Skin cancer is the abnormal growth of cells in the skin. It is the most common type of cancer. It is almost always cured when it is found early and treated. So it is important to see your doctor if you have changes in your skin.
Most skin cancers are the nonmelanoma type. There are two main types of nonmelanoma skin cancer:
There are other types of skin cancer that are not melanoma. But these are much less common. They include Merkel cell carcinoma and several kinds of sarcomas.
Nonmelanoma skin cancer is usually caused by too much sun. Using tanning beds or sunlamps too much can also cause it.
Skin cancer usually appears as a growth that changes in color, shape, or size. This can be a sore that does not heal or a change in a mole or skin growth. These changes usually happen in areas that get the most sun—your head, neck, back, chest, or shoulders. The most common place for skin cancer is your nose.
Your doctor will use a biopsy to find out if you have skin cancer. This means taking a sample of the growth and sending it to a lab to see if it contains cancer cells.
The single greatest risk is from ultraviolet (UV) radiation. This comes from exposure to the sun, especially during the middle of the day. It also comes from exposure to artificial sources of UV, such as indoor tanning.
If you have light skin that sunburns easily, you are more likely to get skin cancer.
Your risk is higher if you are male or if you are over 40. Your risk is higher if others in your family have had it or if you have had it before.
You may also be more likely to get it if you have been exposed often to strong X-rays, to certain chemicals (such as arsenic, coal tar, and creosote), or to radioactive substances (such as radium).
Your doctor will want to remove all of the cancer. There are several ways to do this. The most common way is to numb your skin so that it does not hurt, then cut out the cancer. You will be awake while this is done.
After your treatment, you will need regular checkups, because having skin cancer once means you are more likely to get it again.
You can prevent it by being careful in the sun. Stay out of the sun at midday, when the sun's rays are strongest. Wear sunscreen or other sun protection. Do not use tanning booths or sunlamps.
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Nonmelanoma skin cancer is usually caused by overexposure to the sun and its ultraviolet (UV) rays. Overexposure to UV rays can result from:
Other possible causes of skin cancer include repeated exposure to X-rays, certain chemicals (such as arsenic, coal tar, creosote), and radioactive substances (such as radium). Skin cancer may also be caused by ionizing radiation treatments for skin conditions such as psoriasis or acne.
Nonmelanoma skin cancer may appear as a change in the skin, such as a growth, an irritation or sore that does not heal, or a change in a mole or a skin growth.
Basal cell carcinoma usually affects the head, neck, back, chest, or shoulders. The nose is the most common site. Signs of basal cell carcinoma can vary depending on the type and may include skin changes such as a:
Squamous cell carcinoma usually affects the face, head, or neck. Signs of squamous cell carcinoma include any:
Other conditions, such as actinic keratosis, may have symptoms similar to skin cancer. It is important to have any new or persistent skin change evaluated by your doctor.
Nonmelanoma skin cancer usually develops slowly, invading and destroying nearby tissues. It may take months or years for basal cell or squamous cell carcinomas to develop. Because of this slow growth, skin cancer can often be detected and treated early in its development, increasing the chance for a cure.
Basal cell carcinoma can affect the surface of the skin where it appears. If it is not treated, it can grow larger and cause problems beneath the skin, sometimes damaging the muscles and bones. Basal cell carcinoma very rarely spreads (metastasizes) to other parts of the body.
After you have one basal cell carcinoma, you are more likely to have another one develop in a new place. If basal cell carcinoma comes back at the same place (recurs), it may grow faster and cause more tissue damage.
Squamous cell carcinoma may grow from a small rough spot in sun-damaged skin (actinic keratosis). But this isn't common. Or it may develop from an early form of skin cancer called Bowen's disease. If a squamous cell carcinoma is not treated, it may spread.
Risk factors (things that increase your risk) for nonmelanoma skin cancer include:
Basal cell and squamous cell carcinomas can occur in people with dark skin. But these cancers are much more common in people with light skin.
The risk of squamous cell carcinoma is higher in people who have weakened immune systems. This includes people who have had organ transplants and take medicines to prevent rejection of the new organ.
Call your doctor if you have an irritated or irregular skin growth. This includes any:
Be sure to show your doctor any skin growths that concern you so that they can be evaluated and treated if needed.
Health professionals who can examine and diagnose a suspicious skin growth include:
Doctors who can remove a large skin growth or one in a noticeable area while minimizing scars that may result from surgery include:
Nonmelanoma skin cancer is diagnosed by:
Take steps to detect skin cancer early:
The goals of treatment for nonmelanoma skin cancer are to:
Treatment for nonmelanoma skin cancer depends on the size and location of the cancer, whether it is basal cell or squamous cell, and your age and overall health. The type of treatment will also depend on whether you have had skin cancer at that place before and whether the cancer is in a place where you have had radiation therapy. Because skin cancer usually grows slowly, it often can be detected early and successfully treated.
The most common treatment is surgery to destroy or remove the entire skin growth, including a margin of cancer-free tissue around the growth. Most surgical treatments are very effective, with high cure rates.
The main treatment options are:
Each of these treatments has advantages and disadvantages. Discuss your options with your doctor.
Basal cell carcinoma may also be treated with:
Follow-up treatment for nonmelanoma skin cancer includes skin self-exams and regular exams by your doctor. These exams are extremely important to reduce the risk of the cancer coming back (recurrence).
Almost half of people who have a nonmelanoma skin cancer will develop another one within 5 years.footnote 1 Your doctor may schedule you for exams as often as every 3 to 6 months for the first 2 years and yearly after that, especially for squamous cell carcinoma.
Surgery is usually very effective for both basal and squamous cell carcinoma. But sometimes the cancer can come back (recur). Or in rare cases, it may spread (metastasize). Metastasis is more likely with squamous cell carcinoma than with basal cell.
If basal cell carcinoma comes back, treatment is usually Mohs surgery. But for squamous cell carcinoma that comes back, treatment may include surgery (excision or Mohs surgery) or radiation therapy.
If the cancer does spread, chemotherapy may be used. If basal cell carcinoma spreads after treatment with surgery and radiation, it may be treated with medicines like vismodegib (Erivedge) or sonidegib (Odomzo). Your doctor may suggest that you enroll in a clinical trial if one is available.
Additional information about skin cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/pdq/treatment/skin/Patient.
Most nonmelanoma skin cancer can be prevented by protecting your skin from the sun and ultraviolet (UV) radiation.
Children and babies should be protected from the sun. You should start protecting your child from the sun when he or she is a baby. Because children and teens spend a lot of time outdoors playing, they get most of their lifetime sun exposure in their first 18 years.
Some people believe that a tan may protect them against a sunburn and skin damage. But the amount of sun exposure needed to get a tan can by itself cause skin damage.
Home treatment after a skin cancer is removed includes regular use of skin protection measures to prevent a return (recurrence) of nonmelanoma skin cancer and regular exams to watch for suspicious skin changes.
Perform a skin self-exam once a month.
Certain medicines, such as some antibiotics or diuretics, can make your skin more sensitive to the sun's rays. Ask your doctor about this potential side effect of your medicines, and take extra precautions if needed.
Medicines are rarely used to treat nonmelanoma skin cancer. Surgery is the most common and the most effective treatment. But when surgery is not possible, your doctor may suggest medicines. Medicines may also be used when a skin cancer is too large for surgery or when new skin cancers keep appearing.
Medicines that may be used to treat basal cell carcinoma include:
Medicines that may be used to treat squamous cell carcinoma include:
People treated with medicines will need to have regular follow-up visits with their doctors to make sure the skin cancer is gone.
Chemotherapy may be used to destroy cancer cells in the small number of people who have basal cell or squamous cell carcinoma that has spread (metastasized) to other organs in the body, though metastasis is rare.
Medicines such as 5-FU and imiquimod may cause your skin to be sore. Your skin may turn red, swell, itch, or break out in a rash. Your skin may also be sensitive to sunlight. If your skin turns too red or raw, your doctor may stop the treatment.
Surgery is the most common and most successful method of treating nonmelanoma skin cancer. The goals of surgery are to:
The main types of surgery for nonmelanoma skin cancer include:
Other types of surgery that may be done include:
Each type of treatment has advantages and disadvantages. Discuss your options with your doctor.
Radiation therapy may be used to treat skin cancers in some cases. It may also be recommended for people who may not be able to have surgery because of the location of the skin cancer. Radiation therapy may also be a treatment choice if age or other health conditions make surgery too risky. Radiation therapy is most often used for older adults. It may lead to other skin cancers in younger people as they age.
Radiation therapy may be an effective treatment for people who have low-risk, shallow cancers, such as squamous cell carcinoma in situ (Bowen's disease).
Other treatments for people who cannot have surgery or radiation include photodynamic therapy (PDT), which uses medicines and a special light to treat skin cancer on or very close to the surface of the skin.
- National Comprehensive Cancer Network (2010). Basal cell and squamous cell skin cancers. NCCN Clinical Practice Guidelines in Oncology, Version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf.
Other Works Consulted
- Habif TP, et al. (2011). Premalignant and malignant non-melanoma skin tumors. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 464–507. Edinburgh: Saunders.
- Marks VJ, Hanson NW (2010). Non-melanoma skin cancer. In JC Hall, BJ Hall, eds., Sauer's Manual of Skin Diseases, 10th ed., pp. 305–311. Philadelphia: Lippincott Williams and Wilkins.
- Ormerod A, et al. (2010). Basal cell carcinoma, search date December 2009. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
- Spencer JM (2010). Basal cell carcinoma. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 78–82. Edinburgh: Saunders Elsevier.
- Waldorf HA (2010). Squamous cell carcinoma. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 702–706. Edinburgh: Saunders Elsevier.
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