What Is Skin Cancer?

RATE

Each year, more cases of skin cancer are diagnosed than breast, prostate, lung, and colon cancers combined.1 This makes skin cancer the most common cancer in the United States, affecting nearly 3.4 million Americans annually.2,3

Types of skin cancer

There are three main types of skin cancer:

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Melanoma

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are commonly grouped together as “non-melanoma skin cancer.” Non-melanoma skin cancer is far more common than melanoma, but melanoma is considered more dangerous. Most melanomas are superficial and surgically curable but are more likley to spread (metastasize) to other parts of the body. For this reason, 75% of skin cancer deaths are related to melanoma.4

Fortunately, most skin cancers can be treated and removed when they are caught early. More than 91% of people are still alive 5 years after being diagnosed with melanoma.5

Treatment of all skin cancers can lead to scars. Having skin cancer can decrease quality of life and productivity.6

Risk factors and prevention

The most important modifiable risk factor for skin cancer is exposure to ultraviolet (UV) light. UV light comes from the sun and tanning beds. UV radiation has been called a carcinogen or cancer-causing substance.7 UV rays can damage the DNA in skin cells, which may cause harmful genetic mutations. Cancer develops when these harmful mutations lead to uncontrolled cell growth.

You can reduce your UV exposure and risk of skin cancer by:

  • Using a broad spectrum sunscreen with sun protection factor (SPF) 15 or higher.
  • Seeking shade between 10 am and 2 pm.
  • Wearing long sleeves, long pants, wide-brimmed hats, and sunglasses.
  • Avoiding indoor tanning beds.

Some skin cancer risk factors are things that you cannot change.8,9 These include:

  • Skin color
  • Age and gender
  • Family history of melanoma
  • Presence of multiple moles or atypical moles. Atypical moles may be larger than other moles, with an abnormal color or shape.
  • Inherited medical conditions such as xeroderma pigmentosum, basal cell nevus syndrome, or familial atypical multiple mole-melanoma syndrome.

Not everyone with these risk factors will develop skin cancer. However, if you are at high risk, you may be able to take steps to detect precancer that may turn into cancer–or early signs of cancer. Experts recommend regular skin self-examination. Self-examination will help you to become familiar with your moles, freckles, and blemishes.9 If you notice changes, discuss them with your doctor. Your primary care doctor might also recommend regular follow-up with a dermatologist if you are at high risk.

Diagnosis

As a first step in diagnosing skin cancer, your doctor will want to understand your medical history and do a physical examination.8,9 Your doctor will ask when you first noticed a mark on your skin and how it has changed. Mention any symptoms such as pain, itching, bleeding, or oozing. Your doctor might ask about your sun exposure, sun protective behaviors, and family history of skin cancer.

Your doctor will examine the questionable mark on your skin and check for any other suspicious lesions.8,9 She or he may use a special magnifying lens called a dermatoscope. The dermatoscope allows your doctor to see the features of the lesion better. Your doctor may feel your lymph nodes. Lymph nodes that feel lumpy may be a sign that the cancer has spread.

A skin biopsy is a sample of tissue that is removed and sent to a lab. In the lab, the sample will be studied under a microscope to see whether it contains cancer cells.

If your doctor is concerned that the skin cancer might have spread, you may need additional tests. This is rare with non-melanoma skin cancer or early stage melanoma.8,9 A lymph node biopsy involves taking a small amount of tissue from the lymph node closest to the melanoma skin tumor to look for cancer cells. Imaging tests may be done to look for melanoma that has spread to lymph nodes or distant organs.

The results of these tests are used to stage the skin cancer. The cancer stage indicates how widespread the cancer is.8,9

Treatment

Treatment for skin cancer depends on the skin cancer type, location, size, risk that the cancer returns, and stage.8-11

Therapy
Typical uses
Description
Cryotherapy
AK, early BCC, small SCC
Lesion is frozen with liquid nitrogen
Topical medication
AK, early BCC
Medication is applied directly to the lesion
Excision
BCC, SCC, melanoma
Tumor is removed with a surgical knife
Curettage and electrodesiccation
AK (curettage only), BCC, small SCC
Cancerous tissue is scraped with a curette, destroy remaining cancer cells with an electrode
Mohs surgery
BCC, SCC, some melanoma
Skin is removed one layer of skin at a time until the sample no longer has cancer cells in a layer; this procedure helps save healthy tissue
Radiation therapy
BCC, SCC, melanoma
Additional (adjuvant) treatment to kill any cancer cells that remain after primary treatment of tumor
Targeted therapy
Advanced BCC, melanoma
Medications that target specific mutations that help cancer cells to grow and survive
Immunotherapy
Melanoma
Medications that help boost your body’s immune system in fighting cancer cells
Chemotherapy
Advanced SCC, melanoma
Medications that kill cancer cells

AK, actinic keratosis; BCC, basal cell carcinoma; SCC, squamous cell carcinoma

view references
  1. The Skin Cancer Foundation. Skin cancer facts & statistics. Accessed January 5, 2017 at: http://www.skincancer.org/skin-cancer-information/skin-cancer-facts
  2. American Cancer Society. Cancer facts & figures, 2017. Accessed March 8, 2017 at: http://bit.ly/2ksCPAg
  3. Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the U.S. population, 2012. JAMA Dermatol. 2015;151:1081-1086.
  4. Shenenberger DW. Cutaneous malignant melanoma: a primary care perspective. Am Fam Physician. 2012;85:161-168.
  5. SEER Cancer Stat Facts: Melanoma of the skin. National Cancer Institute. Bethesda, MD. Accessed January 17, 2017 at: http://seer.cancer.gov/statfacts/html/melan.html
  6. Centers for Disease Control and Prevention (CDC). Sunburn and sun protective behaviors among adults aged 18-29 years--United States, 2000-2010. MMWR Morb Mortal Wkly Rep. 2012;61:317-322.
  7. National Toxicology Program. US Department of Health and Human Services. 14th report on carcinogens. Accessed January 11, 2017 at: https://ntp.niehs.nih.gov/pubhealth/roc/index-1.html
  8. American Cancer Society. Melanoma skin cancer. Accessed January 5, 2017 at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003120-pdf.pdf
  9. American Cancer Society. Basal and squamous cell skin cancers. Accessed January 5, 2017 at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003139-pdf.pdf
  10. Firnhaber JM. Diagnosis and treatment of basal cell and squamous cell carcinoma. Am Fam Physician. 2012;86:161-168.
  11. McIntyre WJ, Downs MR, Bedwell SA. Treatment options for actinic keratoses. Am Fam Physician. 2007;76:667-671.
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View Written By | Review Date
Written by: Sarah O'Brien | Last reviewed: May 2017.
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