Skin cancer is the most common type of cancer in the US. It begins on the outer layer of skin, called the epidermis, and is most often caused by exposure to UV light including sunlight and artificial UV light from tanning beds. However, skin cancer can appear anywhere on your body even if it wasn’t exposed heavily to UV light.
There are two primary categories of skin cancer:
Review this section’s important information about skin cancer risk factors, signs and symptoms, staging, and treatment options as you prepare for your first appointment. Then, we will help you and your family in making treatment decisions, together with our medical team at Cancer Care Centers of Brevard. During this process, you will gain the knowledge and confidence to help manage your cancer and continue activities of your daily life.
Knowing which type of skin cancer you have is important because it will affect your skin cancer treatment options. Skin cancers most often form on skin that has been exposed to the sun, including on your head, face, neck, hands, and arms. But skin cancer can occur anywhere, including areas that aren’t normally exposed to the sun.
There are three major types of skin cancers under two primary categories of skin cancer:
Basal cell cancer and squamous cell cancer are the two most common types of skin cancer. These cancers often form on the head, face, neck, hands, and arms; areas that are often exposed to the sun.
BCCs are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the lowest layer of the epidermis, called the basal cell layer. It usually occurs on areas of the skin that have been exposed to the sun and often looks like open sores, red patches, shiny bumps, pink growths, or scars. It is most common on the face. Basal cell skin cancer grows slowly and rarely spreads to other parts of the body. If left untreated, however, it can grow into nearby areas and invade the bone or other tissues beneath the skin.
Squamous cell skin cancer is an uncontrolled growth of abnormal cells that also occurs on parts of the skin that have been exposed to the sun – primarily the upper layers (epidermis). These areas typically include the rim of the ear, lower lip, face, balding scalp, neck, hands, arms and legs. But it also may be in places on your body that do not receive any sun exposure, including inside the mouth and on the genitals. SCCs often look like scaly red patches, open sores, elevated growths with a central depression, or warts. These skin abnormalities may crust or bleed at times. Although not usually life-threatening, untreated squamous cell cancer can sometimes spread to lymph nodes and organs inside the body, causing serious complications.
If skin cancer spreads from its original place to another part of the body, the new growth has the same kind of abnormal cells and the same name as the primary growth, it is still called skin cancer.
While melanoma is much less common than basal cell and squamous cell skin cancers, it is the most serious type of cancer of the skin and has become more common every year, because it is much more likely to spread if not caught early. In the United States, for example, the percentage of people who develop melanoma has more than doubled in the past 30 years. If recognized and treated early, however, melanoma is usually curable. If it is not caught early this type of skin cancer can advance and spread to other parts of the body, where it becomes more difficult to treat.
Melanoma starts in cells in the skin called melanocytes, which are the cells found between the dermis and epidermis. They often look like moles, and some actually start out as moles.
These cancerous growths develop when UV radiation triggers genetic defects to skin cells that lead to rapid multiplication of skin cells that form malignant (cancerous) tumors. Melanomas often resemble moles. Some even develop from moles. While the majority of melanomas are black or brown, some may be skin-colored, pink, red, purple, blue or white.
Melanomas can develop anywhere on the skin, but they are more likely to develop on the trunk (chest and back) in men and on the legs in women. The neck and face are other common areas.
The most important warning sign of melanoma is a new spot on the skin or an existing spot that now appears abnormal. Following the ABCDE guidelines can help you identify the usual signs of melanoma:
Not all melanomas fit these rules. If you notice new spots on the skin or see changes in existing ones, tell your doctor or dermatologist. Click to view some photos that can help you identify whether a mole may be cancerous. These photos are meant as a guide, but it is always best to see a doctor who can give you an exam and perform a biopsy if needed.
While melanoma, basal cell carcinoma, and squamous cell carcinoma account for 99% of all skin cancer cases, the following are other forms of skin cancer that are also important to be aware of.
A rare, aggressive skin cancer that primarily occurs on sun-exposed skin such as the head and neck, as well as the arms, legs, and trunk. MCC usually appears as a firm, pink, red, or purple lump on the skin. Typically, these lumps are painless. Because MCC is a fast-growing cancer it can be hard to treat if it spreads to areas beyond the skin. Learn more about Merkel cell carcinoma from The American Cancer Society.
This type of cancer develops from the cells that line lymph or blood vessels. It can appear on the skin as a darkish/purple-colored tumor (or lesion) or on the inside of the mouth. Although lesions typically do not cause symptoms, they can spread to other parts of the body. KS is caused by the human herpesvirus-8 (HHV-8). Not everyone infected with HHV-8 will get KS. Typically, those most at risk are infected people whose immune systems have been weakened by disease or by drugs given after an organ transplant.
There are a few different types of KS that are named from the populations that they are present in; however, the changes within the KS cells are all very similar. The different types of KS include:
Epidemic (AIDS-related) Kaposi sarcoma develops in those who are HIV infected. Human immunodeficiency virus (HIV) is the virus that causes AIDS. This type is the most common type of KS in the United States. Learn more about Kaposi sarcoma from The American Cancer Society.
Lymphoma is a cancer that starts in the lymphocytes–white blood cells that are vitally important in the functioning of the immune system. While lymphoma commonly involves the lymph nodes, it can begin in other lymphoid tissues such as the spleen, bone marrow, and the skin. The two main types of lymphomas are Hodgkin lymphoma and non-Hodgkin lymphoma. Lymphomas that originated only in the skin are called skin lymphoma (or cutaneous lymphoma).
In addition to some of the typical skin cancer treatments such as photodynamic therapies, chemotherapy, and targeted therapies, lymphoma of the skin may also be treated by stem cell transplants, immunotherapy treatments, and clinical trials involving lymphoma vaccines. Learn more about lymphoma of the skin from The American Cancer Society.
In most cases, skin cancer is identified first by a doctor as an abnormal area on the skin. However, they won’t know if it’s cancerous or not until it’s removed and tested. This is a biopsy. A biopsy is the only sure way to diagnose skin cancer.
You may have the skin cancer biopsy in a dermatologist’s office or as an outpatient in a clinic or hospital. Where it is done depends on the size and place of the abnormal area on your skin. You probably will have local anesthesia.
The dermatologist will never “shave off” or cauterize a growth that might be melanoma. An excisional biopsy will be performed, or, if the growth is too large to be removed entirely, a tissue sample will be taken.
If the biopsy shows that you have skin cancer you will be referred to a cancer specialist, known as an oncologist. Whether melanoma or nonmelanoma skin cancer, your oncologist needs to know the extent (stage) of the disease. Staging is a careful attempt to learn how thick the tumor is, and if it has spread. If the tumor is thick, the doctor may order chest x-rays, blood tests, and scans of the liver, bones, and brain.
Knowing the stage of your cancer helps your cancer doctor:
In some cases, the oncologist may check your lymph nodes to stage the cancer (such surgery may be considered part of the treatment because removing cancerous lymph nodes may help control the disease).
The stage is based on:
Oncologists use the Roman numerals I through IV to indicate a cancer’s stage. Stage I cancers are small and limited to the area where they began. Stage IV indicates advanced cancer that has spread to other areas of the body.
These are the stages of skin cancer:
The following stages are used for melanoma:
There are several ways to approach skin cancer treatment. Your oncologist will work with you to find the best combination given the stage and considering your overall health.
Sometimes all of nonmelanoma skin cancer is removed during the biopsy. In such cases, no further treatment is needed. If you do need more treatment, your doctor will describe your options.
Six types of nonmelanoma skin cancer treatments are often used, alone or in combination. They are:
Melanoma treatment includes nearly all of the same options with the exception of photodynamic therapy.
Surgery is the primary treatment for melanoma, with possible follow up with other types of therapy. Nonmelanoma skin cancers are also often removed with surgery and may include other types of therapy depending on whether it was a basal cell or squamous cell skin cancer.
Surgery to treat skin cancer may be done in one of several ways. The method your oncologist recommends depends on the size and place of the growth and other factors.
Your oncologist can further describe these types of surgery:
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When a drug is put directly on the skin, the treatment is topical chemotherapy. It is most often used when the skin cancer is too large for surgery. It is also used when the doctor keeps finding new cancers.
Most often, the drug comes in a cream or lotion. It is usually applied to the skin one or two times a day for several weeks. A drug called fluorouracil (5-FU) is used to treat basal cell and squamous cell cancers that are in the top layer of the skin only. A drug called imiquimod also is used to treat basal cell cancer only in the top layer of skin.
When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body. This is called systemic chemotherapy.
When chemotherapy is placed directly into the spinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas. This is regional chemotherapy.
One type of regional chemotherapy used for melanoma patients is used to inject the anticancer drugs directly to the arm or leg the cancer is in. The flow of blood to and from the limb is temporarily stopped with a tourniquet. A warm solution with the anticancer drugs is put directly into the blood of the limb. This gives a high dose of drugs to the area where the cancer is.
The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Even if the doctor removes all the melanoma during surgery, there can be some left that can’t be seen. Some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Photodynamic therapy (PDT) uses a chemical along with a special light source, such as a laser light, to kill cancer cells. The chemical is a photosensitizing agent. A cream is applied to the skin or the chemical is injected. It stays in cancer cells longer than in normal cells. Several hours or days later, the special light is focused on the growth. The chemical becomes active and destroys nearby cancer cells.
PDT is used to treat cancer on or very near the surface of the skin.
The side effects of PDT are usually not serious. PDT may cause burning or stinging pain. It also may cause burns, swelling, or redness. It may scar healthy tissue near the growth. If you have PDT, you will need to avoid direct sunlight and bright indoor light for at least 6 weeks after your skin cancer treatment.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Many patients with basal cell or squamous cell skin cancers will be treated surgically with excellent results. For selected patients, especially those who cannot be treated surgically, HDR Brachytherapy provides an effective treatment alternative with few side effects. This is an in-office treatment performed by a Radiation Oncologist.
HDR Brachytherapy for skin cancer is:
An applicator is connected to the HDR treatment unit. Then a tiny radioactive seed leaves the HDR unit, travels through some tubes which rests over each part of the skin cancer for a few seconds and delivers the treatment. After about 5 minutes, the seed has traveled over every part of the skin cancer and the treatment is complete. After the treatment, the seed is securely returned back into the HDR unit. The patient feels nothing during the treatment.
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. The following types of targeted therapy are being used in the treatment of melanoma: