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Skin Cancer Screening and Treatment

Screening for cancer is an examination of people for early stages in the development of cancer even though they have no symptoms. Scientists have studied patterns of cancer in the population to learn which people are more likely to get certain types of cancer. If your doctor suspects that you may have cancer, he or she will order certain tests to see whether you do. These are called diagnostic tests. Some tests are used for diagnostic purposes, but are not suitable for screening people who have no symptoms. If your doctor suggests certain cancer screening tests as part of your health care plan, this does not mean he or she thinks you have cancer.
Skin Cancer Foundation

Melanoma
In its advanced state, it can cause serious illness and even death. Fortunately, melanoma rarely strikes without warning. Learn how to identify melanoma, how it spreads and what treatments are available.

What Is Melanoma?
Melanoma is the most serious form of skin cancer. If it is recognized and treated early, it is almost always curable, but if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths. The American Cancer Society estimates that at present, about 120,000 new cases of melanoma in the US are diagnosed in a year. In 2010, about 68,130 of these were invasive melanomas, with about 38,870 in males and 29, 260 in women.

Melanoma originates in melanocytes, the cells which produce the pigment melanin that colors our skin, hair, and eyes. The majority of melanomas are black or brown, but often they can also be skin-colored, pink, red, purple, blue or white.

Am I at Risk?
Everyone is at some risk for melanoma, but increased risk depends on several factors: sun exposure, number of moles on the skin, skin type and family history (genetics).
Sun exposure
Both UVA and UVB rays are dangerous to the skin, and can induce skin cancer, including melanoma. Blistering sunburns in early childhood increase risk, but cumulative exposure also may be a factor. People who live in locations that have more sunlight — like Florida, Hawaii, and Australia — develop more skin cancers. Avoid using a tanning booth or tanning bed, since it increases your exposure to UV rays, raising your risk of developing melanoma and other skin cancers.
Moles
There are two kinds of moles: normal moles — the small brown blemishes, growths, or "beauty marks" that appear in the first few decades of life in almost everyone — and atypical moles, also known as dysplastic nevi. Atypical moles can be precursors to melanoma, and having them puts you at increased risk of melanoma. But regardless of type, the more moles you have, the greater your risk for melanoma.
Skin Type
As with all skin cancers, people with fairer skin (who often have lighter hair and eye color as well) are at increased risk. Do you know your skin type? Click here to take our Skin Type Quiz.
Family History
Heredity plays a major role in melanoma. About one in every 10 patients diagnosed with the disease has a family member with a history of melanoma. If your mother, father, siblings or children have had a melanoma, you are in a melanoma-prone family. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than people who do not have a family history. If the cancer occurred in a grandmother, grandfather, aunt, uncle, niece or nephew (second-degree relatives), there is still an increase in risk, although not as great.
Melanoma: Like Mother, Like Daughter?
If melanoma is present in your family, you can protect yourself and your children by being particularly vigilant in watching for the early warning signs and finding the cancer when it is easiest to treat.
Personal History
Once you have had melanoma, you run an increased chance of recurrence. People who have or had basal cell carcinoma or squamous cell carcinoma are also at increased risk for developing melanoma.
Weakened Immune System
Compromised immune systems as the result of chemotherapy, an organ transplant, excessive sun exposure, and diseases such as HIV/AIDS or lymphoma can increase your risk of melanoma.

If you are in any of these risk groups, you can protect yourself and your children by practicing safe sun habits, remembering to examine yourself regularly from head to toe, watching for the warning signs, and obtaining yearly exams by a dermatologist or other physician experienced in skin care.

Breakthrough Melanoma Drug Approved— First in a New Class of “Targeted” Treatments

The Most Common Skin Cancer

Basal cell carcinoma (BCC) is the most common form of skin cancer, affecting approximately two million Americans each year. In fact, it is the most common of all cancers. More than one out of every three new cancers are skin cancers, and the vast majority are basal cell carcinomas. These cancers arise in the basal cells, which line the deepest layer of the epidermis (top skin layer).

The Major Cause
Almost all basal cell carcinomas occur on parts of the body excessively exposed to the sun — especially the face, ears, neck, scalp, shoulders, and back. On rare occasions, however, tumors develop on unexposed areas. In a few cases, contact with arsenic, exposure to radiation, open sores that resist healing, chronic inflammatory skin conditions, and complications of burns, scars, infections, vaccinations, or even tattoos are contributing factors.

Who Gets It?
Anyone with a history of sun exposure can develop basal cell carcinoma. However, people who are at highest risk have fair skin, blond or red hair, and blue, green, or grey eyes. Those most often affected are older people, but as the number of new cases has increased sharply each year in the last few decades, the average age of patients at onset has steadily decreased. The disease is rarely seen in children, but occasionally a teenager is affected. Dermatologists report that more and more people in their twenties and thirties are being treated for this skin cancer. Men with basal cell carcinoma have outnumbered women with the disease, but more women are getting basal cell carcinomas than in the past. Workers in occupations that require long hours outdoors and people who spend their leisure time in the sun are particularly susceptible.

Not to Be Ignored
Basal cell carcinomas are easily treated in their early stages. The larger the tumor has grown, however, the more extensive the treatment needed. Although this skin cancer seldom spreads, or metastasizes, to vital organs, it can damage surrounding tissue, sometimes causing considerable destruction and disfigurement — and some basal cell carcinomas are more aggressive than others.

When small skin cancers are removed, the scars are usually cosmetically acceptable. If the tumors are very large, a skin graft or flap may be used to repair the wound in order to achieve the best cosmetic result and facilitate healing.

Risk of Recurrence
People who have had one basal cell carcinoma are at risk for developing others over the years, either in the same area or elsewhere on the body. Therefore, regular visits to a dermatologist should be routine so that not only the site(s) previously treated, but the entire skin surface can be examined.

Basal cell carcinomas on the scalp and nose are especially troublesome, with recurrences typically taking place within the first two years following surgery.

Should a cancer recur, the physician might recommend a different type of treatment. Some methods, such as Mohs micrographic surgery, may be highly effective for recurrences.

Squamous Cell Carcinoma

More than 700,000 new cases of squamous cell carcinoma (SCC) are diagnosed every year. That makes it the second most common skin cancer (after basal 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 including the mucous membranes and genitals, 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.

Who Gets It
People who have fair skin, light hair, and blue, green, or gray eyes are at highest risk of developing the disease. But anyone with a history of substantial sun exposure is at increased risk. Those whose occupations require long hours outdoors or who spend extensive leisure time in the sun are in particular jeopardy. Anyone who has had a basal cell carcinoma is also more likely to develop an squamous cell carcinoma, as is anyone with an inherited, highly UV-sensitive condition such as xeroderma pigmentosum.

Squamous cell carcinomas are at least twice as frequent in men as in women. They rarely appear before age 50 and are most often seen in individuals in their 70s.

The majority of skin cancers in African-Americans are squamous cell carcinomas, usually arising on the sites of preexisting inflammatory skin conditions or burn injuries. Though naturally dark-skinned people are less likely than fair-skinned people to get skin cancer, it is still essential for them to practice sun protection.

Causes
Chronic exposure to sunlight causes most cases of squamous cell carcinoma. Frequent use of tanning beds also multiplies the risk of squamous cell carcinoma; people who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma than those who don’t. But skin injuries are another important source. The cancer can arise in burns, scars, ulcers, long-standing sores and sites previously exposed to X-rays or certain chemicals (such as arsenic and petroleum by-products).

Chronic infections and skin inflammation can also give rise to squamous cell carcinoma. Furthermore, HIV and other immune deficiency diseases, chemotherapy, anti-rejection drugs used in organ transplantation, and even excessive sun exposure itself all weaken the immune system, making it harder to fight off disease and thus increasing the risk of squamous cell carcinoma and other skin cancers.

Occasionally, squamous cell carcinomas arise spontaneously on what appears to be normal, healthy skin. Some researchers believe the tendency to develop these cancers can be inherited.
Precancers, the First Step

Certain precancerous growths, or precancers, most of them resulting from cumulative sun damage, can be associated with the later development of squamous cell carcinoma.

Actinic, or Solar, Keratoses
These rough, scaly, slightly raised growths, ranging in color from brown to red and from about 1 mm to 1 inch in diameter, are found on sun-exposed areas of the body, most often in older people. They can be the first step on the road to squamous cell carcinoma, and some experts even consider them the earliest form of squamous cell carcinoma. From two to ten percent of untreated actinic keratoses (AK) advance to squamous cell carcinoma, according to different studies. Indeed, 40 to 60 percent of squamous cell carcinomas begin as untreated actinic keratoses.

Actinic cheilitis
This form of actinic keratosis occurs most often on the lower lip, causing it to become dry, cracked, scaly and pale or white. Why the lower lip? Because it receives more sun exposure than the upper lip. If not treated promptly, actinic cheilitis can lead to squamous cell carcinoma on the lip.

Leukoplakia
Arising in the mucous membranes, these white patches on the tongue, gums, cheeks, or elsewhere inside the mouth have the potential to develop into squamous cell carcinoma. They may be caused by sources of chronic irritation, such as habitual alcohol consumption or tobacco use, or rough edges on teeth or dentures. They may even be caused by a long-time habit of biting the inside of the lip; however, leukoplakias on the lips are mainly caused by sun damage.

Bowen’s Disease
This is now generally considered an early, noninvasive stage of squamous cell carcinoma. It appears as a persistent red-brown, scaly patch that may resemble psoriasis or eczema. If untreated, it may invade deeper structures. Bowen’s disease is most often caused by exposure to the sun or to arsenic, but other chemical carcinogens, radiation, genetics and trauma also may play a role. The human Papillomavirus (HPV), highly transmissible through sexual contact, has been documented as a cause of one form of Bowen’s disease affecting the genitals. The disease can arise in the mucous membranes of the nose and mouth as well as on the skin. In 2006, the FDA approved an HPV vaccine for use by females aged 9–26; it is considered highly effective in preventing HPV and thereby reducing the risk of both genital warts and cervical cancer as well as Bowen’s disease.