All You Need to Know About Skin Cancer Prevention, Detection, and Treatment

Skin cancer is the most common cancer in the United States, with over 5 million people diagnosed each year. More than two people in the United States die from skin cancer every hour. Melanoma is the most aggressive form of skin cancer but if it is detected early, the survival rate is 99%.

While 1 in 5 Americans will develop skin cancer by the age of 70, most skin cancer is highly preventable. Regular skin checks and early detection of skin cancers can also make it treatable.

What is the Role of Skin?

It may seem obvious — skin is a flexible covering for your entire body that protects against light, heat, infection, and injury, but did you know that skin is an organ, just as your heart, liver, and lungs are? In fact, skin is your largest organ.

As with other organs, your skin performs specific functions, and the condition of your skin is a good indicator of your overall health. Skin is so amazing that it is soft enough to allow your body to move, yet it is tough against tearing and breaking.

Skin has a variety of purposes:

• Prevents dehydration
• Excretes waste through the sweat glands
• Stores fat and water
• Regulates body temperature
• Helps make vitamin D when you are exposed to the sun
• Prevents bacteria from entering the body
• Acts as a barrier between your body and the environment
• Contains numerous nerve endings that help you feel cold, hot, and pain
• Reduces the effects of UV radiation

What is Skin Made Of?

Your skin is made up of three layers — epidermis, dermis, and subcutaneous fat layer called the hypodermis. Each layer of skin has certain functions.

Epidermis
The epidermis is the outer layer of skin, and it consists of two main types of cells. Keratinocytes are responsible for the structure and barrier functions of skin, and melanocytes make melanin that gives skin its color. It protects the more delicate layers of skin.

Dermis
The middle layer of your skin is called the dermis, and it contains hair follicles, blood vessels, sweat glands, lymph vessels, fibroblasts, collagen bundles, sebaceous glands, and nerves. The dermis is held together by collagen, which gives the skin its strength and flexibility.

Subcutaneous Fat Layer
The subcutaneous fat layer is made up of collagen and fat cells and is the deepest layer of skin. It protects the body from injury, helps regulate temperature, and stores adipose fat which is a source of energy.

Types of Skin Cancer

Skin cancer occurs when skin cells grow abnormally, due to changes in their growth patterns. As skin cells grow and die, new cells replace them. Sometimes this process doesn’t happen as it should, and cells grow more quickly. Exposure to UV light from the sun or tanning beds can cause the cells to grow rapidly. Cells can be benign (non-cancerous) or malignant (non-cancerous).

Most skin cancers form on skin which is exposed to the sun, but skin cancers can occur on other areas of the skin.

There are four main types of skin cancer:
Basal Cell Carcinoma
Basal cells are found in the lower epidermis. Basal cell carcinomas tend to develop on the head and neck, usually as the result of sun exposure. Basal cell carcinomas generally grow slowly and don’t often spread to other parts of the body. About 80% of skin cancers develop from basal cells.

Squamous Cell Carcinoma
Approximately 20% of skin cancers develop from squamous cells, the cells that make up the epidermis. Squamous cell carcinoma is mainly caused by exposure to the sun and may be found on many areas of the skin. They are commonly found on the lips and on the skin outside the mouth, vagina, and anus. Between 2-5% of squamous cell carcinomas will spread to other parts of the body.

Merkel Cell Carcinoma
Merkel cell carcinoma is thought to arise from specialized skin cells. It is a rare, aggressive, and fast-growing cancer usually found in the neck and head region. Another name for Merkel cell carcinoma is neuroendocrine carcinoma of the skin.

Melanoma
Melanocytes are cells that make a pigment, called melanin, that gives the skin its color. Melanoma is the most aggressive form of skin cancer that accounts for approximately 1% of skin cancers. It generally starts on skin that is often exposed to the sun but can happen in the throat or the nose, the palms, scalp, genitals, and the soles of the feet.

Even though melanoma makes up about 1% of skin cancers, it causes most skin cancer deaths. If you have experienced five or more sunburns, you double your risk for melanoma.

Signs and Symptoms of Skin Cancer

Skin cancer symptoms can vary in people, but the most common warning sign is a change to your skin. Check your whole body once a month and see your dermatologist if you notice any of the following signs:

• A growth that appears to be transparent, tan, brown, black, or multicolored, and that is increasing in size.
• A brown spot, mole or birthmark that has increased in size, thickness, changes texture or color, or is large.
• A sore that hasn’t healed in three weeks.
• A sore or spot that continues to hurt, scab, bleed, or is itchy.

Melanoma

The CDC recommends the A-B-C-D-E warning signs of melanomas specifically using the following guide:

A: Asymmetrical: Does the mole or spot have an irregular shape with two parts that look very different?

B: Border: Is the border irregular or jagged?

C: Color: Is the color uneven?

D: Diameter: Is the mole or spot larger than the size of a pea?

E: Evolving: Has the mole or spot changed during the past few weeks or months?

Melanoma Staging

Melanoma staging is a process that explains how much a melanoma has spread and how thick it is. There are five stages.

• Stage 0 is also known as melanoma in situ, which means the cancer cells are only in the top layer of the skin.
• Stage 1 means the melanoma is only in the skin and hasn’t spread to lymph nodes or other parts of the body. It is considered low risk and is usually curable by surgery.
• Stage 2 means the melanoma has spread to lymph nodes nearby, or to an area between the lymph nodes and the melanoma. It has not yet spread but it has some features which suggest it will come back.
• Stage 3 means the melanoma has spread to nearby skin or lymph nodes.
• Stage 4 is when the melanoma has spread from the primary site to distant lymph nodes or skin, and has possibly spread to internal organs.

The American Cancer Society reports that the risk of melanoma increases as people age. The average age of diagnosis is 66, but melanoma is not uncommon among people under the age of 30. It is one of the most common cancers in young adults, especially young women.

Melanomas can be curable when they are diagnosed and treated early. Early detection is key, and this is only possible when you perform monthly head to toe examinations of your skin and have any changes checked out by a dermatologist.

Skin Cancer Risk Factors

While anyone can get skin cancer, some people have certain characteristics which puts them at a greater risk than others. These risk factors include:

• Older age
• Spend a lot of time playing or working outside
• Smoking (especially on the lips)
• A lighter, fairer skin color
• People with blond or red hair
• A history of skin cancer
• Exposure to UV light (sun or tanning lamps/beds)
• Family history of skin cancer
• Having green or blue eyes
• Skin that burns, reddens or freckles easily
• Having multiple moles
• Exposure to arsenic compounds or coal
• Repeated X-rays exposure
• Scars from burns or diseases
• People who have had organ transplants or are immuno suppressed
• Living at a higher elevation or latitude
• Rare inherited conditions including xeroderma pigmentosum or basal cell nevus syndrome
• Being male

Even with higher risk factors, skin cancer is preventable. Tanning is not a sign of good health — any change in skin color after UV exposure is a sign of injury.

Preventing Skin Cancer

Prevention is always better than cure. Start skin cancer prevention in childhood and develop lifelong healthy skin habits.

• The UV rays from the sun are strongest between 10 a.m. – 4 p.m. Limit your exposure to the sun during this time and if you must be outside, stay in the shade as much as possible.
• Apply SPF 30 plus sunscreen 15-30 minutes before heading outside. Make sure it has not expired and choose a waterproof sunscreen that protects against UVA and UVB rays.
• Always remember to also apply sunscreen to your ears, feet, and hands. These areas are often overlooked but are frequently exposed to the sun.
• Sunscreen needs to be reapplied every two hours, even when it’s a cloudy day. Reapply after sweating or swimming.
• Use lip balm that is 30 plus SPF.
• Clothing needs to cover your body. Be sure to add a wide-brimmed hat that shades your face, neck, and ears.
• Wear sunglasses with a label saying 100% UVA/UVB protection to protect your eyes and eyelids.
• Do not use tanning beds or sunlamps.
• Practice sun safety all year round, not just in summer.
• Keep babies younger than 6 months out of direct sunlight and dress them in hats and lightweight clothing that covers most of the skin.

Detecting Skin Cancer

See your trusted dermatologist if you notice any changes to your skin. When you visit your dermatologist, they will ask you about your family history, your personal health history and sun habits, and they will perform a physical exam of your skin.

When examining your skin your dermatologist will look for any spots or bumps that look abnormal in shape, size, color, or texture.

They may also do a skin biopsy which is where they cut a small part, or the whole growth from your skin so it can be viewed under a microscope to check for signs of cancer. This can be done via a shave biopsy, punch biopsy, incisional biopsy, or excisional biopsy.

Skin Cancer Treatment Options

It’s scary to be told you have skin cancer, but with OU Health you have treatment options. Treatment depends on the type of skin cancer you are diagnosed with.

Surgery

There are several surgical options depending on the type and stage of the tumor:
Simple excision: The tumor is cut from the skin along with some of the normal tissue around it.

Mohs micrographic surgery: The tumor is cut from the skin in thin layers. Each layer and the edges of the tumor removed are viewed through a microscope to check for cancer cells during the procedure. This allows layers to be removed until cancer cells are no longer identified through the microscope. This surgery takes as little normal tissue as possible and is often used to remove skin cancer on the face, genitals, or fingers. It is also used for skin cancer that doesn’t have a clearly identified border.

Shave excision: A small blade is used to shave off the abnormal area from the surface of the skin.

Curettage and Electrodesiccation/ Electrosurgery: A sharp, spoon-shaped tool called a curette is used to cut a tumor from the skin. An electrode which is shaped like a needle is then used to deliver an electric current to the area to stop the bleeding and destroy cancer cells that may remain around the area of the wound. The process may be repeated between one and three times during the procedure to remove all the cancer.

Laser surgery: A surgical procedure that uses a laser beam as a knife to make cuts in tissue or to remove a lesion on the surface of the skin such as a tumor. This is a bloodless procedure that requires no stitches.

Dermabrasion: A rotating wheel or small particles are used to remove or rub away the top layer of skin and skin cells.

Cryosurgery or Cryotherapy: This treatment uses an instrument to freeze and destroy abnormal skin tissue. It is often used to treat actinic keratosis, a precancerous skin condition that causes rough, scaly patches or bumps on the skin. They are caused by long-term damage by the sun.

Medical Oncology

Radiation therapy: A cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or to stop them from growing.

External radiation therapy: A machine is used outside the body to send radiation toward the area of the body where the cancer is located. This type of radiation therapy is used to treat basal cell carcinoma and squamous cell carcinoma.

Chemotherapy: A cancer treatment that uses drugs to stop the growth of cancer cells. The drugs either kills the cancer cells or stops them from dividing further. This therapy is used to treat basal cell carcinoma, and squamous cell carcinoma of the skin. Actinic keratosis is usually treated by applying directly to the skin in a lotion or cream.

Photodynamic Therapy: This cancer treatment uses both a specific type of light and a drug to destroy cancer cells. The drug is injected into a vein and then activated by the light. It is otherwise applied to the skin. Photodynamic therapy causes minimal damage to healthy skin tissue. It can also be used to treat actinic keratoses.

Immunotherapy: A treatment that uses the patient’s immune system to fight cancer. Substances made naturally by the body or in a laboratory, are used to boost or restore the body’s natural defenses to fight against cancer.

OU Health Stephenson Cancer Center provides expert multidisciplinary care to treat skin cancer including dermatology, medical oncology, and surgical oncology. The team-based approach to care will give you an accurate diagnosis and fit your situation with a personalized treatment plan.

Clinical Trials

Clinical trials are important for discovering new treatments for diseases. This includes new medicines and new diagnostics and improving screening technologies. Treatments that are discovered through clinical trials advance the field by helping diagnose patients earlier and helping them live longer.

Being part of a clinical trial gives you options outside the standard of care. This is especially important for cancers where there are typically modest to low outcome rates.

Expert Advice

Practicing daily sun protection measures is essential for preventing cumulative damage to your DNA and can help prevent most types of skin cancer. Even still, skin cancers can arise in areas of sun-protected skin — getting annual skin exams is very important to catch skin cancer early.

“Our clinical providers are skilled at detecting early skin cancer,” said OU Health dermatologist and dermatopathologist, Dr. Jeffrey D. McBride, M.D., Ph.D., assistant professor and director of dermatopathology in the Department of Dermatology at the University of Oklahoma College of Medicine. “At OU Health, we have the expertise of excellent board-certified dermatopathologists to detect even the earliest of skin cancers under the microscope. We have outstanding dermatologic surgeons who utilize Mohs micrographic surgery to remove cancers, especially on the face, with clear margins during the same visit, along with the best options for repair. If the cancer has spread to the lymph nodes, we have our comprehensive Stephenson Cancer Center that holds weekly Tumor Boards to discuss the best management of all patients. At OU Health, we treat all patients as if they are family.”

OU Health Dermatology

Learn more about the OU Health dermatology services and treatment, request an appointment or get a second opinion, or find out more about the skin cancer team at OU Health by calling (405) 271-6110.