Skin Cancer

Basic Information

The two most common types of skin cancer-basal cell and squamous cell carcinomas-are highly curable. However, melanoma, the third most common skin cancer, is more dangerous, especially among young people. Approximately, 65%-90% of melanomas are caused by exposure to ultraviolet (UV) light or sunlight.

1. Basal Cell Carcinoma

What Is Basal Cell Carcinoma?

Basal cell carcinoma (BCC) is the most common form of cancer. Basal cells line the deepest layer of the epidermis. Basal cell carcinomas are malignant growths--tumors--that arise in this layer.

Basal cell carcinoma can usually be diagnosed with a simple biopsy and is fairly easy to treat when detected early. However, 5 to 10 percent of BCCs can be resistant to treatment or locally aggressive, damaging the skin around them, and sometimes invading bone and cartilage. When not treated quickly, they can be difficult to eliminate. Fortunately, however, this is a cancer that has an extremely low rate of metastasis, and although it can result in scars and disfigurement, it is not usually life threatening.

Cause

The sun is responsible for over 90 percent of all skin cancers, including BCCs, which occur most frequently on the sun-exposed areas of the body: face, ears, neck, scalp, shoulders, hands and feet.

Am I At Risk?

Anyone with a history of frequent or intermittently intense sun exposure can develop BCC, but a number of factors increase risk:
Time Spent Outdoors People who work outdoors - construction workers, groundskeepers, lifeguards, etc. - are at greater risk than people who work indoors, as are those who spend their leisure hours in the sun.
Skin Type Fair-skinned individuals who sunburn easily and tan minimally or not at all have a higher incidence of skin cancer than dark-skinned individuals. Check our skin type chart to see how at risk you are.
Hours of sunlight the more hours of sunlight in the day, the greater the incidence of skin cancer.

Warning Signs

The five most typical characteristics of basal cell carcinoma are shown in the pictures below. Frequently, two or more features are present in one tumor. In addition, BCC sometimes resembles non cancerous skin conditions such as psoriasis or eczema. Only a trained physician can decide for sure. If you observe any of the warning signs or some other change in your skin, consult your physician immediately.

An Open Sore that bleeds, oozes or crusts and remains open for a few weeks. A persistent, non-healing sore is a very common sign of an early basal cell carcinoma.

A Reddish Patch or irritated area, frequently occurring on the chest, shoulders, arms or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no noticeable discomfort.

A Shiny Bump or nodule that is pearly or translucent and is often pink, red or white. The bump can also be tan, black or brown, especially in dark-haired people, and can be confused with a mole.

A Pink Growth with a slightly elevated rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.
A Scar-Like Area which is white, yellow or waxy, and often has poorly defined borders. The skin itself appears shiny and taut. This warning sign can indicate the presence of small roots, which make the tumor larger than it appears on the surface.

2.Squamous Cell Carcinoma

What Is Squamous Cell Carcinoma?

Squamous cell carcinoma (SCC) is the second most common form of skin cancer, with over 250,000 new cases per year estimated in the United States. It arises in the squamous cells that compose most of the upper layer of the skin.

Most SCCs are not serious. When identified early and treated promptly, the future is bright. However, if overlooked, they are harder to treat and can cause disfigurement. While 96 to 97 percent of SCCs are localized, the small percentage of remaining cases can spread to distant organs and become life-threatening.
Cause

Most cases of squamous cell carcinoma are caused by chronic overexposure to the sun. Tumors appear most frequently on the sun-exposed face, neck, bald scalp, hands, shoulders, arms and back. The rim of the ear and the lower lip are especially vulnerable to these cancers.

SCCs may also occur where skin has suffered certain kinds of injury: burns, scars, long-standing sores, sites previously exposed to X-rays or certain chemicals (such as arsenic and petroleum by-products). In addition, chronic skin inflammation or medical conditions that suppress the immune system over an extended period of time may encourage development of the disease.

Occasionally, squamous cell carcinoma arises spontaneously on what appears to be normal, healthy, undamaged skin. Some researchers believe that a tendency to develop this cancer may be inherited.

Am I at Risk?

Anyone with a substantial history of sun exposure can develop squamous cell carcinoma but certain environmental and genetic factors can increase the potential for this disease. Sun Exposure:Sunlight is responsible for over 90 percent of all skin cancers. Working primarily outdoors, living in an area that gets a lot of high intensity sunlight (like Australia), and spending time in tanning booths all increase your exposure to UV rays and thus increase your risk for developing skin cancer, including squamous cell carcinoma.

Skin Type : People who have fair skin, light hair, and blue, green, or gray eyes are at highest risk. Hispanics, Asians and dark-skinned individuals of African descent are far less likely than Caucasians to develop skin cancer. Check out your skin type and how it affects your skin cancer risk.

More than two thirds of the skin cancers that dark-skinned individuals develop are SCCs, usually arising on the sites of preexisting inflammatory skin conditions or burn injuries. It is still essential for them to practice sun protection.

Previous Skin Cancer : Anyone who has had a skin cancer of any type is at increased risk of developing another one.

Reduced Immunity : People with weakened immune systems due to excessive unprotected sun exposure, chemotherapy, or illnesses such as HIV/AIDS are more likely to develop squamous cell carcinoma.
What to Look For

Squamous cell tumors are thick, rough, horny and shallow when they develop. Occasionally, they will ulcerate, which means that the epidermis above the cancer is not intact. There will be a raised border and a crusted surface over a raised, pebbly, granular base. See photos below for examples.

Any bump or open sore in areas of chronic inflammatory skin lesions indicates the possibility of squamous cell carcinoma, and a doctor should be consulted immediately if this is the case. Usually, the skin in these areas reveals telltale signs of sun damage, such as wrinkling, changes in pigmentation and loss of elasticity. That is why tumors appear most frequently on sun-exposed parts of the body.
Precancers and Early Cancers

There are some precursor conditions, called precancers and early cancers (also called carcinoma in situ) that are sometimes associated with the later development of SCC. They include actinic keratosis, actinic chelitis, leukoplakia, and Bowen's disease, although most dermatologists believe that Bowen's disease is just another name for a type of superficial SCC that hasn't spread yet. It appears as a persistent, scaly red-brown, scaly patch. It may resemble eczema or psoriasis.

If you notice any change on your skin - a mole changing appearance, a new growth, a sore that won't heal - have a doctor look at it without delay. Treatments for early cancers are much more effective than treatments for later ones.

Warning Signs

A wart-like growth that crusts and occasionally bleeds

A persistent, scaly red patch with irregular borders that sometimes crusts or bleeds.

open sore that bleeds and crusts and persists for weeks.

An elevated growth with a central depression that occasionally bleeds. A growth of this type may rapidly increase in size.

3. Melanoma

What Is Melanoma?

Melanoma is the most serious form of skin cancer. However, if it is recognized and treated early, it is nearly 100 percent curable. But if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths.

Melanoma is a malignant tumor that originates in melanocytes, the cells which produce the pigment melanin that colors our skin, hair, and eyes. The majority of melanomas are black or brown. However, some melanomas are skin-colored, pink, red, purple, blue or white.

Am I at Risk?

Everyone is at some risk for melanoma, but increased risk depends on several factors: sun exposure, number of moles on the skin, skin type and family history (genetics).

Sun exposureBoth UVA and UVB rays are dangerous to the skin, and can induce skin cancer, including melanoma. Blistering sunburns in early childhood increase risk, but cumulative exposure also is a factor. People who live in locations that get more sunlight - like Florida, Hawaii, and Australia - get more skin cancer. Avoid using a tanning booth or tanning bed, since it increases your exposure to UV rays, increasing your risk of developing melanoma and other skin cancers.

Moles: There are two kinds of moles: normal moles - the small brown blemishes, growths, or "beauty marks" that appear in the first few decades of life in almost everyone - and atypical moles, also known as dysplastic nevi. Regardless of type, the more moles you have, the greater your risk for melanoma.

Skin Type As with all skin cancers, people with fairer skin are at increased risk. You can read more about skin type and risk here.

Family History About one in every ten patients diagnosed with the disease has a family member with a history of melanoma. If your mother, father, siblings or children have had a melanoma, you are in a melanoma-prone family. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than people who do not have a family history. If the cancer occurred in a grandmother, grandfather, aunt, uncle, niece or nephew, there is still an increase in risk, although it is not as great. Read more on family history, below.

Personal History Once you have had melanoma, you run an increased chance of recurrence. Also, people who have or had basal cell carcinoma and squamous cell carcinoma are at increased risk for developing melanoma.

Weakened Immune System Compromised immune systems as the result of chemotherapy, an organ transplant, excessive sun exposure, and diseases such as HIV/AIDS or lymphoma can increase your risk of melanoma.

More about Family History

We are all at risk for melanoma. However, some people are more at risk than others. Heredity plays a major role. If your mother, father, siblings, or children (first-degree relatives) have had a melanoma, you are part of a melanoma-prone family. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than members of the general public who do not have a family history of the disease. If the cancer occurred in a grandmother, grandfather, aunt, uncle, niece, or nephew (second-degree relatives), there is still an increase in risk compared to the general population, though it is not as great.

About one of every ten patients diagnosed with the disease has a family member with a history of melanoma. If melanoma is present in your family, you can protect yourself and your children by being particularly vigilant in watching for the early warning signs and finding the cancer when it is easiest to treat.
Close Relatives Examined

When this skin cancer is diagnosed, it is standard practice for physicians to recommend that close relatives be examined immediately for melanoma and for the presence of unusual or atypical moles. These moles are also called "dysplastic nevi." You can read more about atypical moles here.
Family Syndrome

When atypical moles are found in an individual belonging to a melanoma family, the condition is known as FAMMM, standing for Familial Atypical Multiple Mole Melanoma Syndrome. People with this syndrome are at the greatest risk of developing melanoma. In contrast, a research study found that those family members who did not have atypical moles were much less likely to develop melanoma.
Genetic Risk Factors

A mutation (alteration) in a recently discovered gene, the BRAF, may play a part in causing melanoma. In one study, this mutated gene was found in two-thirds of the melanoma cells analyzed. BRAF is called a "switch" gene, because it turns on to allow the cells to grow and divide. Mutations in this gene can lead to uncontrolled cell growth and cancer. The discovery is an exciting research breakthrough, but physicians and patients are still years away from reaping the rewards. Ultimately, the understanding of the BRAF gene could lead to the development of diagnostic tools and drug therapies. The mutations most commonly seen in familial melanoma occur in another gene, p53. When this gene is in its normal state, its main function is to give damaged cells time to repair themselves and not progress to cancer. However, when the gene is altered, it becomes unable to perform this function, and cancer can result. A number of gene mutations in addition to p53 and BRAF have been associated with familial melanoma. In the future, families might be screened so as to identify those members who are carrying a defective gene.

Moles in an Active Stage

Moles in people belonging to melanoma-prone families are subject to change at certain times of life. They may get larger or show alterations in color or elevation, so for those periods, they are described as being active. While the reasons for these changes are not fully known, there could be a hormonal component: Moles are more active at puberty and during pregnancy. Many - but not all - physicians advise high-risk individuals not to take hormonal medications, such as oral contraceptives or hormone replacement therapy.

Examination Scheduling

Individuals with the Atypical Mole Syndrome can improve their chances of early detection by increasing the frequency of skin self-examination and by visiting a physician more often. The clinician may take photographs to document whether there are new moles or changes in older ones.

Children: A Special Case

Children in melanoma-prone families need special care, because familial melanoma is likely to make its appearance early in life. Even though these cancers usually do not appear until after adolescence, they may arise in much younger children who have a family history of melanoma. Most physicians, therefore, advise parents to make a point of studying a child's skin frequently from infancy on.

Physician examination should start at the age of ten and continue on a twice-a-year basis thereafter. Particular care should be taken at puberty and during adolescence when hormonal changes activate the moles. Here is some encouraging news: Because melanoma families are on the lookout for the disease and seek professional consultation early, the survival rate for familial melanoma is even higher than that for non-familial melanomas.

Warning Signs: The ABCDEs of Melanoma

Moles, brown spots and growths on the skin are usually harmless - but not always. Anyone who has more than 100 moles is at greater risk for melanoma. The first signs can appear in one or more atypical moles. That's why it's so important to get to know your skin very well and to recognize any changes in the moles on your body. Look for the ABCDEs of melanoma, and if you see one or more, make an appointment with a physician immediately.

Asymmetry

If you draw a line through this mole, the two halves will not match.

Border

The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.

Color

Having a variety of colors is another warning signal. A number of different shades of brown, tan or black could appear. A melanoma may also become red, blue or some other color.

Diameter

Melanomas usually are larger in diameter than the size of the eraser on your pencil (1/4 inch or 6 mm), but they may sometimes be smaller when first detected.

Evolving

Any change - in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting - points to danger.

Prompt action is your best protection.