Skin Cancer

What Is Skin Cancer?

Skin cancer is a disease in which skin cells grow abnormally. In healthy skin new cells develop all the time to replace older cells. These normal new cells multiply and grow in an orderly way.

If skin cells grow out of control they form a mass or ‘tumor’. 

A skin tumor is considered benign (not cancer) if it is limited to a few cell layers and does not invade surrounding tissues or organs. But if the tumor spreads to surrounding tissues it is considered malignant or cancerous. 

Most skin growths are benign (not harmful).

There are 3 different types of skin cancer. They are different because they arise from one of the 3 different types of cells in the outer layer of the skin (see below to read about the different types of cells).

Each kind of skin cancer has its own distinctive appearance. Certain skin cancers also tend to develop in specific areas of the body.

The 3 different types of skin cancer:

• 1. Basal cell carcinoma is the most common kind of skin cancer. More than 90 per cent of all skin cancers in the United States are basal cell carcinomas. Fortunately, basal cell carcinoma also is the least serious kind of skin cancer. That’s because it grows slowly and rarely spreads. It spreads in less than 1 out of every 1,000 patients.

• 2. Squamous cell carcinoma is more serious because it does spread to vital organs inside the body. Spread occurs in a few cases in every 100. It does so slowly. At first cancer cells tend to spread only as far as the nearest lymph nodes structures, which filter out and trap the cancer cells. If spread has occurred, the affected lymph nodes can be removed before cancer spreads to vital organs.

• 3. Malignant melanoma is the most serious kind of skin cancer because it may spread quickly from the skin through the lymph nodes or blood, to internal organs. For more information about melanoma, go to Melanoma.

To read about ‘What causes skin cancer?’ please go to ‘what causes skin cancer?’  

Who is most at risk of developing skin cancer

Anyone can get skin cancer. Although most cases occur in people over age 50 with fair skin, it can develop in younger people, and those with dark skin. In general, an individual’s lifetime exposure to UV light determines his risk.

Certain individuals have a risk that is higher than the rest of the population. Included are people who:

• Have light skin that freckles easily and tends to burn rather than tan. Individuals with blond or red hair and blue or light gray eyes often have fair skin. The skin type table can help determine an individual’s risk.
• Live in geographic regions closer to the equator, where sunlight is strongest. Residents of Florida, Texas, and southern California, for instance, have a greater risk than those in Maine, Wisconsin, and North Dakota.
• Work outdoors or spend lots of time in leisure activities in the sun.
• Already have had skin cancer. A diagnosis of skin cancer means that an individual has a higher-than-normal risk for the disease. These individuals must take great care to minimize UV exposure and follow other preventive measures.

The risk of skin cancer also varies with the kind of sun exposure.

• Basal cell carcinoma and squamous cell carcinoma are more common in people who spend a lot of time in the sun over many years. This includes people who work outdoors or engage in other daily outdoor activities in warm climates.
• Malignant melanoma is more common in people who get occasional, high-intensity sun exposure. People who sunbathe on vacations or during brief sunny periods in cold climates may get such exposure.
• Some studies show that a single serious sunburn can increase the risk of skin cancer by 50 percent.

DETERMINING YOUR SUSCEPTIBILITY TO SKIN CANCER- SKIN TYPE

* Generally based on first exposure to summer sun following winter without exposure

What Causes Skin Cancer?

Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. Energy from the sun actually is a form of radiation. It consists of visible light and other rays that people can’t see. Invisible infrared radiation, for instance, makes sunlight feel hot. UV also is invisible, and causes sunburn and sun tan.

UV rays damage DNA, the genetic material that makes up genes. Genes control the growth and overall health of skin cells. If the genetic damage is severe, a normal skin cell may begin to grow in the uncontrolled, disorderly way of cancer cells. UV also can cause sunburn, and other damage that makes the skin look prematurely old and wrinkled.

Two kinds of rays exist in ultraviolet radiation:

• Ultraviolet A (UVA)
• Ultraviolet B (UVB)

Scientists once thought that excessive exposure to UVB rays was the main cause of skin cancer. Now they think that UVA also is involved. That’s why it is important to use a sunscreen product that protects against both UVA and UVB rays.

Some cases of skin cancer, however, may be hereditary and run in families. In those cases, skin cancer is caused by abnormal genes that children inherit from their parents. Genes make parents and children look somewhat alike. They also make them likely to get some of the same diseases.

What Are The Symptoms Of Skin Cancer?

Skin cancer first appears as a growth, or abnormal accumulation of cells. It sometimes takes the form of a sore or pimple that does not heal. The sore may bleed or ooze fluid, crust or scab over, and then ooze or bleed again. Cancer can occur on almost area of the skin, but is most common on areas often exposed to the sun. Skin cancer usually is painless.

Symptoms Of Skin Cancer

The most common symptoms are:

1. A new growth on the skin.

2. A change in an existing skin growth.

3. A sore that does not heal.

Not all changes in the skin are symptoms of skin cancer. Most moles and other growths are harmless and do not need to be removed. Moles that are unattractive, or in areas where they are constantly irritated by clothing, can be removed by a doctor.

The average person has dozens of moles and other skin growths that are benign or noncancerous. They include:

• Birthmarks, or “congenital nevi,” are moles that are present at birth.
• Acquired moles begin to develop early in adolescence, growing and darkening throughout the teenage years. Many adults have 40-60 acquired moles.
• Liver spots, or “solar lentigines,” are flat tan-to-brown spots that occur mainly on the face, neck, hands, and forearms. They have nothing to do with the   liver. Rather, they develop as a result of aging and sun exposure.
• Seborrheic keratoses are raised, wart-like, tan-to-brown growths that occur as people age.
• Acquired cherry angiomas are smooth, dome-shaped red spots that usually develop on the chest and back. Most are bright red, and appear as people age.
• Skin tags are small, soft flaps of skin that grow on the neck, in the armpits, and groin area are caused by repeated friction.
• Actinic keratoses are slightly scaly, reddish patches that form on people with sun-damaged skin. They are precancerousgrowths that may changes into a squamous cell carcinoma. That’s why doctors recommend removal of actinic keratoses.

How Can You Tell If A Mole Is Cancerous?

Although most skin growths are not cancer, it’s important to check with the doctor about new growths or changes in old growths. When growths become cancerous, they may change in size or color, or become sores that do not heal.

Doing a regular skin self-examination is a good way to monitor the skin for early symptoms of skin cancer. Skin self examination is especially important for people who have had skin cancer. It can detect new cancers, and recurrences of past cancer, at an early and most curable stage.

Where Does Skin Cancer Usually Develop?

Basal cell carcinomas usually occur on parts of the body that are often exposed to the sun. These are the face, neck, V-shaped area of the chest, and upper back. They occur less often on the top sides of the arms and hands.

• These tumors sometimes look like a sore or pimple that does not heal.
• They may ooze yellowish fluid, crust over with a scab, and then break down and ooze again.
• When the surrounding skin is stretched, a basal cell carcinoma has a pearly gray look, with tiny blood vessels often visible inside the tumor.

   

Squamous cell carcinomas also appear most often on the face and neck, V-shaped are of the chest, and upper back. They are more likely than basal cells carcinomas to form on the top of the arms and hands.

• Squamous cell carcinomas look like an inflamed (pinkish or reddish), scaly growth that feels sore or tender.
• Some may repeatedly break open, bleed, and crust – never fully healing.
•  

Malignant melanomas usually form on the trunk (the area of the body between the neck and the hips) or legs. These areas don’t get constant sun exposure. Rather, they are areas that get periodic intense exposure and sun burn.

• Melanomas may form from an existing mole or freckle, or begin to grow from a normal-appearing area of the skin.
• Moles and freckles are usually light to dark brown and have a clear-cut edge or border.
• Melanomas usually are multi-colored. The may combine different shades of brown and black, sometimes with areas of red, white or blue.
• They often have an irregular or uneven border.
• They may sometimes bleed.

   

How Is Skin Cancer Diagnosed?

Doctors often can recognize skin cancer just by looking at it.

• Encourage your doctor to look for growths by doing a complete examination of the entire skin surface during a physical examination at least once a year; more often if you already have a past history of skin cancer.
• Many people detect skin cancer themselves while doing a regular skin self-examination. A biopsy, however, is the only certain way of identifying skin cancer, and determining the specific type of cancer. In a biopsy, the doctor removes cells or tissues for examination under a microscope. The examination usually is done by a dermatopathologist, a doctor who studies diseased tissue under a microscope.

Two types of biopsy are done for most skin cancers:

• An excisional biopsy excises, or cuts away, the entire visible growth. For small nonmelanoma skin cancer, an excisional biopsy may also be the only treatment necessary, whereas other cancers like malignant melanoma generally require additional removal of a wider margin of normal tissue around the site.
• An incisional biopsy, or core biopsy, removes only a sample of the growth. Further treatment is necessary if the microscopic examination reveals cancer cells. This is the most common type of biopsy.

The Different Types Of Skin Cancer?

There are a number of different types of skin cancers depending on the type of skin cell from which they arise. Each kind of skin cancer has its own distinctive appearance. Certain skin cancers also tend to develop in specific areas of the body.

• Basal cell carcinoma
• Squamous cell carcinoma
• A third type, malignant melanoma, is relatively rare but can be very dangerous.

Basal cell carcinoma and squamous cell carcinoma are called nonmelanoma to set them apart from the more serious melanoma skin cancers.

• Basal cell carcinoma is the most common kind of skin cancer. More than 90 per cent of all skin cancers in the United States are basal cell carcinomas. Fortunately, basal cell carcinoma also is the least serious kind of skin cancer. That’s because it grows slowly and rarely spreads. It spreads in less than 1 out of every 1,000 patients.
• Squamous cell carcinoma is more serious because it does spread to vital organs inside the body. Spread occurs in a few cases in every 100. It does so slowly. At first cancer cells tend to spread only as far as the nearest lymph nodes structures, which filter out and trap the cancer cells. If spread has occurred, the affected lymph nodes can be removed before cancer spreads to vital organs.
• Malignant melanoma is the most serious kind of skin cancer because it may spread quickly from the skin through the lymph nodes or blood, to internal organs.

For further information about melanoma, go to Melanoma.

Who Is Most At Risk Of Developing Skin Cancer?

Anyone can get skin cancer. Although most cases occur in people over age 50 with fair skin, it can develop in younger people, and those with dark skin. In general, an individual’s lifetime exposure to UV light determines his risk.

Certain individuals have a risk that is higher than the rest of the population. Included are people who:

• Have light skin that freckles easily and tends to burn rather than tan. Individuals with blond or red hair and blue or light gray eyes often have fair skin. The skin type table can help determine an individual’s risk.
• Live in geographic regions closer to the equator, where sunlight is strongest. Residents of Florida, Texas, and southern California, for instance, have a greater risk than those in Maine, Wisconsin, and North Dakota.
• Work outdoors or spend lots of time in leisure activities in the sun.
• Already have had skin cancer. A diagnosis of skin cancer means that an individual has a higher-than-normal risk for the disease. These individuals must take great care to minimize UV exposure and follow other preventive measures.

The risk of skin cancer also varies with the kind of sun exposure.

• Basal cell carcinoma and squamous cell carcinoma are more common in people who spend a lot of time in the sun over many years. This includes people who work outdoors or engage in other daily outdoor activities in warm climates.
• Malignant melanoma is more common in people who get occasional, high-intensity sun exposure. People who sunbathe on vacations or during brief sunny periods in cold climates may get such exposure.
• Some studies show that a single serious sunburn can increase the risk of skin cancer by 50 percent.

DETERMINING YOUR SUSCEPTIBILITY TO SKIN CANCER- SKIN TYPE

* Generally based on first exposure to summer sun following winter without exposure

How Do Doctors Determine The Stage Of Skin Cancer?

Cancers go through distinct periods, phases, or stages in their growth. The process of determining the stage of cancer is called “staging.” A doctor must know the stage of a cancer in order to pick the most effective treatment. Advanced cancer that has spread needs treatment quite different than localized cancer growing only in the original tumor site.

Skin cancer is “staged” by information obtained from various tests. Doctors usually divide skin cancer into two stages, localized and metastatic.

• Localized skin cancer has not moved beyond the visible tumor. Most skin cancers are diagnosed in this stage. The biopsy is the only test needed to determine the stage.
• Metastatic cancer has spread beyond the original site. The doctor may suspect that spread has occurred when a skin cancer is unusually large or has been growing for a long time or there are symptoms of internal problems, such as a cough or headache. In such cases, the doctor will examine lymph nodes in the area for signs of spread. In addition, the doctor may order other tests, such as chest x-rays, MRI, or CT scan, to see if cancer has spread elsewhere in the body.

At first, cancer is restricted, or localized, to one place in the body. Skin cancer diagnosed early usually is growing only in the area of the visible tumor. Later in its life, if untreated, some skin cancers may reach a more advanced stage, spreading to nearby lymph nodes. In the most advanced stage, cancer has spread to other organs in the body.

How Is Skin Cancer Treated?

Treatment of skin cancer depends on the

• type of skin cancer
• its stage and location and the
• individual’s age and overall health

People with small basal cell carcinomas, for instance, may need only simple treatment. That’s because basal cell cancers rarely spread to other parts of the body and seldom are fatal. Squamous cell carcinomas have a greater tendency to spread, and may require more treatment. Malignant melanoma may require complicated treatment because of its high risk for spreading.

Skin cancers are usually treated by a dermatologist, a doctor who specializes in skin diseases. Treatment often can be done in the doctor’s office. Most require only a local anesthetic. The patient goes home after treatment, and can soon resume regular activities.

Some tiny skin cancers are completely removed and cured during the biopsy. No more treatment is needed. However, most require additional treatment to eliminate all of the cancer cells.

Three kinds of treatment are used for most skin cancers. They re:

• Surgery: Taking out or destroying the cancer.
• Chemotherapy: Giving drugs to kill the cancer cells.
• Radiation therapy: Using powerful energy from x-rays or other sources to destroy the cancer cells.

In addition to these, there are other treatment options.

Surgery

Surgery is the most common treatment. The doctor may use any of several surgical methods:

• Simple excision involves cutting out the tumor with a margin of surrounding normal skin to be sure it is completely removed.
• Cryosurgery (cryo = “cold”) freezes and kills the cancer cells. It uses liquid nitrogen, which has a temperature of 196 degrees below zero centigrade. The extreme cold instantly kills the tumor, which falls off like a scab after the area thaws. Cryosurgery itself is painless. However, the treated area may become swollen and painful after it thaws. Cryosurgery is used mainly for small or superficial skin cancers, and to remove precancerous growths.
• Curettage and electrodessication combines two methods. In one, the doctor uses a curette, a sharp, spoon-shaped instrument, to scoop out the tumor. The area is then treated with electrodessication, applying electrical current produced by a special machine. It controls bleeding, and dehydrates and kills any cancer cells remaining near the edge of tumor area.
• Micrographic surgery (or Mohs surgery) attempts to remove all of the tumor and as little surrounding normal tissue as possible. The doctor removes one layer of tumor, and examines it with a microscope. If cancer cells are present he removes another layer, and examines that. The process continues until all cancer cells have been removed.
• Laser surgery uses the highly focused beam of light from a laser to destroy cancer cells. It is seldom used for cancers that have not grown beyond the outer layer of the skin.

  Modern ways of doing surgery reduce the amount of scar tissue that forms afterward. Nonetheless, skin cancer surgery will leave a visible scar. Its size usually depends on the size of the cancer and the amount of tissue removed during surgery.

• Cryosurgery for a small tumor usually leaves a faint, white scar that is barely visible.
• Treatment of large cancers may require a skin graft to close the defect. Grafting involves removing skin from another part of the body and moving it to the area where the cancer was removed. Scars often fade and become less visible with time.

Chemotherapy

Chemotherapy means treatment with anti-cancer drugs. The treatment for skin cancer often uses anti-cancer drugs in a lotion or cream applied to the skin. This localized, or topical, chemotherapy is for superficial tumors that have not advanced beyond the top layer of the skin. Topical chemotherapy usually does not produce nausea or other body-wide side effects. It does cause redness and inflammation in treated parts of the skin.

Systemic chemotherapy also may be given in a pill, injected into a muscle, or intravenous form through a needle in a vein. This body-wide, or systemic, chemotherapy can kill cancer cells that have spread outside the skin. It may cause nausea and other side effects in some individuals. Side effects are common, but can generally be controlled. This treatment is generally used only for metastic cancer.

Radiation Therapy

Radiation therapy, or radiotherapy, uses a special kind of energy carried by invisible rays or particles to kill cancer cells, or keep them from growing. X-rays are the kind of radiation often used to kill skin cancer. The amounts are much higher than those used in an ordinary mammogram or chest x-ray. This therapy often is used for cancers that occur in areas difficult to treat with surgery, especially in the very elderly, who may be unable to safely undergo surgery. These include cancers on the ears, eyelids, and tip of the nose.

Treatment is painless and does not make the body radioactive. Several treatments may be needed to kill all of the cancer cells.

Radiation therapy may cause:

• Rash, redness, or dryness in the area. Those changes are temporary and disappear.
• Other changes in skin texture or color may develop after radiation therapy. They may become more noticeable years later.

For further information about radiation therapy, go to Radiation Therapy.

Other Treatments

Several other treatments may be used for skin cancer, including:

• Photodynamic therapy uses drugs that collect inside a tumor. The doctor then focuses a special light on the tumor. The light triggers a chemical reaction in the drug that destroys tumor cells, but does not harm surrounding normal tissue.
• Biological therapy tries to use the body’s own natural defenses to attack and destroy cancer cells. It sometimes is called biological response modifier (BRM) therapy or immunotherapy. In one form of biological therapy, disease-fighting white blood cells are removed. The cells are grown in a laboratory and exposed to substances that boost their disease-fighting ability. The activated cells then are injected back into the body to attack the tumor. Biological therapy is used mainly for advanced forms of cancer that cannot be treated with other methods. It is available in clinical trials, studies conducted in medical centers to determine its safety and effectiveness.

Experimental Treatments for Skin Cancer

People with severe forms of skin cancer sometimes can choose between standard therapy and experimental therapy. Standard therapy is the traditional treatment used by most doctors. Most standard treatments have been in use for years. Standard therapy, however, may not work for all patients. It may not cure the disease, or it may cause too many side effects.

In such cases, people with serious cancer may benefit from experimental therapy. These are brand new treatments that scientists are studying inclinical trials. Clinical trials are experiments in new treatments that are tested on people. They are designed to find better ways of treating people.

Clinical trials do give cancer patients access to the newest and most hopeful scientific discoveries. Experimental treatment, however, may prove less effective than the traditional therapy. For instance, it may have hidden side effects. However, experimental therapies may also prove to be more effective than traditional treatments.

Talk with the doctor to decide whether a clinical trial makes sense for your type and stage of cancer.

For a list of clinical trials: (http://www.clinicaltrials.gov.)

Experimental Therapies For Skin Cancers

People with severe forms of skin cancer sometimes can choose between standard therapy and experimental therapy. Standard therapy is the traditional treatment used by most doctors. Most standard treatments have been in use for years. Standard therapy, however, may not work for all patients. It may not cure the disease, or it may cause too many side effects.

In such cases, people with serious cancer may benefit from experimental therapy. These are brand new treatments that scientists are studying inclinical trials. Clinical trials are experiments in new treatments that are tested on people. They are designed to find better ways of treating people.

Clinical trials do give cancer patients access to the newest and most hopeful scientific discoveries. Experimental treatment, however, may prove less effective than the traditional therapy. For instance, it may have hidden side effects. However, experimental therapies may also prove to be more effective than traditional treatments.

Talk with the doctor to decide whether a clinical trial makes sense for your type and stage of cancer.

For a list of clinical trials: (http://www.clinicaltrials.gov.)

Can Treatment Cure Skin Cancer?

Doctors often measure the success of cancer treatment in terms of the five-year survival rate. A person usually is considered to be cured if he or she is alive and without any trace of skin cancer five years after first being diagnosed. The chances of a cure depend on many factors, including how early the disease was diagnosed and effectively treated.

Listed below are five-year survival rates for skin cancer:

• Basal cell carcinoma is more than 99 percent.
• Squamous cell carcinoma is more than 95 percent.
• Malignant melanoma is about 88 percent for cases treated when the cancer is still localized. About 82 percent of melanoma cases are diagnosed at this stage. The survival rates drop to 58 percent when melanoma has spread to nearby lymph nodes, and 13 percent when it has spread to distant parts of the body.

What Kind Of Follow Up Care Is Needed After Treatment?

People who are treated for skin cancer should see their doctor for regular follow-up visits. Follow-up visits allow the doctor to check the tumor site to make sure that the cancer has not come back in the same place, or recurred. If it does recur, additional treatment will be needed.

How Can Skin Cancer Be Prevented?

The most important preventive measure is to avoid excessive exposure to the sun. Ultraviolet (UV) radiation in sunlight damages the genetic material DNA in skin cell genes. This increases the risk that a normal cell will start growing abnormally and become cancerous. UV rays also damage the structure of the skin in ways that cause premature skin aging and wrinkling.

Prevention must begin in childhood. That’s because most people get about 50% of their lifetime sun exposure before age 18.

What Is The Outlook For Skin Cancer?

There is reason for both concern and optimism. Some scientists are concerned that thinning of Earth’s protective ozone layer may cause more cases of skin cancer. The ozone layer is a band of gas high in the atmosphere. It filters some UV radiation from sunlight. Industrial chemicals, now banned in the United States and some other countries, have caused the layer to become thinner. Thus, more UV rays are reaching the Earth’s surface, and may raise skin cancer risks.

People have become more aware about the importance of early detection and prevention. In addition, there are many new advances in understanding and treating skin cancer.

• Scientists are getting a better understanding of malignant melanoma, the most serious type of skin cancer. They have found that some people inherit damaged genes from their parents. Genes do more than make children and parents look somewhat alike. They may make parents and children more likely to get certain diseases. That’s why some diseases are hereditary, or run in families. Scientists have discovered a gene, called the p16 gene, that can predispose to malignant melanomas.
• New discoveries raise hope for better treatment of malignant melanoma in the years ahead. One of the most promising is gene therapy. It involves replacing an abnormal gene, like p16, with a normal copy. Clinical trials of certain forms of gene therapy already are underway.
• Advances in genetics research also are leading to better ways of staging melanoma. Staging means finding whether the disease has spread, and how far. It can help doctors pick the right treatment.

Regular staging involves checking lymph node tissue for cancer cells with a microscope. Newly developed “molecular staging” is more sensitive. It can detect melanoma cells not visible in ordinary staging. Molecular staging can spot just one melanoma cell hidden among one million normal cells.

Skin Cancer: Frequently Asked Questions

Here are some frequently asked questions related to skin cancer.

Q: My husband was treated for small skin cancers on his forearms. The dermatologist said they were basal cell carcinomas. She used curettage and electrodessication to destroy the tumors, and told my husband it cured the cancer. Was the doctor being too confident?

A: The doctor was just being realistic. Basal cell carcinoma is the most highly curable form of skin cancer. Cancer is such a serious disease because of its tendency to spread. The tumor sheds cells that travel through the bloodstream and lodge in the lungs, brain, liver, or bone. The cells then grow new tumors that destroy vital organs. Basal cell carcinoma almost never spreads from the original location, and almost always can be cured. That’s fortunate because it also is the most common type of skin cancer.

Q: I’ve been referred to a dermatologist by my family doctor. She thinks that a growth on my back may be skin cancer. If it is skin cancer, what questions should I ask the dermatologist?

A: It’s important to ask questions and work with the doctor in planning treatment and follow-up care. Start the dialogue by asking about the exact kind of skin cancer you have, how serious it is, and whether to be concerned that the cancer has spread. Some other important questions include:

• What is the usual treatment?
• Will treatment cure the cancer?
• What type of scar will likely develop?
• How will I know if the cancer has come back?
• How often will I come back for follow-up care?
• What can I do to reduce my risk of getting skin cancer again?

Q: As I get older, I seem to be developing more and more moles, freckles, and other skin growths. I’m worried that some may be skin cancer, or change into skin cancer. What professional and self care would you recommend?

A: Encourage your primary care physician to do a total skin examination at each yearly routine physical examination and/or see a dermatologist yearly for a total body skin examination. That involves inspecting every inch of your skin, including the genital region and the area between the buttocks. If the doctor spots suspicious growths, you’ll probably get a referral to a dermatologist. Chances are good that these professional exams will put your mind at ease. That’s because most people have dozens of skin growths, and they usually are not cancer. Once you know that your skin is normal, get in the habit of doing a skin self-examination to watch for new growths or changes in existing growths.

Q: How can I tell if a skin growth is dangerous? Is there any special appearance that I should watch for?

A: Only a doctor can tell between a benign growth and cancer. Sometimes, it takes a biopsy for the doctor to be sure. In general, however, be alert for growths that enlarge and ooze fluid or blood, crust or clot over, and then ooze or bleed again. A sore that doesn’t heal after a week or two may be cancerous. Be on the lookout for moles or skin spots that are:

• Bigger from edge to edge than a pencil eraser
• Have uneven or ragged edges
• Show combinations of more than one color
• Have a different appearance on one half than on the other

Those are warning signs of possible skin cancer. Check with the doctor if they occur.

Q: The doctor on a radio talk show advised a man with skin cancer to see a “mole surgeon.” I heard only a few seconds of the show. What did he mean?

A: The talk show doctor probably was discussing Mohs micrographic surgery. It’s a special kind of skin cancer surgery that requires special training. Doctors who get the training sometimes are called Mohs surgeons. In Mohs surgery, the doctor tries to remove all of the tumor and as little surrounding normal tissue as possible. The doctor removes one layer of tumor, and examines it with a microscope. If cancer cells are present he removes another layer, and examines that. The process continues until all cancer cells have been removed. Mohs surgery has an advantage aside from the smallest possible scar. It has a very high cure rate. But Mohs surgery is not suitable for all kinds of skin cancer; it is very expensive and time consuming. People with skin cancer should talk with their doctor about the different treatment options.

Q: What is the best way of preventing skin cancer?

A: Avoid too much exposure to the sun. That’s the No. 1 cause of skin cancer. Try to avoid two kinds of exposure:

• The kind of constant day-to-day exposure that occurs in people who work outdoors or enjoy outdoor sports or leisure activities.
• Less-frequent but more intense exposure that causes sun burn. Vacationers and others who get intense sun exposure a few times a year may be at high risk for malignant melanoma, the most serious kind of skin cancer.

When you are in the sun, wear tightly woven clothing that shields the skin. A broad-brimmed hat is ideal in the summer. Be sure to use a “broad-spectrum” sun screen that protects again both kinds of ultraviolet (UV) light, UVA and UVB.

Q: If skin cancer occurs mainly in older people, why is it so important for children to avoid getting too much sun?

A: Childhood sun exposure may set the stage for adult skin cancer. The average person gets about 50% of his or her total lifetime sun exposure by age 18. Most severe sun burns also occur during childhood and adolescence. A single severe sunburn may increase an individual’s risk of skin cancer.

Q: After examining my skin, the family doctor said I have the warning signs of skin cancer. He said to be especially careful about avoiding excessive sun, get regular check-ups, and to do regular skin self-examinations. How could he tell?

A: The doctor probably discovered actinic keratoses, a pre-cancerous condition caused by long-term overexposure to the sun. An actinic keratosis feels like a small rough spot on the skin. It may be flesh-colored or reddish pink with whiteish scales. These growths often form on the backs of the hands, arms, face, and ears of individuals with sun-damaged skin. Most actinic keratoses do not change into skin cancer. Some, however, do. Doctors advise that actinic keratoses be destroyed as a precaution. Most are removed by freezing with liquid nitrogen or by using topical chemotherapy applied over several weeks.

Skin Cancer: Putting it all Together

Here is a summary of the important facts and information related to skin cancer.

• Skin cancer is the most common type of cancer in the United States.
• An individual’s lifetime exposure to sunlight and skin type largely determines their risk for skin cancer.
• It is important to regularly monitor your skin for early symptoms of skin cancer.
• Most skin cancers are cured with relatively simple treatment. Others, however, can be life threatening.
• Skin cancer is almost 100 percent curable if found and treated early.

Skin Cancer: Glossary

Here are definitions of medical terms related to skin cancer.

Actinic keratosis: a precancerous skin growth that occurs on sun-damaged skin often looks like a red scaly patch and feels like “sandpaper”.

Basal cell carcinoma: the most common form of skin cancer that involves cells in the lower part, or base, of the epidermis, the outer layer of skin.

Benign: non-cancerous, a growth that does not spread to other parts of the body or damage normal tissue.

Biopsy: removal and examination of cells or tissue under a microscope to check for cancer.

Carcinoma: cancer that starts in tissues that cover or line organs in the body.

Chemotherapy: treatment with anti-cancer drugs.

Clinical trial: a research study done on human volunteers to decide if a new treatment is safe and effective.

Curettage: a surgical method of removing diseased tissue with a curette, a sharp-edged instrument.

Curette: a spoon-shaped surgical instrument with a sharp edge.

Dermatologist: a medical doctor who specializes in treatment of skin cancer and other skin diseases.

Dermatopathologist: a medical doctor, generally a dermatologist with subspeciatyl training in skin pathology.

Dermis: the layer of skin, located under the epidermis.

Electrodessication: a surgical method of drying-out tissue by touching it with a needle-like electrode that passes electric current into the tissue.

Epidermis: the outermost layer of skin, which is in contact with the environment, located above the dermis.

Laser: an electronic device that focuses light into an intense beam used in skin cancer surgery to cut or destroy tissue.

Localized: cancer that is limited to one small area of the body and has not spread.

Lymph nodes: clusters of tissue found in the underarms, groin, neck, and other parts of the body that help fight disease. When cancer spreads, they often trap cancer cells.

Malignant: a cancerous growth that may destroy nearby normal tissue and spread to other parts of the body.

Melanocytes: skin cells that produce a pigment called melanin and can change into malignant melanoma.

Melanoma: cancer that occurs in melanocytes and is the most serious kind of skin cancer.

Metastasize: the spread of cancer cells from the original tumor to distant parts of the body.

Mohs micrographic surgery: a method of treating skin cancer in which all the cancer and as little normal tissue as possible is removed.

Mole: a small usually dark skin growth that develops from pigment-producing cells called melanocytes.

Pathologist: a doctor who helps diagnose disease by examining cells and tissues under a microscope.

Photodynamic therapy: treatment with drugs that kill cancer cells when exposed to a special light.

Precancerous: a growth that may eventually turn malignant and become cancerous.

Radiation therapy: treatment that uses x-rays and other sources of radiation to kill cancer cells.

Recur: cancer that returns after treatment to the same site or a new site in the body.

Staging: determining the stage or extent to which a cancer has advanced.

Squamous cell carcinoma: cancer that occurs in squamous cells, which are specialized cells near the skin surface that produce protective keratin.

Sunscreen solution: a lotion, cream or oil that protects the skin from harmful ultraviolet radiation, premature aging, and skin cancer.

Topical chemotherapy: treatment with anticancer drugs in a cream or solution applied to the skin over a period of time

Tumor: any abnormal growth of tissue that can be either benign (non-cancerous) or malignant (cancerous).

Ultraviolet radiation: invisible rays in sunlight that cause suntan, sunburn, premature skin aging, and most cases of skin cancer.

Skin Cancer: Additional Sources of Information

Here are some reliable sources that can provide more information on skin cancer.

American Cancer Society (ACS) 
Phone: (800) 227-2345 (toll-free hotline) 
www.cancer.org

National Cancer Institute (NCI), Cancer Information Service 
Phone: (800) 4-CANCER
Phone: (800) 422-6237
www.nci.nih.gov

American Academy of Dermatology 
Phone: (888) 462-3376 (toll-free) 
Phone: (847) 330-0230
http://www.aad.org

National Coalition for Cancer Survivorship 
Phone: (877) NCCS YES
Phone: (877) 622-7937
Fax: (301) 565-9670
Email: info@cansearch.org 
www.canceradvocacy.org