What Is Skin Cancer?

Skin cancer is a very common cancer that affects more than a million people each year. The most serious skin cancer is melanoma. According to the National Cancer Institute, in 2012, 76,250 people in the U.S. will be diagnosed with melanoma and there will be 9,180 deaths. The most common type of skin cancer is non-melanoma skin cancer (NMSC). Two types of NMSC are basal cell and squamous cell. Both types of malignancies are related to ultraviolet light exposure from the sun.¹ ² ³

Basal Cell Carcinoma

Basal cell cancer begins in the deepest layer of the epidermis, the basal cell layer. About eight out of ten skin cancers are basal cell carcinomas. Ultraviolet light exposure from the sun can lead to skin cancer, damaging DNA and its repair system, as well as mutations in tumor-suppressing genes. Basal cell carcinoma grows by direct extension and appears to rely on the surrounding supportive tissue to grow. Therefore, it does not metastasize through blood vessels or lymphatics. Its course is unpredictable. It may grow slowly for years, and then suddenly grow rapidly. But if left untreated, it can grow into nearby areas and spread into the bone or other tissues beneath the skin. After treatment, basal cell carcinoma can recur in the same place on the skin. New basal cell cancers can also start in other places on the skin. As many as half of the people who have one basal cell cancer will get a new skin cancer within five years.⁴

Squamous Cell Carcinoma

This form of skin cancer arises in the squamous cells that make up most of the skin's upper layers (epidermis). Squamous cell carcinomas may occur on all areas of the body but are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, bald scalp, neck, hands, arms and legs. Often the skin in these areas reveals telltale signs of sun damage, such as wrinkling, changes in pigmentation, and loss of elasticity. With thorough screening these cancers can be identified at an early stage. With the selection of the appropriate treatment option, these cancers can result in excellent local control with excellent cosmetic results.⁵

Risk Factors

The risk of developing skin cancer is affected by where you live. People who live in areas that get high levels of UV 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 rays. 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, in order to prevent skin cancer later in life.

Types of Treatment for Skin Cancer

A wide variety of modalities used to treat basal cell and squamous cell carcinoma have been developed. These include surgical excision, Mohs micrographic surgery, and radiation therapy. The location of the cancer and the extent of the disease affect the treatment options available to patients.3 Surgery is often used as a treatment for skin cancer. There are several types of surgery depending on the stage and location of cancer.

Radiation therapy with high-energy rays (such as X-rays) can be used to destroy cancer cells. During radiation treatment, radiation is directed to the target tissue and transmits energy that damages and destroys the cancer cells. It does this by damaging the genetic material of the cells, which triggers cell death. The radiation damages genetic material in both normal and malignant cells and does not discriminate between them. However, normal cells are able to recover from the damage, while the cancer cells do not. Radiation therapy, which delivers excellent cosmetic results, aims to maximize the number of cancer cells destroyed, while minimizing the damage to nearby normal cells.

References

1 American Cancer Society (2007 Statistics from the American Cancer Society), accessed February 9, 2009.

2 Chan S, Dhadda S, Swindell R: Single fraction radiotherapy for small carcinoma of the skin. Clinical Oncology 2007; 19: 256–259.

3 Barlow JO, Zalla MJ, Kyle A, DiCaudao DJ, Lim KK, Yiannias JA. Journal of the American Academy of Dermatology 2006; 54; 1034–1039.

4 The Skin Cancer Foundation (2008)

5 Cancer Therapy Evaluation Program (Common Terminology Criteria for Adverse Events, Version 3.0, DCTD, NCI, NIH, DHHS. March 31, 2003), published August 9, 2006.

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