Squamous Cell Carcinoma: Common In Sun
Squamous cell carcinoma, also called squamous cell cancer, is the second most common type of skin cancer. It accounts for about 20 percent of cases.
This type of cancer starts in flat cells in the outer part of the epidermis. It commonly crops up on sun-exposed areas, such as the face, ears, neck, lips, and hands. It can also develop on scars or chronic sores.
Squamous cell carcinomas may develop from precancerous skin spots, known as actinic keratosis .
These cancers might look like:
- A firm, red bump
- A flat lesion with a scaly, crusted surface
- A sore that heals and then reopens
People with lighter skin are more at risk for developing squamous cell carcinoma, but the skin cancer can also affect those with darker skin.
Other risk factors include:
- Having light eyes, blond or red hair, or freckles
- Being exposed to the sun or tanning beds
- Having a history of skin cancer
- Having a history of sunburns
- Having a weakened immune system
- Having the genetic disorder xeroderma pigmentosum
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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.
Diagnosis Of Skin Cancer
It is important to check your skin regularly and check with your doctor if you notice any changes.
In the majority of cases, your GP will examine you, paying attention to any spots that may look suspicious. Your GP may perform a biopsy . In some cases your GP may refer you to a specialist, such as a dermatologist, if necessary.
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Rarer Types Of Non Melanoma Skin Cancer
There are other less common types of skin cancer. These include:
- Merkel cell carcinoma
- T cell lymphoma of the skin
- Sebaceous gland cancer
These are all treated differently from basal cell and squamous cell skin cancers.
Merkel cell carcinoma
Merkel cell carcinoma is very rare. Treatment is with surgery or radiotherapy, or both. This usually works well, but sometimes the cancer can come back in the same place. And sometimes it spreads to nearby lymph nodes or to other parts of the body.
Sebaceous gland cancer
Sebaceous gland cancer is another rare type of skin cancer affecting the glands that produce the skin’s natural oils. Treatment is usually surgery for this type of cancer.
Kaposi’s sarcoma
Kaposis sarcoma is a rare condition. It’s often associated with HIV but also occurs in people who don’t have HIV. It’s a cancer that starts in the cells that form the lining of lymph nodes and the lining of blood vessels in the skin. Treatment is surgery or radiotherapy, and sometimes chemotherapy.
T cell lymphoma of the skin
T cell lymphoma of the skin can also be called primary cutaneous lymphoma. It’s a type of non Hodgkin lymphoma. There are a number of different types of treatment for this type of cancer.
Causes Of Skin Cancer
One of the main causes of skin cancer is being exposed to UV rays. UV rays are invisible, and are produced by the sun, and tanning equipment.
UV rays cause skin cancer by creating changes in the cells of your skin. In some cases, the UV rays cause direct damage to your cells. Tans and sunburns, for example, are both signs that UV rays have damaged your skin. In other cases, UV rays cause skin cancer indirectly, by weakening the immune system.
Many studies on skin cancer show that people who have suffered many severe sunburns in childhood are at greater risk of developing skin cancer. Family history, some chemical exposures, and immune dysfunction conditions can also create a greater risk of developing skin cancer.
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What Is Skin Type
There are six types of skin, ranging from very fair to very dark , according to the scientific classification known as Fitzpatrick skin typing. Developed in 1975 by a Harvard Medical School physician named Thomas Fitzpatrick, MD, the system classifies skin type according to the amount of skin pigment you have and your skins reaction to sun exposure. Determining your skin type can help predict your overall risk for sun damage and skin cancer.
Treatment For Skin Cancer
If you are diagnosed with skin cancer, you may have multiple options for treatment. Based on the specifics of your case, your doctor will recommend your best course of action. The suggested methods for fighting the cancer may include:
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Cryotherapy. In cryotherapy, a doctor freezes and kills precancerous or cancerous skin cells using liquid nitrogen. This technique is most often used to treat minor basal or squamous carcinomas or precancerous skin conditions.
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Surgery. Different types of skin cancer may be removed by surgery. Surgery can be excisional – simply cutting out a cancerous area and the skin surrounding it – or may involve meticulous removal of layers of skin.
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Radiation therapy. In radiation therapy, energy beams are used to kill cancerous cells. Radiation therapy may help finish off a cancer that was not fully removed by surgery, and can also be instrumental in cases that dont allow for surgery.
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Chemotherapy. This type of therapy uses drugs to kill cancer cells. To treat some cases of skin cancer, chemotherapy may be applied locally through topical creams or lotions. It may also be administered by IV to target multiple body parts at once.
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Immunotherapy. Immunotherapy, also called biological therapy, involves boosting the immune system to fight cancer cells. With the help of strengthening medicines, the immune system may be better prepared to kill cancerous cells.
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Skin Pigment And Ability To Tan
Ultraviolet radiation from sunlight affects everybody’s skin to some extent, but the skin’s response varies widely from person to person. Peoples’ sensitivity to the sun varies according to the amount of pigment in the skin and the skin’s ability to tan.
Ultraviolet radiation causes tanning in two different ways: by immediate tanning and by delayed tanning. Immediate tanning causes the skin to darken in response to UVA. This darkening begins during the period of exposure, but fades within a few hours or days. The amount of tanning increases according to the skin’s natural darkness and previous amount of tanning.
Delayed tanning occurs two to three days after exposure to either UVA or UVB. It lasts from several weeks to months, and is maintained by repeated exposure to sunlight. With delayed tanning, the skin increases its production and distribution of dark pigment. The skin also becomes thicker. These changes can follow sunburning or develop gradually over a long period of repeated brief exposures to sunlight.
Some people burn easily after the first hour of sun exposure following winter or any period away from the sun. Other people, especially those with dark skin, rarely burn. This difference in reaction makes it possible to classify skin into one of six different types .
Table adapted from: SunSmart Victoria , Australia
Spotting Signs Of Melanoma
A preventative measure you can take to catch skin cancer early, or to catch it before it spreads to other parts of the body, is to regularly check your skin. Its recommended that you check your skin at least once a month to make sure everything checks out, and visit your physician if you believe something might be suspicious. When checking your skin, theres a helpful guide to follow, and its called the ABCDE system.
- Asymmetrical moles make sure the moles are equal on both sides
- Borders examine whether the edges of the moles are jagged, irregular, or not smooth
- Colors check if the there are different colors in the mole
- Diameter Measure the mole to see if its larger than 6 millimeters
- Evolution The most important step in the process. Routinely check to see if the mole change over time, whether its in color, size, shape, or its itchy and painful.
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How Is Skin Cancer Diagnosed
First, your dermatologist may ask you if you have noticed any changes in any existing moles, freckles or other skin spots or if youve noticed any new skin growths. Next, your dermatologist will examine all of your skin, including your scalp, ears, palms of your hands, soles of your feet, between your toes, around your genitals and between your buttocks.
If a skin lesion is suspicious, a biopsy may be performed. In a biopsy, a sample of tissue is removed and sent to a laboratory to be examined under a microscope by a pathologist. Your dermatologist will tell you if your skin lesion is skin cancer, what type you have and discuss treatment options.
What Is A Melanocyte
Melanocytes are skin cells found in the upper layer of skin. They produce a pigment known as melanin, which gives skin its color. There are two types of melanin: eumelanin and pheomelanin. When skin is exposed to ultraviolet radiation from the sun or tanning beds, it causes skin damage that triggers the melanocytes to produce more melanin, but only the eumelanin pigment attempts to protect the skin by causing the skin to darken or tan. Melanoma occurs when DNA damage from burning or tanning due to UV radiation triggers changes in the melanocytes, resulting in uncontrolled cellular growth.
About Melanin
Naturally darker-skinned people have more eumelanin and naturally fair-skinned people have more pheomelanin. While eumelanin has the ability to protect the skin from sun damage, pheomelanin does not. Thats why people with darker skin are at lower risk for developing melanoma than fair-skinned people who, due to lack of eumelanin, are more susceptible to sun damage, burning and skin cancer.
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How Is Skin Cancer Treated
Treatment depends upon the stage of cancer. Stages of skin cancer range from stage 0 to stage IV. The higher the number, the more cancer has spread.
Sometimes a biopsy alone can remove all the cancer tissue if the cancer is small and limited to your skins surface only. Other common skin cancer treatments, used alone or in combination, include:
Cryotherapy uses liquid nitrogen to freeze skin cancer. The dead cells slough off after treatment. Precancerous skin lesions, called actinic keratosis, and other small, early cancers limited to the skins top layer can be treated with this method.
Excisional surgery
This surgery involves removing the tumor and some surrounding healthy skin to be sure all cancer has been removed.
Mohs surgery
With this procedure, the visible, raised area of the tumor is removed first. Then your surgeon uses a scalpel to remove a thin layer of skin cancer cells. The layer is examined under a microscope immediately after removal. Additional layers of tissue continue to be removed, one layer at a time, until no more cancer cells are seen under the microscope.
Mohs surgery removes only diseased tissue, saving as much surrounding normal tissue as possible. Its most often used to treat basal cell and squamous cell cancers and near sensitive or cosmetically important areas, such as eyelids, ears, lips, forehead, scalp, fingers or genital area.
Curettage and electrodesiccation
Chemotherapy and immunotherapy
Determining If The Cancer Has Spread
As part of your diagnosis, your doctor will also determine what stage the cancer is in. The different stages refer to whether and how far the cancer has spread in your body, on a Roman numeral scale of I to IV. A stage I cancer is small and contained to the body part where it originated, whereas a stage IV cancer has spread aggressively to other parts of the body.
Depending on the type of skin cancer that a person has, it may be more or less likely that it has spread through the body. For instance, basal cell skin cancer rarely spreads beyond the skin where it starts. However, melanomas and large squamous cell carcinomas are more likely to spread into other regions of the body. Cases of melanoma, in particular, may call for further tests to determine the specific stage theyre in.
Your doctor may evaluate multiple factors in order to stage the cancer. Using biopsies and imaging tests, your doctor may take a look at:
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The size and thickness of the tumor, and whether it has grown into surrounding tissues
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Nearby lymph nodes, to check for signs of cancer spread
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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
When Should I See My Healthcare Provider
Make an appointment to see your healthcare provider or dermatologist as soon as you notice:
- Any changes to your skin or changes in the size, shape or color of existing moles or other skin lesions.
- The appearance of a new growth on your skin.
- A sore that doesnt heal.
- Spots on your skin that are different from others.
- Any spots that change, itch or bleed.
Your provider will check your skin, take a biopsy , make a diagnosis and discuss treatment. Also, see your dermatologist annually for a full skin review.
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Cybill Shepherd’s Melanoma Battle
- In 2001, actress Cybill Shepherd, 71, was diagnosed with melanoma after discovering a mole on the back of her neck. She had the growth removed and has been in remission since.
- Melanoma is the deadliest form of skin cancer, affecting 100,350 adults annually.
- A helpful way to detect signs of melanoma is by checking your skin, particularly following the ABCDE system.
Legendary actress Cybill Shepherd, 71, may be best known for her iconic roles in The Last Picture Show, Taxi Driver and Alice, but her personal life has always been a bit more out of the public eye than other celebrities. Known for her stunning beauty, it may be surprising for people to know that Shepherd actually battled an aggressive form of skin cancer.
With her fair skin, blonde hair, and striking blue eyes, Shepherds beauty became known across movie screens all over the country. However, in 2001 she was diagnosed with melanoma, an aggressive form of skin cancer, when doctors discovered a growth on her back. She kept her diagnosis out of the public for the duration of her treatment, but eventually spoke about the experience in 2004 after she had been in remission for three years.
After going through successful treatment, Shepherds team shared that she has checkups every few months in order to make sure there were no signs of recurrence. Thankfully, each scan came back clear.
Surgery For Skin Cancer
Small skin cancer lesions may be removed through a variety of techniques, including simple excision , electrodesiccation and curettage , and cryosurgery .
Larger tumors, lesions in high-risk locations, recurrent tumors, and lesions in cosmetically sensitive areas are removed by a technique called Mohs micrographic surgery. For this technique, the surgeon carefully removes tissue, layer by layer, until cancer-free tissue is reached.
Malignant melanoma is treated more aggressively than just surgical removal. To ensure the complete removal of this dangerous malignancy, 1-2 cm of normal-appearing skin surrounding the tumor is also removed. Depending on the thickness of the melanoma, neighboring lymph nodes may also be removed and tested for cancer. The sentinel lymph node biopsy method uses a mildly radioactive substance to identify which lymph nodes are most likely to be affected.
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When To Seek Medical Care For Skin Cancer
Many people, especially those who have fair coloring or have had extensive sun exposure, periodically check their entire body for suspicious moles and lesions.
Have your primary health care provider or a dermatologist check any moles or spots that concern you.
See your health care provider to check your skin if you notice any changes in the size, shape, color, or texture of pigmented areas .
If you have skin cancer, your skin specialist or cancer specialist will talk to you about symptoms of metastatic disease that might require care in a hospital.