What Is Skin Cancer?

When thinking about cancer risks, many of us forget about the largest organ in our bodies: our skin. In this article, Dr. Elise Craig of Dermatology, Surgery and Cosmetics of Northeast Ohio discusses many skin cancer facts.

What Are the Types of Skin Cancer?

Skin cancer is an abnormal overgrowth of atypical cells that develops in the skin. As dermatologists, we mainly deal with the three most common skin cancers, Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma.

However, we occasionally see two more unusual types of carcinomas: Sebaceous Gland Carcinoma and Merkel Cell Carcinoma.

Merkel cell carcinoma is an uncommon but aggressive cancer that develops from the merkel cells (the specialized pressure receptor cells) in the skin, typically showing up on the head of older sun damaged patients. A sebaceous gland carcinoma is a rare form of cancer arising from the sebaceous (oil) glands, they tend to show up around the eyes.

How Common is Cancer of the Skin?

Basal cell carcinoma is the most common type of skin cancer, representing about 80% of cases, one in four people will develop one in their lifetime. Squamous cell carcinomas come in second, with 2 million annual diagnoses in the U.S. More rare but still prevalent, about 100,000 Americans receive melanoma skin cancer diagnoses per year.

Is It Hereditary?

Skin cancer is generally not hereditary, but you may inherit genetic factors that put you at risk, such as fair skin. You aren’t guaranteed to develop basal cell skin cancer just because a parent had it, but if you have their same skin type, and have gotten a lot of sun damage (sun burns, spent time in tanning beds, etc.) you are more likely to develop one. A small percentage of melanomas are genetic, so if you have multiple family members who have had a melanoma, you should be evaluated by a dermatologist.

What Are the Stages of Skin Cancer?

Skin cancers become more dangerous the longer they are on a person without being diagnosed, but most have a high cure rate when you detect them early. Doctors classify cancer in stages based on where the abnormal cells have spread. The majority of skin cancers are diagnosed as Stage 0 or Stage 1, meaning the cancerous cells are only in the skin. When the skin cancer has moved further into the layers below the skin or into the lymph nodes, we consider it Stage 2 and Stage 3. If the cancer has spread into other organs, like the lungs or brain, we call that Stage 4 disease.

How and Where Does Skin Cancer Develop?

In general, excessive sun exposure is what causes skin cancer. UV light from the sun is a form of radiation that alters our cells and DNA. The abnormalities develop based on what areas receive the most sun.

Basal cell cancer tends to occur most often on the head and neck, with squamous cell occurring most often on the head, neck, and extremities. Where Melanoma tends to develop depends on the patient’s sex. It generally occurs on the head, neck, and trunks of men and the arms and legs of women.

How Can I Tell That Skin Cancer Is Developing?

Skin cancer varies in appearance, but dermatologists look for:

• New pink bumps that remain after one or two months
• Rough, scaly pink patches, especially on the face
• Spots that are sore, tender, or bleed on their own
• New or changing moles

Some skin growths are considered precancerous skin lesions. For example, Actinic Keratosis (AK) sometimes turns into squamous cell skin cancer. Therefore, it is important to treat precancerous growths and many different methods are available. Your dermatologist may perform a skin biopsy to determine if a growth is cancerous.

Can I Do a Self-Exam?

Examining yourself is an excellent method for early detection of precancerous skin growth, but don’t let normal moles scare you. You can use the “ABCDEs of Melanoma” to track the size and shape and other aspects of skin growths:

• Asymmetry
• Borders that are irregular or jagged
• Color change
• Diameter larger than a pencil eraser
• Evolution (noticeable changes)

You may experience tenderness, pain, or itching around the affected area. Skin cancers don’t often spread inside the body, but if they do, you may feel sick or experience significant unintended weight loss. If you have experienced such weight loss, we encourage regular routine cancer screenings as well as a skin check.

Who Does Skin Cancer Affect?

Anyone can develop skin cancer cells, including people of all genders, ages, and skin types. People having pale or freckled skin, blue or green eyes, and blond or red hair have the highest risk. Other factors that put you at risk of skin cancer include excessive sunburns, smoking, organ transplantation, weakened immune system, chemical exposure, and tanning bed use. Age can also be a factor. The longer you live, the higher your risk becomes. However, people are developing skin cancer at younger and younger ages due to tanning bed use and too much sun exposure / sun burns..

Even a single indoor tanning bed session can significantly increase your risk of skin cancer. The risk of melanoma increases by 20%, squamous cell carcinoma by 60%, and basal cell carcinoma by almost 30%.

Do Those With More Melanin Get Skin Cancer?

People with darker skin can develop skin cancer, although they develop it less frequently. Diagnosis of Melanoma is often delayed in darker-skinned patients, due to many different reasons, which is why it’s essential to be informed and have your skin and moles evaluated by a dermatologist regardless of your skin color.

Can Skin Cancer Be Prevented?

You can prevent skin cancer by taking care to avoid sun exposure or wearing protective, high-SPF sunscreen and sun-protecting clothing when you are in the sun. High-SPF sunscreen is a must to protect against ultraviolet rays.

My fellow dermatologists recommend wearing sunscreen with at least a 50 SPF level reapplied every one to two hours. Forget the common sunburn myth that getting that first summer sunburn helps you tan for the rest of the season. This is not true, and each sunburn increases your risk of getting cancer.

What Other Habits Help Prevent Skin Cancer?

Prevent damage to your skin’s cells in the following ways:

• Wear protective clothing that covers your body: That thin, white tank top isn’t offering much sun protection.
• Wear wide-brimmed hats: Opt for a hat with a wide, 360-degree brim instead of a baseball hat, which doesn’t cover your ears, which are frequent sites for cancer.
• If you are in the sun, take frequent breaks, and avoid the middle of the day hours where the sun is directly overhead.

How Do Doctors Treat Skin Cancer?

Treatment depends on the type of skin cells and particular cancer growth patterns.

ED&C (Electrodessication and Curettage)

Cancers caught early may receive this procedure, in which doctors apply local anesthesia then scrape away the cancerous cells until they reach the normal cells. Follow-up is with cauterization.

Excision

If a cancerous lesion has grown deeper or wider, doctors will cut away the affected skin layers down to the fat, then use stitches to close the opening.

Mohs

Specially trained dermatologists will use the more complex but successful Mohs procedure to remove cancerous tissue while sparing normal skin in cosmetically sensitive areas. It requires the Mohs surgeon to read and evaluate the tissue microscopically and determine what is cancer and what is healthy. The surgeon removes it in stages to ensure disease-free margins. Finally, the Mohs surgeon reconstructs the surgical site, but sometimes when the cancer removal has left a very large area that will be challenging to repair (nose, eyelid, etc.), a plastic surgeon or oculoplastics doctor may reconstruct the surgical site.

Treatments to remove cancerous skin tend to be minimally invasive, outpatient procedures. When we catch cancers early, radiation treatment is not usually necessary. If radiation therapy becomes necessary, the patient often sees a medical or surgical oncologist in addition to a dermatologist.

Talk to Your Dermatologist About Skin Cancer

Talk to a dermatologist here at Dermatology, Surgery, and Cosmetics of Northeast Ohio to learn more. Contact us online today!