Skin cancer is an over growth or multiplying of abnormal skin cells. There are multiple types of skin cancer. Skin cancer is most common on the head and neck, and exposed areas of the arm and legs. These areas of the body accumulate the most sun exposure over the course a lifetime, and the sun’s ultraviolet rays are what cause the mass majority of skin cancers. Certain skin types are also more likely to develop skin cancer. For example, individuals with lighter colored eyes, hair, and skin, who tend to freckle and burn are more at risk than those with darker eyes, hair and skin, who do not tend to burn. For these reasons, sun avoidance during peak hours (10 a.m. to 4 p.m.), and the regular use of sunscreen and sun protective clothing are recommended to avoid the damage that leads to skin cancer development. There are many companies now that design activewear with sun protection that is lightweight and comfortable. In addition, a broad brimmed hat is recommended as a baseball cap will only effectively protect your scalp and forehead. Below is a link to a handout with information on how to conduct a skin exam, apply sunscreen properly, and track any changing moles.
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Basal Cell Skin Cancer (Basal Cell Carcinoma or BCC)
This is the most common form of skin cancer, and most commonly occurs on the nose. These typically start out as a pearly papule that may look like a pimple, but it does not clear up in a few week, and instead slowly grows. These develop from an abnormal overgrowth of the cells that re-populate the epidermis that normally are located at the base of the epidermis – the basal cells. Though these tumors are known to be slow growing, and very unlikely to spread in the body, they are locally destructive. These tumors can put down extensive roots and spread farther in the skin than what is visible with the eye, for example, invading into cartilage, nerve, fat, muscle, and even bone. It is important to have these completely removed early to avoid the damage that can result from their growth.
Actinic Keratosis (AK)
These are abnormal overgrowth of skin cells in the epidermis called squamous cells. In this case though, the overgrowth of this cell type has not reached a cancerous stage, so these are thought of as a “pre-cancer.” On the skin, patients describe these as rough flaky areas that may feel like “a grain of sand.” When left untreated, some will persist on, unchanging for years, while others will regress, and some will go on to become full blown skin cancer – a squamous cell carcinoma. Actinic Keratoses can be treated in different ways, for example, with liquid nitrogen, topical creams, and with photodynamic therapy.
Squamous cell skin cancer (Squamous Cell Carcinoma or SCC)
This is the second most common form of skin cancer, it occurs most commonly on the head and neck, and exposed arms. However, these are frequently seen on the front of the legs as well, or the shin area. This form of skin cancer grows more quickly, and though it can be confined to the top layer of skin, it frequently grows roots. Squamous cell carcinoma can be more aggressive and does have a potential to spread internally. This is more likely in cases where an individual is immunosuppressed, or the tumor is invading deeply in the second layer of skin, or tracking along nerves. These tumors need to be treated early as they are not only locally destructive, but can spread along nerves, into lymph nodes, and internally.
This type of skin cancer results from a proliferation of the pigment producing cells in the skin called melanocytes. These can overgrow but remain only in the top layer of skin (Melanoma in situ), or they can extend into the second layer of skin. Melanoma is typically a darkly pigmented area on the skin, but it can also be flesh colored (amelanotic melanoma). Frequently these are noticed by a family member or the individual as they tend to appear as a mole that begins to change noticeably. Melanoma must be removed as it can spread quickly internally and can even be fatal. Early detection and treatment is key.
Other forms of skin cancer
Though basal cell skin cancer, squamous cell skin cancer, and melanoma are the most widely known amongst the public, there are numerous other types of skin cancer and tumor that can grow in the skin. For example, Merkel Cell carcinoma is far more rare than melanoma, but it is also far more aggressive. It is important to examine your skin regularly. If a spot is growing, changing, itching, or bleeding, or if a spot appeared to be a pimple, but it has been over 2-3 weeks and it is not resolving, it should be evaluated. As with all cancers, early detection is key.