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Skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of your skin. Your skin protects your body against heat, light, infection, and injury. It also stores water, fat, and vitamin D.
The skin has two main layers and several kinds of cells. The top layer of skin is called the epidermis. It contains three kinds of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and cells called melanocytes, which give your 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 your skin also grows from tiny pockets in the dermis, called follicles. The dermis makes sweat, which helps to cool your body, and oils that keep your 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 statement. These types of skin cancer are called non- melanoma 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. See the patient information statement on melanoma for in- formation on the treatment of that type of cancer. 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 your body, but it is most common in places that have been exposed to more sunlight, such as your 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 your skin are cancer, but you should see your doctor if you notice changes in your skin.

Like most cancers, skin cancer is best treated when it is found (diagnosed) early. If you have a spot or lump on your skin, your 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 your doctor's office. Before the biopsy, you will be given a local anesthetic to numb the area for a short period of time.

Most nonmelanoma skin cancers can be cured. Your chance of recovery (prognosis) and choice of treatment depend on the type of skin cancer you have 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. See the patient information statements on cutaneous T-cell lymphoma or Kaposi's sarcoma for treatment of these cancers. Cancers that start in other parts of the body may also spread (metastasize) to the skin.

Stage Explanation

Types of Skin Cancer

Once skin cancer is found, more tests may be done to see if the cancer has spread. This is called staging. Your doctor needs to know the stage and type of your skin cancer to plan treatment. The following types are used to plan treatment:

Basal cell cancer Basal cell cancer is the most common type of nonmelanoma skin cancer. It usually occurs on areas of your 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 carcinoma Squamous cell tumors also occur on areas of your 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 your 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

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

Recurrent disease means that the cancer has come back (recurred) after it has been treated.

Treatment Options Overview

How Skin Cancer Is Treated

There are treatments for all patients with skin cancer. Three kinds of treatments are used:

surgery (taking out the cancer)
chemotherapy (using drugs to kill cancer cells)
radiation therapy (using x-rays to kill cancer cells).
Biological therapy (using your body's immune system to fight cancer) is being tested in clinical trials.

Many skin cancers are treated by doctors who treat skin diseases (dermatologists). Often, the cancer can be treated in your doctor's office.

Surgery is the most common treatment for skin cancer. Your doctor may remove the cancer using one of the following:

* Electrodesiccation and curettage numbs the lesion and removes it with a sharp instrument.
* Cryosurgery freezes the tumor and kills it.
* Simple excision cuts the cancer from your skin along with some of the healthy tissue around it.
* Micrographic surgery removes the cancer and as little normal tissue as possible. During this surgery, the doctor removes the cancer and then uses a microscope to look at the cancerous area to make sure no cancer cells remain.
* Laser therapy uses a narrow beam of light to remove cancer cells.

Surgery may leave a scar on your skin. Depending on the size of the cancer, skin may be taken from another part of your 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 tries to get your own body to fight cancer. It uses materials made by your own body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Photodynaniic therapy uses a certain type of light and a special chemical to kill cancer cells.

Treatment by Type

Treatment for skin cancer depends on the type and stage of your disease, your age, and your overall health.
You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into a clinical trial. 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.