Skin cancer is the most common form of cancer in the United States. In fact, it is estimated by the American Cancer Society that more than two million cases of skin cancer will be diagnosed this year.
There are three major types of skin cancer: basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Both basal cell and squamous cell carcinoma are highly treatable. Malignant melanoma is the most serious type of skin cancer and more likely to spread to other parts of the body.
There are several factors which may increase a person’s risk of getting skin cancer, including:
• Sunlight (UV Radiation) – too much exposure to UV radiation, either from the sun or tanning lamps increases a person’s risk for melanoma.
• Fair skin – people with fair skin, freckling or red or blond hair have a higher risk of melanoma.
• Moles – certain types of moles increase a person’s chance of getting melanoma.
• Age – chances of being diagnosed with skin cancer increase as a person gets older, but skin cancer is also found in young people.
• Family history – around 10 percent of people with melanoma have a close relative with the disease. This may be because the family tends to spend more time in the sun or because family members have fair skin, or both.
• Immune suppression – people who have been treated with medicines that suppress the immune system have an increased chance of developing melanoma.
• History of melanoma – people who have already had melanoma have a higher risk of getting it again.
• Gender – men have a higher risk than women.
• Xeroderma pigmentation – people with this rare, inherited condition are at a greater risk of getting melanoma.
Signs and Symptoms
Men and women should know the pattern of moles, freckles and other marks and check their skin about once a month. They should consult their healthcare provider if they have a mole or growth that worries them or has changed in size, shape or color. The ABCD rule can help distinguish a normal mole from melanoma:
• Asymmetry – one half of the mole does not match the other half.
• Border irregularity – the edges of the mole are raged or notched.
• Color – the color of the mole is not the same all over. There may be shades of tan, brown or black and sometimes patches of red, white or blue.
• Diameter – the mole is wider that about ¼ inch.
If cancer is suspected, a physician will perform further tests, which may include a skin biopsy. Types of skin biopsies include:
• Incisional and excisional biopsy that removes a wedge of the skin to look at the deepest layers. An incisional biopsy removed only part of the tumor. An excisional biopsy removes the entire tumor.
• Shave biopsy in which the doctor “shaves” off the top layers of skin.
• Punch biopsy in which the doctor uses a round tool to cut through all the layers of the skin and bring up a sample of tissue.
Tests also may be needed to determine if the cancer has spread to other parts of the body. These might include:
• X-ray of the chest to see if the cancer has spread to the lungs
• CT scan to see if the cancer has spread to other organs
• MRI to see if the cancer has spread to the brain or spinal cord
• PET scan to see if the cancer has spread elsewhere
• Nuclear bone scans to see if the cancer has spread to the bones
• Fine needle aspiration biopsy in which the physician uses a thin needle to remove very small samples of tissue from organs or lymph nodes
• Surgical lymph node biopsy to remove an abnormally large lymph node through a small incision
• Sentinel lymph node biopsy, the surgeon injects a radioactive substance into the area of the melanoma, then checks the lymph nodes for radioactivity to find which one is the first to drain fluid from the skin near the melanoma. Then the lesion is injected with a blue dye that will travel to the node that the cancer would first drain into. When this first node, called the sentinel node, had been identified, it will be removed and looked at under a microscope. If cancer cells are found in this lymph node, the rest of the lymph nodes in the area are removed.
Treatment options are different for different types and stages of skin cancer, but may include surgery, radiation therapy or chemotherapy. Each treatment option may be used alone or in combination.
• Surgery – removal of the melanoma, amputation of a finger or toe, or removal of lymph nodes are common types of surgery for melanoma. Non-melanoma is most commonly treated with surgery, ranging from simple excisions to laser surgery, to lymph node surgery.
• Radiation Therapy is the use of high-energy rays to kill cancer cells in the treated area. It is usually administered from a machine outside the body. It may also be used after surgery to kill cancer cells that may remain after surgery.
• Chemotherapy is the use of drugs to kill cancer cells. Topical chemotherapy is an anticancer medicine that is placed directly onto the skin. Systemic chemotherapy uses drugs taken by mouth or injected into a vein. This treatment can be used when the cancer has spread to other organs.