The Most Common Kind of Cancer

Your skin is your body’s largest organ. It has many functions, and the most important one is keeping germs and harmful substances out of your body. Your skin has three layers: 

• Epidermis: the outside layer, that acts as a barrier
• Dermis: contains hair follicles, sweat glands and connective tissue
• Hypodermis: the deepest layer, made of fat and connective tissue

Skin cancer begins in the epidermis, which is made up of three kinds of cells:

• Squamous cells: thin, flat cells that form the top layer
• Basal cells: round cells under the squamous cells
• Melanocytes: cells that make pigment that gives the skin its color

Skin cancer affects millions of Americans each year. In fact, more people are diagnosed with skin cancer each year in the U.S. than all other cancers combined, and more than two people die of the disease every hour. At least one in five Americans will develop skin cancer by the age of 70.

There are three common types of skin cancer:

• Basal cell carcinoma (BCC): the most common skin cancer that rarely spreads to nearby lymph nodes or other organs.
• Cutaneous squamous cell carcinoma (cSCC): also a common type, but not as common as basal cell. It has a somewhat higher rate of spread.
• Melanoma: affects melanocytes. It’s more serious and much more likely to spread, but is not as common. Its rate of spread to lymph nodes is anywhere from 2% to 40%, depending on its depth. Melanoma is responsible for about 75% of skin cancer deaths.

Higher stage cutaneous squamous cell carcinoma and melanoma patients have lower survival rates. Basal cell carcinoma that has spread can decrease your quality of life, but most people who are treated have a normal life span.

The most common cause of skin cancer is ultraviolet (UV) radiation, usually from sun exposure, but you can also be exposed to this through tanning beds. That is why it is extremely important to wear sunscreen and protect your skin from the sun.

Other risk factors include:

• Age - the longer you are exposed to the sun over time, the higher your risk of developing skin cancer
• Having a fair complexion, blond or red hair, freckles, blue eyes and/or a tendency to sunburn
• Being immunocompromised, typically due to taking immunosuppressive drugs because of an organ transplant or being chronically immunosuppressed, because your body's immune system is not able to fight cancer cells as well
• A personal history of skin cancer
• Some diseases, such as human papilloma virus (HPV), as well as chronic inflammation from burns and other wounds, which can lead to cutaneous squamous cell carcinoma.
• People who have had an organ transplant or are chronically immunosuppressed have an immune system that is not able to fight cancer cells well.
• Hereditary diseases, including xeroderma pigmentosum and Gorlin (basal cell nevus) syndrome

No everyone with risk factors gets skin cancer. However, if you have risk factors, it's a good idea to discuss them with your health care provider.

The best way to prevent skin cancer is to protect your skin from the sun. Use sunscreen with a sun protection factor (SPF) of at least 15 when you go outside, even if it’s cloudy. Seek shelter in the shade, and don’t use tanning beds or sunlamps. Even if you tan easily or have darker skin, you’re still at risk of getting skin cancer. If you have fair skin, your risk is even higher.

Have your doctor check any lesions, moles or changes on your skin. It’s a good idea to have your skin checked by a doctor every year.

Symptoms, Diagnosis & Outlook

Skin cancer symptoms can vary depending on the type of skin cancer and its location on the skin. In general, any new or changing spots on your skin that persist for two weeks or more should be brought to your doctor’s attention.

The most common location for certain kinds of skin cancer is on sun-exposed skin, such as the face, neck, arms and legs. Skin cancer often has no symptoms in its early stages, though symptoms can appear at any point.

Look for: 

• A new spot on the skin or an existing spot that changes in size, shape or color. These changes can vary greatly so there is no one way to describe how a skin cancer looks.
• A spot that is itchy or painful
• A nonhealing sore that bleeds or develops a crust
• Thick, raised or rough skin that seems to spread
• Dark brown or black lesions, or different colors within a lesion
• A red- or skin-colored shiny bump on the top of the skin
• A red rough or scaly spot that you can feel
• A growth with a raised border and central crust or bleeding
• A wart-like growth
• Irregular or indistinct borders, including a scar-like growth without a well-defined border

Doctors who specialize in the treatment of skin are called dermatologists. Your Penn State Health dermatologist will ask you to answer in-depth questions about your personal and family medical history and will examine your skin using dermoscopy, which is a microscopic examination of the lesions. Depending on the location of your skin cancer, you may also be treated by a specialist in head and neck surgery, called an otolaryngologist.

You may have a biopsy, in which a small tissue sample is taken from the area to confirm the diagnosis and check for the extent of any cancer. In most cases, biopsies can be performed in the office, but your specialist may want a more thorough evaluation by performing a biopsy in the operating room under general anesthesia. The different types of skin cancer biopsies include:

• Local excision/excisional biopsy: all or part of the suspicious area is removed with a scalpel under local anesthetic. Depending on the size and location of the area, this type of biopsy may be done in a doctor's office or as an outpatient procedure at a hospital. If the growth is small enough to be removed entirely during the biopsy, local excision can be both a diagnostic procedure and a treatment.
• Punch biopsy: the doctor uses a special tool to punch through the suspicious area and remove a round cylinder of tissue. If needed, patients may receive stitches to close the wound.
• Shave biopsy: the doctor shaves off a piece of the growth. This can be performed with a scalpel, surgical scissors or other special tools. Typically, no stitches are needed.

After the biopsy procedure, the skin sample is sent to a pathologist, which is a doctor who specializes in diagnosing disease. After examining the tissue under a microscope, the pathologist will make a diagnosis.

Results include benign (noncancerous) growths, such as moles, warts and benign skin tumors. If the sample reveals cancer, the pathologist will determine if it is a basal cell carcinoma, squamous cell carcinoma, melanoma or other skin cancer.

Your doctor may also order the following tests:

• Computed tomography (CT or CAT) scan: takes detailed images of internal organs, bones, soft tissue and blood vessels. Your physician is able to use the cross-sectional images to confirm the presence, size and location of cancer. 
• Magnetic resonance imaging (MRI) scan: takes detailed pictures to help diagnose cancer and monitor the effectiveness of treatments. You may have a brain MRI if your doctor suspects the cancer has spread to this area.
• Positron emission tomography (PET) scan: generally used in later-stage cancers to determine if cancer has spread to other organs. PET scans are sometimes combined with CT scans to provide a more precise and accurate diagnosis. 

Cancer is often described in stages that rate the severity of the cancer and help your doctor determine the best treatment plan for you. Skin cancer stages range from 1, which is the least severe, to the most severe, stage 4.

Treatments for skin cancer include:

• Surgery: usually the main treatment. When surgeons remove the cancer, they may also remove nearby lymph nodes (called the sentinel lymph nodes) to see whether the cancer has spread to them. If these lymph nodes contain cancer cells, other lymph nodes may need to be removed.
  • If the skin cancer is near your throat, your throat may need reconstruction. You may also need a skin graft using tissue from elsewhere in your body.
• Radiation treatment, with or without chemotherapy, along with surgery, or if surgical treatment is not appropriate. Radiation as the main treatment can only be done once. If radiation is the main treatment instead of surgery, and the cancer returns, surgery may be the only option.

Side effects of surgery for skin cancer can include:

• Anesthesia risks
• Infection
• Bleeding
• Pain
• Scars and other cosmetic damage

Side effects of radiation depend upon where the cancer is, and can include:

• Skin redness, blistering or peeling
• Changes in skin color
• Hair loss in the area being treated
• Damage to glands and teeth if the cancer is nearby

Chemotherapy side effects depend on the type of drugs used.

If you follow the recommended treatment for early-stage skin cancer, you will most likely fully recover. Your chance for long-term survival is excellent. Keep in mind that life span and quality of life after skin cancer depends on your age, health and other factors. Your doctor will talk to you about what to expect and how to care for yourself after treatment.

Why Choose Penn State Health for Care

Comprehensive, Compassionate Care

Penn State Health provides specialized testing, treatment and management for skin cancer. Our medical team is consistently recognized nationally through Best Doctors in America and America’s Top Doctors awards. Our specialists also participate in worldwide conferences and speaking engagements in countries including India, Korea, Germany, Japan and others.

Leading-Edge Clinical Trials

The skin cancer experts at Penn State Health Milton S. Hershey Medical Center and Penn State Cancer Institute are committed to offering their patients the latest treatment options, including access to leading-edge clinical trials. Our superb clinical research team includes dedicated research nurses, clinical trial coordinators and data analysts and gives patients the opportunity to participate in the latest clinical trials. Learn more about new Penn State Health clinical trials at StudyFinder.

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