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Skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of the skin. The skin protects the body against heat, light, infection, and injury. It also stores water, fat, and vitamin D.
The skin has 2 main layers and several kinds of cells. The top layer of skin is called the epidermis. It contains 3 kinds of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and cells called melanocytes, which give the skin its color.
The inner layer of skin is called the dermis. This layer is thicker, and contains blood vessels, nerves, and sweat glands. The hair on the skin also grows from tiny pockets in the dermis, called follicles. The dermis makes sweat, which helps to cool the body, and oils that keep the skin from drying out.
There are several types of cancer that start in the skin. The most common are basal cell cancer and squamous cell cancer, which are covered in this PDQ patient information summary. These types of skin cancer are called nonmelanoma skin cancer. Melanoma is a type of skin cancer that starts in the melanocytes. It is not as common as basal cell or squamous cell skin cancer, but it is much more serious. (Refer to the PDQ summary on Melanoma Treatment for more information.)
Skin cancer is more common in people with light colored skin who have spent a lot of time in the sunlight. Skin cancer can occur anywhere on the body, but it is most common in places that have been exposed to more sunlight, such as the face, neck, hands, and arms.
Skin cancer can look many different ways. The most common sign of skin cancer is a change on the skin, such as a growth or a sore that won't heal. Sometimes there may be a small lump. This lump can be smooth, shiny and waxy looking, or it can be red or reddish brown. Skin cancer may also appear as a flat red spot that is rough or scaly. Not all changes in the skin are cancer, but a doctor should be seen if changes in the skin are noticed.
If there is a spot or lump on the skin, a doctor may remove the growth and look at the tissue under a microscope. This is called a biopsy. A biopsy can usually be done in a doctor's office. Before the biopsy, the patient will be given a local anesthetic to numb the area for a short period of time.
Most nonmelanoma skin cancers can be cured. The chance of recovery (prognosis) and choice of treatment depend on the type of skin cancer and how far it has spread.
Other kinds of cancer that may affect the skin include cutaneous T-cell lymphoma, a cancer of the lymph system, and Kaposi's sarcoma. (Refer to the PDQ summaries on Mycosis Fungoides and the Sezary Syndrome Treatment and Kaposi's Sarcoma Treatment for more information.) Cancers that start in other parts of the body may also spread (metastasize) to the skin.
Once skin cancer is found, more tests may be done to see if the cancer has spread. This is called staging. A doctor needs to know the stage and type of skin cancer to plan treatment. The following types are used to plan treatment:
Basal cell cancer is the most common type of nonmelanoma skin cancer. It usually occurs on areas of the skin that have been in the sun. Often this cancer appears as a small raised bump that has a smooth, pearly appearance. Another type looks like a scar, and it is firm to the touch. Basal cell cancers may spread to tissues around the cancer, but it usually does not spread to other parts of the body.
Squamous cell tumors also occur on areas of the skin that have been in the sun, often on the top of the nose, forehead, lower lip, and hands. They may also appear on areas of the skin that have been burned, exposed to chemicals, or had x-ray therapy. Often this cancer appears as a firm red bump. Sometimes the tumor may feel scaly or bleed or develop a crust. Squamous cell tumors may spread to the lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).
Actinic keratosis is a skin condition that is not cancer, but can change into basal cell or squamous cell skin cancer in some people. It appears as rough, red or brown, scaly patches on the skin, usually in areas that have been exposed to the sun.
Recurrent disease means that the cancer has come back (recurred) after it has been treated.
There are treatments for all patients with skin cancer. Three kinds of treatments are used:
Many skin cancers are treated by doctors who treat skin diseases (dermatologists). Often, the cancer can be treated in a doctor's office.
Surgery is the most common treatment of skin cancer. A doctor may remove the cancer using one of the following:
Surgery may leave a scar on the skin. Depending on the size of the cancer, skin may be taken from another part of the body and put on the area where the cancer was removed. This is called a skin graft. New ways of doing surgery and grafting may reduce scarring.
Radiation therapy uses x-rays to kill cancer cells and shrink tumors. Radiation therapy for skin cancer comes from a machine outside the body (external radiation therapy).
Chemotherapy uses drugs to kill cancer cells. In treating skin cancer, chemotherapy is often given as a cream or lotion placed on the skin to kill cancer cells (topical chemotherapy). Chemotherapy may also be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy given in this way is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the skin. Systemic chemotherapy is being tested in clinical trials.
Biological therapy (using the body's immune system to fight cancer) is being tested in clinical trials. Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.
Photodynamic therapy uses a certain type of light and a special chemical to kill cancer cells.
Treatment of skin cancer depends on the type and stage of the disease, and the patient's age and overall health.
Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in some parts of the country for patients with skin cancer. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Treatment may be one of the following:
It is important to have the skin examined regularly so the cancer can be treated if it comes back (recurs).
Treatment may be one of the following:
It is important to have the skin examined regularly so the cancer can be treated if it comes back (recurs).
Treatment may be one of the following:
Call
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
PDQ is a comprehensive cancer database available on Cancer.gov.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
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