Skin cancer causes, symptoms, and treatment here

About

What is skin cancer?

Skin cancer starts with the abnormal growth of skin cells that may cause a mole, a scaly patch of skin or a sore that doesn’t heal. Skin cancer most often develops on areas that have maximum exposure to the sun’s ultraviolet radiation. However, it can develop anywhere on or inside (mucous membranes) your body. Regular skin checks are important to find new moles or changes in existing moles. Screening for suspicious skin growths is especially important if you have fair skin, spend lots of time in the sun, have a history of skin cancer or serious sunburns, or you are older. Screening helps with early identification and treatment, when skin cancer is most successfully treated. Most skin cancers can be removed successfully if found and treated early.

Are there different types of skin cancer?

Yes, there are two types: melanoma and nonmelanomas. Nonmelanomas can be either basal cell carcinoma or squamous cell carcinoma. These are the most common types of skin cancer. Melanoma is the most serious, can be potentially life-threatening, and is most likely to spread to other parts of the body. It is also the rarest type.

Why should I worry about skin cancer?

Basal cell and squamous cell carcinomas can be expensive and disfiguring to treat. Melanoma can spread to other parts of the body and be life-threatening. Always have a dermatologist check any new moles, changes in old moles or other skin growths, or a sore that won’t heal.

Causes

What causes skin cancer?

Skin cancer develops because of mutations in skin cells’ DNA. Cancer cells grow rapidly and form a mass or cancerous tumor. The majority of cases are caused by ultraviolet (UV) radiation from the sun, tanning beds or sunlamps. UV radiation damages unprotected skin and causes a sunburn. Repeated UV exposure causes the skin to change: aging prematurely and its texture becomes rougher. As the damage builds up, skin cancer can develop.

Skin cancer can also develop on skin that gets no sun exposure. Other factors contribute to skin cancer including exposure to toxic chemicals or having a disease that weakens your immune system.

Skin cancer starts in the top layer of skin, the epidermis. It’s a thin layer that protects skin cells, which the body constantly sheds. The top layer of skin includes three main types of cells:

Squamous cells grow below the outer skin surface and provide an inner lining for the skin.
Basal cells, which grow beneath the squamous cells, produce new skin cells.
Melanocytes grow in the lower part of the epidermis. They produce the pigment (melanin) that gives skin its color. To protect the skin, melanocytes produce more melanin when you are exposed to UV radiation.

Who’s at risk for skin cancer?

Anyone can get skin cancer. However, your chances of getting skin cancer are much higher if you have one or more of these risk factors:

Fair skin, blue or green eyes, or blond or red hair; fair skin has less melanin to protect it from UV radiation
Skin that easily burns, freckles or reddens when exposed to UV radiation
A history of sunburns, especially as a child or teenager
Personal or family history of skin cancer
Spend a lot of time outdoors with unprotected skin, or use tanning beds or sunlamps
Have lots of abnormal skin moles
Are older
Live at a high altitude (where UV radiation is strongest), and/or in a sunny, warm climate
Have actinic keratoses (rough, scaly patches or lesions that range from brown to dark pink), which are more likely to develop on the head, face and hands of fair-skinned people who have sun damage
Weakened immune system, such as a person taking immunosuppressant medications after an organ transplant, or an HIV/AIDS patient
Exposure to radiation to treat skin conditions
Exposure to toxic chemicals

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Symptoms

What are the symptoms of skin cancer?

Skin cancer is most likely to develop on the scalp, face, lips, nose, ears, neck, chest, arms and hands. In women it can develop on the legs. It can also develop under the nails, on your palms, soles, or genital area. Be aware of any change in a mole, a new mole(s) that develops, or a sore that doesn’t heal. These signs can signal a potential skin cancer.

Different types of skin cancer have different symptoms.

Melanoma can develop on normal skin or in an existing mole. Having one or more of the “ABCDE” warning signs can indicate that a mole has developed melanoma:

A - Asymmetrical, an irregular shaped mole
B - Borders of the mole are uneven or blurry
C - Color is uneven
D - Diameter is larger than a pencil eraser
E - Evolving or changing

Basal cell carcinoma looks like a pearly or waxy bump that is flat and flesh-colored. It can also appear as a brown lesion, or develop as a bleeding sore that scabs over, heals, and then returns.

Squamous cell carcinoma can develop as a firm, red nodule, or as a flat sore with a scaly or crusty surface.

The following types of skin cancer are much rarer and include:

Kaposi sarcoma develops in the skin’s blood vessels, causing reddish-purple patches on skin or mucous membranes. It develops mainly in people who have a weakened immune system, such as people with HIV/AIDS or are organ transplant patients. It can also occur in older men with Italian or Eastern European Jewish ancestry.

Merkel cell carcinoma causes firm, shiny nodules on or just below the skin’s surface or in hair follicles on the head, neck or torso.

Sebaceous gland carcinoma is an aggressive cancer that starts in the skin’s oil-producing glands and causes hard but painless nodules.

How quickly can skin cancer spread?

Melanoma, the most serious type, can grow very quickly and be life-threatening in just six weeks. If it’s not treated promptly it can spread (metastasize) to internal organs or other parts of the body.

Diagnosis

How is skin cancer diagnosed?

Your dermatologist will examine your skin with a magnifier and may take a small sample of tissue (biopsy) from any suspicious-looking growths. The tissue will be examined under a microscope for cancer cells. A biopsy can also reveal the type of cancer you have.

If cancer is found, additional testing will determine the stage of your cancer. Staging reveals the extent of the cancer or how serious it is, and what treatments would be most successful. Stage I cancers are small and have not spread beyond the area where they developed. Stages II and III are increasingly serious. Stage IV is the most serious, and indicates advanced cancer that has spread to other areas.

If you have melanoma, a large squamous cell carcinoma, or a Merkel cell carcinoma, you’ll need additional testing to determine its stage. Because basal cell cancer rarely spreads; removing the whole growth is enough to determine its stage.

Additional testing may include imaging tests to determine if cancer has spread to nearby lymph nodes, or a sentinel lymph node biopsy to remove a lymph node and test it for cancer.

Treatment

How is skin cancer treated?

Treatment depends on the stage, size, type, depth, and location of the cancer. Small cancers on the skin’s surface can be removed in the doctor’s office during a skin biopsy. This is usually all the treatment they need.

Larger and/or deeper skin cancers may require additional treatments, and those may include:

Cryosurgery uses liquid nitrogen to freeze small cancers. The dead tissue falls off within a few days.
Surgery is appropriate for most skin cancers. The cancerous tissue is cut out, along with a small margin of healthy tissue to ensure any stray cancer cells are also removed.
Mohs (moz) surgery may be used for basal and squamous cell carcinomas, for larger or difficult-to-treat cancers, or for recurring cancers. It’s used in areas where it’s important to preserve as much skin as possible such as the nose. The cancer is removed one layer at a time, and each layer is analyzed for cancer cells. The dermatologist continues removing layers until no abnormal cells are found.
Curettage with electrodesiccation is a method where, after cutting out most of the growth, layers of cancer cells are scraped away using a circular blade. An electric needle kills any remaining cancer cells.
Curettage with cryotherapy is like the method above, but cryosurgery is used to freeze the base and edges of the affected area. Both methods are used to treat basal or thin squamous cell cancers.
Radiation therapy uses powerful energy beams like X-rays to kill cancer cells. It’s used when all the cancer cannot be removed during surgery.
Chemotherapy uses medications to kill cancer cells. Topical creams or lotions are used directly on the skin to treat cancers that affect only the top layer of skin. Chemotherapy pills (systemic therapy) treat cancers that have spread to other parts of the body.
Photodynamic therapy used medications to make cancer cells sensitive to light. A laser is then used to kill them.
Biologic therapy can target your body’s immune system to kill cancer cells.

Because most skin cancers are preventable, protect yourself by following these tips:

Avoid being in the sun between 10 a.m. and 4 p.m., even in winter or on cloudy days.
Do not use tanning beds or sunlamps. Their UV radiation is just as dangerous as sunshine.
Wear sunscreen with a SPF of 30 every day if you are outside for more than a few minutes. Reapply after two hours, and after swimming or sweating.
Cover your skin and head with a broad-brimmed hat and tightly woven clothing; sunscreen cannot provide complete protection from UV radiation.
Wear sunglasses that protect against both UVA and UVB radiation.
Ask your doctor or pharmacist if any of the medications and over-the-counter drugs you take make your skin more sensitive to sunlight.
Check your skin regularly and report any changes to your doctor.

References

**Mayo Clinic. (Dec. 2020). Skin Cancer. Retrieved 10-6-21, {https://www.mayoclinic.org/diseases-conditions/skin-cancer/symptoms-causes/syc-20377605}**

**Mayo Clinic. (Dec. 2020). Skin Cancer: Diagnosis and Treatment. Retrieved 10-6-21, {https://www.mayoclinic.org/diseases-conditions/skin-cancer/diagnosis-treatment/drc-20377608}**

**Centers for Disease Control and Prevention. (April, 2021). What is Skin Cancer? Retrieved 10-6-21, {https://www.cdc.gov/cancer/skin/basic_info/what-is-skin-cancer.htm}**

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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Skin Cancer