What is Skin Cancer?
Skin cancer is not one disease. The most common type of skin cancer is epithelial skin cancer, which includes basal cell cancer and squamous cell cancer. Epithelial skin cancer is rarely deadly and usually appears as a persistent pink bump, a sore that does not heal, a scaling red patch, or a warty growth. The less common but more serious form of skin cancer is melanoma. Melanoma is a potentially deadly cancer that develops as an unusual mole, a new mole, or a mole that changes. Melanoma and epithelial skin cancers are curable if removed at an early stage of development. More than half of all melanomas are discovered by patients. You can help in early detection. The following information will help you take personal responsibility for early detection of melanoma and epithelial skin cancer.
Who has the greatest risk for developing skin cancer?
Epithelial skin cancer
Epithelial skin cancer (basal cell carcinoma and squamous cell carcinoma) is mostly caused by excessive exposure to sun or artificial sources of ultraviolet radiation, mostly in white adults.
Epithelial skin cancer risk is increased several-fold if you have one or more of the following:
- Personal history of epithelial skin cancer.
- Family history of epithelial skin cancer in a parent, sibling, or child.
- Actinic keratoses: red, rough, scaling patches on sun-exposed skin.
- Tendency to freckle following sun exposure.
- Excessive exposure to sun or sun lamps.
- Tendency to burn and relative inability to tan in the sun.
- Red or blond hair, and blue or green eyes.
Not all epithelial skin cancers are caused by excessive sun exposure. Other predisposing factors for developing epithelial skin cancer include the following:
- X-ray (radiation) therapy to skin or internal organs, usually for treatment of disease.
- Scar related to heat burn, chemical burn, and scarring skin diseases.
- Chronic ulcer or chronic draining sinus.
- Immune suppression from disease or medication, such as organ transplant.
Melanoma occurs mostly in white adults. However, anyone can develop melanoma, regardless of gender, race, or age. Melanoma is extremely rare before puberty and tends to increase with age.
Your melanoma risk is markedly increased if you have one or more of the following:
- Prominent moles: 5 moles at least as large as this spot ( ) (7 to 10-fold risk), 12 moles at least as large as this spot ( ) (54-fold risk), or 20 moles at least as large as this spot ( ) (7 to 14-fold risk).
- Dysplastic moles (atypical moles): moles this size ( ) or larger that have uneven or dark coloration or fried egg appearance, and often uneven or fuzzy boarders ( 7 to 27-fold risk).
- A congenital mole: a mole that your parents told you was present at birth (2 to 21-fold risk).
- Lentigo maligna: single, irregular, large “varnish stain” spot on sun-damaged skin (10-fold risk).
- Personal history of melanoma (9-fold risk).
- Family history of melanoma in a parent, sibling, or child (8-fold risk).
The above traits do not guarantee that you will develop melanoma but justify your seeking medical advice.
Your melanoma risk is slightly to moderately increased if you have one or more of the following:
- Suppression of the immune system, due to disease or medication (4-fold risk).
- Tendency to freckle following sun exposure (2 to 4-fold risk).
- Tendency to burn and relative inability to tan in the sun (2 to 3-fold risk).
- Red or blond hair, and blue or green eyes (2-fold risk).
- Excessive sun exposure (2-fold risk).
Signs and symptoms of a developing skin cancer
The following signs and symptoms may indicate a developing skin cancer:
- Mole or freckle that has changed or is changing in some way for more than 2 weeks, for example, becoming darker or lighter, larger, more raised, or changing shape or outline.
- New mole or freckle that you are sure wasn’t there before.
- Mole or freckle that is continually tender, itching, or scaling for no apparent reason.
- Unexplained sore that oozes, bleeds, scabs, and has not healed after 4 weeks.
- Persistent pink or red bump, lump, or warty growth.
- Mole or freckle that is prominent or unusual in some way.
- Single scaling pink or red patch that has not responded to treatment with ointments or salves.
These signs and symptoms do not guarantee that you have a skin cancer, but justify your seeking medical advice.
Some people avoid or delay seeking medical advice because their information is misleading or false. The following are some of the more common misconceptions about skin cancer:
Melanoma is always deadly. Some people believe that melanoma is not treatable. Not true! Melanoma is curable if detected and treated in an early stage of development. Currently, 94% of people whose melanoma shows no sign of spread at the time of diagnosis are without signs of cancer 5 years later. Timely detection and surgical excision of melanoma usually result in cure.
Don’t touch a mole that is changing because you will cause cancer to spread. This myth started 50 years ago when patients delayed seeking medical advice until melanomas were large, oozing, and painful. Neglected tumors have a greater chance of spreading to vital internal organs. Once the cancer cells of melanoma are removed, these cells can no longer do harm. If cancer cells of melanoma have not spread elsewhere before surgical removal, the cure is guaranteed.
All skin cancers are the same. Melanoma is the least common but potentially most deadly of the main types of skin cancer. The more common epithelial skin cancers, basal cell cancer and squamous cell cancer, are curable at least 98% of the time. Epithelial skin cancers cause local destruction of tissue but rarely spread to vital internal organs. Some squamous cell cancers can spread to lymph nodes and vital internal organs, particularly when developing in scarring skin disease and skin sites exposed to x-ray (radiation) therapy and in patients whose immune system is suppressed by medication or disease. When diagnosed early, epithelial skin cancer is usually able to be treated with less complicated therapy and with a minimum of destruction of involved tissues.
Only whites develop melanoma and epithelial skin cancer. While non-whites rarely develop melanoma and epithelial skin cancer, the same warnings signs and symptoms apply. Melanoma can appear anywhere on the skin of non-whites, but in about half the cases, melanoma appears on the palms of the hands, soles of the feet, nail beds, or mucous membranes (inner eyelids, nose, mouth, anus, and genitalia), usually as a new or changing black spot and sometimes a pink or red patch. Epithelial skin cancer rarely occurs in non-whites unless there has been exposure to x-ray (radiation) therapy that has been used to treat disease; a chronic ulcer related to burn or scarring skin disease; a chronic draining sinus; excessive exposure to natural sunlight or artificial sources of ultraviolet radiation; or within areas of pigment loss.
What can you expect during an examination for skin cancer?
A physician will usually offer to examine your entire skin surface. In addition to areas exposed to the sun, melanoma and epithelial skin cancer can occur on skin sites not commonly exposed to the sun, such as palms, soles, hairy scalp, genitalia, anal area, between toes and fingers, and nail beds.
What can you do to help prevent death from skin cancer?
Delay in seeking help is responsible for the majority of skin cancer deaths. Denial of a problem is your greatest enemy, second only to ignorance of the meaning of the usual signs and symptoms that could indicate a developing cancer. If you have questions about skin cancer and its warning signs, or if you have any of the signs or symptoms or risk factors listed above, take action by consulting your dermatologist or general physician.
Copyright, Arthur R. Rhodes, 1996