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Skin cancer



Alternative Name

Cancer - skin

Overview

Skin cancer is the most common cancer in people. In the US, more than 3.5 million skin cancers in over 2 million people are diagnosed each year. Skin cancer occurs when there is uncontrolled growth of the cells that make up the outer layer of skin, our epidermis. The most common types of skin cancers are basal cell carcinoma, squamous cell carcinoma and melanoma. Melanoma arises from our pigmented cells. Although melanomas are less common than the other two types of skin cancer, it is more dangerous. For all skin cancers, the earlier you detect them, the easier and more successful your treatment can be.


Review Date: 5/12/2011

Reviewed By: Sandra Osswald, MD, Associate Professor, Chief of Dermatology and Cutaneous Surgery



Risk Factors

There are many factors that may increase your risk of skin cancer. These are some factors to consider:

Sun exposure is a very important risk factor. Chronic sun exposure, history of sunburns and indoor tanning may increase your risk of skin cancer.

Having fair skin and light hair/eyes such as blond or red hair and blue or green eyes may increase your risk.

Family history of skin cancer

Personal history of a previous skin cancer

Personal history of precancerous skin lesions such as actinic keratoses which occur on sun damaged skin.

Having many moles or atypical moles called dysplastic moles may increase your risk

History of radiation treatments

History of immunosuppression, such as organ transplant patients requiring chronic medications to weaken their immune system

Signs/Symptoms

Actinic Keratosis
Illustration of the anatomy of the biliary system
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Fortunately, the skin is part of our body that we can examine every day. Skin cancer is often related to sun exposure so it often occurs on areas exposed to the sun, particularly the face, arms, upper chest, back, and lower legs. However, it is important to know that skin cancer can occur anywhere on the body, even on the bottom of the feet or between the toes. A skin growth that is new or changing should alert you to it. A spot that is painful, itches, erodes or bleeds, or scabs over are potential signs. Pay attention as well to a sore that does not seem to heal.

Basal Cell Carcinoma
Basal cell carcinoma
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Basal cell carcinomas have varying appearances, but usually are found on chronically sun exposed areas such as your face, ears and scalp. Common appearances are as a pearly or translucent bump, a crusted or ulcerated nodule or scar-like lesion.

Squamous cell carcinomas are also very commonly found on sun exposed areas of the face, ears, scalp and hands. Common appearances are as a scaly or crusted firm red nodule. These are also often persistent sores or non-healing lesions.

Squamous Cell
Skin Cancer

Illustration of the anatomy of the biliary system
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Melanomas can occur on sun exposed areas, but depending on type, may be found anywhere on the body. People with darker skin types should pay particular attention to the hands and feet and nails. Although melanomas can arise from a pre-existing mole, many are new pigmented lesions. So, one should pay attention to a mole that changes in size, shape or color, as well as new, changing moles. A common tool to use is the ABCDE's that may help you detect skin cancer early.

Melanoma
Illustration of the anatomy of the biliary system
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A = Asymmetry. Is the lesion asymmetric with one side different than the other?
B = Border. Is the border of the lesion very irregular?
C = Color. Are there different colors of brown within the lesion, or areas that are blue, red or even white?
D= Diameter. Is the lesion growing bigger, say greater than 6mm or much greater than the size of a pencil eraser? This does not mean it is melanoma, but should be looked at carefully.
E= Evolution. Have you noticed the lesion to be changing or growing larger?

There are other less common cancers that can be found on the skin. For example, there are Merkel cell carcinomas that are found on sun exposed areas of older individuals on the head, neck, arms and legs. These are seen as red or pink firm nodules.

If you discover any worrisome findings, consider getting a professional full skin examination.

Diagnosis

Diagnosis begins with a skin examination. A specialized lighted device, called a dermatoscope, is sometimes used to examine certain lesions carefully. If there are any suspicious lesions noted on examination, your doctor may ask if you would agree to a skin biopsy. This procedure involves removing the lesion or a sample of the lesion of concern so that it may be sent for pathologic evaluation. Pathologic evaluation can determine if the lesion is a skin cancer and if so, what type of skin cancer it is. Biopsies can usually be performed as an outpatient office procedure under local anesthesia. When the pathology is reviewed, you are then notified of the results and if any further testing or treatment is recommended.

Treatment

Treatment for skin cancer will depend on the type, size and extent of the skin cancer. Smaller skin cancers may be treated by your Dermatologist, while certain cancers on the face or larger or more extensive skin cancers may require Mohs surgery and/or multidisciplinary care. Our Mohs surgeon has specialty training in this technique and is located with our CTRC clinic. If multidisciplinary care is required, we will often coordinate efforts among our many available subspecialties. Specialties that we often coordinate with include our colleagues in Medical and Surgical Oncology, ENT, Ophthalmology, Plastic Surgery, Nuclear medicine and Radiation therapy.

Treatment options will be discussed with you. Treatment options may include:

Cryotherapy or freezing lesions with liquid nitrogen. This is treatment often used to destroy small precancerous lesions, such as actinic keratoses.

Electrodesiccation and curettage. This treatment may be used for superficial skin cancers. The doctor will scrape away cancer cells using a curette and use an electric needle to destroy cancer cells.

Excisional surgery. The doctor will cut out or excise the tumor with a margin of healthy tissue. The margin of tissue will depend on the type and extent of the skin cancer. Usually, this tissue is sent for pathologic evaluation.

Mohs surgery. This procedure is used for skin cancers that need to be removed from areas such as the face or digits, where there is not a lot of normal tissue to spare. This procedure allows skin cancer to be removed without taking an excessive amount of surrounding normal tissue. Mohs surgery gives excellent curative rates as 100% of the margin is evaluated for tumor. This technique is also best for larger, recurrent or more aggressive tumors where looking at the entire margin is critical.

Blu-U photodynamic therapy. This procedure involves using a topical medicine that makes cancer cells sensitive to light and then applying light therapy to destroy cancer cells.

Chemotherapy, topical and systemic, and biologic therapies. There are a variety of topical medications, such as 5 fluorouracil (Efudex, Carac), and systemic medications that can be used to destroy cancerous cells, as well as immunomodulators that can alter your immune system.

Radiation therapy. Radiation therapy can be used particularly for patients in whom surgery is not the best option as well as for adjunctive treatment.

Prevention

There are many ways you can help prevent skin cancer.

Seek the shade, especially between 10am and 4pm

Cover up your skin with dark, tight woven clothing over your arms and legs; wear large brimmed hats and sunglasses

Wear sunscreen everyday that provides broad spectrum coverage, both UVA and UVB, and is at least SPF 30

Don't use tanning beds and don't burn

Examine your skin from head to toe every month and see your doctor every year for a professional skin examination

Dermatology

If you would like to request an appointment with a physician, or if there is a direct referral from a physician, please call:

Appointments: (210) 450-9840

Fax: (210) 450-6092