Risk Factors

Several factors influence the risk of developing skin cancer:

• Ultraviolet (UV) radiation: UV radiation comes from the sun, sunlamps, tanning beds, or tanning booths. A person's risk of skin cancer is related to lifetime exposure to UV radiation. Most skin cancer appears after age 50, but the sun damages the skin from an early age.
• Personal or family history of skin cancer: A person who has had skin cancer previously needs regular skin exams to watch for signs of new cancer growth. A person who has a close family member (parent, sibling, or child) with skin cancer may have an increased risk of the disease.
• Actinic keratosis: This is a type of flat, scaly growth on the skin. It is most often found on areas exposed to the sun, especially the face and the backs of the hands. The growths may appear as rough red or brown patches on the skin. They may also appear as cracking or peeling of the lower lip that does not heal. Without treatment, a small number of these scaly growths may turn into squamous cell cancer.
• Bowen's disease: This is a type of scaly or thickened patch on the skin. It may turn into squamous cell skin cancer. Other conditions that make the skin sensitive to the sun: These includexeroderma pigmentosum, albinism, basal cell nevus syndrome, scars or burns on the skin, and chronic skin inflammation.

Symptoms

A change on the skin is the most common sign of skin cancer. This may be a new growth, a sore that doesn't heal, or a change in an old growth. Not all skin cancers look the same. Watch for these symptoms:

• Small, smooth, shiny, pale, or waxy lump
• Firm, red lump
• Sore or lump that bleeds or develops a crust or a scab
• Flat red spot that is rough, dry, or scaly and may become itchy or tender
• Red or brown patch that is rough and scaly
• A mole that is abnormal in border, size, or color or that is asymmetrical

Huntsman Cancer Institute (HCI) recommends that people examine their skin monthly to get familiar with individual patterns of moles and freckles, and to look for symptoms of cancerous skin changes. If anything abnormal is detected, visit a dermatologist as soon as possible.

Screening and Diagnosis

Current screening recommendations for skin cancer include the following:

• A monthly skin self-exam to look for symptoms of cancerous skin changes.
  1. Examine the body from all sides in front of a mirror. Bend the elbows and look carefully at the forearms, upper arms, and palms.
  2. Look at the backs of the legs and feet, the soles, and spaces between the toes.
  3. Examine the back of the neck and scalp with a hand mirror, parting and lifting the hair. Also, check the back, buttocks, and genital area.
• A yearly skin exam by a dermatologist. Learn about HCI's annual free skin cancer screening by calling the Cancer Learning Center at 1-888-424-2100.

Those with a family history of melanoma may need to follow a different screening schedule based on recommendations from his or her health care provider.

If an abnormal area is detected, a biopsy is the only way to find out if cancer is present or not. This helps a doctor know if there is cancer and if it has started to spread.

Types of Skin Cancer Biopsies
There are four types of skin biopsy:

• Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area.
• Incisional biopsy: The doctor uses a scalpel to remove part of the growth.
• Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it.
• Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth.

Staging

If the biopsy shows cancer, the doctor needs to know the stage (extent) of the disease. In some cases, the doctor may check lymph nodes to stage the cancer.

The stage is determined by the results of the biopsy:

• The size of the tumor
• How deeply it has grown beneath the top layer of skin
• Whether it has spread to nearby lymph nodes or to other parts of the body

In very few cases, imaging tests (such as a CT scan, x-ray, and MRI) are also used to help determine the stage.

Stages of Nonmelanoma Skin Cancer

Stage 0: Cancer involves only the top layer of skin. This is called carcinoma in situ.

Stage I: The tumor is two centimeters wide (three-quarters of an inch) or smaller.

Stage II: The tumor is larger than two centimeters wide (three-quarters of an inch).

Stage III: Cancer that has spread below the skin to cartilage, muscle, bone, or to nearby lymph nodes. It has not spread to other places in the body.

Stage IV: Cancer that has spread to other places in the body.

Treatment

At Huntsman Cancer Institute, skin cancer is treated by a team of specialists, including dermatologists (doctors who specialize in diseases of the skin), medical oncologists, radiation oncologists, nurses, social workers, dietitians, and other professionals.

Treatment options for nonmelanoma skin cancer include the following:

• Surgery
• Topical chemotherapy
• Photodynamic therapy
• Radiation therapy
• Clinical trials

The treatment that's right for each patient depends on the type and stage of the disease, the size and place of the growth, and the patient's general health and medical history.

Surgery

This treatment removes cancer from the body. Types of surgery include the following:

• Excisional skin surgery is a common treatment to remove skin cancer. After numbing the area, the surgeon removes the growth with a scalpel. The surgeon also removes a border of skin around the growth, called the margin. The margin is examined under a microscope to be certain that all the cancer cells have been removed. The size of the margin depends on the size of the growth.
• Mohs surgery (also called Mohs micrographic surgery) is often used for skin cancer. The area of the growth is numbed. A specially trained surgeon shaves away thin layers of the growth. Each layer is immediately examined under a microscope. The surgeon continues to shave away tissue until no cancer cells can be seen under the microscope. In this way, the surgeon can remove all the cancer and only a small bit of healthy tissue. See our educational video about Mohs Surgery.
• Electrodesiccation and curettage is often used to remove small basal cell skin cancers. The doctor numbs the area to be treated. The cancer is removed with a sharp tool shaped like a spoon. This tool is a curette. An electric current is sent into the treated area to control bleeding and kill any cancer cells that may be left. Electrodesiccation and curettage is usually a fast and simple procedure.
• Cryosurgery is often used for people who are not able to have other types of surgery. It uses extreme cold to treat early-stage or very thin skin cancer. Liquid nitrogen creates the cold. The doctor applies liquid nitrogen directly to the skin growth. This treatment may cause swelling. It may also damage nerves, causing a loss of feeling in the treated area.
• Laser surgery uses a narrow beam of light to remove or destroy cancer cells. It is most often used for growths that are on the outer layer of skin only.
• Grafts are sometimes needed to close an opening in the skin left by surgery. The surgeon first numbs and then removes a patch of healthy skin from another part of the body, such as the upper thigh. The patch is then used to cover the area where skin cancer was removed.
• Wound care for these procedures is discussed in our dermatology wound care factsheets.

Topical chemotherapy

This treatment uses anticancer drugs in a lotion or cream applied to the skin.

Photodynamic therapy

This treatment uses a drug called a photosensitizer (or photosensitizing agent) and a particular type of light. When photosensitizers are exposed to a specific wavelength of light, they produce a form of oxygen that kills nearby cells.

Radiation therapy

Although it is not a common treatment for skin cancer, radiation therapy may be used for skin cancer in areas where surgery could be difficult or leave a bad scar. This treatment may be used for growths on the eyelid, ear, or nose. It also may be used if the cancer comes back after surgery.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or to ask any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.