TYPES OF SKIN CANCER

There are three major types of skin cancer —

1. Basal cell carcinoma

What is it? Basal cell carcinomas (BCCs) are abnormal, uncontrolled growths that arise from the skin’s basal cells in the outermost layer of skin (epidermis).

Where is it usually found? These cancers most often develop on skin areas typically exposed to the sun, especially the face, ears, neck, scalp, shoulders and back.

What causes it? Most BCCs are caused by the combination of intermittent, intense exposure and cumulative, long-term exposure to UV radiation from the sun.

How many people get it? BCC is the most common form of skin cancer, with more than 4 million cases diagnosed in the United States each year.

How serious is it? BCCs can be locally destructive if not detected and treated early. Occasionally these cancers metastasize (spread); and in very rare instances they can be fatal.

2.Squamous cell carcinoma

What is it? Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells arising from the squamous cells in the outmost layer of skin (epidermis).

Where is it usually found? SCCs are common on sun-exposed areas such as the ears, face, scalp, neck and hands, where the skin often reveals signs of sun damage, including wrinkles and age spots.

What causes it? Cumulative, long-term exposure to UV radiation from the sun and tanning beds causes most SCCs.

How many people get it? SCC is the second most common form of skin cancer. More than 1 million cases are diagnosed each year in the U.S.

How serious is it? SCCs can sometimes grow rapidly and metastasize if not detected and treated early.

3.Melanoma

What is it? Melanoma is a cancer that develops from melanocytes, the skin cells that produce melanin pigment, which gives skin its color.

Where is it usually found? Melanomas often resemble moles and sometimes may arise from them. They can be found on any area of the body, even in areas that are not typically exposed to the sun.

What causes it? Melanoma is often triggered by the kind of intense, intermittent sun exposure that leads to sunburn. Tanning bed use also increases risk for melanoma.

How many people get it? In 2020, more than 196,060 new cases of melanoma are expected to occur in the U.S., about 100,350 of which will be invasive.

How serious is it? Melanoma is the most dangerous of the three most common forms of skin cancer. Melanomas can be curable when caught and treated early. In 2020, melanoma is projected to cause about 6,850 deaths.

WHAT ARE THE RISK FACTORS FOR SKIN CANCER?

The most common risk factors for skin cancer are as follows.

• Ultraviolet light exposure, either from the sun or from tanning beds. Fair-skinned individuals, with hazel or blue eyes, and people with blond or red hair are particularly vulnerable. The problem is worse in areas of high elevation or near the equator where sunlight exposure is more intense.
• A chronically suppressed immune system (immunosuppression) from underlying diseases such as HIV/AIDS infection or cancer, or from some medications such as prednisone or chemotherapy
• Exposure to ionizing radiation (X-rays) or chemicals known to predispose to cancer such as arsenic
• Certain types of sexually acquired wart virus infections
• People who have a history of one skin cancer have a 20% chance of developing second skin cancer in the next two years.
• Elderly patients have more skin cancers.

Skin cancer treatments

Most cases of skin cancer may be treated in a dermatologist’s office or with outpatient surgery. But more aggressive skin cancers, such as melanoma or Merkel cell carcinoma, may require more extensive treatments, such as surgery, chemotherapy or immunotherapy. The most common treatments for skin cancer include:

Surgery

Surgery is the primary treatment for most skin cancers. For patients with basal cell or squamous cell carcinomas, a dermatologist or other qualified doctor may perform an outpatient procedure using a local anesthetic. In these procedures, like with most skin cancer surgeries, the cancer cells are removed, along with a small amount of surrounding skin, known as the margin. Learn more about surgery for non-melanoma skin cancer.

Topical treatments

In some cases, nonsurgical forms of therapy may be used to remove or destroy localized skin cancer cells. These techniques may be used, either alone or in combination with other treatments, to treat early-stage basal cell or squamous cell carcinomas or noncancerous or pre-cancerous lesions. Topical treatments include:

Photodynamic therapy: This technique uses photosensitive medication combined with light in an effort to kill cancer cells. In this technique, a light-sensitive substance, usually aminolevulinic acid , is applied directly to the tumor. Up to 18 hours later, the treated area is exposed to a special blue light that activates the medication, targeting cancer cells on the skin. This type of treatment is most often used on actinic keratoses, precancerous growths that may develop into squamous cell carcinomas if not treated.

Topical chemotherapy: This therapy applies a chemotherapy cream, usually fluorouracil , directly to the skin tumor. Application may be prescribed twice daily for as little as three weeks or as long 12 weeks. Topical chemotherapy may be used to treat basal cell carcinoma or actinic keratoses. The drug, also known as 5-FU, typically only affects the cells it reaches, and cannot penetrate deeply into the skin. It is generally used only for very superficial skin cancers.

Immune response modifier: The topical cream imiquimod may be used to treat actinic keratoses or superficial basal cell carcinomas. Application may be prescribed for several times a day for two to eight weeks. Imiquimod, which is designed to activate the immune system to attack cancer cells, works by stimulating the body to produce interferon, a natural protein that fights foreign invaders and cancer cells.

Chemotherapy

In most cases, systemic chemotherapy is recommended for patients with advanced skin cancer, especially Merkel cell carcinoma that has spread to distant parts of the body. Topical chemotherapy may be an option for localized basal cell carcinoma.

Radiation therapy

Skin cancer radiation therapy may be used following surgery in the area where lymph nodes were removed, to kill any remaining cancer cells. It may also be used if the cancer comes back, to reduce the size of the metastases and to relieve symptoms, particularly if the cancer has spread to the brain or bones.

Radiation therapy techniques used to treat skin cancer include:

External beam radiation therapy (EBRT): EBRT directs a beam of radiation from outside the body at cancerous tissues inside the body. It is a cancer treatment option that uses doses of radiation to destroy cancerous cells and shrink tumors. Advantages of using EBRT to treat skin cancer may include:

• EBRT is an outpatient procedure. This technique does not carry the standard risks or complications associated with major surgery for skin cancer, which can include surgical bleeding, post-operative pain or the risk of stroke, heart attack or blood clot.
• The procedure itself is painless.
• EBRT poses no risk of radioactivity to you or others with whom you have contact. As you undergo EBRT, you may continue normal activities with family and friends.

Intensity modulated radiation therapy (IMRT): If you have previously had radiation therapy for skin cancer and are experiencing recurrent tumors in the treated area, IMRT may be an option for you. Compared to standard radiotherapy, IMRT allows our radiation oncologists to use higher radiation doses than traditional therapies would allow in these areas. At the same time, IMRT helps to spare more of the surrounding healthy skin tissue from harmful doses of radiation.

TomoTherapy^®: This technology combines a form of intensity modulated radiation therapy (IMRT), with the accuracy of computed tomography (CT) scanning technology, in one machine. TomoTherapy may have may offer the following advantages for skin cancer patients:

• Uses built-in CT scanning to confirm the exact shape and location of a skin tumor seconds before your treatment begins
• Targets hard-to-reach skin tumors by sculpting small, powerful and more precise radiation beams at the tumors from a full 360 degrees.
• Limits treatment-related side effects by reducing damage to nearby healthy tissue.
• Reduces radiation exposure to muscle tissue, the spine, lungs and other sensitive organs

Targeted therapy

Targeted therapy works by seeking out specific characteristics in cancer cells, such as gene mutations or proteins. Targeted therapy drugs are designed to attach themselves to those cells, to kill them or help other therapies, such as chemotherapy, work better.

A certain type of targeted therapy drug approved to treat rare cases of advanced basal cell carcinoma are called hedgehog pathway inhibitors because they target the hedgehog pathway, a signaling mechanism critical to healthy cell growth in the fetus. The pathway typically goes dormant by adulthood, but cancer cells may re-activate the hedgehog pathways in adults, promoting tumor growth in some cases. Because of the pathway’s importance to developing fetuses, these drugs should not be taken by women who are pregnant or who may become pregnant.

Other targeted therapy drugs have been approved to treat melanoma, a potentially aggressive form of skin cancer.

Immunotherapy

Immunotherapy, which is designed to help the immune system identify and attack cancer cells, may be an option to treat Merkel cell carcinoma and melanoma.

Checkpoint inhibitors are immunotherapy drugs that work by targeting signaling proteins that allow cancer cells to disguise themselves as healthy cells.

Cytokines are immunotherapy drugs that use molecules to help regulate immune activity. The drugs alpha-interferon (IFN-alpha) and interleukin-2 (IL-2) are cytokines that may be used to treat some cases of advanced melanoma. These drugs stimulate the rapid growth and activity of immune cells so that they quickly attack the cancer cells.

Immunotherapy may not be recommended for all patients. Because they stimulate the immune system, immunotherapy treatments may also lead to side effects, such as skin rashes or gastrointestinal problems.

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