Skin cancer is, by far, the most prevalent cancer that is diagnosed in the United States. Melanoma, which typically appears as an unusual mole, is the most dangerous, but thankfully also the least common. Other types of skin cancer, Basal Cell Carcinoma and Squamous Cell Carcinoma (both non-melanoma skin cancers), are the most common types of skin cancer. Over 5.4 million cases of non-melanoma skin cancer are treated in more than 3.3 million people each year in the U.S. Even more, treatment of non-melanoma skin cancers increased by nearly 77-percent between 1992 and 2006 and over the past three decades more people have developed skin cancer than all other cancers combined. Each year there are more new cases of skin cancer reported than colon, lung, prostate and breast combined.
What can be inferred from this data? Skin cancer is by far the most common type of cancer. There are many variants out there and each can appear different in terms of symptoms on the skin. Even though some are more aggressive and dangerous than others, they are all important because even the least aggressive lesion can grow and become a big problem with time if left untreated.
Basal Cell Carcinoma
Approximately eight out of 10 skin cancers discovered are what’s known as basal cell carcinomas (also known as basal cell cancers), and they usually develop on areas that have been exposed to the sun, specifically the head and neck. They often develop as pearly pale pink, or red bumps that can look similar to an pimple. Otherwise, they can appear as “sores” or just bright red scaly patches on the skin. While typically found on the aforementioned head and neck, basal cell carcinomas can occur anywhere on the body; larger or long-standing basal cell carcinomas may exhibit oozing, crusting or bleeding. There is a variant of basal cell carcinoma that can also have blue or brown areas.
They are generally very slow growing, so even if a lesion has been there for many years and appears to be innocuous. It could still be a basal cell carcinoma and slowly but surely invading the lower levels of the skin over time.
Approximately two of every 10 skin cancers reported are of the squamous cell carcinoma type (also referred to as squamous cell cancers). Some of these cancers begin as actinic keratoses (AK), a sort of pre-skin cancerous lesion. AKs usually show up as small, rough or scaly pink-red patches that tend to start on sun-exposed areas. They are often easier to feel than see and feel gritty or rough like sandpaper. People may often feel like it’s a little area of dry skin that never quite goes away. It is common for actinic keratoses to feel better on some days and worse on others, but they usually never completely heal.
Since actinic keratoses are at risk for becoming skin cancer, they should be treated. The treatment of an AK is much easier and less invasive than that of skin cancer, so treating AKs will save you from a surgical procedure if it did go on to become a skin cancer.
Bowen’s/Squamous Cell Carcinoma In Situ
Squamous cell carcinoma in situ – also called Bowen’s disease – represents the earliest form of squamous cell skin cancer (SCC) and often appears as rough patches in sun-exposed areas, or sometimes in the skin of the anal or genital areas. These patches tend to be larger, redder and scalier than AKs, and because Bowen disease can be hard to tell apart from SCC (and can sometimes progress to an invasive SCC).
It will be difficult for you to tell the difference between Bowen’s or Squamous Cell Carcinoma In Situ, and will usually require a biopsy to make the diagnosis. In any case, it will need to be treated as any other skin cancer would.
Squamous Cell Carcinoma
Squamous cell carcinomas tend to look like red, crusty bumps and may sometimes have a very thick crust on top. They usually occur on sun-exposed areas of the body (seeing a pattern form here?) such as the face, ears, neck, lips and backs of the hands. They can also develop in scars or skin sores on any part of the body. Squamous cell cancers are more likely to grow into deeper layers of skin and spread to other parts of the body than basal cell cancers, although it is still rare. They can be more dangerous when they occur on the head and neck and also, when they occur in patients who have a compromised immune system either from illness or medications that they are taking.
In any case, they should be treated aggressively to prevent growth or spread.
We all have some moles on our bodies, and nearly all of them are completely harmless. A normal mole is usually identified as an evenly-colored brown, tan or black spot on the skin and can be either flat or raised, round or oval. As we begin to move into our focus on melanomas, it must be mentioned that melanoma is a cancer that begins in the cells that give skin its color (melanocytes) – but normal moles also develop from these skin cells. When these moles become slightly irregular in size, shape, or color then there’s a chance that they are becoming atypical or “dysplastic” (medical term for irregular). Dysplastic moles are concerning because they are moving in the direction of melanoma. Most dysplastic moles will never become melanoma, but we do not leave them on the body to take the risk. Any irregular, new or changing mole should be evaluated also.
The rarest type (at least when compared to basal cell and squamous cell) skin cancer is also the far more dangerous type – melanomas typically look like brown spots like moles, but often have more than one color,exhibit jagged borders, and are not regular circles or ovals. Melanomas do not have to have all of these characteristics, so identification may be difficult, which is why examination and treatment by a dermatologist is so vital. Melanomas can occur anywhere on the skin, but they are more likely to start in specific areas – the “trunk” (chest and back) is the most common site amongst men, while the legs are the most common areas in women. The neck and face, like other skin cancers, are other common sites to find melanoma.
These often look different from other spots on the skin, but the diagnosis is not always so easy. If you have a particularly concerning spot or new mole, then make sure you see a dermatologist, a skin specialist like Dr. Steele, that evaluates thousands of moles and is skilled in the nuances of the appearance of normal moles, dysplastic moles, and melanoma. If anything just doesn’t look right to you, then it is better to get it evaluated sooner than later.
Melanomas are typically brown or black, but some can appear as pink, tan white or any other color. They are also more likely than normal moles to have more than one color or be uneven in color. They are often irregular and asymmetric in shape as well and deviate from a uniformly circular or oval shape. Melanomas can grow quickly or slowly, so new moles and change in moles is an important red flag. Melanomas can occur in places that can be difficult to spot and areas that have not gotten a lot of sun over time, like the bottoms of the feet, genitalia, anus, etc. so skin exams at home and in the dermatologist office are important.
Melanomas are more common in fair-skinned people, however they can occur in people of all races and ethnicities. When we see them in people of darker skin types they are more likely to develop on the palms of the hands, soles of the feet or under the nails.
Melanoma is uniquely dangerous because it can readily spread from the skin to other organs through the lymph nodes, just like internal cancers like breast, colon and lung cancer can. When the tumor is more advanced then there are many more diagnostic and prognostic tests that are required with aggressive treatment regimens. On the other hand, if melanoma is caught early while it is still in the most superficial layers of skin, then it can be treated with a very high cure rate just by removing the lesion with and extra safety margin of tissue.
Early detection is key when if comes to melanoma, and really, all types of skin cancer. How you catch skin cancer early has everything to do with being very aware of your skin; look yourself over head-to-toe once a month, and see a dermatologist once or twice a year while always remembering to use sunscreen, being smart in the sun and steering clear of tanning beds.