Prognosis For Skin Cancer
It is not possible for a doctor to predict the exact course of a disease. However, your doctor may give you the likely outcome of the disease. If detected early, most skin cancers are successfully treated.
Most non-melanoma skin cancers do not pose a serious risk to your health but a cancer diagnosis can be a shock. If you want to talk to someone see your doctor. You can also call Cancer Council 13 11 20.
Precancerous Types Of Skin Cancer
Some precancerous growths, often attributable to sun exposure, can lead to skin cancer over time. However, if they are recognized and removed early, you could avoid a cancer diagnosis. These growths include:
- Actinic keratosis: About 40-60% of squamous cell cancer cases began as actinic keratosis. Anywhere between 2-10% of these growths will develop into SCC, sometimes in as little as a couple of years. Actinic cheilitis is a type of actinic keratosis that appears on the lower lip, and is at higher risk for developing into skin cancer
- Bowens disease: This early, noninvasive form of SCC is at high risk of becoming skin cancer if not addressed. It presents as an eczema-like scaly patch and is usually red or brown in color. These growths have been linked to sun exposure, radiation, carcinogen exposure, genetics, and trauma
- Leukoplakia: These white patches on the lips, tongue, and gums may be caused by alcohol and tobacco use, and can turn into squamous cell carcinoma. Cancer sites on the lips may be caused by sun damage
- Keratoacanthoma: This dome-shaped growth is usually found on sun-exposed skin and usually grows quickly at first, then slows down. Many shrink and go away on their own, but if they continue to grow, this tumor can turn into squamous cell carcinoma. They are usually removed surgically
How Is Nonmelanoma Skin Cancer Treated
Your treatment choices depend on how large the skin cancer is, where it is, and what stage it is. It also depends on the test results. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goal of treatment, and the possible risks and side effects. Other things to think about are if the cancer can be removed with surgery and your overall health.
Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in 1 area. Systemic treatment is used to destroy or control cancer cells that may have traveled through your body. Surgery and radiation are local treatments. When taken by pill or injection, chemotherapy is a systemic treatment. You may have just 1 treatment or a combination of treatments.
Nonmelanoma skin cancer may be treated with:
- Surgery
- Creams applied to the area
- Chemotherapy
- Immunotherapy
Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.
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External Beam Radiation Therapy
The following three sections refer to treatment using x-rays.
Conventional external beam radiation therapy
Historically conventional external beam radiation therapy was delivered via two-dimensional beams using kilovoltage therapy x-ray units, medical linear accelerators that generate high-energy x-rays, or with machines that were similar to a linear accelerator in appearance, but used a sealed radioactive source like the one shown above. 2DXRT mainly consists of a single beam of radiation delivered to the patient from several directions: often front or back, and both sides.
Conventional refers to the way the treatment is planned or simulated on a specially calibrated diagnostic x-ray machine known as a simulator because it recreates the linear accelerator actions , and to the usually well-established arrangements of the radiation beams to achieve a desired plan. The aim of simulation is to accurately target or localize the volume which is to be treated. This technique is well established and is generally quick and reliable. The worry is that some high-dose treatments may be limited by the radiation toxicity capacity of healthy tissues which lie close to the target tumor volume.
Intensity-modulated radiation therapy
Squamous Cell Carcinoma Pictures
Squamous cell carcinoma also appears in areas most exposed to the sun and, as indicated in the pictures below, often presents itself as a scab or sore that doesnt heal, a volcano-like growth with a rim and crater in the middle or simply as a crusty patch of skin that is a bit inflamed and red and doesnt go away over time.
Any lesion that bleeds or itches and doesnt heal within a few weeks may be a concern even if it doesnt look like these Squamous cell carcinoma images.
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The Four Major Types Of Melanoma
- superficial spreading melanoma: the most common type of melanoma lesions are usually flat, irregular in shape, and contain varying shades of black and brown it can occur at any age
- lentigo maligna melanoma: usually affects the elderly involves large, flat, brownish lesions
- nodular melanoma: can be dark blue, black, or reddish-blue, but may have no color at all it usually starts as a raised patch
- acral lentiginous melanoma: the least common type typically affects the palms, soles of the feet, or under finger and toenails
When Should I Call My Healthcare Provider
Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:
- New symptoms or symptoms that get worse
- Signs of an infection, such as a fever
- Side effects of treatment that affect your daily function or dont get better with treatment
Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.
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Squamous Cell Skin Cancer
SCC is generally faster growing than basal cell cancers. About 20 out of every 100 skin cancers are SCCs. They begin in cells called keratinocytes, which are found in the epidermis.
Most SCCs develop on areas of skin exposed to the sun. These areas include parts of the head, neck, and on the back of your hands and forearms. They can also develop on scars, areas of skin that have been burnt in the past, or that have been ulcerated for a long time.
SCCs don’t often spread. If they do, it’s most often to the deeper layers of the skin. They can spread to nearby lymph nodes and other parts of the body, but this is unusual.
For More Information About Skin Cancer
National Cancer Institute, Cancer Information Service Toll-free: 4-CANCER 422-6237TTY : 332-8615
Skin Cancer Foundation
Media file 1: Skin cancer. Malignant melanoma.
Media file 2: Skin cancer. Basal cell carcinoma.
Media file 3: Skin cancer. Superficial spreading melanoma, left breast. Photo courtesy of Susan M. Swetter, MD, Director of Pigmented Lesion and Cutaneous Melanoma Clinic, Assistant Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System.
Media file 4: Skin cancer. Melanoma on the sole of the foot. Diagnostic punch biopsy site located at the top. Photo courtesy of Susan M. Swetter, MD, Director of Pigmented Lesion and Cutaneous Melanoma Clinic, Assistant Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System.
Media file 5: Skin cancer. Melanoma, right lower cheek. Photo courtesy of Susan M. Swetter, MD, Director of Pigmented Lesion and Cutaneous Melanoma Clinic, Assistant Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System.
Continued
Media file 6: Skin cancer. Large sun-induced squamous cell carcinoma on the forehead and temple. Image courtesy of Dr. Glenn Goldman.
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Merkel Cell Carcinoma: Rare And Aggressive
Merkel cell carcinoma is a rare, aggressive neuroendocrine cancer that occurs in the skin. These cancers tend to grow quickly and metastasize even at an early stage, first to nearby lymph nodes and then to distant sites such as the lungs, brain, bones and other organs.
Merkel cell carcinomas tend to occur as a single painless lump that is:
- Fast-growing
How Skin Cancer Forms
Skin cancer is a cancer that forms in the tissue of the skin. Cells differ in shape and function in various organs, but all cells reproduce by dividing. The process of normal tissue growth and repair is usually controlled. However, when uncontrolled, abnormal growth results in masses of tissue called tumors, which can be benign or malignant .
Benign tumors do not spread. Malignant tumors, on the other hand, invade and destroy normal tissue as they grow. Cancer cells also can break away from the tumor and spread through the blood or lymphatic vessels to form additional tumors in other parts of the body.
The skin consists of two main layers:
Epidermis This outer, top skin layer is where most skin cancers begin. The epidermis contains four types of cells:
- Squamous cells are the thin flat cells of the outer skin layer. Squamous cell carcinoma is skin cancer that begins in the squamous cells.
- Basal cells are round skin cells that lie under the squamous cells, deeper in the skin. Basal cell carcinoma is skin cancer that begins in the basal cells.
- Merkel cells are among the basal cells in the deepest epidermis layer. These cells are connected to the nerves endings. Merkel cell carcinoma is rare cancer that begins in the Merkel cells.Read more about Merkel Cell Carcinoma
- Melanocytes are scattered among the basal cells and make melanin, the pigment that colors your skin. Melanoma is a skin cancer type that begins in the melanocytes.
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What Causes Skin Cancer
The main cause of skin cancer is overexposure to sunlight, especially when it results in sunburn and blistering. Ultraviolet rays from the sun can damage the skin and, over time, lead to skin cancer. The UV light damages DNA in the skin and causes it to grow abnormally. Exposure to certain chemicals such as tar and coal can cause skin cancer for those with jobs that require them to frequently be in contact with these chemicals. Those with a weakened immune system also have an increased risk for skin cancer.
Distinguishing Benign Moles From Melanoma
To find melanoma early, it is important to examine your child’s skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. Recognizing changes in your child’s moles is crucial in detecting melanoma at its earliest stage.
It is normal for children to develop new moles over time, so the traditional ABCDEs of melanoma in adults differ in children. Pediatric melanoma often presents as a pink or red new bump that is uniform in color and can be of any diameter. A changing, or evolving mole can also be concerning.
The ABCDEs of pediatric melanoma are:
- A Amelanotic, meaning not the traditional brown, tan, blue or black color normally associated with a mole or melanoma
- B Bleeding, Bump
- D De novo , any Diameter
- E Evolution, meaning changing in size, shape or other characteristics
Melanomas vary greatly in appearance. New red or pink bumps or moles that are itchy or bleeding should be checked by your child’s doctor. Always consult your child’s doctor if you have questions about a mole or other skin lesion.
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Risk Factors Of Skin Cancer
Anyone can get skin cancer, however, certain factors may increase your chances of getting it. These factors include:
- Fair skin. Less melanin in your skin means you have less protection from UV radiation. Natural blonds or redheads, those with light-colored eyes, and freckles make you a bigger candidate for skin cancer. Those who have a history of sunburns also have an increased skin cancer risk .
- Considerable sun exposure. If you like to work on your tan, you might not be doing yourself any favors, especially if youre not protected by sunscreen, clothing, or a hat. The extra UV rays make you more prone to skin cancer.
- Moles. Moles, especially irregular or large moles, are more likely to become cancerous down the road. If you have abnormal moles, be sure to check them regularly to make sure they havent changed.
- Sunny climates. You may live in a sunny paradise, but it means youre exposing yourself to more sunlight than folks who live in cooler climates. Make sure you cover up to avoid putting yourself at additional risk.
- Weakened immune systems. People with weakened immune systems, including those with HIV/AIDS or those with organ transplants, should be aware of their increased risk of skin cancer.
- History of skin cancer. If your parents or siblings have had skin cancer, it should serve as a warning that you should be extra cautious. Additionally, if you have a personal history with skin cancer, you may be at risk to get it again.
The Warning Signs Of Skin Cancer
Skin cancers — including melanoma, basal cell carcinoma, and squamous cell carcinoma — often start as changes to your skin. They can be new growths or precancerous lesions — changes that are not cancer but could become cancer over time. An estimated 40% to 50% of fair-skinned people who live to be 65 will develop at least one skin cancer. Learn to spot the early warning signs. Skin cancer can be cured if it’s found and treated early.
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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.
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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Squamous Cell Carcinoma In Situ
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DermNet NZ
Squamous cell carcinoma in situ, also known as Bowens disease, is a precancerous condition that appears as a red or brownish patch or plaque on the skin that grows slowly over time. The patches are often found on the legs and lower parts of the body, as well as the head and neck. In rare cases, it has been found on the hands and feet, in the genital area, and in the area around the anus.
Bowens disease is uncommon: only 15 out of every 100,000 people will develop this condition every year. The condition typically affects the Caucasian population, but women are more likely to develop Bowens disease than men. The majority of cases are in adults over 60. As with other skin cancers, Bowens disease can develop after long-term exposure to the sun. It can also develop following radiotherapy treatment. Other causes include immune suppression, skin injury, inflammatory skin conditions, and a human papillomavirus infection.
Bowens disease is generally treatable and doesnt develop into squamous cell carcinoma. Up to 16% of cases develop into cancer.
What Is The Outlook For People With Skin Cancer
Nearly all skin cancers can be cured if they are treated before they have a chance to spread. The earlier skin cancer is found and removed, the better your chances for a full recovery. Ninety percent of those with basal cell skin cancer are cured. It is important to continue following up with a doctor to make sure the cancer does not return. If something seems wrong, call a doctor right away.
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