Introduction
The Skin
What Is Cancer?
Types of Skin Cancer
Cause and Prevention
Symptoms
Detection and Diagnosis
Detection
Diagnosis
Treatment Planning
Treating Skin Cancer
Surgery
Curettage and Electrodesiccation
Mohs' Surgery
Cryosurgery
Laser Therapy
Grafting
Radiation
Topical Chemotherapy
Clinical Trials
Followup Care
Questions To Ask the Doctor
Skin Cancer Research
Other Booklets
How To Do a Skin Self-Exam
National Cancer Institute Information
Resources
Introduction
Each year, about a million people in the
United States learn that they have skin
cancer. This National Cancer Institute
(NCI) booklet will give you some important
information about this disease. It
explains how skin cancer is diagnosed and
treated and has information about
preventing this disease.
Words that may be new to readers appear in
italics. Definitions of these words and
other terms related to skin cancer can be
found in the Dictionary. For some words, a
"sounds-like" spelling is also given.
Other NCI booklets are listed in the Other
Booklets section. Our materials cannot
answer every question you may have about
skin cancer. They cannot take the place of
talks with doctors, nurses, and other
members of the health care team. We hope
our information will help with those
talks.
Research has led to better methods of
diagnosing and treating this disease. It
is encouraging to know that skin cancer is
now almost 100 percent curable if found
early and treated promptly.
Our knowledge about skin cancer and other
types of cancer is increasing rapidly. For
up-to-date information or to order this
publication, call the NCI-supported Cancer
Information Service (CIS) toll free at
1-800-4-CANCER (1-800-422-6237).
The Skin
The skin is the body's outer covering. It
protects us against heat, light, injury,
and infection. It regulates body
temperature and stores water, fat, and
vitamin D. Weighing about 6 pounds, the
skin is the body's largest organ. It is
made up of two main layers: the outer
epidermis and the inner dermis.
The epidermis (outer layer of the skin) is
mostly made up of flat, scale-like cells
called squamous cells. Under the squamous
cells are round cells called basal cells.
The deepest part of the epidermis also
contains melanocytes. These cells produce
melanin, which gives the skin its color.
Epidermis and dermis
The dermis (inner layer of skin) contains
blood and lymph vessels, hair follicles,
and glands. These glands produce sweat,
which helps regulate body temperature, and
sebum, an oily substance that helps keep
the skin from drying out. Sweat and sebum
reach the skin's surface through tiny
openings called pores.
What Is Cancer?
Cancer is a group of more than 100
diseases. Although each type of cancer
differs from the others in many ways,
every cancer is a disease of some of the
body's cells.
Healthy cells that make up the body's
tissues grow, divide, and replace
themselves in an orderly way. This process
keeps the body in good repair. Sometimes,
however, normal cells lose their ability
to limit and direct their growth. They
divide too rapidly and grow without any
order. Too much tissue is produced, and
tumors begin to form. Tumors can be benign
or malignant.
Benign tumors are not cancer. They do not
spread to other parts of the body and are
seldom a threat to life. Often, benign
tumors can be removed by surgery, and they
are not likely to return.
Malignant tumors are cancer. They can
invade and destroy nearby healthy tissues
and organs. Cancer cells also can spread,
or metastasize, to other parts of the body
and form new tumors.
Types of Skin Cancer
The two most common kinds of skin cancer
are basal cell carcinoma and squamous cell
carcinoma. (Carcinoma is cancer that
begins in the cells that cover or line an
organ.) Basal cell carcinoma accounts for
more than 90 percent of all skin cancers
in the United States. It is a slow-growing
cancer that seldom spreads to other parts
of the body. Squamous cell carcinoma also
rarely spreads, but it does so more often
than basal cell carcinoma. However, it is
important that skin cancers be found and
treated early because they can invade and
destroy nearby tissue.
Basal cell carcinoma and squamous cell
carcinoma are sometimes called nonmelanoma
skin cancer. Another type of cancer that
occurs in the skin is melanoma, which
begins in the melanocytes. More
information about this disease can be
found in the booklet What You Need To Know
About™ Melanoma.
Cause and Prevention
Skin cancer is the most common type of
cancer in the United States. According to
current estimates, 40 to 50 percent of
Americans who live to age 65 will have
skin cancer at least once. Although anyone
can get skin cancer, the risk is greatest
for people who have fair skin that
freckles easily -- often those with red or
blond hair and blue or light-colored
eyes.
Ultraviolet (UV) radiation from the sun is
the main cause of skin cancer. (Two types
of ultraviolet radiation -- UVA and UVB --
are explained in the ultraviolet (UV)
radiation definition in the Dictionary.)
Artificial sources of UV radiation, such
as sunlamps and tanning booths, can also
cause skin cancer.
The risk of developing skin cancer is
affected by where a person lives. People
who live in areas that get high levels of
UV radiation from the sun are more likely
to get skin cancer. In the United States,
for example, skin cancer is more common in
Texas than it is in Minnesota, where the
sun is not as strong. Worldwide, the
highest rates of skin cancer are found in
South Africa and Australia, areas that
receive high amounts of UV radiation.
In addition, skin cancer is related to
lifetime exposure to UV radiation. Most
skin cancers appear after age 50, but the
sun's damaging effects begin at an early
age. Therefore, protection should start in
childhood to prevent skin cancer later in
life.
Whenever possible, people should avoid
exposure to the midday sun (from 10 a.m.
to 2 p.m. standard time, or from 11 a.m.
to 3 p.m. daylight saving time). Keep in
mind that protective clothing, such as sun
hats and long sleeves, can block out the
sun's harmful rays. Also, lotions that
contain sunscreens can protect the skin.
Sunscreens are rated in strength according
to a sun protection factor (SPF), which
ranges from 2 to 30 or higher. Those rated
15 to 30 block most of the sun's harmful
rays.
NCI is supporting research to try to find
new ways to prevent skin cancer. This
research involves people who have a high
risk of developing skin cancer -- those
who have already had the disease and those
who have certain other rare skin diseases
that increase their risk of skin cancer.
Symptoms
The most common warning sign of skin
cancer is a change on the skin, especially
a new growth or a sore that doesn't heal.
Skin cancers don't all look the same. For
example, the cancer may start as a small,
smooth, shiny, pale, or waxy lump. Or it
can appear as a firm red lump. Sometimes,
the lump bleeds or develops a crust. Skin
cancer can also start as a flat, red spot
that is rough, dry, or scaly.
Both basal and squamous cell cancers are
found mainly on areas of the skin that are
exposed to the sun -- the head, face,
neck, hands, and arms. However, skin
cancer can occur anywhere.
Actinic keratosis, which appears as rough,
red or brown scaly patches on the skin, is
known as a precancerous condition because
it sometimes develops into squamous cell
cancer. Like skin cancer, it usually
appears on sun-exposed areas but can be
found elsewhere.
Changes in the skin are not sure signs of
cancer; however, it is important to see a
doctor if any symptom lasts longer than 2
weeks. Don't wait for the area to hurt --
skin cancers seldom cause pain.
Detection and Diagnosis
Detection
The cure rate for skin cancer could be 100
percent if all skin cancers were brought
to a doctor's attention before they had a
chance to spread. Therefore, people should
check themselves regularly for new growths
or other changes in the skin. Any new,
colored growths or any changes in growths
that are already present should be
reported to the doctor without delay. (See
the How To Do a Skin Self-Exam section for
a simple guide on how to do a skin
self-exam.)
Doctors should also look at the skin
during routine physical exams. People who
have already had skin cancer should be
sure to have regular exams so that the
doctor can check the skin -- both the
treated areas and other places where
cancer may develop.
Diagnosis
Basal cell carcinoma and squamous cell
carcinoma are generally diagnosed and
treated in the same way. When an area of
skin does not look normal, the doctor may
remove all or part of the growth. This is
called a biopsy. To check for cancer
cells, the tissue is examined under a
microscope by a pathologist or a
dermatologist. A biopsy is the only sure
way to tell if the problem is cancer.
Doctors generally divide skin cancer into
two stages: local (affecting only the
skin) or metastatic (spreading beyond the
skin). Because skin cancer rarely spreads,
a biopsy often is the only test needed to
determine the stage. In cases where the
growth is very large or has been present
for a long time, the doctor will carefully
check the lymph nodes in the area. In
addition, the patient may need to have
additional tests, such as special x-rays,
to find out whether the cancer has spread
to other parts of the body. Knowing the
stage of a skin cancer helps the doctor
plan the best treatment.
Treatment Planning
In treating skin cancer, the doctor's main
goal is to remove or destroy the cancer
completely with as small a scar as
possible. To plan the best treatment for
each patient, the doctor considers the
location and size of the cancer, the risk
of scarring, and the person's age, general
health, and medical history.
It is sometimes helpful to have the advice
of more than one doctor before starting
treatment. It may take a week or two to
arrange for a second opinion, but this
short delay will not reduce the chance
that treatment will be successful. There
are a number of ways to find a doctor for
a second opinion:
The patient's doctor may be able to
suggest a doctor, such as a dermatologist
or a plastic surgeon, who has a special
interest in skin cancer.
The Cancer Information Service, at
1-800-4-CANCER, can tell callers about
treatment facilities, including cancer
centers and other programs that are
supported by the National Cancer
Institute.
Patients can get the names of doctors from
local and national medical societies, a
nearby hospital, or a medical school.
The Directory of Medical Specialists lists
doctors' names and gives their background.
It is in most public libraries.
Treating Skin Cancer
Treatment for skin cancer usually involves
some type of surgery. In some cases,
doctors suggest radiation therapy or
chemotherapy. Sometimes a combination of
these methods is used.
Surgery
Many skin cancers can be cut from the skin
quickly and easily. In fact, the cancer is
sometimes completely removed at the time
of the biopsy, and no further treatment is
needed.
Curettage and Electrodesiccation
Doctors commonly use a type of surgery
called curettage. After a local anesthetic
numbs the area, the cancer is scooped out
with a curette, an instrument with a
sharp, spoon-shaped end. The area is also
treated by electrodesiccation. An electric
current from a special machine is used to
control bleeding and kill any cancer cells
remaining around the edge of the wound.
Most patients develop a flat, white scar.
Mohs' Surgery
Mohs' technique is a special type of
surgery used for skin cancer. Its purpose
is to remove all of the cancerous tissue
and as little of the healthy tissue as
possible. It is especially helpful when
the doctor is not sure of the shape and
depth of the tumor. In addition, this
method is used to remove large tumors,
those in hard-to-treat places, and cancers
that have recurred. The patient is given a
local anesthetic, and the cancer is shaved
off one thin layer at a time. Each layer
is checked under a microscope until the
entire tumor is removed. The degree of
scarring depends on the location and size
of the treated area. This method should be
used only by doctors who are specially
trained in this type of surgery.
Cryosurgery
Extreme cold may be used to treat
precancerous skin conditions, such as
actinic keratosis, as well as certain
small skin cancers. In cryosurgery, liquid
nitrogen is applied to the growth to
freeze and kill the abnormal cells. After
the area thaws, the dead tissue falls off.
More than one freezing may be needed to
remove the growth completely. Cryosurgery
usually does not hurt, but patients may
have pain and swelling after the area
thaws. A white scar may form in the
treated area.
Laser Therapy
Laser therapy uses a narrow beam of light
to remove or destroy cancer cells. This
approach is sometimes used for cancers
that involve only the outer layer of
skin.
Grafting
Sometimes, especially when a large cancer
is removed, a skin graft is needed to
close the wound and reduce the amount of
scarring. For this procedure, the doctor
takes a piece of healthy skin from another
part of the body to replace the skin that
was removed.
Radiation
Skin cancer responds well to radiation
therapy (also called radiotherapy), which
uses high-energy rays to damage cancer
cells and stop them from growing. Doctors
often use this treatment for cancers that
occur in areas that are hard to treat with
surgery. For example, radiation therapy
might be used for cancers of the eyelid,
the tip of the nose, or the ear. Several
treatments may be needed to destroy all of
the cancer cells. Radiation therapy may
cause a rash or make the skin in the area
dry or red. Changes in skin color and/or
texture may develop after the treatment is
over and may become more noticeable many
years later.
Topical Chemotherapy
Topical chemotherapy is the use of
anticancer drugs in a cream or lotion
applied to the skin. Actinic keratosis can
be treated effectively with the anticancer
drug fluorouracil (also called 5-FU). This
treatment is also useful for cancers
limited to the top layer of skin. The 5-FU
is applied daily for several weeks.
Intense inflammation is common during
treatment, but scars usually do not
occur.
Clinical Trials
In clinical trials (research studies with
cancer patients), doctors are studying new
treatments for skin cancer. For example,
they are exploring photodynamic therapy, a
treatment that destroys cancer cells with
a combination of laser light and drugs
that make the cells sensitive to light.
Biological therapy (also called
immunotherapy) is a form of treatment to
improve the body's natural ability to
fight cancer. Interferon and tumor
necrosis factor are types of biological
therapy under study for skin cancer.
Followup Care
Even though most skin cancers are cured,
the disease can recur in the same place.
Also, people who have been treated for
skin cancer have a higher-than-average
risk of developing a new cancer elsewhere
on the skin. That's why it is so important
for them to continue to examine themselves
regularly, to visit their doctor for
regular checkups, and to follow the
doctor's instructions on how to reduce the
risk of developing skin cancer again.
Questions To Ask the Doctor
Skin cancer has a better prognosis, or
outcome, than most other types of cancer.
Although skin cancer is the most common
type of cancer in this country, it
accounts for much less than 1 percent of
all cancer deaths. It is cured in 85 to 95
percent of all cases. Still, any diagnosis
of cancer can be frightening, and it's
natural to have concerns about medical
tests, treatments, and doctors' bills.
Patients have many important questions to
ask about cancer, and their doctor is the
best person to provide answers. Most
people want to know exactly what kind of
cancer they have, how it can be treated,
and how successful the treatment is likely
to be. The following are some other
questions that patients might want to ask
their doctor:
What types of treatment are available?
Are there any risks or side effects of
treatment?
Will there be a scar?
Will I have to change my normal
activities?
How can I protect myself from getting skin
cancer again?
How often will I need a checkup?
Some patients become concerned that
treatment may change their appearance,
especially if the skin cancer is on their
face. Patients should discuss this
important concern with their doctor. And
they may want to have a second opinion
before treatment. (See the Treatment
Planning section.)
Skin Cancer Research
Scientists at hospitals and research
centers are studying the causes of skin
cancer and looking for new ways to prevent
the disease. They are also exploring ways
to improve treatment.
When laboratory research shows that a new
prevention or treatment method has
promise, doctors use it with people in
clinical trials. These trials are designed
to answer scientific questions and to find
out whether the new approach is both safe
and effective. People who take part in
clinical trials make an important
contribution to medical science and may
have the first chance to benefit from
improved methods.
People interested in taking part in a
trial should discuss this option with
their doctor. Taking Part in Clinical
Trials: What Cancer Patients Need To Know
is a National Cancer Institute booklet
that explains some of the possible
benefits and risks of such studies.
One way to learn about clinical trials is
through PDQ®, a computerized resource
developed by the National Cancer
Institute. This resource contains
information about cancer treatment and
about clinical trials in progress all over
the country. The Cancer Information
Service can provide PDQ information to
patients and the public.
Other Booklets
The National Cancer Institute booklets
listed below are available free of charge
by calling 1-800-4-CANCER.
Facing Forward: Life After Cancer
Treatment
Radiation Therapy and You: A Guide to
Self-Help During Treatment
Taking Time: Support for People With
Cancer and the People Who Care About Them
What You Need To Know About™ Melanoma
What You Need To Know About™ Moles and
Dysplastic Nevi
When Cancer Recurs: Meeting the Challenge
Siga Adelante: la vida después del
tratamiento del cáncer (Facing Forward
Series: Life After Cancer Treatment)
Booklets About Cancer Research
Taking Part in Clinical Trials: Cancer
Prevention Studies
Taking Part in Clinical Trials: What
Cancer Patients Need To Know
If You Have Cancer... What You Should Know
About Clinical Trials
La participación en los estudios clínicos:
Estudios para la prevencion del cáncer
(Taking Part in Clinical Trials: Cancer
Prevention Studies)
La participación en los estudios clínicos:
Lo que los pacientes de cáncer deben saber
(Taking Part in Clinical Trials: What
Cancer Patients Need To Know)
Si tiene cáncer...lo que debería saber
sobre estudios clínicos (If You Have
Cancer... What You Should Know About
Clinical Trials)
How To Do a Skin Self-Exam
You can improve your chances of finding
skin cancer promptly by performing a
simple skin self-exam regularly.
The best time to do this self-exam is
after a shower or bath. You should check
your skin in a well-lighted room using a
full-length mirror and a hand-held mirror.
It's best to begin by learning where your
birthmarks, moles, and blemishes are and
what they usually look like. Check for
anything new -- a change in the size,
texture, or color of a mole, or a sore
that does not heal.
Check all areas, including the back, the
scalp, between the buttocks, and the
genital area.
Look at the front and back of your body in
the mirror, then raise your arms and look
at the left and right sides.
Bend your elbows and look carefully at
your palms; forearms, including the
undersides; and the upper arms.
Examine the back and front of your legs.
Also look between your buttocks and around
your genital area.
Sit and closely examine your feet,
including the soles and the spaces between
the toes.
Look at your face, neck, and scalp. You
may want to use a comb or a blow dryer to
move hair so that you can see better.
By checking your skin regularly, you will
become familiar with what is normal. If
you find anything unusual, see your doctor
right away. Remember, the earlier skin
cancer is found, the better the chance for
cure.
National Cancer Institute Information
Resources
You may want more information for
yourself, your family, and your doctor.
The following National Cancer Institute
(NCI) services are available to help you.
Telephone
Cancer Information Service (CIS)
Provides accurate, up-to-date information
on cancer to patients and their families,
health professionals, and the general
public. Information specialists translate
the latest scientific information into
understandable language and respond in
English, Spanish, or on TTY equipment.
Toll-free: 1-800-4-CANCER
(1-800-422-6237)
TTY (for deaf and hard of hearing
callers): 1-800-332-8615
Internet
http
://cancer.gov
NCI's Web site contains comprehensive
information about cancer causes and
prevention, screening and diagnosis,
treatment and survivorship; clinical
trials; statistics; funding, training, and
employment opportunities; and the
Institute and its programs.
