Skin cancer causes and symptoms

Skin cancer facts

The number of basal cell and squamous cell skin cancers (i.e., keratinocyte carcinomas), more commonly referred to as nonmelanoma skin cancers (NMSC), is difficult to estimate because these cases are not required to be reported to cancer registries. One study of NMSC occurrence in the US estimated that in 2006, 3.5 million cases were diagnosed among 2.2 million people. Most cases of NMSC are highly curable. An estimated 76,100 new cases of melanoma will be diagnosed in 2014. Melanoma accounts for less than 2% of all skin cancer cases, but the vast majority of skin cancer deaths. Melanoma is rare among African Americans; lifetime risk of developing the disease is 0.1%, compared to 2.4% among whites. Incidence rates are higher in women than in men before the age of 45, but by the age of 60, rates in men are more than double those in women and by the age of 80 they are almost triple. Melanoma incidence rates have been increasing for at least 30 years. From 2006 to 2010, incidence rates among whites increased by 2.7% per year.

Deaths by skin cancer:

An estimated 9,710 deaths from melanoma and 3,270 deaths from other types of skin cancer (not including NMSC) will occur in 2014. Death rates for melanoma have been declining rapidly in whites younger than 50: from 2006 to 2010, rates decreased by 2.6% per year in men and by 2.0% per year in women. In contrast, among whites 50 and older, death rates increased by 1.1% per year in men and by 0.2% per year in women during this same time period.

Signs and symptoms of skin cancer

Important warning signs of melanoma include changes in the size, shape, or color of a mole or other skin lesion, the appearance of a new growth on the skin, or a sore that doesn’t heal. Changes that progress over a month or more should be evaluated by a doctor. Basal cell carcinomas may appear as growths that are flat, or as small, raised, pink or red, translu- cent, shiny areas that may bleed following minor injury.

Squamous cell carcinomas may appear as growing lumps, often with a rough surface, or as flat, reddish patches that grow slowly.

Risk factors of skin cancer:

Risk factors vary for different types of skin cancer. For melanoma, major risk factors include a personal or family history of melanoma and the presence of atypical, large, or numerous (more than 50) moles. Other risk factors for all types of skin cancer include sun sensitivity (e.g., sunburning easily, difficulty tanning, or natural blond or red hair color); a history of excessive sun exposure, including sunburns; use of tanning booths; diseases or treatments that suppress the immune sys- tem; and a past history of skin cancer.

Prevention of skin cancer:

Skin should be protected from intense sun expo- sure by wearing tightly woven clothing and a wide-brimmed hat, applying sunscreen that has a sun protection factor (SPF) of 30 or higher to unprotected skin, seeking shade (especially at midday, when the sun’s rays are strongest), and avoiding sun- bathing and indoor tanning. Sunglasses should be worn to protect the skin around the eyes. Children in particular should be protected from the sun because severe sunburns in child- hood may greatly increase the risk of melanoma later in life. Tanning beds and sun lamps, which provide an additional source of UV radiation, can cause skin cancer and should be avoided. The International Agency for Research on Cancer has classified indoor tanning devices as “carcinogenic to humans” based on an extensive review of scientific evidence.

Early detection of skin cancer:

At this time, the best way to detect skin cancer early is to recognize new or changing skin growths, particularly those that look different than surrounding moles. All major areas of the skin should be examined regularly, and any new or unusual lesions, or a progressive change in a lesion’s appearance (size, shape, or color, etc.), should be evaluated promptly by a physician. Melanomas often start as small, mole-like growths that increase in size and may change color. A simple ABCD rule outlines the warning signals of the most common type of melanoma:

A is for asymmetry (one half of the mole does not match the other half);
B is for border irregularity (the edges are ragged, notched, or blurred);
C is for color (the pigmentation is not uni- form, with variable degrees of tan, brown, or black);
D is for diameter greater than 6 millimeters (about the size of a pencil eraser). Other types of melanoma may not have these signs, so be alert for any new or changing skin growths.

Treatment of skin cancer:

Most early skin cancers are diagnosed and treated by removal and microscopic examination of the cells. Early stage basal cell and squamous cell cancers can be treated in most cases by one of several methods:
surgical excision, electrodesic- cation and curettage (tissue destruction by electric current and removal by scraping with a curette), or cryosurgery (tissue destruction by freezing). Radiation therapy and certain topical medications may be used in some cases. For malignant melanoma, the primary growth and surrounding normal tissue are removed and sometimes a sentinel lymph node is biopsied to determine stage. More extensive lymph node surgery may be needed if the sentinel lymph nodes contain cancer. Melanomas with deep invasion or that have spread to lymph nodes may be treated with surgery, immunotherapy, chemotherapy, and/or radiation therapy. Advanced cases of melanoma are treated with palliative surgery, newer targeted or immunotherapy drugs, and sometimes chemotherapy and/or radiation therapy. The treatment of advanced melanoma has changed in recent years with the FDA approval of targeted drugs such as vemu- rafenib (Zelboraf), dabrafenib (Tafinlar), and trametinib (Mekinist) and the immunotherapy drug ipilimumab (Yervoy).

Survival by skin cancer:

Almost all cases of basal cell and squamous cell skin cancer can be cured, especially if the cancer is detected and treated early. Melanoma is also highly curable if detected in its earliest stages and treated properly. However, melanoma is more likely than NMSCs to spread to other parts of the body. The 5- and 10-year relative survival rates for people with melanoma are 91% and 89%, respectively. For localized melanoma (84% of cases), the 5-year survival rate is 98%; survival declines to 62% and 16% for regional and distant stage disease, respectively.

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