Skin Cancer

The skin is the largest organ in our body. It provides protection against heat, cold, light, and infection. The skin is made up of two major layers (epidermis and dermis) as well as various types of cells. The top (or outer) layer of the skin-the epidermis-is composed of three types of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and melanocytes, cells that provide skin its color and protect against skin damage. The inner layer of the skin-the dermis-is the layer that contains the nerves, blood vessels, and sweat glands.

What Is Skin Cancer?

Skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of your skin. There are several types of cancer that originate in the skin. The most common types are basal cell carcinoma (70 percent of all skin cancers) and squamous cell carcinoma (20 percent). These types are classified as nonmelanoma skin cancer. Melanoma (five percent of all skin cancers) is the third type of skin cancer. It is less common than basal cell or squamous cell skin cancer, but potentially much more serious. Other types of skin cancer are rare.

Basal cell carcinoma is the most common type of skin cancer. It typically appears as a small raised bump that has a pearly appearance. It is most commonly seen on areas of the skin that have received excessive sun exposure. These cancers may spread to the skin around the cancer but rarely spread to other parts of the body.

Squamous cell carcinoma is also seen on the areas of the body that have been exposed to excessive sun (nose, lower lip, hands, and forehead). Often this cancer appears as a firm red bump or ulceration of the skin that does not heal. Squamous cell carcinomas can spread to lymph nodes in the area.

Melanoma is a skin cancer (malignancy) that arises from the melanocytes in the skin. These cancers typically arise as pigmented (colored) lesions in the skin with an irregular shape, irregular border, and multiple colors. It is the most harmful of all the skin cancers, because it can spread to other sites in the body. Fortunately, most melanomas have a very high cure rate when identified and treated early.

Skin cancer is a disease that has shown a steady increase over the past 20 years. Fortunately, with early diagnosis and treatment, it remains a very curable disease. A variety of factors have been identified that place a person at a higher risk to develop skin cancer (see "Am I at risk?").

The vast majority of skin cancers can be cured if diagnosed and treated early. Aside from protecting your skin from sun damage, it is important to recognize the early signs of skin cancer.

• Skin sores that do not heal,
• Bumps or nodules in the skin that are enlarging, and
• Changes in existing moles (size, texture, color).

If you notice any of the factors listed above see your doctor right away. If you have a spot or lump on your skin, your doctor may remove the growth and examine the tissue under the microscope. This is called a biopsy. A biopsy can usually be done in the doctor's office and usually involves numbing the skin with a local anesthetic. Examination of the biopsy under the microscope will tell the doctor if the skin lesion is a cancer (malignancy).

There are varieties of treatments available, including surgery, radiation therapy, and chemotherapy, to treat skin cancer. Treatment for skin cancer depends on the type and size of cancer, your age, and your overall health.

Surgery is the most common form of treatment. It generally consists of an office or outpatient procedure to remove the lesion and check edges to make sure all the cancer was removed. In many cases, the site is then repaired with simple stitches. In larger skin cancers, your doctor may take some skin from another body site to cover the wound and promote healing. This is termed skin grafting. In more advanced cases of skin cancer, radiation therapy or chemotherapy (drugs that kill cancer cells) may be used with surgery to improve cure rates.

People with any of the factors listed below have a higher risk of developing skin cancer and should be particularly careful about sun exposure.

• long-term sun exposure
• fair skin (typically blonde or red hair with freckles)
• place of residence (increased risk in Southern climates)
• presence of moles, particularly if there are irregular edges, uneven coloring, or an increase in the size of the mole
• family history of skin cancer
• use of indoor tanning devices
• severe sunburns as a child
• nonhealing ulcers or nodules in the skin.

Early identification of skin cancer can save your life.

The single most important thing you can do to lower your risk of skin cancer is to avoid direct sun exposure. Sunlight produces ultraviolet (UV) radiation that can directly damage the cells (DNA) of our skin. People who work outdoors (farming, construction, boating, outdoor sports) are at the highest risk of developing a skin cancer. The sun's rays are the most powerful between 10 am and 2 pm, so you must be particularly careful during those hours. If you must be out during the day, wear clothing that covers as much of your skin as possible, including a wide-brimmed hat to block the sun from your face, scalp, neck, and ears. In addition to protective clothing, the use of a sunscreen can reflect light away from the skin and provide protection against UV radiation. When selecting a sunscreen, choose one with a Sun Protection Factor (SPF) of 15 or more. Sunscreen products do not completely block the damaging rays, but they do allow you to be in the sun longer without getting sunburn. In addition to being sun-smart, it is critical to recognize early signs of trouble on your skin. The best time to do self-examination is after a shower in front of a full-length mirror. Note any moles, birthmarks, and blemishes. Be on the alert for sores that do not heal or new nodules on the skin. Any mole that changes in size, color, or texture should be carefully examined. If you notice anything new or unusual, see your physician right away. Catching skin cancer early can save your life.

The new Ultraviolet (UV) Index provides important information to help you plan your outdoor activities and avoid overexposure to the damaging rays of the sun. Developed by the National Weather Service and the Environmental Protection Agency , the UV Index is issued daily as a national service.

The UV Index gives the next day's amount of exposure to UV rays. The Index predicts UV levels on a 0-10+ scale (see chart).

Always take precautions against overexposure, and take special care when the UV Index predicts exposure levels of moderate to above (5 - 10+).

© 2004 AAO-HNS/AAO-HNSF