Skin Cancer

What Are Basal Cell Carcinoma and Squamous Cell Carcinoma?

Basal cell carcinoma (BCC) is the most common type of skin cancer, accounting for about 80 percent of all skin cancers. Squamous cell carcinoma (SCC) is responsible for about 15 percent of all skin cancers. Both of these types of skin cancer are associated with sun exposure and a light complexion. Fortunately, both skin cancers can usually be treated successfully if identified early and handled appropriately.

BCC is a slow-growing skin cancer with very little ability to spread to other parts of the body. It can be locally invasive, however, growing into and destroying nearby structures such as the nose, ear, or eye. When located on the body, the skin cancer can grow large and invade down to muscle or bone and create an open wound, but this type of destruction usually takes several years to occur.

SCC is a more aggressive skin cancer than BCC. It usually grows more quickly and can cause greater destruction than BCC. In addition to being locally invasive, SCC can spread to lymph nodes or other parts of the body. This type of spread occurs most often in SCCs that are present on the lips, ears, hands, and fingers, as well as in patients whose immune systems do not work well. In the vast majority of cases, SCC remains only in the skin.

What Is Melanoma?

Melanoma is a potentially deadly skin cancer that comes from melanocytes, which are the cells in the skin that produce pigment. Fortunately, this type of cancer can usually be handled effectively if it is identified and treated in its early stages.

The prognosis for melanoma depends on the stage of the skin cancer at the time of diagnosis, which is based on specific features of the lesion and whether or not there is any evidence of this cancer elsewhere in the body.

The most important factor associated with survival in patients with melanoma is the thickness of the lesion. Thickness is most commonly reported as a measurement of depth given in millimeters, known as Breslow’s depth. Sometimes the thickness is reported in a different way— called the Clark’s level—which is designated with the Roman numerals I through V, with I being the thinnest and V being the thickest.

In general, the thicker melanoma is, the worse the prognosis. Some melanomas are designated as melanoma in situ, which means that the cancer is limited to the uppermost portion of the skin, dubbed the epidermis. Melanoma in situ has a long-term survival rate of nearly 100 percent when treated with appropriate skin cancer surgery.

Melanomas with a Breslow’s depth of less than 1 mm are considered thin melanomas and have a favorable long-term survival rate with appropriate surgical treatment. For skin cancers with a Breslow’s depth of greater than 1 mm, the long-term survival rate decreases as the depth increases.

For these thicker skin cancers, the lymph nodes are sometimes surgically removed and checked under a microscope for the presence of cancer cells. In these cases, whether or not cancer is detected in the lymph nodes becomes an important factor in predicting long term survival.

What Are the Signs and Symptoms of Skin Cancer?

Skin cancer often occurs on areas of the skin that are frequently exposed to the sun, but it can also occur on areas that do not normally get exposed to sunlight.

How can you tell if a spot is skin cancer? Lesions look different depending on the type you have.

A sudden change in your skin—such as a new growth or evolution in an existing mole—is a common sign of cancer. Some of the typical symptoms are a new mole, changes to the size, shape, and color of a mole, a pearly or waxy bump on the face or head area, or scar-like areas on the skin.

What Are the Risk Factors for Skin Cancer?

Although anyone can get skin cancer, there are certain groups that are more susceptible to the disease. Your risk will be higher if you spend a lot of time in the sun, get sunburned easily or have a history of sunburns, live in a sunny or high-altitude climate, have light-colored eyes, hair, and skin, have freckled skin, have a large number of moles or irregularly shaped moles, have a family history of skin cancer, or are taking medications that suppress or weaken your immune system.

Skin Cancer Prevention and Detection: What Can You Do to Reduce Your Risk of Skin Cancer?

Are there ways to prevent skin cancer? Regular sun protection can decrease your chances for developing future cancers. The following steps should be taken for sun protection. They are listed in order of importance, but should be used together whenever possible:

• Do not intentionally expose your skin to natural or artificial sunlight.
• Avoid sun exposure when possible, especially in the middle part of the day, when the sun is most directly overhead.
• Protect your skin from the sun with a physical barrier. Wear a hat with a broad brim, sunglasses, a long-sleeved shirt, and pants when outdoors.
• Apply a broad-spectrum sunscreen with an SPF of 30 or higher to all skin surfaces that you cannot cover with clothes.

A patient’s long-term outcome for skin cancer depends on a range of factors, including the stage at which the cancer is discovered. That’s why we recommend prevention first and foremost, as well as routine skin checks in order to spot and examine suspicious moles and lesions as early as possible.

What Should You Do If You Have Been Diagnosed with Skin Cancer?

What happens if you are diagnosed with skin cancer? What happens after a positive skin cancer biopsy? The first step is to get treatment for the skin cancer. After this is completed, you should schedule regular follow-up exams with your dermatologist, who will inspect the area where the skin cancer was treated to make sure the malignant cells are not growing back. The dermatologist will also check your skin for new skin cancers in other areas.

You should also examine your own skin thoroughly each month. Use a well-lighted room and the combination of a full-length mirror and a handheld mirror to check all of the areas that are hard to see. A spouse, parent, or friend can also help you. Notify us of any new growths, any spots that are changing, and any spots that “look funny.” Also pay attention to any spot that bleeds for no good reason or gets a scab that won’t heal. Most skin cancers are discovered by a patient or spouse and then brought to the attention of a doctor. Carefully examining your own skin is the best defense against a future skin cancer.

Once you have been diagnosed with BCC or SCC, you have a 50 percent chance of having another skin cancer within the next five years. Once you have been diagnosed with melanoma, you are in the highest risk group for developing a new melanoma. You should have a full skin exam by a dermatologist two to four times a year for the first five years after the melanoma has been diagnosed, and then at least once a year for the rest of your life.

If you have had melanoma, you need to let your primary care doctor know. You also need to let your doctor know if you develop any health changes, such as unintentional weight loss, severe headache, weakness, and jaundice. Other health care providers who should be notified of your history of melanoma include your dentist, your ophthalmologist, and your gynecologist.

You should notify all of your first-degree relatives—your parents, siblings, and children—that you have had a melanoma, as this skin cancer tends to run in families. All of your first-degree relatives should have a full skin exam by a dermatologist at least once a year.