Surgical Dermatology

Skin Cancer

Skin cancer is the most common of all cancers. It affects more than two million Americans each year, and the numbers are on the rise. Skin cancer is the easiest cancer to cure, as long as it is diagnosed and treated early. If skin cancer is not treated early it can lead to disfigurement and even death.

Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.

One in five Americans will develop skin cancer in the course of a lifetime.

Causes

Skin cancer is the uncontrolled growth of abnormal skin cells. It occurs when unrepaired DNA damage to skin cells triggers mutations, or genetic defects, that lead the skin cells to multiply rapidly and form malignant tumors. This DNA damage is most often caused by ultraviolet radiation from sunshine or tanning beds.

Risk Factors

Anyone can get skin cancer, even those who have skin of color. Most people who get skin cancer, however, have lighter skin.

• People who are more likely to get skin cancer:
• Excessive time spent in the sun.
• Use tanning beds or sun lamps.

Resided in an area that gets intense sunlight, such as Florida, the Caribbean, or northern Australia.

Any length of exposure, even if it occurred years ago or was short, increases your risk.

There are also some general characteristics which may increase a person’s risk for getting skin cancer, which include:

• Skin: A person’s skin type and the moles on one’s skin affect the person’s risk for getting skin cancer. The risk increases when the person has:
  • Fair skin, especially when the person also has blond or red hair and blue, green, or gray eyes.
  • Had bad sunburns, especially blistering sunburns.
  • Skin that burns or freckles rather than tans.
  • 50 or more moles.
  • Moles called “atypical nevi” or “dysplastic nevi.”
• Family history of skin cancer.
• Medical history: Having (or having had) any of the following puts a person at greater risk for getting skin cancer:
  • Previous skin cancer.
  • Actinic keratoses (AKs). Having AKs means the skin has lots of damage. This damage increases the risk of getting all types of skin cancer. Sometimes, an AK can progress to a type of skin cancer called squamous cell carcinoma.
  • Organ transplant. The medicine that prevents the body from rejecting the organ also weakens the immune system. A weak immune system increases the risk of skin cancer.
  • Bad burn. Skin cancer can develop where the skin has been badly burned.
  • X-ray treatments. Receiving many x-ray treatments to treat a medical condition increases the risk. This takes many years to develop.
  • A disease that weakens the immune system. Lymphoma and human immunodeficiency virus (HIV) are a few diseases that weaken the immune system.
  • Xeroderma pigmentosum. People who inherit this rare disease get many skin cancers.
  • Gorlin’s syndrome (also called basal cell nevus syndrome). People who have this rare disease can get many basal cell carcinomas early in life. They also have a higher risk of getting melanoma and non-Hodgkins lymphoma.
  • Receiving an organ transplant greatly increases the risk of developing skin cancer.
• Exposure to chemicals: People exposed to any of the following have a much higher risk of skin cancer:
  • Arsenic (working with or swallowing)
  • Coal
  • Industrial Tar
• Tobacco: Smoking or chewing tobacco may increase the risk of getting squamous cell carcinoma, a type of skin cancer, in the mouth or throat.

Symptoms

The most common warning sign of skin cancer is a change to your skin. And the most common change is something growing on your skin. This growth can appear on the skin in many ways. The following explains the signs and symptoms of the most common types of skin cancer.

• Basal Cell Carcinoma (BCC)— This is the most common type of skin cancer. It most often appears on skin that gets lot of sun, such as the face, scalp, neck, hands, and arms, but can appear on any part of the body.
  • BCC often grows slowly. It may look like a:
  • Reddish patch of dry skin that won’t heal
  • Flesh-colored (or pink, red, or brown) pearl-shaped lump
  • Pimple that just won’t clear
  • Sore that bleeds, heals, and then returns
  • Scar that feels waxy — may be skin-colored, white, or yellow
  • Group of slow-growing, shiny pink or red growths — look like sores, often scaly and bleed easily
  • Flat or sunken growth — feels hard, maybe white or yellow

• Squamous Cell Carcinoma (SCC) — This is a very common type of skin cancer. It often appears on skin that get lots of sun, such as an ear, face, bald scalp, neck, or arm. But it can appear elsewhere — even inside the mouth, on the lip, or on the genitals. Too much sun is often the cause, but it is not the only cause. SCC can appear on skin that was badly burned, had lots of radiation (such as x-rays), or was exposed to strong chemicals.
  • SCC often has a reddish color. Without treatment, it can grow deeply. If this happens, the cancer can spread to other parts of the body. This can be deadly. SCC often looks like a:
    • Hard (scaly or crusty) reddish bump, patch, or pearl-shaped growth
    • Open sore that itches and bleeds; it can heal and return
    • Scaly patch on the lip; skin on the lip can get thick

• Melanoma — Melanoma often appears in an existing mole or looks like a new mole. By knowing where you have moles on your skin, you can find melanoma when it first appears. When treated early, melanoma is often curable.
  • Here’s what to look for:
  • A mole on the skin that is growing, changing shape, or changing color
  • A mole that looks scaly, oozes, or bleeds
  • New dark spot on the skin that looks like a mole, but grows quickly
  • Pain, itch, or bleeding in a new spot on the skin
  • Streak (usually brown or black) underneath a fingernail or toenail
  • Bruise on the foot that does not heal

• Actinic Keratosis — Actinic keratoses (AK), also called solar keratoses, are scaly, crusty growths (lesions) caused by damage from the sun’s ultraviolet (UV) rays. It is a potential pre-cancerous lesion. They typically appear on sun-exposed areas such as the face, bald scalp, lips, and the back of the hands, and are often elevated, rough in texture, and resemble warts. Most become red, but some will be tan, pink, and/or flesh-toned. If left untreated, up to ten percent of AKs develop into squamous cell carcinoma (SCC), the second most common form of skin cancer. In rarer instances, AKs may also turn into basal cell carcinomas, the most common form of skin cancer.
• Merkel Cell Carcinoma — This is a rare type of skin cancer that can appear on the skin as a hard patch or firm bump. It is an aggressive ski cancer that grows and spreads quickly and can return even after treatment.
• Sebaceous Carcinoma — This is a rare and aggressive skin cancer which can spread. If found and treated early, treatment is often successful. These cancers often begin on an eyelid and appear as a painless, round, tumor on the eyelid. They can appear on any sebaceous gland.
• Dermatofibrosarcoma Protuberans (DFSP) –This is a rare skin cancer which begins in the middle layer of skin, known as the dermis. DFSP grows slowly and rarely spreads to other parts of the body. The first sign of this skin cancer is often a small bump on the skin. It may resemble a deep-seated pimple or rough patch of skin. DFSP can also look like a scar. In children, it may remind you of a birthmark.

Diagnosis

To diagnose skin cancer, a dermatologist looks at the skin. A dermatologist will carefully examine growths, moles, and dry patches.

To get a better look, a dermatologist may use a device called a dermatoscope. The device shines light on the skin. It magnifies the skin. This helps the dermatologist to see pigment and structures in the skin.

If a dermatologist finds something that looks like skin cancer, the dermatologist will remove it (or part of it). The removed skin will be sent to a lab. Your dermatologist may call this a biopsy. Skin cancer cannot be diagnosed without a biopsy. A biopsy is quick, safe, and easy for a dermatologist to perform. A biopsy should not cause anxiety. The discomfort and risks are minimal.

*Source: American Academy of Dermatology | Skin Cancer Foundation | Utah Department of Health

Treatment

There are many effective treatments for skin cancer. A dermatologist selects treatment after considering the following:

• Type of skin cancer.
• Where the skin cancer appears on the body.
• Whether the skin cancer is aggressive.
• Stage of the cancer.
• Patient’s health.

After considering the above, your dermatologist will choose 1 or more of the following treatments for skin cancer.

• Surgical treatment: When treating skin cancer, the goal is to remove all of the cancer. When the cancer has not spread, this is often possible. To remove skin cancer, the following surgical treatment may be used:
  • “Excision: To perform this, the dermatologist numbs the skin and then surgically cuts out the skin cancer and a small amount of normal-looking skin. This normal-looking skin is called a margin. There are different types of excision. Most excisions can be performed in a dermatologist’s office.
  • Mohs surgery: A dermatologist who has completed additional medical training in Mohs surgery performs this procedure. Mohs surgery effectively removes the skin where cancerous cells are found, and the margins are checked until they are clear.
  • Curettage and electrodesiccation: This surgical procedure may be used to treat small basal cell and squamous cell skin cancers. It involves scraping the tumor with a curette (a surgical instrument shaped like a long spoon) and then using an electric needle to gently cauterize (burn) the remaining cancer cells and some normal-looking tissue. This scraping and cauterizing process is typically repeated 3 times. The wound tends to heal without stitches.

• Immunotherapy: This treatment uses the patient’s own immune system to fight the cancer. The patient applies a cream (generic name is imiquimod) to the skin as directed by the dermatologist.
• Cryosurgery: The dermatologist freezes the skin cancer. Freezing destroys the treated area, causing the skin and cancer cells to slough off.
• Chemotherapy applied to the skin: The generic name for the medicine used in this treatment is 5-fluorouracil or 5-FU. The patient applies 5-FU to the skin cancer. It destroys the damaged skin cells. When the skin heals, new skin appears.
• Chemotherapy: If the cancer spreads beyond the skin, chemotherapy may kill the cancer cells. When a patient gets chemotherapy, the patient takes medicine. This medicine may be swallowed, injected (shots), or infused (given with an IV). The medicine travels throughout the body and kills the cancer cells. The medicine also destroys some normal cells. This can cause side effects, such as vomiting and hair loss. When chemotherapy stops, the side effects usually disappear.
• Photodynamic therapy: This treatment consists of 2 phases. First, a chemical is applied to the skin cancer. This chemical sits on the skin cancer for several hours. During the second phase, the skin cancer is exposed to a special light. This light destroys the cancer cells.
• Radiation therapy: Radiation may be used to treat older adults who have a large skin cancer, skin cancers that cover a large area, or a skin cancer that is difficult to surgically remove. Radiation therapy gradually destroys the cancer cells through repeat exposure to radiation. A patient may receive 15 to 30 treatments. This treatment is often only recommended for older adults. Many years after a person is exposed to radiation, new skin cancer can develop.

Prevention

Since its inception in 1979, The Skin Cancer Foundation has always recommended using a sunscreen with an SPF 15 or higher as one important part of a complete sun protection regimen. Sunscreen alone is not enough, however. Here is the full list of of their skin cancer prevention tips:

• Seek the shade, especially between 10 AM and 4 PM.
• Do not burn.
• Avoid tanning and never use UV tanning beds.
• Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
• Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
• Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside.Reapply every two hours or immediately after swimming or excessive sweating.
• Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
• Examine your skin head-to-toe every month.
• See your physician every year for a professional skin exam.

*Source: American Academy of Dermatology | Skin Cancer Foundation | Utah Department of Health

What Is Skin Cancer?

Skin cancer is cancer that develops in the layers of the skin. It is usually in areas that are exposed to the sun and can usually be seen or felt on the skin. Skin cancer may cover a large area, or look like a small spot. Even small spots can be dangerous because they can spread under the skin and infect other areas. There are several different types of skin cancer. The most deadly is melanoma. Other common types of skin cancer include basal cell carcinoma and squamous cell carcinoma.

Melanoma is the most deadly type of skin cancer. It can take many shapes and appearances. Melanoma is usually a dark color like brown, blue, or black. Other signs to look for include: irregular borders, asymmetry (one half looks different than the other half), and size – melanomas are usually large (bigger than a pencil eraser)

Basal cell carcinomas can be treated easily if found early. They can be red, pink, or white in color. Some are a patch of color while others are bumps which often appear shiny. Sometimes this type of cancer causes sores that never completely heal, or come back shortly after healing.

Squamous cell carcinoma usually takes on one of two forms. It may be a rough patch or can look and feel like a wart.

What Causes Skin Cancer?

There are many things that may lead to skin cancer. Some of these things are out of our control, but by reducing exposure to the sun and other UV rays we can lower our chances of getting skin cancer. The things we can’t control: family history, light skin type, the intensity of the sun, high altitude. The things we can control: time spent in sun, UV rays from tanning beds, amount of skin exposed to the sun.

Can Skin Cancer Be Prevented?

There are things we can do to lower our chances of getting skin cancer. These things are: Wear sunscreen with SPF 15 or greater, apply sunscreen 30-45 minutes before going outside, reapply sunscreen every two to three hours, stay in the shade as much as possible, wear long pants and long-sleeve shirts to protect skin from the sun, wear sunglasses, avoid the sun during the hottest parts of the day (This is when the UV rays are the strongest), and avoid tanning beds.

What Does SPF Mean?

SPF means “Sun Protection Factor.” It is a measure of how well the sunscreen protects you from harmful UV rays from the sun. Sunscreen must be re-applied every two to three hours, even if it has a high SPF number.
Adults and children should always wear at least SPF 15.

What SPF Is Needed to Prevent Skin Cancer?

To lower the chance of skin cancer, adults and children should always wear at least SPF 15.

Do Tanning Beds Cause Skin Cancer?

Recent research says that yes, tanning beds can cause cancer. The World Health Organization strongly urges all people to avoid using tanning beds, especially those under the age of 18.

Are There Different Types of Skin Cancer?

There are different types of skin cancer. Each type is named after which type of cell it begins in. The three most common types of skin cancer are melanoma, basal cell carcinoma, and squamous cell carcinoma.

How Can I Tell If I Have Skin Cancer?

Only a doctor can tell if you have skin cancer. Be sure to talk to your doctor if you notice any unusual moles, bumps, or red patches, or if you notice a change in any moles you already have. It may be a good idea to perform a monthly self-skin check. Talk to your doctor if you notice any new moles, bumps, or rough patches that are unusual, or if you notice a change in any you already had. Things to look for include: changes in any moles, bumps, or rough patches, moles with a dark color (blue, black, purple, green, etc), moles that are not the same color or shade throughout, moles with irregular/wavy borders, moles that are asymmetrical (one side looks different than the other side), moles that are bigger around than the eraser on the top of a pencil, or spots that itch or bleed.

Does Skin Cancer Have Symptoms?

Many times the only symptoms of skin cancer are those that can be seen or felt on the skin. Some skin cancers cause dark-colored (blue, black, green, purple) moles or spots. Cancerous moles may also be large, have irregular/wavy borders, or be asymmetrical. Other skin cancers may cause red, white, or pink bumps. Sometimes these bumps are smooth and shiny. Skin cancers may also cause rough patches on the skin or spots that itch or bleed.

Who Can Get Skin Cancer?

Anyone can get skin cancer. Skin cancer used to be more common among middle-aged people and the elderly, but people are now getting skin cancer in their twenties—and even their teens.

How Is Skin Cancer Diagnosed?

If your doctor thinks you may have skin cancer, he or she will take a small piece of skin from the area. This will then be sent to a laboratory where it will be examined for signs of cancer. Your doctor may also take a small piece of tissue from lymph nodes near the area to see if cancer has spread.

How Is Skin Cancer Treated?

Each patient’s treatment is unique and depends on the patient and how advanced their cancer is. The patient’s doctor and specialists will help determine which treatment is best. Treatment options may include: surgery, systemic chemotherapy (taken through an IV or orally), topical chemotherapy (put directly on the skin in a cream or ointment), radiation therapy, cryotherapy, immunotherapy, or laser surgery.

Do I Have A Higher Chance of Getting Skin Cancer If A Family Member Had It?

If a family member had skin cancer, you may have a higher chance of getting it. Some things, such as skin type, environment, and lifestyle are similar among family members.

*Source: American Academy of Dermatology | Skin Cancer Foundation | Utah Department of Health

Skin Cancer Prevention

Follow these tips to protect your skin from the damaging effects of sun exposure and reduce your risk of skin cancer.

Skin Self-Exam: How to Do

You can catch skin cancer early by following dermatologists’ tips for checking your skin.

What to Expect at a Skin Cancer Screening

The American Academy of Dermatology’s members have been providing free skin cancer screenings to the public since 1985. Watch this video to learn what happens during a screening, and visit www.aad.org to find a free screening near you.

Can You Spot Skin Cancer?

Anyone can get skin cancer, regardless of skin color. It is estimated that one in five Americans will develop skin cancer in their lifetime. When caught early, skin cancer is highly treatable. Through SPOTme®, the American Academy of Dermatology’s mission is to reduce the number of deaths from skin cancer in the United States by educating the public about skin cancer risk and providing free SPOTme® skin cancer screenings to catch and detect skin cancer in its earliest, most treatable stages.

How to Apply Sunscreen

Sunscreen can protect your skin against skin cancer and premature aging. However, it is not as effective unless it’s applied correctly. Follow these tips from dermatologists when applying sunscreen.

How to Apply Self-Tanner

These basic tips will help you apply self-tanner so you get even coverage and longer-lasting results.

Skin of Color: How to Prevent and Detect Skin Cancer

Although people of color have a lower risk of developing skin cancer than Caucasians, when skin cancer develops in people of color, it is often diagnosed at a more advanced stage – making it more difficult to treat. The good news is that there is a lot people can do to protect their skin and reduce their risk of getting skin cancer, including melanoma, the deadliest form.

Infant Sun Protection: How to Keep Your Baby Safe

Skin cancer is the most common cancer in the United States, and it only takes one blistering sunburn during childhood or adolescence to nearly double a person’s chance of developing melanoma – the deadliest form of skin cancer – later in life. To protect your baby from the sun, follow these tips from board-certified dermatologists.

Who’s Got Your Back?

Think applying sunscreen to your own back is easy? In this video, a UV camera quickly reveals all the spots you can miss, underscoring the importance of asking friends or loved ones for help.

How to Treat Sunburn

Your skin can burn if it gets too much sun without proper protection from sunscreen and clothes. To help heal and soothe stinging skin, it is important to begin treating sunburn as soon as you notice it. Follow these dermatologists’ tips to help relieve the discomfort.

Check Him Out

The men in our lives… may need a little help seeing things. Research has shown that women are NINE times more likely than men to notice melanoma on others. In addition, men assisted by women during skin exams are less likely to miss skin lesions than women assisted by men.

Sun Safety – Spotting Skin Cancer

Outdoor workers have a higher risk for developing skin cancer. This program will help this group learn the facts about skin cancer and find out ways to protect themselves.

Skin Cancer Types Treatment: Melanoma Basal Cell Carcinoma, Squamous Cell Carcinoma

Skin cancer types symptoms signs treatments and melanoma prevention from Miami Beach Skin Center for Cosmetic Dermatology. Learn what basal call carcinoma squamous cell carcinoma and melanoma look like and how skin cancers are treated with Moh’s surgery.

Knowing the Signs of Skin Cancer

Holly Firfer Skin looks into Cancer.

DermTV – Skin Cancer Removal Demonstration

DermTV – The ABCDE Rule for Detecting Precancers and Melanomas

In the US, one person dies approximately every hour from melanoma skin cancer. This is sad but unnecessary, but it’s curable if you catch it early, and thus death from melanoma preventable. In this episode of DermTV, Dr. Schultz explains the ABCDE rule for detecting precancers and melanomas so you don’t end up an unfortunate and sad statistic.

Why You Can Get Skin Cancer Anywhere

Did you know that you can get skin cancer inbetween your toes? How is that possible considering the skin between your toes doesn’t get any sun exposure? In this episode of DermTV, Dr. Schultz discusses why you can get sunscreen anywhere on your body, even on the areas not exposed to the sun.

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