Skin cancer strikes more people worldwide than any other form of cancer. Although more common in fair-skinned people, anyone can develop skin cancer.

According to the Centers for Disease Control and Prevention, one million US adults will be diagnosed with the disease this year.

The main cause of skin cancer is ultraviolet (UV) radiation from sunlight, especially when too much time is spent in the sun. Avoiding sun overexposure is the best defense against skin cancer. And, catching skin cancer early can provide a better chance for successful treatment.

Facts about skin cancer:

According to the latest statistics available from the American Cancer Society and the Centers for Disease Control and Prevention (CDC):

• Skin cancer is a malignant tumor that grows in the skin cells and accounts for 50 percent of all cancers.
• In the US alone, 1 million Americans will be diagnosed this year with non-melanoma skin cancer, and 55,100 will be diagnosed with melanoma.
• Although exposure to the sun's ultraviolet (UV) rays is said to be the most important factor in the cause of skin cancers, about 70 percent of American adults do not use sun-protection measures.
• The sun exposure that leads to skin cancer occurs many years before the skin cancer. Therefore, protection should start in childhood to prevent skin cancer later in life.

In addition, consider the following statistics from the American Cancer Society and the American Academy of Dermatology:

• Basal cell carcinoma accounts for more than 75 percent of all skin cancers in the US.
• Both basal cell and squamous cell carcinomas have a 95 percent cure rate when detected and treated early.
• Skin cancer incidence rates are 10 times higher for Caucasians than for African Americans. However, people with dark-pigmented skin can develop melanoma, particularly on the palms of the hands, on the soles of the feet, under the nails, and inside the mouth.

Causes of Skin Cancer

Although there are other contributing factors, including heredity and environmental factors, damage to the skin resulting from sunburns, and non-burning exposure to UV light, play a major role in the development of skin cancer. The exposure that people have in their first 20 years of life is a life long risk factor for skin cancer.

In most cases, the sun’s ultraviolet rays react with a chemical called melanin, that is found in the skin. This is the first defense against the sun, as it is the melanin that absorbs the dangerous UV rays that can do serious skin damage. A sunburn develops when the amount of UV damage exceeds the protection that the skin's melanin can provide. While a small amount of exposure to sunlight is healthy and pleasurable, too much can be dangerous. Measures should be taken to prevent overexposure to sunlight in order to reduce the risks of cancers, premature aging of the skin, the development of cataracts, and other harmful effects.

What does tanning do to the skin?

Tanning is the skin's response to ultraviolet (UV) light - a protective reaction to prevent further injury to the skin from the sun. However, tanning does not prevent skin cancer. Over exposure to UV light even without a history of sunburn is a major risk factor for the more common types of skin cancers, such as basal cell carcinoma and squamous cell carcinoma.

What are risk factors for skin cancer?

The following are possible risk factors for skin cancer:

• Heredity
  People with a family history of skin cancer are generally at a higher risk of developing the disease. People with fair skin and a northern European heritage appear to be most susceptible.
• Environment
  Due to a reduction of ozone in the earth's atmosphere, the level of UV light today is higher than it was 50 or 100 years ago. Ozone serves as a filter to screen out and reduce the amount of UV light that we are exposed to. With less atmospheric ozone, a higher level of UV light reaches the earth's surface.

Other factors that contribute to skin cancer:

• having many moles or having atypical moles
• exposure to coal and arsenic compounds
• elevation- Ultraviolet light is stronger as elevation increases (because the thinner atmosphere at higher altitudes cannot filter UV as effectively as it does at sea level).
• latitude- The rays of the sun are strongest near the equator.
• repeated exposure to x-rays
• scars from disease and burns

What are the Different Types of Skin Cancer?

Basal Cell Carcinoma

Basal cell cancer, sometimes referred to as a non-melanoma skin cancer, usually appears as a small, fleshy bump or nodule on the head, neck, or hands. Basal cell carcinomas may also appear on the trunk of the body, often as flat growths. Recurrent bleeding without trauma to the skin is a hallmark of these skin cancers. Basal cell carcinoma accounts for more than 90 percent of all skin cancers in the United States. It is often easily detected and has an excellent record for successful treatment.

According to the American Academy of Dermatology, the cure rate for basal cell carcinoma is 95 percent, when properly treated. Although this type of cancer rarely spreads to other parts of the body, it can grow locally and has the potential to spread to adjacent structures, not just the skin. This can cause considerable local damage.

Having had a basal cell carcinoma is the number one risk factor for developing another skin cancer. In fact, 50 percent of patients who develop a basal cell carcinoma will develop another basal cell carcinoma within five years.

Basal cell carcinoma is the most common cancer found in Caucasians. Although this type of cancer can occur in anyone, it is most common in fair-skinned individuals. Risk factors include having light hair, blue eyes, fair complexions, and an inability to tan (burn easily).

This highly treatable form of cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. This generally does not spread to other organs.

However, early treatment is still important, because the smaller the basal cell carcinoma, the less scarring that will result from treatment.

Squamous Cell Carcinoma

Squamous cell skin cancer (also referred to as non-melanoma skin cancer) may appear as nodules, or as red, scaly patches of skin.

Squamous cell carcinoma is the second most common skin cancer. Like basal cell carcinomas, they can be found on anyone, but are most common in Caucasians, especially fair-skinned individuals.

According to the American Academy of Dermatology, the cure rate for squamous cell carcinoma is 95 percent, when properly treated.

Squamous cell carcinoma is commonly found on the rim of the ear, face, lips and mouth. This skin cancer is generally more aggressive than basal cell carcinoma. It can spread to other parts of the body, but this is not a common occurrence. It should be noted that squamous cell carcinomas in non-sun exposed areas, or those occurring in old scars, chronic wounds, or areas other than the skin, tend to be much more aggressive and spread more readily. This is also true for transplant patients who are on immunosuppressive medications.

Melanoma

Melanoma is a more serious type of cancer than the more common basal cell cancer, or squamous cell cancer. Although the incidence of melanoma is much lower than other types of skin cancer, it has the highest death rate and is responsible for 75 percent of all deaths from skin cancer.

Melanoma is a disease of the skin in which cancer cells form damaged or changing melanocytes (the cells that produce color in the skin or pigment known as melanin.) Melanoma usually occurs in adults, but it may occasionally be found in children and adolescents. Melanoma may also be called cutaneous melanoma or malignant melanoma. Melanoma is the rarest, but most virulent, form of skin cancer.

Melanoma can appear on anyone, and on any area of the body covered by skin or mucosa, such as the eyes, mouth, and vagina. It is not limited to sun-exposed areas and can be found on the feet, hands, groin, and scalp.

What are the risk factors for melanoma?

Persons with the following characteristics may be at an increased risk for melanoma:

• blond or red hair
• blue eyes
• fair complexion
• family history of melanoma
• a changed or changing mole
• many ordinary moles (more than 50)
• many freckles
• an immunosuppressive disorder
• dysplastic nevi
• sun exposure- The amount of time spent unprotected in the sun, especially before 20 years of age, directly affects your risk of skin cancer.
• inability to tan

Dark-brown or black skin is not a guarantee against melanoma. African-Americans can develop this cancer, especially on the palms of the hands, soles of the feet, under nails, or in the mouth.

What are the signs of melanoma?

The following are the most common signs of melanoma:

• change in the size, shape, or color of a mole
• oozing or bleeding from a mole
• a mole that feels itchy, hard, lumpy, swollen, or tender to the touch

Because most malignant melanoma cells still produce melanin, melanoma tumors usually (but not always) have areas shaded brown or black. Melanoma can appear on the body as a new mole or occur within an existing mole.

Men often develop melanoma on the area of the body between the shoulders and hips, or on the head or neck. Women frequently develop melanoma on the arms and legs. However, melanoma can spread quickly to other parts of the body through the lymph system or blood. Like most cancers, melanoma is best treated when it is diagnosed early.

The symptoms of melanoma may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Distinguishing benign moles from melanoma:

To prevent melanoma, it is important to examine your skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. According to recent research, certain moles are at higher risk for changing into malignant melanoma. Moles that are present at birth, and atypical moles, have a greater chance of becoming malignant. Recognizing changes in moles, by following this ABCD Chart, is crucial in detecting malignant melanoma at its earliest stage. The warning signs are:

Normal Mole / Melanoma	Sign	Characteristic
	Asymmetry	when half of the mole does not match the other half
	Border	when the border (edges) of the mole are ragged or irregular
	Color	when the color of the mole varies throughout
	Diameter	if the mole's diameter is larger than a pencil's eraser
Photographs Used By Permission: National Cancer Institute

How is melanoma diagnosed?

Medical examinations and tests are used to determine if a suspicious area is melanoma skin cancer. In addition to a complete medical history, including family history, questions are asked about the marking on the skin, such as when you first noticed it, as well as if and how it has changed in size or appearance.
The suspected area, as well as the rest of your body, is examined, noting the size, shape, color, texture, and if there is bleeding or scaling. A biopsy of the skin may be taken. The biopsy procedure chosen depends on the site and size of the affected area.

Biopsies involve removing a sample of skin for examination under the microscope to determine if melanoma is present. The biopsy is performed under local anesthesia. The patient usually just feels a small needle stick and slight burning for about one minute, with a little pressure, but no pain.

Treatment for skin cancer:

Specific treatment for skin cancer will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

There are several kinds of treatments for skin cancer, including the following:

• Surgery- Surgery, a common treatment for skin cancer, is used about 90 percent of the time and often includes the following procedures:

cryosurgery - the tumor is frozen, which kills the cancer cells.
electrodesiccation and curettage - the lesion is burned and removed with a sharp instrument.
simple excision - the cancer is cut from the skin along with some of the healthy tissue around it.
Mohs micrographic surgery - the cancer and as little normal tissue as possible is removed. During this procedure, the physician removes the cancer and then uses a microscope to look at the cancerous area to make sure no cancer cells remain. This is used to treat either large skin cancers, recurrent skin cancers, or skin cancers in difficult anatomic locations (near the eyes, sides of the nose, etc.)

• Radiation Therapy- Radiation therapy uses x-rays to kill cancer cells and shrink tumors.

High Dose Radiation (HDR) treatment for skin cancer patients is also available at Huntington Hospital. Developed by a Huntington radiation oncologist, this revolutionary technique uses a small radioactive source in a special applicator which is applied directly to the skin lesion. The outcome is equivalent to surgery, but unlike surgery it is achieved non-invasively and without side effects or scarrring. Any lesion smaller than three centimeters (about one inch) can be treated. Most patients require eight to ten treatments which are spaced out over a few weeks.

Other types of treatment include:

• Chemotherapy - treatment with drugs to destroy cancer cells.
• Topical chemotherapy - chemotherapy given as a cream or lotion placed on the skin to kill cancer cells.
• Systemic chemotherapy - chemotherapy taken by pill, or needle injection into a vein or muscle.
• Biological therapy (sometimes called biological response modifier (BRM) therapy, or immunotherapy)
  The objective of biological therapy is to try to get your own body to fight cancer by using materials made by your own body, or made in a laboratory, to boost, direct, or restore your body's natural defenses against disease.photodynamic therapy
  Photodynamic therapy uses a certain type of light and a special chemical to kill cancer cells.
• Immunotherapy- Immunotherapy for the treatment of melanoma involves the injection of a medication (called interferon) to boost the body's own immune system, helping it to slow the growth of the cancer.
• Vaccine therapy- This is sometimes used for patients with metastatic melanomas.

Prevention of skin cancer:

The American Academy of Dermatology (AAD) has declared war on skin cancer by recommending these three preventive steps:

• Wear protective clothing, including a hat with a four-inch brim.
• Apply sunscreen all over your body and avoid the midday sun from 10 a.m. to 4 p.m.
• Regularly use a broad-spectrum sunscreen with an SPF of 15 or higher, even on cloudy days.

The following six steps have been recommended by the AAD and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer.

1. Minimize exposure to the sun at midday - between the hours of 10 a.m. and 4 p.m.
2. Apply sunscreen, with at least an SPF of 15 or higher that protects against both UVA and UVB rays, to all areas of the body that are exposed to the sun.
3. Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.
4. Wear clothing that covers the body and shades the face. Hats should provide shade for both the face and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eye by filtering as much as 80 percent of the rays, and protecting the lids of the eyes as well as the lens.
5. Avoid exposure to UV radiation from sunlamps or tanning salons.
6. Protect children. Keep them from excessive sun exposure when the sun is strongest (between 10 a.m. and 4 p.m.), and apply sunscreen liberally and frequently to children 6 months of age and older.

The American Academy of Pediatrics (AAP) approves of the use of sunscreen on infants younger than 6 months old if adequate clothing and shade are not available. Parents should still try to avoid direct sun exposure and dress the infant in lightweight clothing that covers most surface areas of the skin. However, parents also may apply a minimal amount of sunscreen to the infant's face and back of the hands.

Remember, sand and pavement reflect UV rays even under the umbrella. Snow is also a particularly good reflector of UV rays. Reflective surfaces can reflect up to 85 percent of the sun’s damaging rays.

© Copyright 2008 by Huntington Hospital