Skin cancer is the most common form of cancer in the United States. While skin cancers can be found on any part of the body, about 80 percent appear on the face, head or neck, where they can be disfiguring as well as dangerous.
Here are some of the cancer and precancerous types of the skin:
Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common form of cancer, with about one million new cases estimated in the U.S. each year. Not only is it the most common skin cancer, but it is the most common of all types of cancer. One in four Americans are likely to develop a basal cell carcinoma.
Basal cells line the deepest layer of epidermis. The growths are malignant tumors that arise in this layer of skin. BCCs occur most frequently on sun-exposed regions of the body. Although this skin cancer rarely spreads to other organs of the body (i.e., metastasizes), it can cause destruction of surrounding tissue. However, 5-10% of BCCs can be resistant to treatment or be locally aggressive, which damages the skin around them and sometimes invades bone and cartilage beneath. When not treated quickly, they can be difficult to eliminate. Thus early detection and treatment are needed.
Most basal cell carcinomas are caused by chronic sun exposure, especially in people with fair skin, light hair and blue, green or grey eyes. In a few instances there are other contributing factors such as burns, exposure to radiation, arsenical intoxication and stasis dermatitis of the legs.
Basal cell carcinoma may have several different appearances on your skin. Some warning signs that may indicate basal cell carcinoma are an open sore, a reddish patch, a growth with an elevated border and a central indentation, a bump or nodule and a scar-like area.
After a biopsy has been taken and the diagnosis confirmed by a board certified Nurse Practitioner, treatment is required. Several effective methods are available to treat this tumor. The choice of therapy depends on the size, location and subtype of the basal cell carcinoma encountered. The patient’s age and general health are also taken into consideration. The more common treatment options include excisional surgery, electrosurgery, radiation therapy and Mohs surgery.
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is the second most-common skin cancer (Basal Cell being the most), affecting more than 250,000 Americans each year.
Squamous cell carcinoma is a major type of cancer that arises from the superficial layer (epidermis) of the skin and mucous membranes and occurs most commonly on areas exposed to the sun. When identified early and treated promptly, SCCs are not serious. However, if overlooked, they are harder to treat and can cause disfigurement. While 96-97% of SCCs are localized, the small percentage of remaining cases can penetrate, destroy underlying tissue, spread to distant organs (metastasize) and become life-threatening.
Chronic sun exposure is the leading cause of squamous cell carcinoma, especially in people with fair skin, light hair and blue, green or grey eyes.
Other factors which may contribute to the development of this type of cancer include burns, scars, exposure to radiation or chemicals, chronic inflammatory conditions and immuno-suppression. Although more likely to develop in fair-skinned individuals, squamous cell carcinoma may occur in dark-skinned people, especially at sites of pre-existing inflammatory conditions or burns.
Signs which may indicate the presence of a squamous cell carcinoma include scaly red patches, elevated growth with central depression, wart-like growths, nodules and open sores. All of these types of lesions may develop a crusted surface or bleed.
After a biopsy has been taken and the diagnosis confirmed microscopically by a board certified Nurse Practitioner, treatment is required. Several effective methods are available to treat this tumor. The choice of therapy depends on the size, location, depth of penetration and type of squamous cell carcinoma encountered. The patient’s age and general health are also taken into consideration. The more common treatment options include excisional surgery, electrosurgery, radiation therapy and Mohs surgery.
When properly treated the cure rate for squamous cell carcinoma is approximately 95%.
Melanoma is the most serious form of skin cancer. Even so, if diagnosed and removed while it is still thin and limited to the outermost skin layer, it is almost 100% curable. Once the cancer advances and metastasizes (spreads) to other parts of the body, it is hard to treat and can be deadly. During the past 10 years, the number of cases of melanoma has increased more rapidly than that of any other cancer. Over 51,000 new cases are reported to the American Cancer Society each year and it is probable that a great many more occur and are not reported.
What is melanoma?
The answer to the question asked by patients, their families and other concerned people is that melanoma is the most serious form of skin cancer. To reach a more complete understanding, it is necessary to learn how the cells in the body become malignant.
The Origin of Melanoma
Melanoma is a malignant tumor that originates in melanocytes, the cells which produce the pigment melanin that colors our skin, hair, and eyes and is heavily concentrated in most moles. The majority of melanomas, therefore, are black or brown. However, melanomas occasionally stop producing pigment. When that happens, the melanomas may no longer be dark, but are skin-colored, pink, red or purple.
Some Are More Dangerous
The physician will tell you whether the melanoma is early or advanced by describing it as either in situ or invasive. “In situ” is Latin and means “in one site” or “localized.” Melanomas in situ occupy only the uppermost part of the epidermis, the top layers of the skin.
Invasive melanomas are the more serious, as they have penetrated more deeply into the skin and may have traveled from the original tumor through the body.
The Four Basic Types
- Superficial spreading melanoma is by far the most common type, accounting for about 70% of all cases. As you might expect, this melanoma travels along the top layer of the skin for a fairly long time before penetrating more deeply. The first sign is the appearance of a flat or slightly raised discolored patch that has irregular borders and is somewhat geometrical in form. The color varies, and you may see areas of tan, brown, black, red, blue or white. Sometimes an older mole will change in these ways or a new one will arise. A melanoma can be seen almost anywhere on the body, but is most likely to occur on the trunk in men, the legs in women and the upper back in both. Most melanomas found in the young are of the superficial spreading type.
- Lentigo maligna is similar to the superficial spreading type, as it also remains close to the skin surface for quite a while, and usually appears as a flat or mildly elevated mottled tan, brown or dark brown discoloration. This type of in situ melanoma is found most often in the elderly, arising on chronically sun-exposed, damaged skin on the face, ears, arms and upper trunk. Lentigo maligna is the most common form of melanoma in Hawaii.
Lentigo maligna melanoma is the invasive form.
- The third type of melanoma, acral lentiginous melanoma, also spreads superficially before penetrating more deeply. It is quite different from the others, though, as it usually appears as a black or brown discoloration under the nails or on the soles of the feet or palms of the hands. This type of melanoma is sometimes found in dark-skinned people. It is the most common melanoma in African-Americans and Asians and the least common among Caucasians.
- Unlike the other three types, nodular melanoma, is usually invasive at the time it is first diagnosed. The malignancy is recognized when it becomes a bump. The color is most often black, but occasionally is blue, gray, white, brown, tan, red or skin tone. The most frequent locations are the trunk, legs, and arms, mainly of elderly people, as well as the scalp in men. This is the most aggressive of the melanomas, and is found in 10% to 15% of cases.
What treatment is available?
The best treatment is early detection. A quick look from the trained eye of our practitioners can confirm whether or not a lesion is suspicious for melanoma. If so, the next step is to perform a biopsy. The area is made numb, and a portion, or the entire lesion is removed for examination under the microscope. This simple, quick procedure can be performed in our practitioner’s office. If a melanoma is detected, treatment is guided by how deep in the skin the melanoma is.
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Actinic Keratosis and Precancerous growths:
The term “precancerous” is used because these abnormal areas of skin are more likely to turn malignant than healthy skin. Precancerous growths (lesions) are visible to the naked eye and they look different from normal cells when examined under a microscope. They are important to recognize, because they are a warning sign of potential skin cancer.
Actinic keratoses (AKs) are rough, dry and scaly patches of skin that develop on the outermost layer of the skin after years of exposure to ultraviolet (UV) rays of the sun. Often they feel like sandpaper or crusts of dry skin. These lesions typically range in color from skin-toned to reddish brown and in size from that of a pinhead to larger than a quarter. Occasionally, a lesion has a rapid upward growth and resembles an animal horn and is called a “cutaneous horn.”
These lesions are considered to be the earliest stage in the development of skin cancer and can progress to Squamous Cell Carcinoma, a type of skin cancer that can be fatal if left untreated . Having AKs makes one more susceptible to other forms of skin cancer, including melanoma. Melanoma is considered the most lethal form of skin cancer because it can rapidly spread to the lymph system and internal organs.
AKs are most likely to appear on the face, lips, ears, scalp, neck, backs of the hands and forearms, shoulders and back — the parts of the body most often exposed to sunshine.
AKs usually appear after age 40 because they take years to develop. However, even teens can have AKs when they live in areas that receive high-intensity sunlight year round, such as Florida and southern California.
Millions of Americans have AKs and the number continues to grow. In fact, AKs are so common today that treatment for these lesions ranks as one of the most frequent reasons people consult a Nurse Practitioner.
Dysplastic nevi, also known as atypical moles, are unusual benign moles that may resemble melanoma. People who have them are at an increased risk of melanoma. The larger the number of atypical moles, the greater the risk. Individuals with 10 or more atypical moles have 12 times the risk of developing melanoma as members of the general public.
Heredity plays a part and people with a family history of melanoma (two or more close blood relatives), as well as atypical moles are at the highest risk. However, those with atypical moles and no family history still have a 7 to 27 times higher risk than the general public.
The classic atypical mole syndrome has the following characteristics:
100 or more moles
One or more moles greater than 8mm (1/3 inch) or larger in diameter
One or more moles that look atypical
Normal Moles Vs. Dysplastic Nevi
The average young adult has about 10-20 normal moles or growths. Generally, normal moles have the following characteristics:
Shape: symmetrical, round or oval
Border: regular, sharp and well-defined
Color: usually tan, brown or skin color
Diameter: usually 6 mm (1/4 inch) or smaller — about the size of a pencil eraser
Location: often concentrated on sun-exposed areas such as the face, trunk, arms and legs.
Onset: early childhood through age 40
Uniformity: resemble one another
Even normal moles increase the likelihood of malignancy, provided they are numerous. The greater the total number of moles on the body, the greater the overall danger of melanoma.
Dysplastic Nevi Vs. Melanoma
It is sometimes difficult to tell the difference between dysplastic nevi and melanoma. A mole that appears suspicious–changes in size, shape or color–or if a new mole appears after 40, the provider will remove the entire mole or a part of it for microscopic examination. Sometimes a melanoma begins within a dysplastic nevus.
Sometimes, melanomas will begin within the mole itself. Dysplastic nevi usually have the following characteristics:
- Shape: asymmetrical; a line drawn through the middle would not create matching halves
- Border: irregular or poorly defined
- Color: variation with shades of tan, brown, dark brown, black, red, white or blue
- Diameter: generally but not always larger than 6 mm
- Location: most commonly on the back, chest, abdomen, extremities and scalp; may also occur on normally unexposed areas such as buttocks, groin or female breasts
- Growth: enlargement of a previously stable mole or appearance of a new mole after age 40 should raise suspicion
- Surface: central portion is flat to slightly raised
- Appearance: greatly varied; dysplastic nevi often look different from one another
- Number: from a few to well over 100
More Serious Warning Signs
Some dysplastic nevi display more serious warning signs of melanoma: itching, elevation, crusting, oozing, a bluish-black color, pain, bleeding, swelling and ulceration. If any of these warning signs appear on your own skin or that of a friend or family member, consult a Nurse Practitioner right away. It could be the first sign of skin cancer.
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