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Skin Cancer

Each year, about a million people in the United States learn that they have skin cancer. This National Cancer Institute (NCI) booklet will give you some important information about this disease. It explains how skin cancer is diagnosed and treated and has information about preventing this disease.

This information cannot answer every question you may have about skin cancer. They cannot take the place of talks with doctors, nurses, and other members of the health care team. We hope our information will help with those talks.

Research has led to better methods of diagnosing and treating this disease. It is encouraging to know that skin cancer is now almost 100 percent curable if found early and treated promptly.

Our knowledge about skin cancer and other types of cancer is increasing rapidly. 

The Skin

The skin is the body's outer covering. It protects us against heat, light, injury, and infection. It regulates body temperature and stores water, fat, and vitamin D. Weighing about 6 pounds, the skin is the body's largest organ. It is made up of two main layers: the outer epidermis and the inner dermis.

The epidermis (outer layer of the skin) is mostly made up of flat, scale-like cells called squamous cells. Under the squamous cells are round cells called basal cells. The deepest part of the epidermis also contains melanocytes. These cells produce melanin, which gives the skin its color.

The dermis (inner layer of skin) contains blood and lymph vessels, hair follicles, and glands. These glands produce sweat, which helps regulate body temperature, and sebum, an oily substance that helps keep the skin from drying out. Sweat and sebum reach the skin's surface through tiny openings called pores.

What Is Cancer?

Cancer is a group of more than 100 diseases. Although each type of cancer differs from the others in many ways, every cancer is a disease of some of the body's cells.

Healthy cells that make up the body's tissues grow, divide, and replace themselves in an orderly way. This process keeps the body in good repair. Sometimes, however, normal cells lose their ability to limit and direct their growth. They divide too rapidly and grow without any order. Too much tissue is produced, and tumors begin to form. Tumors can be benign or malignant.

Types of Skin Cancer

The two most common kinds of skin cancer are basal cell carcinoma and squamous cell carcinoma. (Carcinoma is cancer that begins in the cells that cover or line an organ.) Basal cell carcinoma accounts for more than 90 percent of all skin cancers in the United States. It is a slow-growing cancer that seldom spreads to other parts of the body. Squamous cell carcinoma also rarely spreads, but it does so more often than basal cell carcinoma. However, it is important that skin cancers be found and treated early because they can invade and destroy nearby tissue.

Basal cell carcinoma and squamous cell carcinoma are sometimes called nonmelanoma skin cancer. Another type of cancer that occurs in the skin is melanoma, which begins in the melanocytes. 

Cause and Prevention

Skin cancer is the most common type of cancer in the United States. According to current estimates, 40 to 50 percent of Americans who live to age 65 will have skin cancer at least once. Although anyone can get skin cancer, the risk is greatest for people who have fair skin that freckles easily -- often those with red or blond hair and blue or light-colored eyes.

Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. (Two types of ultraviolet radiation -- UVA and UVB -- are explained in the ultraviolet (UV) radiation definition in the Dictionary.) Artificial sources of UV radiation, such as sunlamps and tanning booths, can also cause skin cancer.

The risk of developing skin cancer is affected by where a person lives. People who live in areas that get high levels of UV radiation from the sun are more likely to get skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, areas that receive high amounts of UV radiation.

In addition, skin cancer is related to lifetime exposure to UV radiation. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age. Therefore, protection should start in childhood to prevent skin cancer later in life.

Whenever possible, people should avoid exposure to the midday sun (from 10 a.m. to 2 p.m. standard time, or from 11 a.m. to 3 p.m. daylight saving time). Keep in mind that protective clothing, such as sun hats and long sleeves, can block out the sun's harmful rays. Also, lotions that contain sunscreens can protect the skin. Sunscreens are rated in strength according to a sun protection factor (SPF), which ranges from 2 to 30 or higher. Those rated 15 to 30 block most of the sun's harmful rays.

NCI is supporting research to try to find new ways to prevent skin cancer. This research involves people who have a high risk of developing skin cancer -- those who have already had the disease and those who have certain other rare skin diseases that increase their risk of skin cancer.

Symptoms

The most common warning sign of skin cancer is a change on the skin, especially a new growth or a sore that doesn't heal. Skin cancers don't all look the same. For example, the cancer may start as a small, smooth, shiny, pale, or waxy lump. Or it can appear as a firm red lump. Sometimes, the lump bleeds or develops a crust. Skin cancer can also start as a flat, red spot that is rough, dry, or scaly.

Both basal and squamous cell cancers are found mainly on areas of the skin that are exposed to the sun -- the head, face, neck, hands, and arms. However, skin cancer can occur anywhere.

Actinic keratosis, which appears as rough, red or brown scaly patches on the skin, is known as a precancerous condition because it sometimes develops into squamous cell cancer. Like skin cancer, it usually appears on sun-exposed areas but can be found elsewhere.

Changes in the skin are not sure signs of cancer; however, it is important to see a doctor if any symptom lasts longer than 2 weeks. Don't wait for the area to hurt -- skin cancers seldom cause pain.

Detection and Diagnosis

Detection

The cure rate for skin cancer could be 100 percent if all skin cancers were brought to a doctor's attention before they had a chance to spread. Therefore, people should check themselves regularly for new growths or other changes in the skin. Any new, colored growths or any changes in growths that are already present should be reported to the doctor without delay. (See the How To Do a Skin Self-Exam section for a simple guide on how to do a skin self-exam.)

Doctors should also look at the skin during routine physical exams. People who have already had skin cancer should be sure to have regular exams so that the doctor can check the skin -- both the treated areas and other places where cancer may develop.

Diagnosis

Basal cell carcinoma and squamous cell carcinoma are generally diagnosed and treated in the same way. When an area of skin does not look normal, the doctor may remove all or part of the growth. This is called a biopsy. To check for cancer cells, the tissue is examined under a microscope by a pathologist or a dermatologist. A biopsy is the only sure way to tell if the problem is cancer.

Doctors generally divide skin cancer into two stages: local (affecting only the skin) or metastatic (spreading beyond the skin). Because skin cancer rarely spreads, a biopsy often is the only test needed to determine the stage. In cases where the growth is very large or has been present for a long time, the doctor will carefully check the lymph nodes in the area. In addition, the patient may need to have additional tests, such as special x-rays, to find out whether the cancer has spread to other parts of the body. Knowing the stage of a skin cancer helps the doctor plan the best treatment.

Treatment Planning

In treating skin cancer, the doctor's main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history.

It is sometimes helpful to have the advice of more than one doctor before starting treatment. It may take a week or two to arrange for a second opinion, but this short delay will not reduce the chance that treatment will be successful. There are a number of ways to find a doctor for a second opinion:

Treating Skin Cancer

Treatment for skin cancer usually involves some type of surgery. In some cases, doctors suggest radiation therapy or chemotherapy. Sometimes a combination of these methods is used.

Surgery

Many skin cancers can be cut from the skin quickly and easily. In fact, the cancer is sometimes completely removed at the time of the biopsy, and no further treatment is needed.

Curettage and Electrodesiccation

Doctors commonly use a type of surgery called curettage. After a local anesthetic numbs the area, the cancer is scooped out with a curette, an instrument with a sharp, spoon-shaped end. The area is also treated by electrodesiccation. An electric current from a special machine is used to control bleeding and kill any cancer cells remaining around the edge of the wound. Most patients develop a flat, white scar.

Mohs' Surgery

Mohs' technique is a special type of surgery used for skin cancer. Its purpose is to remove all of the cancerous tissue and as little of the healthy tissue as possible. It is especially helpful when the doctor is not sure of the shape and depth of the tumor. In addition, this method is used to remove large tumors, those in hard-to-treat places, and cancers that have recurred. The patient is given a local anesthetic, and the cancer is shaved off one thin layer at a time. Each layer is checked under a microscope until the entire tumor is removed. The degree of scarring depends on the location and size of the treated area. This method should be used only by doctors who are specially trained in this type of surgery.

Cryosurgery

Extreme cold may be used to treat precancerous skin conditions, such as actinic keratosis, as well as certain small skin cancers. In cryosurgery, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells. After the area thaws, the dead tissue falls off. More than one freezing may be needed to remove the growth completely. Cryosurgery usually does not hurt, but patients may have pain and swelling after the area thaws. A white scar may form in the treated area.

Laser Therapy

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

Grafting

Sometimes, especially when a large cancer is removed, a skin graft is needed to close the wound and reduce the amount of scarring. For this procedure, the doctor takes a piece of healthy skin from another part of the body to replace the skin that was removed.

Radiation

Skin cancer responds well to radiation therapy (also called radiotherapy), which uses high-energy rays to damage cancer cells and stop them from growing. Doctors often use this treatment for cancers that occur in areas that are hard to treat with surgery. For example, radiation therapy might be used for cancers of the eyelid, the tip of the nose, or the ear. Several treatments may be needed to destroy all of the cancer cells. Radiation therapy may cause a rash or make the skin in the area dry or red. Changes in skin color and/or texture may develop after the treatment is over and may become more noticeable many years later.

Topical Chemotherapy

Topical chemotherapy is the use of anticancer drugs in a cream or lotion applied to the skin. Actinic keratosis can be treated effectively with the anticancer drug fluorouracil (also called 5-FU). This treatment is also useful for cancers limited to the top layer of skin. The 5-FU is applied daily for several weeks. Intense inflammation is common during treatment, but scars usually do not occur.

Clinical Trials

In clinical trials (research studies with cancer patients), doctors are studying new treatments for skin cancer. For example, they are exploring photodynamic therapy, a treatment that destroys cancer cells with a combination of laser light and drugs that make the cells sensitive to light. Biological therapy (also called immunotherapy) is a form of treatment to improve the body's natural ability to fight cancer. Interferon and tumor necrosis factor are types of biological therapy under study for skin cancer.

Followup Care

Even though most skin cancers are cured, the disease can recur in the same place. Also, people who have been treated for skin cancer have a higher-than-average risk of developing a new cancer elsewhere on the skin. That's why it is so important for them to continue to examine themselves regularly, to visit their doctor for regular checkups, and to follow the doctor's instructions on how to reduce the risk of developing skin cancer again.

Questions To Ask the Doctor

Skin cancer has a better prognosis, or outcome, than most other types of cancer. Although skin cancer is the most common type of cancer in this country, it accounts for much less than 1 percent of all cancer deaths. It is cured in 85 to 95 percent of all cases. Still, any diagnosis of cancer can be frightening, and it's natural to have concerns about medical tests, treatments, and doctors' bills.

Patients have many important questions to ask about cancer, and their doctor is the best person to provide answers. Most people want to know exactly what kind of cancer they have, how it can be treated, and how successful the treatment is likely to be. The following are some other questions that patients might want to ask their doctor:

Some patients become concerned that treatment may change their appearance, especially if the skin cancer is on their face. Patients should discuss this important concern with their doctor. And they may want to have a second opinion before treatment.

This information is not intended to be a substitute for professional medical advice.
You should not use this information to diagnose or treat a health problem or disease without consulting
with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns
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