About Basal Cell Carcinoma
The Most Common Skin Cancer
Basal cell carcinoma is the most common form
of skin cancer, affecting
800,000 Americans
each year. In fact, it
is the most common
of all cancers. One out
of every three new
cancers is a skin cancer,
and the vast majority
are basal cell carcinomas,
often referred
to by the abbreviation,
BCC. These cancers
arise in the basal cells,
which are at the
bottom of the epidermis
(outer skin layer).
Until recently, those most
often affected
were older people, particularly
men who had
worked outdoors. Although
the number of new
cases has increased sharply
each year in
the last few decades, the
average age of
onset of the disease has
steadily decreased.
More women are getting
BCCs than in the past;
nonetheless, men still
outnumber them greatly.
The Major Cause
Chronic exposure to sunlight is the cause
of almost all basal cell
carcinomas, which
occur most frequently on
exposed parts of
the body -- the face, ears,
neck, scalp,
shoulders, and back. Rarely,
however, tumors
develop on non-exposed
areas. In a few cases,
contact with arsenic, exposure
to radiation,
and complications of burns,
scars, vaccinations,
or even tattoos are contributing
factors.
Who Gets It
Anyone with a history of frequent sun exposure
can develop basal cell
carcinoma, often referred
to as BCC. But people who
have fair skin,
light hair, and blue, green,
or gray eyes
are at highest risk. Those
whose occupations
require long hours outdoors
or who spend
extensive leisure time
in the sun are in
particular jeopardy. Dark-skinned
individuals
are far less likely than
fair-skinned to
develop skin cancer. More
than two-thirds
of the skin cancers that
they do develop,
however, are squamous cell
carcinomas, usually
arising on the sites of
preexisting inflammatory
skin conditions or burn
injuries.
What to Look For
The five most typical characteristics of
basal cell carcinoma are
shown below. Frequently,
two or more features are
present in one tumor.
In addition, basal cell
carcinoma sometimes
resembles non-cancerous
skin conditions such
as psoriasis or eczema.
Only a trained physician,
usually a specialist in
diseases of the skin,
can decide for sure. Learn
the signs of basal
cell carcinoma, and examine
your skin regularly
-- as often as once a month
if you are at
high risk. Be sure to include
the scalp,
backs of ears, neck, and
other hard-to-see
areas. (A full-length mirror
and a hand-held
mirror can be very useful).
If you observe
any of the warning signs
or some other change
in your skin, consult your
physician immediately.
The Skin Cancer Foundation
advises people
to have a total body skin
exam by a qualified
skin specialist at regular
intervals. The
physician will suggest
the correct time frame
for follow-up visits, depending
on your specific
risk factors, such as skin
type and history
of sun exposure.
The Five Warning Signs of Basal Cell Carcinoma
| An Open Sore that bleeds, oozes, or crusts
and remains open
for three or more
weeks.
A persistent, non-healing
sore is a very
common sign of an
early basal cell
carcinoma. |
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| A Reddish Patch or irritated area, frequently
occurring on the
chest, shoulders,
arms,
or legs. Sometimes
the patch crusts.
It may
also itch or hurt.
At other times, it
persists
with no noticeable
discomfort. |
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| A Shiny Bump or nodule, that is pearly or
translucent and is
often pink, red,
or white.
The bump can also
be tan, black, or
brown,
especially in dark-haired
people, and can
be confused with
a mole. |
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| A Pink Growth with a slightly elevated rolled
border and a crusted
indentation in the
center.
As the growth slowly
enlarges, tiny blood
vessels may develop
on the surface. |
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| A Scar-like Area which is white, yellow or
waxy, and often has
poorly defined borders.
The skin itself appears
shiny and taut. Although
a less frequent sign,
it can indicate the
presence of an aggressive
tumor. |
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About Squamous Cell Cancer
Squamous Cell
Squamous cell carcinoma, the second most
common skin cancer after
basal cell carcinoma,
afflicts more than 200,000
Americans each
year. It arises from the
epidermis and resembles
the squamous cells that
comprise most of
the upper layers of skin.
Squamous cell cancers
may occur on all areas
of the body including
the mucous membranes, but
are most common
in areas exposed to the
sun.
Although squamous cell carcinomas usually
remain confined to the
epidermis for some
time, they eventually penetrate
the underlying
tissues if not treated.
In a small percentage
of cases, they spread (metastasize)
to distant
tissues and organs. When
this happens, they
can be fatal. Squamous
cell carcinomas that
metastasize most often
arise on sites of
chronic inflammatory skin
conditions or on
the mucous membranes or
lips.
What Causes It
Chronic exposure to sunlight causes most
cases of squamous cell
carcinoma. That is
why tumors appear most
frequently on sun-exposed
parts of the body: the
face, neck, bald scalp,
hands, shoulders, arms,
and back. The rim
of the ear and the lower
lip are especially
vulnerable to the development
of these cancers.
Squamous cell carcinomas may also occur where
skin has suffered certain
kinds of injury:
burns, scars, long-standing
sores, sites
previously exposed to X-rays
or certain chemicals
(such as arsenic and petroleum
by-products).
In addition, chronic skin
inflammation or
medical conditions that
suppress the immune
system over an extended
period of time may
encourage development of
squamous cell carcinoma.
Occasionally, squamous cell carcinoma arises
spontaneously on what appears
to be normal,
healthy, undamaged skin.
Some researchers
believe that a tendency
to develop this cancer
may be inherited.
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Who Gets It
Anyone with a substantial history of sun
exposure can develop
squamous cell carcinoma.
But people who have
fair skin, light hair,
and blue, green,
or gray eyes are at highest
risk. Those whose
occupations require long
hours outdoors or
who spend extensive leisure
time in the sun are
in particular jeopardy.
Dark-skinned individuals
of African descent
are far less likely
than fair-skinned individuals
to develop skin cancer.
More than two thirds
of the skin cancers
that they do develop,
however, are squamous
cell carcinomas, usually
arising on the sites
of preexisting inflammatory
skin conditions or
burn injuries.
Precancerous Conditions
Certain precursor conditions, some of which
result from extensive
sun damage, are worth
noting. They are
sometimes associated with
the later development
of squamous cell carcinoma.
They include:
- Actinic, or solar, keratosis. Actinic keratoses
are rough, scaly,
slightly raised
growths
that range in color
from brown to red
and
may be up to one
inch in diameter.
They appear
most often in older
people.
- Actinic cheilitis. A type of actinic keratosis
occurring on the
lips, it causes them to
become dry, cracked,
scaly, and pale or white.
It mainly affects
the lower lip, which typically
receives more sun
exposure than the upper
lip.
- Leukoplakia. These white patches on the tongue
or inside of the
mouth have the potential
to develop into
squamous cell carcinoma.
- Bowen's disease. This is now generally considered
to be a superficial
squamous cell cancer
that has not yet
spread. It appears as a
persistent red-brown,
scaly patch which may
resemble psoriasis
or eczema. If untreated,
it may invade deeper
structures.
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Regardless of appearance, any change in a
preexisting skin growth,
or the development
of a new growth or open
sore that fails to
heal, should prompt an
immediate visit to
a physician. If it is a
precursor condition,
early treatment will prevent
it from developing
into a squamous cell carcinoma.
Often, all
that is needed is a simple
surgical procedure
or application of a topical
chemotherapeutic
agent.
Squamous cell carcinomas occur most frequently
on areas of the body that
have been exposed
to the sun for prolonged
periods. Usually,
the skin in these areas
reveals telltale
signs of sun damage, such
as wrinkling, changes
in pigmentation, and loss
of elasticity.
About Melanoma
Melanoma is the most serious form of skin
cancer. Even so, if diagnosed
and removed
while it is still thin
and limited to the
outermost skin layer, it
is almost 100% curable.
Once the cancer advances
and metastasizes
(spreads) to other parts
of the body, it
is hard to treat and can
be deadly. During
the past 10 years the number
of cases of
melanoma has increased
more rapidly than
that of any other cancer.
Over 51,000 new
cases are reported to the
American Cancer
Society each year, and
it is probable that
a great many more occur
and are not reported.
What is melanoma?
The answer to the question asked by patients,
their families, and other
concerned people
is that melanoma is the
most serious form
of skin cancer. To reach
a more complete
understanding, it is necessary
to learn how
the cells in the body become
malignant.
The Origin of Melanoma
Melanoma is a malignant tumor that originates
in melanocytes, the cells
which produce the
pigment melanin that colors
our skin, hair,
and eyes and is heavily
concentrated in most
moles. The majority of
melanomas, therefore,
are black or brown. However,
melanomas occasionally
stop producing pigment.
When that happens,
the melanomas may no longer
be dark, but
are skin-colored, pink,
red, or purple.
Some Are More Dangerous
The physician will tell you whether the melanoma
is early or advanced by
describing it as
either in situ or invasive. "In situ" is Latin
and means "in one
site" or "localized."
Melanomas in situ occupy only the uppermost part of the epidermis,
the top layers of the skin.
Invasive melanomas are the more serious,
as they have penetrated
more deeply into
the skin and may have travelled
from the
original tumor through
the body.
The Four Basic Types
Melanomas fall into four basic categories.
Three of them begin in situ and sometimes become invasive; the fourth
is invasive from the start.
It is helpful
to recognize the names
and be able to define
the characteristics of
each type.
- Superficial spreading melanoma is by far
the most common type,
accounting for about
70 percent of all cases.
As you might expect,
this melanoma travels
along the top layer
of the skin for a fairly
long time before
penetrating more deeply.
The first sign is the appearance of a flat
or slightly raised discolored
patch that
has irregular borders
and is somewhat geometrical
in form. The color varies,
and you may see
areas of tan, brown,
black, red, blue, or
white. Sometimes an older
mole will change
in these ways, or a new
one will arise. The
melanoma can be seen
almost anywhere on the
body, but is most likely
to occur on the
trunk in men, the legs
in women, and the
upper back in both. Most
melanomas found
in the young are of the
superficial spreading
type.
- Lentigo maligna is similar to the superficial
spreading type, as it
also remains close
to the skin surface for
quite a while, and
usually appears as a
flat or mildly elevated
mottled tan, brown, or
dark brown discoloration.
This type of in situ melanoma is found most often in the elderly,
arising on chronically
sun-exposed, damaged
skin on the face, ears,
arms, and upper trunk.
Lentigo maligna is the
most common form of
melanoma in Hawaii.
Lentigo maligna melanoma is the invasive
form.
- The third type of melanoma, acral lentiginous
melanoma, also spreads
superficially before
penetrating more deeply.
It is quite different
from the others, though,
as it usually appears
as a black or brown discoloration
under the
nails or on the soles
of the feet or palms
of the hands. This type
of melanoma is sometimes
found in dark-skinned
people.
It is the most common
melanoma in African-Americans
and Asians, and the least
common among Caucasians.
- Unlike the other three types, nodular melanoma,
is usually invasive at
the time it is first
diagnosed. The malignancy
is recognized when
it becomes a bump. The
color is most often
black, but occasionally
is blue, gray, white,
brown, tan, red, or skin
tone.
The most frequent locations are the trunk,
legs, and arms, mainly
of elderly people,
as well as the scalp in
men. This is the
most aggressive of the
melanomas, and is
found in 10 to 15 percent
of cases.
Malignant Melanomas
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Malignant melanomas are usually small brown-black
or larger multicolored
patches, plaques or
nodules with irregular
outline. They may
crust on the surface
or bleed. Many of them
may arise in pre-existing
moles.
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