Skin Cancer


General Information

What is skin cancer?

Skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of the skin. The skin protects the body against heat, light, infection, and injury. It also stores water, fat, and vitamin D.

The skin has 2 main layers and several kinds of cells. The top layer of skin is called the epidermis. It contains 3 kinds of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and cells called melanocytes, which give the skin its color.

The inner layer of skin is called the dermis. This layer is thicker, and contains blood vessels, nerves, and sweat glands. The hair on the skin also grows from tiny pockets in the dermis, called follicles. The dermis makes sweat, which helps to cool the body, and oils that keep the skin from drying out.

There are several types of cancer that start in the skin. The most common are basal cell cancer and squamous cell cancer, which are covered in this PDQ patient information summary. These types of skin cancer are called nonmelanoma skin cancer. Melanoma is a type of skin cancer that starts in the melanocytes. It is not as common as basal cell or squamous cell skin cancer, but it is much more serious. (Refer to Melanoma Treatment for more information.)

Skin cancer is more common in people with light colored skin who have spent a lot of time in the sunlight. Skin cancer can occur anywhere on the body, but it is most common in places that have been exposed to more sunlight, such as the face, neck, hands, and arms.

Skin cancer can look many different ways. The most common sign of skin cancer is a change on the skin, such as a growth or a sore that won't heal. Sometimes there may be a small lump. This lump can be smooth, shiny and waxy looking, or it can be red or reddish brown. Skin cancer may also appear as a flat red spot that is rough or scaly. Not all changes in the skin are cancer, but a doctor should be seen if changes in the skin are noticed.

If there is a spot or lump on the skin, a doctor may remove the growth and look at the tissue under a microscope. This is called a biopsy. A biopsy can usually be done in a doctor's office. Before the biopsy, the patient will be given a local anesthetic to numb the area for a short period of time.

Most nonmelanoma skin cancers can be cured. The chance of recovery (prognosis) and choice of treatment depend on the type of skin cancer and how far it has spread.

Other kinds of cancer that may affect the skin include cutaneous T-cell lymphoma, a cancer of the lymph system, and Kaposi's sarcoma. (Refer to Cutaneous T-Cell Lymphoma Treatment and Kaposi's Sarcoma Treatment for more information.) Cancers that start in other parts of the body may also spread (metastasize) to the skin.

Stage Information

Types of skin cancer:

Once skin cancer is found, more tests may be done to see if the cancer has spread. This is called staging. A doctor needs to know the stage and type of skin cancer to plan treatment. The following types are used to plan treatment:

Basal cell cancer
Basal cell cancer is the most common type of nonmelanoma skin cancer. It usually occurs on areas of the skin that have been in the sun. Often this cancer appears as a small raised bump that has a smooth, pearly appearance. Another type looks like a scar, and it is firm to the touch. Basal cell cancers may spread to tissues around the cancer, but it usually does not spread to other parts of the body.

Squamous cell carcinoma
Squamous cell tumors also occur on areas of the skin that have been in the sun, often on the top of the nose, forehead, lower lip, and hands. They may also appear on areas of the skin that have been burned, exposed to chemicals, or had x-ray therapy. Often this cancer appears as a firm red bump. Sometimes the tumor may feel scaly or bleed or develop a crust. Squamous cell tumors may spread to the lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Actinic keratosis
Actinic keratosis is a skin condition that is not cancer, but can change into basal cell or squamous cell skin cancer in some people. It appears as rough, red or brown, scaly patches on the skin, usually in areas that have been exposed to the sun.

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated.

Treatment Option Overview

How skin cancer is treated:

There are treatments for all patients with skin cancer. Three kinds of treatments are used:

-surgery (taking out the cancer)
-chemotherapy (using drugs to kill cancer cells)
-radiation therapy (using x-rays to kill cancer cells)

Many skin cancers are treated by doctors who treat skin diseases (dermatologists). Often, the cancer can be treated in a doctor's office.

Surgery is the most common treatment of skin cancer. A doctor may remove the cancer using one of the following:

-Electrodesiccation and curettage is surgery that uses an electric current to dehydrate the tumor (electrodesiccation), then uses a specialized surgical tool (curet) to remove the tumor.
-Cryosurgery freezes the tumor and kills it.
-Simple excision cuts the cancer from the skin along with some of the healthy tissue around it.
-Micrographic surgery removes the cancer and as little normal tissue as possible. During this surgery, the doctor removes the cancer and then uses a microscope to look at the cancerous area to make sure no cancer cells remain.
-Laser therapy uses a highly focused beam of light that destroys only the cancer cells.

Surgery may leave a scar on the skin. Depending on the size of the cancer, skin may be taken from another part of the body and put on the area where the cancer was removed. This is called a skin graft. New ways of doing surgery and grafting may reduce scarring.

Radiation therapy uses x-rays to kill cancer cells and shrink tumors. Radiation therapy for skin cancer comes from a machine outside the body (external radiation therapy).

Chemotherapy uses drugs to kill cancer cells. In treating skin cancer, chemotherapy is often given as a cream or lotion placed on the skin to kill cancer cells (topical chemotherapy). Chemotherapy may also be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy given in this way is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the skin. Systemic chemotherapy is being tested in clinical trials.

Biological therapy (using the body's immune system to fight cancer) is being tested in clinical trials. Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Photodynamic therapy uses a certain type of light and a special chemical to kill cancer cells.

Treatment By Type

Treatment of skin cancer depends on the type and stage of the disease, and the patient's age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in some parts of the country for patients with skin cancer. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Basal Cell Carcinoma of the Skin
Treatment may be one of the following:

1. Surgery to remove the cancer and as little of the normal tissue as
possible. During the surgery, the doctor removes the cancer and then uses
a microscope to look at the surgical area to make sure no cancer cells
remain (micrographic surgery).
2. Surgery to remove the cancer from the skin along with some of the healthy
skin around the cancer.
3. Surgery that uses an electric current to dehydrate the tumor
(electrodesiccation), then uses a specialized surgical tool (curet) to
remove the tumor.
4. Surgery that freezes and kills the cancer (cryosurgery).
5. Radiation therapy.
6. Surgery using a highly focused beam of light that destroys only the
cancer cells (laser therapy).
7. Topical chemotherapy.
8. A clinical trial of chemoprevention.
9. A clinical trial of biological therapy.
10. A technique that uses light-sensitive drugs to kill the cancer
(photodynamic therapy).

It is important to have the skin examined regularly so the cancer can be treated if it comes back (recurs).

Squamous Cell Carcinoma of the Skin
Treatment may be one of the following:

1. Surgery to remove the cancer and as little of the normal tissue as
possible. During the surgery, the doctor removes the cancer and then uses
a microscope to look at the surgical area to make sure no cancer cells
remain (micrographic surgery).
2. Surgery to remove the cancer from the skin along with some of the healthy
skin around the cancer.
3. Surgery that uses an electric current to dehydrate the tumor
(electrodesiccation), then uses a specialized surgical tool (curet) to
remove the tumor.
4. Surgery that freezes and kills the cancer (cryosurgery).
5. Radiation therapy.
6. Topical chemotherapy.
7. Surgery using a highly focused beam of light that destroys only the
cancer cells (laser therapy).
8. A clinical trial of biological therapy with or without chemoprevention
therapy.

It is important to have the skin examined regularly so the cancer can be treated if it comes back (recurs).

Actinic Keratosis
Treatment may be one of the following:

1. Topical chemotherapy.
2. Surgery that freezes and kills the cancer (cryosurgery).
3. Surgery that uses an electric current to dehydrate the tumor
(electrodesiccation), then uses a specialized surgical tool (curet) to
remove the tumor.
4. Removing the top layer of skin with a special machine (dermabrasion).
5. Shaving the very top layer of skin (shave excision).
6. Surgery using a highly focused beam of light that destroys only the
cancer cells (laser therapy).






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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