Skin Cancer

Causes

Cancer happens when cells in the body divide without control or order. Over time, the cells can form into a growth or tumor. The growths invade and take over nearby tissue. The reason why this happens is not known. Genetics and the environment (sun) can play a role.

UV radiation damages the DNA of skin cells. Both the sun and tanning beds make these UV rays. The damage may build up over a lifetime. It can also happen after a brief intense exposures, like sunburns.

Risk Factors

While skin cancer can develop in anyone, it is more likely to develop in people with:

• Fair skin that freckles easily
• Red or blonde hair
• Blue or green eyes
• Light natural skin color

Other things that may raise the risk of skin cancer are:

• A past skin cancer
• Family history of skin cancer
• Excessive sun exposure without protective clothing or sunscreen
• Regular use of tanning beds
• Skin damage from burns or infections
• Exposure to arsenic or industrial coal tar
• Radiation therapy
• Light treatments for psoriasis, especially psoralen ultraviolet A (PUVA)
• A weak immune system from illness, medicine, or an organ transplant
• Certain genetic diseases, such as basal cell nevus syndrome or xeroderma pigmentosum

Symptoms

The first symptoms of skin cancers are a change in the skin. One type of change is actinic keratosis. It is considered a precancerous change. This scaly, crusty change to skin can develop into skin cancer if left untreated.

Skin changes caused by cancer depend on the type of skin cancer. For example:

Basal cell carcinoma may appear as a:

• Slowly expanding, painless growth
• Bleeding scab or sore that heals and recurs
• Flat, firm, pale area
• Small, raised, pink, red, or pearly area that may bleed easily
• Large oozing, crusted area

Squamous cell carcinoma may appear as a:

• Growing lump with rough, scaly, or crusted surfaces
• Slow-growing flat, reddish patch in the skin
• Recurrent, nonhealing ulceration or bleeding

Skin cancers can happen anywhere, but are more common on places exposed to the sun. Finding skin cancer early offers the best chance for a cure. Steps to find a skin cancer are:

• Telling the doctor about any skin changes or symptoms when they appear
• Regular skin checks by a doctor—for those with lighter skin
• Doing regular skin screenings at home as instructed by the doctor

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. If the doctor suspects cancer, a biopsy will be done. A sample of the skin will be taken and tested for the cancer cells.

The nearby lymph nodes (glands) may be checked if the growth is large. Cancer in the lymph nodes means the cancer may have spread. More tests will be needed if cancer is found in the lymph nodes.

Tests are used to assess the stage of cancer. Skin cancer may be stage 0 to 4. Stage 0 and 1 cancers only affect the local area. Stage 4 cancer has spread to other areas of the body. Staging will help to guide treatment.

Treatment

Treatment will depend on the type of cancer, the size of the growth, and the person's health. Options may include:

Surgery

Many skin cancers can be fully cut out of the skin. Some skin cancer can be completely removed during a biopsy. Larger skin cancers may be removed by surgery. If skin cancer is completely removed, no further treatment is needed. Surgery may be:

• Simple excision—A scalpel is used to cut out the lesion.
• Curettage and electrodesiccation—The cancer is scooped out with a sharp, spoon-shaped tool. It is used for small skin cancers that are not deep.
• Mohs micrographic surgery—The lesion is shaved off in thin layers. The doctor will repeat the process until the removed layers show no signs of cancer. Mohs is used to remove:
  • Large tumors
  • Tumors in hard-to-treat places
  • Tumors of unclear shape and depth
  • Cancers that have come back
• Cryosurgery—cancer cells are frozen with a special tool and killed. The dead tissue will fall off once it warms up. This may be used to treat small cancers or those on top layers of skin. It may also be used for tissue that could turn into cancer.

Laser Therapy

Laser therapy uses a narrow beam of light to remove or destroy cancer cells. This is sometimes used for cancers in the outer layer of skin.

Radiation Therapy

Radiation can kill cancer cells and shrink tumors. It is aimed at the cancer to avoid damaging as much healthy tissue as possible.

Topical Chemotherapy

A medical gel or lotion is applied over the area. It will kill the cancer cells over time. This works best to treat skin conditions before they become cancer. It may also be used for cancers on the outer layer of the skin.

Immunotherapy and Targeted Therapy

These therapies use medicine to help attack cancer. Immunotherapy helps to boost the immune system. It can help the body find and attack cancer cells. Targeted therapy is a medicine that slows or stop cancers from growing and spreading.

Prevention

To help reduce the risk of skin cancer:

• Avoid spending too much time in the sun.
• Avoid the sun during peak sunlight hours.
• Protect your skin from the sun with clothing. Wear a shirt, sunglasses, and a hat with a broad brim.
• Use broad-spectrum (UVA and UVB) sunscreen on skin that will be exposed to the sun. Use sun protection factor (SPF) of 30 or more.
• Use a protective lip balm.
• Wear sunglasses with 99% or 100% UV absorption.
• Do not use sun lamps or tanning booths.

If you see any changes in your skin contact your doctor for a skin exam.