What is Skin Cancer?

Basal cell carcinoma (BCC) is the most common form of cancer, with about a million new cases estimated in the U.S. each year. Basal cells line the deepest layer of the epidermis. An abnormal growth, a tumor, in this layer is, therefore, a basal cell carcinoma.

Basal cell carcinoma can usually be diagnosed with a simple biopsy and is fairly easy to treat when detected early. However, 5 to 10 percent of BCCs can be resistant to treatment or locally aggressive, damaging the skin around them, and sometimes invading bone and cartilage. When not treated quickly, they can be difficult to eliminate. Fortunately, however, this is a cancer that has an extremely low rate of metastasis, and although it can result in scars and disfigurement, it is not usually life threatening.

Cause
The sun is responsible for over 90 percent of all skin cancers, including BCCs, which occur most frequently on the sun-exposed areas of the body: face, ears, neck, scalp, shoulders, and back.

Am I at risk?
Anyone with a history of frequent or intermittently intense sun exposure can develop BCC, but a number of factors increase risk.

Time Spent Outdoors - People who work outdoors, construction workers, groundskeepers, lifeguards, etc., are at greater risk than people who work indoors, as are those who spend their leisure hours in the sun.

Skin Type - Fair-skinned individuals who sunburn easily and tan minimally or not at all have a higher incidence of skin cancer than dark-skinned individuals.

Hours of sunlight - The more hours of sunlight in the day, the greater the incidence of skin cancer. For example, there are more cases in Arizona, Texas and Florida, states that are closer to the equator and get more sun, than in the more northern states of Maine, Oregon and Washington.

Warning Signs
The five most typical characteristics of basal cell carcinoma are shown in the pictures below. Frequently, two or more features are present in one tumor. In addition, BCC sometimes resembles noncancerous skin conditions such as psoriasis or eczema. Only a trained physician can decide for sure. If you observe any of the warning signs or some other change in your skin, consult your physician immediately. 

 Nodular basal cell carcinoma - Most common type. This tumor usually resembles a smooth, round, waxy pimple, pale yellow or pearl gray, and may vary in size from a few millimeters to 1 centimeter. Often, the skin covering the nodule is so thin that the slightest injury will cause it to bleed. These tumors are often depressed in the middle and show ulceration. As the tumor grows, it destroys healthy structures in its path, including nerves, muscles and blood vessels. Large tumors are easily diagnosed, but smaller ones are often difficult to tell from noncancerous skin conditions, such as warts, seborrheic keratoses, moles, and psoriasis.

Superficial - This is a less common form of BCC. It is a progressively spreading, slow-growing cancer that differs greatly from other types. The tumor is red, with a slightly raised, ulcerated or crusted surface, often bordered with pearly or threadlike formations. Tumors usually appear as patches on the torso, but can develop more extensively on the face and neck. This is often mistaken for other skin conditions such as fungal infections, eczema or psoriasis.

Sclerosing or Fibrosing - Fibrosing basal cell carcinoma is also called morphea-like carcinoma. This fibrosing type of tumor begins as a flat or slightly depressed, shiny, hard, yellow-white patch with an irregular border. Sometimes, it may be present for years without growing or being recognized. More often, though, the lesion grows quickly, reaching a diameter of several centimeters within a few months. This is a fairly uncommon type of skin cancer, and can be difficult to eradicate because of invisible root-like extensions of the tumor that reach into the underlying tissue.

Pigmented - Pigmented basal cell carcinoma is similar to nodular basal cell carcinoma, but is more likely to appear in people with dark hair or dark eyes. As its name implies, this growth is almost black and can easily be mistaken for the more aggressive melanoma.

Fibroepithelioma - This is a rare type of basal cell carcinoma appearing as one or more slightly elevated, reddish lesions. Usually they arise on the back.

Basosquamous carcinoma - Squamous and basal cell carcinoma can coexist as one tumor growth at the same time. Clinically, it can look like a basal cell or squamous cell carcinoma. Basosquamous cell carcinomas are believed by some researchers to have a greater tendency to metastasize. These tumors require immediate and aggressive treatment.

Basal cell nevus syndrome - Rarely, basal cell carcinoma may develop as part of an inherited condition, commonly referred to as nevoid basal cell carcinoma syndrome or Gorlin syndrome. Unlike other skin cancer conditions, this syndrome may develop during childhood or adolescence, and as many as 50-100 cancers may be involved. Sometimes, the skin cancers increase in number as the person reaches adulthood. Clinically, they have the same appearance as basal cell carcinomas.

Treatment
The vast majority of BCCs are not serious if detected early and treated quickly. The BCCs that cause trouble are the ones that have been neglected until they have become so thick that they are hard to treat.

There is no one best method to treat all skin cancers and precancers. The choice is determined by many factors, including the location, type and size, whether it is a primary tumor or a recurrent one, the health and preference of the patient, and the physician's experience with the technique. For example, a treatment that has a high cure rate and is painless but leaves a large scar might be acceptable for a tumor on the body, but not on the face.

Almost all treatments can be performed in the physician’s office or in a special surgical facility. Most skin cancer removal can be done using a local anesthetic. Rarely, extensive tumors may require general anesthesia and hospital admission. 

 Melanoma is the most serious form of skin cancer. However, if it is recognized and treated early, it is nearly 100 percent curable. But if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths. The American Cancer Society estimates that in 2007, there will be 8,110 fatalities, 5,220 in men and 2,800 in women in the U.S. The number of new cases of melanoma is estimated at 59,940. Of these new cases, 33,910 will be in men and 26,030 in women. Melanoma is a malignant tumor that originates in melanocytes, the cells which produce the pigment melanin that colors our skin, hair and eyes. The majority of melanomas are black or brown. However, some melanomas are skin-colored, pink, red, purple, blue or white.

Am I at risk?
Everyone is at some risk for melanoma, but increased risk depends on several factors: sun exposure, number of moles on the skin, skin type and family history (genetics).

Sun exposure - Both UVA and UVB rays are dangerous to the skin and can induce skin cancer, including melanoma. Blistering sunburns in early childhood increase risk, but cumulative exposure also is a factor. People who live in locations that get more sunlight — like Florida, Hawaii, and Australia — get more skin cancer. Avoid using a tanning booth or tanning bed, since it increases your exposure to UV rays, thus increasing your risk of developing melanoma and other skin cancers.

Moles- There are two kinds of moles: normal moles — the small brown blemishes, growths, or "beauty marks" that appear in the first few decades of life in almost everyone — and atypical moles, also known as dysplastic nevi. Regardless of type, the more moles you have, the greater your risk for melanoma.

Skin Type- As with all skin cancers, people with fairer skin are at increased risk.

Family History- About one in every ten patients diagnosed with the disease has a family member with a history of melanoma. If your mother, father, siblings or children have had a melanoma, you are in a melanoma-prone family. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease than people who do not have a family history. If the cancer occurred in a grandmother, grandfather, aunt, uncle, niece or nephew, there is still an increase in risk, although it is not as great.

Personal History- Once you have had melanoma, you run an increased chance of recurrence. Also, people who have or had basal cell carcinoma and squamous cell carcinoma are at increased risk for developing melanoma.

Weakened Immune System - A compromised immune system resulting from chemotherapy, an organ transplant, excessive sun exposure, and diseases such as HIV/AIDS or lymphoma can increase your risk of melanoma.

Warning Signs: The ABCDEs of Melanoma
Moles, brown spots and growths on the skin are usually harmless — but not always. Anyone who has more than 100 moles is at greater risk for melanoma. The first signs can appear in one or more atypical moles. That's why it's so important to get to know your skin very well and to recognize any changes in the moles on your body. Look for the ABCDEs of melanoma, and if you see one or more, make an appointment with a dermatologist immediately. 

Types of Melanoma

The basic types of Melanomas fall into four categories. Three of them begin in situ, meaning they occupy only the top layers of the skin and sometimes become invasive; the fourth is invasive from the start. Invasive melanomas are more serious, as they have penetrated deeper into the skin and may have spread to other areas of the body.

Superficial spreading melanoma - By far the most common type, accounting for about 70 percent of all cases. This is the one most often seen in young people. As the name suggests, this melanoma travels along the top layer of the skin for a fairly long time before penetrating more deeply.

The first sign is the appearance of a flat or slightly raised discolored patch that has irregular borders and is somewhat geometrical in form. The color varies, and you may see areas of tan, brown, black, red, blue or white. This type of melanoma can occur in a previously benign mole. The melanoma can be found almost anywhere on the body, but is most likely to occur on the trunk in men, the legs in women, and the upper back in both.

Lentigo maligna- Similar to the superficial spreading type, as it also remains close to the skin surface for quite a while, and usually appears as a flat or mildly elevated mottled tan, brown or dark brown discoloration. This type of in situ melanoma is found most often in the elderly, arising on chronically sun-exposed, damaged skin on the face, ears, arms, and upper trunk. Lentigo maligna is the most common form of melanoma in Hawaii. When this cancer becomes invasive, it is referred to as lentigo maligna melanoma.

Acral lentiginous melanoma - Spreads superficially before penetrating more deeply. It is quite different from the others, though, as it usually appears as a black or brown discoloration under the nails, on the soles of the feet or palms of the hands. It is the most common melanoma in African-Americans and Asians, and the least common among Caucasians.

Nodular melanoma- Usually invasive at the time it is first diagnosed. The malignancy is recognized when it becomes a bump. It is usually black, but occasionally is blue, gray, white, brown, tan, red or skin tone.

The most frequent locations are the trunk, legs and arms, mainly of elderly people, as well as the scalp in men. This is the most aggressive of the melanomas, and is found in 10 to 15 percent of cases.

Treatment
When it comes to the early stages of the disease, the future is bright. Most people with thin, localized melanomas are cured by appropriate surgery. Early detection still remains the best weapon in fighting skin cancer.

More treatments are available for more advanced disease. The cure rate continues to rise. Research has produced a greater understanding of melanoma, leading to the development of new drugs. A Brevard Skin and Cancer Center physician will go over all treatment options with you.