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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Skin cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is skin cancer?
STAGE EXPLANATION
Types of skin cancer
Basal cell cancer
Squamous cell carcinoma
Actinic keratosis
Recurrent
TREATMENT OPTION OVERVIEW
How skin cancer is treated
Treatment by type
BASAL CELL CARCINOMA OF THE SKIN
SQUAMOUS CELL CARCINOMA OF THE SKIN
ACTINIC KERATOSIS
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is skin cancer?

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. See the patient information summary on melanoma for information 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 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. See the patient information summaries 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. 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

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 carcinoma

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

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 OPTION OVERVIEW


How skin cancer is 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 by type

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.


BASAL CELL CARCINOMA OF THE SKIN

Treatment may be one of the following:

1. Surgery to remove the cancer and as little of the normal tissue as possible. During the surgery, the doctor removes the cancer and then uses a microscope to look at the surgical area to make sure no cancer cells remain (micrographic surgery).

2. Surgery to remove the cancer from the skin along with some of the healthy skin around the cancer.

3. Surgery that uses an electric current to dehydrate the tumor (electrodesiccation), then uses a specialized surgical tool (curet) to remove the tumor.

4. Surgery that freezes and kills the cancer (cryosurgery).

5. Radiation therapy.

6. Surgery using a highly focused beam of light that destroys only the cancer cells (laser therapy).

7. Topical chemotherapy.

8. A clinical trial of chemoprevention.

9. A clinical trial of biological therapy.

10. A technique that uses light-sensitive drugs to kill the cancer (photodynamic therapy).

It is important to have the skin examined regularly so the cancer can be treated if it comes back (recurs).


SQUAMOUS CELL CARCINOMA OF THE SKIN

Treatment may be one of the following:

1. Surgery to remove the cancer and as little of the normal tissue as possible. During the surgery, the doctor removes the cancer and then uses a microscope to look at the surgical area to make sure no cancer cells remain (micrographic surgery).

2. Surgery to remove the cancer from the skin along with some of the healthy skin around the cancer.

3. Surgery that uses an electric current to dehydrate the tumor (electrodesiccation), then uses a specialized surgical tool (curet) to remove the tumor.

4. Surgery that freezes and kills the cancer (cryosurgery).

5. Radiation therapy.

6. Topical chemotherapy.

7. Surgery using a highly focused beam of light that destroys only the cancer cells (laser therapy).

8. A clinical trial of biological therapy with or without chemoprevention therapy.

It is important to have the skin examined regularly so the cancer can be treated if it comes back (recurs).


ACTINIC KERATOSIS

Treatment may be one of the following:

1. Topical chemotherapy.

2. Surgery that freezes and kills the cancer (cryosurgery).

3. Surgery that uses an electric current to dehydrate the tumor (electrodesiccation), then uses a specialized surgical tool (curet) to remove the tumor.

4. Removing the top layer of skin with a special machine (dermabrasion).

5. Shaving the very top layer of skin (shave excision).

6. Surgery using a highly focused beam of light that destroys only the cancer cells (laser therapy).


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about skin cancer, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, you can speak with a trained information specialist who can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklet about skin cancer may be helpful:

What You Need To Know About Skin Cancer

The following general booklets on questions related to cancer may also be helpful:

Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
What You Need To Know About Cancer

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that can help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 07/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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