Skin Cancer

Statistics

Cancer of the skin is the most common of all cancers. Melanoma is expected to be diagnosed in about 76,690 persons in 2013, accounting for less than 5 percent of all skin cancer cases but the vast majority of skin cancer deaths.

  • Cancer of the skin is the most common of all cancers. It is important to identify the specific type of skin cancer because it affects treatment options and prognosis.
  • Although melanoma is less common, it is more serious than other types of skin cancer.  Melanoma accounts for less than 2% of skin cancer cases, yet causes a large majority of skin cancer deaths.
  • About 74,000 new cases of melanoma cancer will be diagnosed in the United States (about 40,000 in men and 30,000 in women).
  • Approximately 10,000 deaths from these cancers are expected in 2015 (about 7,000 men and 3,000 women).
  • Melanoma rates have been rising for at least 30 years.
  • Melanoma is more than 20 times more common in whites than in African Americans.
  • It is one of the most common cancers in young adults, especially among young women.

Source: American Cancer Society

Types of Skin Cancer

Non-melanoma- (usually basal cell and squamous cell cancers)is the most common cancers of the skin. They are called non-melanoma because they develop from skin cells other than melanocytes. Because they rarely spread elsewhere in the body, they are less worrisome than melanomas.

Melanoma- Melanoma is a cancer that begins in the melanocytes. Because most of these cells keep on making melanin, melanoma tumors are often brown or black, but this is not always the case. Melanoma most often appears on the trunk of fair-skinned men and on the lower legs of fair-skinned women, but it can appear other places as well. While having dark skin lowers the risk of melanoma, it does not mean that a person with dark skin will never develop melanoma.

Risk Factors

We do not yet know exactly what causes melanoma skin cancer, but we do know that certain risk factors are linked to the disease.

  • Sunlight (UV radiation): Too much exposure to ultraviolet (UV) radiation is a risk factor for melanoma. The main source of such radiation is sunlight. Tanning lamps and booths are another source.
  • Moles: A mole (nevus) is a benign (not cancerous) skin tumor. Certain types of moles increase a person’s chance of getting melanoma. People with numerous moles, and those who have large moles, have an increased risk for melanoma and should have frequent skin exams by a dermatologist (skin doctor).
  • Fair skin: People with fair skin, freckling, or red or blond hair have a higher risk of melanoma.
  • Family history: Around 10 percent of people with melanoma have a close relative (mother father, brother, sister, child) with the disease. This could be because the family tends to spend more time in the sun or because the members have fair skin, or both.
  • Immune suppression: People who have been treated with medicines that suppress the immune system, such as transplant patients, have an increased risk of developing melanoma.
  • Age: Melanoma is more likely to happen to older people. But it is one of the few cancers that is also found in younger people.
  • Gender: Men have a higher rate of this cancer than women.
  • Xeroderma pigmentosum (XP): This is a rare, inherited condition. People with XP are less able to repair damage caused by sunlight and are thus at greater risk of melanoma.
  • Past history of melanoma: A person who has already had melanoma has a higher risk of getting another melanoma.

Early Detection

If a doctor thinks you might have a melanoma, he or she will take a sample of the skin to look at under a microscope. This is called a biopsy.

  • Incisional and excisional biopsies: If the doctor has to look at a tumor in the deeper layers of the skin, an incisional or excisional biopsy will be done. A surgical knife is used to cut through the full thickness of skin. A wedge of skin is removed, and the edges of the wound are sewn together.
  • Shave biopsy: After numbing the area, the doctor “shaves” off the top layers of the skin. A shave biopsy is useful for many types of skin diseases and in treating benign moles. But it is not recommended if a melanoma is suspected because the sample may not be thick enough to find out how deeply the cancer goes into the tissues.
  • Punch biopsy: In a punch biopsy a deeper sample of skin is removed. The doctor uses a tool that looks like a tiny round cookie cutter. Once the skin is numbed, the doctor rotates the tool on the surface of the skin until it cuts through all the layers of the skin and brings up a sample of tissue.
  • Fine needle aspiration biopsy (FNA) can sometimes be used if the doctor suspects the melanoma has spread to organs such as the lung or liver. A thin needle is used to remove very small tissue samples from a tumor. The test rarely causes much discomfort and does not leave a scar.
  • Surgical (excisional) lymph node biopsy: This method involves removing an abnormally large lymph node through a small incision.
  • Sentinel lymph node biopsy has become the standard method for finding out if the cancer has spread to lymph nodes in patients with more advanced melanoma.
  • X-rays: Sometimes the doctor will order x-rays of the chest to see if the cancer has spread to the lungs.

Prevention

According to the American Cancer Society, the best prevention methods for skin cancer are:

  • The best way to lower the risk of melanoma is to avoid too much exposure to the sun and other sources of UV light.
  • Avoid being outdoors in sunlight too long, especially in the middle of the day when UV light is most intense.
  • Protect your skin with clothing, including a shirt with long sleeves and a hat with a broad brim.
  • Use sunscreen and lip balm. They should have an SPF factor of 15 or more. Apply the sunscreen correctly. Many people do not use enough–a palmful is best. Put it on about 20 to 30 minutes before you go outside so your skin can absorb it. And you should put it on again every two hours. Use it even on hazy days or days with light or broken cloud cover. Don’t stay out in the sun longer just because you’re using sunscreen as that defeats the purpose.
  • Wear sunglasses. Wrap-around sunglasses with at least 99% UV absorption give the best protection.
  • Avoid other sources of UV light such as tanning beds and sun lamps.

Radiation Therpay Treatment Options

IGRT (image-guided radiation therapy)

IMRT (intensity modulated radiation therapy)

Other Treatment Options

Surgery

  • Simple excision: Thin melanomas can be completely cured by a minor operation called simple excision. The tumor is cut out, along with an amount of normal skin at the edges. The wound is carefully stitched back together. This surgery will leave a scar.
  • Re-excision:If the melanoma were confirmed by biopsy, the area will need to be excised again. More skin will be cut away from the area around the melanoma and the tissue will be examined to make sure that no cancer cells remain in the skin.
  • Amputation: If the melanoma is on a finger or toe, the treatment may mean amputation.
  • Lymph node dissection: Once a diagnosis of melanoma has been made, the doctor will check the lymph nodes nearest the cancer. If the nodes are not enlarged, then a sentinel node biopsy may be done. If the sentinel node does not show cancer, then the disease has most likely not spread to other nodes. There would be no need to remove lymph nodes.

Once it looks like the melanoma has spread from the skin to distant organs (such as the lungs or brain), doctors generally assume it can no longer be cured by surgery.

  • Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. External beam radiation focuses radiation from outside the body on the skin tumor. This method may be used for treating some patients with melanoma.
  • Chemotherapy- Several types of chemotherapy can be used for stage IV melanoma. Although chemotherapy does not usually work as well for melanoma as it does for some other types of cancer, it may relieve symptoms or extend the life of some patients with stage IV melanoma.
  • Immunotherapy- helps a person’s immune system to better attack the cancer. There are several types of immunotherapy used for people with advanced melanoma.