Types of skin cancer
Skin cancer is the most common form of cancer in the United States and worldwide. Skin cancer tends to occur on sun-exposed skin and in those with lighter skin tones. A family history of skin cancer increases your risk. Early skin cancer diagnosis and treatment is important for good prognosis.
Diagnosis of skin cancer
Board certified dermatologists are thoroughly trained to identify subtle skin lesions that are suspicious for skin cancer. Devices such as the dermatoscope allow a dermatologist to evaluate features of skin lesions not easily seen by the naked eye. Suspicion of skin cancer may warrant a biopsy, a board certified dermatopathologist will microscopically evaluate the lesion under greater scrutiny.
The main types of Skin Cancer
Two main groups account for a large portion of cancers that originate in the skin: non-melanoma skin cancers (NMSC) and melanoma. The two most common NMSCs are basal cell carcinoma and squamous cell carcinoma. Basal cell carcinomas comprise nearly 80% of skin cancers, followed by 16% for squamous cell carcinoma, and 4% for melanomas. Most skin cancers have a good prognosis if caught early.
Basal Cell Carcinoma (BCC)
BCC is the most common type of skin cancer. The average lifetime risk for a Caucasian individual to develop a BCC is about 30%. It is slow growing and rarely spreads to other areas of the body. But if undiagnosed and untreated, it can grow deep and destroy local tissues, like cartilage and bone. Although BCC is common in fair skinned individuals, it can occur in people of color.
BCC develops on skin that has been exposed to the sun for years and from tanning bed use, caused by ultraviolet radiation. It is usually found on the face, chest, neck and back of the hands, but can occur on any part of the body exposed to the sun. A BCC looks like a flesh-colored, pearly bump or pinkish patch of skin, frequently found on the nose, eyelids, cheeks, and lips.
Because BCC is typically found on areas that are of aesthetic importance, like the face, eyes, lips and nose, Mohs surgical excision may be preferred to spare healthy tissues and prevent disfigurement. Mohs surgery is a microscopic surgery technique that allows for smaller areas of excision and better prognostic outcomes.
Squamous Cell Carcinoma (SCC)
SCC is the second most common type of skin cancer. It develops on unprotected skin that has been exposed to intense, long-term sun and tanning bed ultraviolet radiation. SCC can spread to other parts of the body, become disfiguring and even deadly. Every year more than 15,000 Americans die of SCC. When caught early, it can be treated with favorable outcomes.
SCC commonly develops on the face, ears, neck, chest, lips, back of the hands, and the legs. It can also develop on the genitals, in burns, scars, ulcers, and in areas exposed to x-rays and chemicals. Women often get SCC on their legs, but it can develop anywhere on skin that is exposed to long- term ultraviolet radiation. Indoor tanning increases the risk of SCC by 67%.
SCC lesions may appear as firm, red bumps or scaly patches, or sores that won’t heal. It can also appear as raised growths with a depressed center, and in wart like growths, but can also be flat with minor skin changes.
Other than long term intense UV radiation, risk factors include:
- A prior BCC or SCC
- A family history of SCC
- A family history of melanoma
- Men are more frequently affected than women, but women are catching up
- The majority of diagnoses are made in people over the age of 50. However, women under 40 are diagnosed more often than in the past, likely due to the use of tanning beds.
As with BCC, because SCC is commonly found on areas of aesthetic importance like the face and ears, minimal surgical procedures such as Mohs surgery may be warranted to spare healthy tissues, reduce the risk of recurrence, and produce good aesthetic outcomes.
Melanoma is the deadliest form of skin cancer. It can appear as a newly formed pigmented lesion or from a pre-existing mole or birthmark. Melanomas can form virtually anywhere on the skin, including the palms and soles, underneath nails, the mouth, vagina, and eye.
Everyone is at risk for developing Melanoma, but people with a family history of melanoma are at a 10% increased risk. When a first degree relative has had melanoma, the risk increases to a 50% chance of developing this disease.
Other risk factors include:
- Even a single blistering sunburn in childhood.
- People who live in warm, sunny climates year round
- The use of tanning beds in the teens and early twenties
- Fair skinned people with light eye color and blond or red hair
- A large number of moles
- the development of a new mole or a change in the size, color and shape of the mole
- a mole that is larger than 1/4 inch
- a sore that won’t heal
- multicolored moles and spots whose borders extend into the surrounding skin
- painful, tender and itchy skin lesions
- scaly, oozing, bleeding bumps or nodules
One in 27 men and one in 40 women will develop melanoma during their lives. The five-year survival rate for people diagnosed with melanoma that are treated before it has metastasized is 99%. Being aware of risk factors and practicing good sun protection are important first steps. Routine skin examinations by a board trained dermatologist are essential for close evaluation and monitoring of suspicious lesions.