Keeping Cancer In Check
Chronic exposure to the sun or intermittent sunburns can lead to skin cancer. Skin cancer risk doubles with five or more sunburns in a lifetime, but just one bad sunburn can double the risk of melanoma. While skin cancer is uncommon in African Americans, Latinos and Asians, it can also be more deadly because they are often diagnosed later in the course of the disease.
Its important to examine your skin regularly. You should report any changes in an existing mole or any new moles to your physician. People with fair complexions have the highest risk of developing skin cancer, but everyone should avoid the sun and practice safety measures to protect their skin.
The American Cancer Society;recommends the Slip, Slop, Slap and Wrap policy. When you go out in the sun, slip on a shirt, slop on sunscreen, slap on a hat and wrap on sunglasses to protect your eyes and the sensitive skin around them.
Exposure to the UV rays of tanning lamps is not safe. Tanning lamps give out UV rays, which can cause long-term skin damage and can contribute to skin cancer. Tanning bed use has been linked with an increased risk of melanoma, especially for people under 30. Most doctors and health organizations recommend not using tanning beds and sun lamps.
What Is A Basal Cell
One of three main types of cells in the top layer of the skin, basal cells shed as new ones form. BCC most often occurs when DNA damage from exposure to ultraviolet radiation from the sun or indoor tanning triggers changes in basal cells in the outermost layer of skin , resulting in uncontrolled growth.
Where Do Skin Cancers Start
Most skin cancers start in the top layer of skin, called the epidermis. There are 3 main types of cells in this layer:
- Squamous cells: These are flat cells in the upper part of the epidermis, which are constantly shed as new ones form. When these cells grow out of control, they can develop into squamous cell skin cancer .
- Basal cells: These cells are in the lower part of the epidermis, called the basal cell layer. These cells constantly divide to form new cells to replace the squamous cells that wear off the skins surface. As these cells move up in the epidermis, they get flatter, eventually becoming squamous cells. Skin cancers that start in the basal cell layer are called basal cell skin cancers or basal cell carcinomas.
- Melanocytes: These cells make the brown pigment called melanin, which gives the skin its tan or brown color. Melanin acts as the bodys natural sunscreen, protecting the deeper layers of the skin from some of the harmful effects of the sun. Melanoma skin cancer starts in these cells.
The epidermis is separated from the deeper layers of skin by the basement membrane. When a skin cancer becomes more advanced, it generally grows through this barrier and into the deeper layers.
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Four Reasons To Treat Basal Cell Carcinoma
Even when lesions from basal cell carcinoma on your skins surface dont appear to be changing, the cancer might still be growing. Some BCCs grow in irregular patterns under the skin, making the cancer seem smaller than it is. The cancer can affect tissue and bones. While major organs are rarely affected, muscle and nerve damage can occur, according to the Skin Cancer Foundation.
When not treated, the growth of the cancer can cause disfigurement because of internal damage. Treatment, which usually includes excision of the tumor, can be quite extensive when the cancer continues to grow unchecked. The longer you wait, the more damage and disfigurement the tumor can do and the more difficult it is to treat without causing cosmetic issues, according to Rex Amonette, M.D., the co-founder of The Skin Cancer Foundation.
When treated early, BCC is highly curable. Mohs surgery, a common treatment for BCC, has a cure rate of 99 percent. Excision, where the physician cuts out the growth, has a cure rate above 95 percent.
Most treatments for BCC are done as outpatient and often can be performed in your doctors office. Treatment does not usually involve extended time away from work or family.
Basal Cell Carcinoma: The Most Common Skin Cancer
Basal cell carcinoma, which is also called basal cell skin cancer, is the most common form of skin cancer, accounting for about 80 percent of all cases.
Rates of basal cell carcinoma have been increasing. Experts believe this is due to more sun exposure, longer lives, and better skin cancer detection methods.
This type of cancer begins in the skins basal cells, which are found in the outermost layer, the epidermis. They usually develop on areas that are exposed to the sun, like the face, head, and neck.
Basal cell carcinomas may look like:
- A flesh-colored, round growth
- A pinkish patch of skin
- A bleeding or scabbing sore that heals and then comes back
They typically grow slowly and dont spread to other areas of the body. But, if these cancers arent treated, they can expand deeper and penetrate into nerves and bones.
Though its rare, basal cell carcinoma can be life-threatening. Experts believe that about 2,000 people in the United States die each year from basal cell carcinoma or squamous cell carcinoma.
Some risk factors that increase your chances of having a basal cell carcinoma include:
- Being exposed to the sun or indoor tanning
- Having a history of skin cancer
- Being over age 50
- Having chronic infections, skin inflammation, or a weakened immune system
- Being exposed to industrial compounds, radiation, coal tar, or arsenic
- Having an inherited disorder, such as nevoid basal cell carcinoma syndrome or xeroderma pigmentosum
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Actinic Keratosis Signs And Symptoms
Many people have actinic keratosis , also called solar keratosis, on their skin. It shows that youâve had enough sun to develop skin cancer, and it is considered a precursor of cancer, or a precancerous condition.
Usually AK shows up on the parts of your body that have received the most lifetime sun exposure, like the face, ears, scalp, neck, backs of the hands, forearms, shoulders and lips.
Some of the same treatments used for nonmelanoma skin cancers are used for AK to ensure it does not develop into a cancerous lesion.
This abnormality develops slowly. The lesions are usually small, about an eighth of an inch to a quarter of an inch in size. You may see a few at a time. They can disappear and later return.
- AK is a scaly or crusty bump on the skinâs surface and is usually dry and rough. It can be flat. An actinic keratosis is often noticed more by touch than sight.
- It may be the same color as your skin, or it may be light, dark, tan, pink, red or a combination of colors.
- It can itch or produce a prickling or tender sensation.
- These skin abnormalities can become inflamed and be encircled with redness. Rarely, they bleed.
What Will Happen After Treatment
Youll be glad when treatment is over. Your doctor will want you to check your skin at least once a month. It will be very important to protect yourself from getting too much sun.
For years after treatment ends, you will see your skin cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed. Be sure to go to all of these follow-up visits. Your doctor will ask about symptoms and check you for signs of the cancer coming back or a new skin cancer. Other exams and tests may also be done.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life making healthy choices and feeling as good as you can.
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How Do You Prevent Basal Cell Skin Cancer
The best way to prevent basal cell carcinoma and other skin cancers is to protect the skin from the sun.
- Wear sunscreen with an SPF of at least 30. Apply sunscreen at least 30 minutes prior to sun exposure, and reapply every 2 hours or more frequently if swimming or sweating.
- Wear protective clothing and a wide-brimmed hat.
- Avoid the midday sun, between the hours of 10 a.m. to 4 p.m., when the sun’s rays are the strongest.
- Avoid tanning beds.
- Examine your skin regularly for new moles, spots, bumps, or growths, and inform your doctor of any skin changes.
In patients who are at higher risk for recurrence of basal cell carcinoma, certain medications may be used, however, studies on the effectiveness of these medications have had mixed results.
- Celecoxib , a type of nonsteroidal anti-inflammatory drug , may offer modest risk reduction, but studies on its effectiveness for preventing tumors are mixed.
- Oral nicotinamide is a vitamin supplement available over the counter. Additional studies are needed to determine its effectiveness in preventing skin cancers. Consult your doctor before taking any supplements because of possible side effects or drug interactions.
- Topical fluorouracil has been shown to help prevent other skin conditions and precursors to basal cell carcinoma, however, the data are mixed on whether it may help prevent BCC.
The Risks The Causes What You Can Do
Basal cell carcinoma is caused by damage and subsequent DNA changes to the basal cells in the outermost layer of skin. Exposure to ultraviolet radiation from the sun and indoor tanning is the major cause of BCCs and most skin cancers.
Understanding what causes BCC and the factors that increase your risk of getting it can help you prevent the disease or detect it in its earliest stages, when its easiest to treat.
These factors increase your BCC risk:
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Visit Us Dermatology Partners
Whether youre worried a spot youve noticed is cancerous or youre just ready for your annual professional skin exam, the U.S. Dermatology Partners team would love to hear from you. You can get started scheduling your visit by completing our online request form. Once we receive your scheduling request, one of our local team members will be in touch to finalize the details of your office visit.
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After Skin Cancer Treatment
Most skin cancer is cured surgically in the dermatologist’s office. Of skin cancers that do recur, most do so within three years. Therefore, follow up with your dermatologist as recommended. Make an appointment immediately if you suspect a problem.
If you have advanced malignant melanoma, your oncologist may want to see you every few months. These visits may include total body skin exams, regional lymph node checks, and periodic chest X-rays and body scans. Over time, the intervals between follow-up appointments will increase. Eventually these checks may be done only once a year.
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Biological Therapies And Melanoma
Biological therapies are treatments using substances made naturally by the body. Some of these treatments are called immunotherapy because they help the immune system fight the cancer, or they occur naturally as part of the immune system.;There are many biological therapies being researched and trialled, which in the future may help treat people with melanoma. They include monoclonal antibodies and vaccine therapy.;
What Happens If You Let Skin Cancer Go Untreated
Many patients who are diagnosed with skin cancer, especially in the earliest stages, find themselves wondering whether treatment is really necessary. Skin cancer, like other forms of cancer, is serious and requires proper treatment. According to Dr. Valerie Truong of U.S. Dermatology Partners in Dallas, Plano, Sherman, and Corsicana, Texas, The visible part of skin cancer can often be like the tip of an iceberg. What you see on the surface is only a small percentage of the actual cancer. Even if the skin cancer appears to be negligible, there is always a risk that it will grow and spread. I recommend that people who suspect they have skin cancer get a skin check for an earlier diagnosis, and therefore, earlier treatment. In this blog, Dr. Truong talks more about what happens if you let skin cancer go untreated and the potential risks that may arise for skin health as well as overall health and well-being.
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What Is Skin Cancer
Cancer can start any place in the body. Skin cancer starts when cells in the skin grow out of control.
Skin cancer cells can sometimes spread to other parts of the body, but this is not common. When cancer cells do this, its called metastasis. To doctors, the cancer cells in the new place look just like the ones from the skin.
Cancer is always named based on the place where it starts. So if skin cancer spreads to another part of the body, its still called skin cancer.
Ask your doctor to use this picture to show you where your cancer is
Where Does Bcc Develop
As the above pictures show, this skin cancer tends to develop on skin that has had lots of sun exposure, such as the face or ears. Its also common on the bald scalp and hands. Other common areas for BCC include, the shoulders, back, arms, and legs.
While rare, BCC can also form on parts of the body that get little or no sun exposure, such as the genitals.
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How To Spot A Bcc: Five Warning Signs
Check for BCCs where your skin is most exposed to the sun, especially the face, ears, neck, scalp, chest, shoulders and back, but remember that they can occur anywhere on the body. Frequently, two or more of these warning signs are visible in a BCC tumor.
Please note: Since not all BCCs have the same appearance, these images serve as a general reference to what basal cell carcinoma looks like.
An open sore that does not heal
A reddish patch or irritated area
A small pink growth;with a slightly raised, rolled edge and a crusted indentation in the center
A shiny bump or nodule
A scar-like area;that is flat white, yellow or waxy in color
Symptoms Of Basal Cell Carcinoma
There are several types of basal cell carcinomas.
The nodular type of basal cell carcinoma usually begins as small, shiny, firm, almost clear to pink in color, raised growth. After a few months or years, visible dilated blood vessels may appear on the surface, and the center may break open and form a scab. The border of the cancer is sometimes thickened and pearly white. The cancer may alternately bleed and form a scab and heal, leading a person to falsely think that it is a sore rather than a cancer.
Other types of basal cell carcinomas vary greatly in appearance. For example, the superficial type appears as flat thin red or pink patches, and the morpheaform type appears as thicker flesh-colored or light red patches that look somewhat like scars.
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Questions To Ask The Doctor
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- What will happen next?
There are many ways to treat skin cancer. The main types of treatment are:
Most basal cell and squamous cell cancers can be cured with surgery or other types of treatments that affect only the spot on the skin.
The treatment plan thats best for you will depend on:
- The stage and grade of the cancer
- The chance that a type of treatment will cure the cancer or help in some way
- Your age and overall health
- Your feelings about the treatment and the side effects that come with it
Different Kinds Of Skin Cancer
There are many types of skin cancer. Some are very rare. Your doctor can tell you more about the type you have.
The two most common kinds of skin cancers are:
- Basal cell cancer, which starts in the lowest layer of the skin
- Squamous cell cancer, which starts in the top layer of the skin
Another kind of skin cancer is called melanoma. These cancers start from the color-making cells of the skin . You can read about melanoma in If You Have Melanoma Skin Cancer.
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What Is The Likely Outcome For Someone Who Has Bcc
When found early and treated, this skin cancer can often be removed. However, this skin cancer can return. You also have a higher risk of developing another BCC or other type of skin cancer.
Thats why self-care becomes so important after treatment for BCC. Youll find the self-care that dermatologists recommend at, Basal cell carcinoma: Self-care.
ReferencesBichakjian CK, Armstrong A, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol 2018;78:540-59.
Bichakjian CK, Olencki T, et al. Basal cell skin cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2016;14:574-97.
Cameron MC, Lee E, et al. Basal cell carcinoma: Epidemiology; pathophysiology; clinical and histological subtypes; and disease associations. J Am Acad Dermatol 2019;80:303-17.
Cameron MC, Lee E, et al. Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention. J Am Acad Dermatol 2019;80:321-39.
Nouri K, Ballard CJ, et al. Basal cell carcinoma. In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 61-81.
Xie P, Lefrançois P. Efficacy, safety, and comparison of sonic hedgehog inhibitors in basal cell carcinomas: A systematic review and meta-analysis. J Am Acad Dermatol 2018;79:1089-100.