so individuals with melanoma should have their adult family members screened as well.

A dermatologist can detect skin cancers by doing a complete skin check. A complete skin check begins by reviewing prior skin cancers, sunburns and work and recreational activities, along with sun protection strategies. Family history is also important. A skin check should include the scalp, lips, mouth, nails, groin, and toes. A skin check can also include the use of dermoscopy, which is a polarized light that helps to detect skin cancer.

How do dermatologists treat skin cancer?

When diagnosed early, most skin cancer is treatable and curable. Basal cell carcinoma usually does not spread beyond the skin, while squamous cell in advanced cases may spread beyond the skin to the lymph nodes. Melanoma has a significant risk of spread to lymph nodes and organs, but early detection and curative therapy can prevent this. Treatments for skin cancer include.

• Surgical removal. Most skin cancers can be removed in a skin excision procedure. An excision removes the tumor and a small margin and has an over 95% cure rate. Excisions can be performed safely in the outpatient setting.

• Mohs surgery. Mohs surgery is the treatment of choice and gold standard therapy for basal cell carcinoma and squamous cell carcinoma of the face, hands, feet, neck and scalp. It has an over 99% cure rate and can be performed safely in the office.

• Topical therapy. Select skin cancers that are thin and low grade can be treated with topical creams such as fluorouracil and imiquimod that enhance natural immune responses to the tumor. A dermatologist can decide if these are appropriate for your skin cancer.

• Radiation. Radiation can be used in select skin cancer cases with the assistance of a radiation oncologist.

• Immunotherapy. Immunotherapy is available for advanced and metastasized tumors with the assistance of a medical oncologist.