Skin cancer is the most common type of cancer in the United States. Every year more than 1 million Americans are diagnosed with some type of skin cancer. Knowing the type of skin cancer you have is important because it affects the treatment plan your doctors develop for you. Fortunately, skin cancers, including melanoma, can be successfully treated the earlier they are detected; the 5-year survival rate for melanoma is 99 percent when detected early.
Since there are different types of skin cancer, there are different symptoms associated with each cancer. There are three major types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma—the most serious type of skin cancer. Merkel cell carcinoma, while rare, often begins in skin areas exposed to the sun, especially the head, neck, and face.
Many patients find early signs of skin cancer by being proactive and diligent about performing skin self-exams, and watching for any changes in their skin. You should consult with your doctor if you notice any marks on your skin that change color, size, feels differently or if you have a wound that does not heal. Early detection of any skin cancer makes a crucial difference in your prognosis and treatment.
Types of Skin Cancer
Basal cell carcinoma may appear as:
- A pearly or waxy bump on your face, ears or neck
- A flat, flesh-colored or brown scar-like lesion on the chest or back
Squamous cell carcinoma may appear as:
- A firm, red nodule on the face, lips, ears, neck, arms or hands
- A flat lesion with a scaly crusted surface on the face, ears, necks, arms or hands
Melanoma warning signs may be identified by remembering your A-B-C-D-Es when examining your skin:
- “A” is for asymmetrical; a mole/spot may have two parts looking different or are irregularly shaped
- “B” is for border; the edges can be uneven or irregular
- “C” is for color; the color may be uneven
- “D” is for diameter; the mole/spot may be larger than a pea
- “E” is for evolving; you may notice the mole/spot changed recently
Merkel cell carcinoma may appear as:
- A single, painless, dome-shaped lump that may appear pink, red or purple
- The bump may appear shiny and sometimes the top of the bump may begin to bleed
Skin Cancer Risk Factors
Your skin is the largest organ of your body and consists of different layers including the upper/outer layer (epidermis) and the lower/inner layer (dermis). Skin cancer is the abnormal growth of skin cell and originates in the epidermis. The skin most exposed to sunlight such as your face, neck, and hands is more prone to skin cancer, however, skin cancer may occur anywhere on your body. While there are some risk factors that you cannot control, such as skin color, there are ways to reduce your risk of skin cancer. For instance, the daily use of a sunscreen with an SPF 15 or higher has been shown to reduce your risk of developing squamous cell carcinoma by 40 percent.
If you have any of the following, you could be at higher risk for melanoma and other types of skin cancers:
- Sunburns (at least one blistering burn) as a child or adolescent
- Fair skin and light colored eyes
- A personal history of melanoma or other skin cancers
- A family history of melanoma
- Multiple moles
- Atypical (oddly shaped) moles
- A mole or lesion that is changing size or shape or is itching or bleeding
- A history of UVA sunbed/tanning salon use
Skin Cancer Diagnosis & Staging
If your physician suspects a skin cancer during a physical examination, there are several tests that you may have to determine the cancer type and stage. These include:
- Biopsy: During this test, cells from the area of concern are removed so they can be studied in the lab. There are a number of types of biopsies and your physician determines which one is appropriate based on many factors including the type of suspected skin cancer, location and size. Skin biopsies include:
- Shave biopsy (tangential): A small blade is used to remove a sample of the suspect area and sent to the lab for examination.
- Punch biopsy: A sharp, hollow, circular blade is rotated on the skin to cut through the layers of the skin and remove a sample of the suspect area.
- Excisional and incisional biopsies: An excisional biopsy removes the suspect area as well as some surrounding tissue; an incisional biopsy removes part of the suspected tumor.
- Imaging Tests: Your physician may order imaging tests, including Magnetic Resonance Imaging (MRI), Computed Tomography (CT) or Positron Emission Tomography (PET) scans if it is believed the cancer spread beyond the skin.
- Additional testing for melanoma and merkel cell carcinoma: Melanoma can spread quickly to the lymph nodes or other areas of the body. If you are diagnosed with a melanoma, your physician may order:
- Sentinel lymph node biopsy: A sentinel lymph node biopsy is a way of pinpointing the first few lymph nodes into which a tumor drains (called the “sentinel” node). This helps doctors remove only those nodes that are most likely to contain cancer cells, since sentinel nodes are the first place cancer is likely to spread. It also helps to alleviate the need for additional nodes to be removed if the sentinel node is negative.
- Fine needle aspiration: A thin needle is inserted externally and guided to the tumor to acquire a tissue sample.
- Surgical lymph node biopsy: A surgical lymph node biopsy may be used to remove lymph node tissue or the whole suspect lymph node(s).
Once your doctor diagnoses your type of skin cancer, the doctor determines how significant the cancer is and defines the stage of the cancer. Your physician works with you to design the best treatment plan for your specific type of skin cancer.