Skin Cancer

Skin cancer is the most common cancer in the United States, affecting about 1 in 5 people at some point in their lives. While most types can be cured if caught early, understanding the signs, risk factors, and ways to protect yourself is essential for prevention and early detection.

Table of contents

• What is Skin Cancer?
• Main Types of Skin Cancer
• What Causes Skin Cancer?
• Risk Factors
• Signs and Symptoms
• Getting Diagnosed
• Treatment Options
• Preventing Skin Cancer
• Living with and After Skin Cancer

What is Skin Cancer?

Skin cancer is a disease in which cells in the skin grow out of control^[1]. Normally, as skin cells grow old and die, new cells form to replace them. When this process doesn’t work as it should, cells grow more quickly and may become cancerous^[4].

The skin is the body’s largest organ. It covers your entire body and protects you against harmful factors from the environment such as the sun, hot temperatures, and germs^[8]. Skin cancer begins in the epidermis, which is the upper or outer layer of the skin^[2].

Main Types of Skin Cancer

The epidermis is made up of three kinds of cells: squamous cells (thin, flat cells that form the top layer), basal cells (round cells under the squamous cells), and melanocytes (cells that make melanin, the pigment that gives skin its color)^[2].

• Skin (epidermis)
• Basal cells
• Squamous cells
• Melanocytes

Basal cell carcinoma and squamous cell carcinoma are the two most common types of skin cancer. They begin in the basal and squamous layers of the skin. Both can usually be cured, but treatment is expensive and can leave scars^[2]. These two types are often grouped together and called non-melanoma skin cancer because they develop from skin cells other than melanocytes^[8].

Melanoma, the third most common type of skin cancer, begins in the melanocytes. Of all types of skin cancer, melanoma causes the most deaths because of its tendency to spread to other parts of the body, including vital organs like the brain and liver^[2]. Melanoma is much less common than the other types but much more likely to invade nearby tissue and spread to other parts of the body^[6].

Other, less common types of skin cancer include Merkel cell carcinoma, Kaposi sarcoma, sebaceous gland carcinoma, and dermatofibrosarcoma protuberans^[4].

What Causes Skin Cancer?

Most cases of skin cancer are caused by overexposure to ultraviolet (UV) rays from the sun, tanning beds, or sunlamps^[2]. The two main causes of skin cancer are the sun’s harmful ultraviolet rays and using UV tanning beds^[1].

UV rays from the sun damage DNA in your skin, causing abnormal cells to form. These abnormal cells rapidly divide in a disorganized way, forming a mass of cancer cells^[4]. In the short term, this damage can cause a sunburn. Over time, UV damage adds up, leading to changes in skin texture, premature skin aging, and sometimes skin cancer^[2].

UV radiation from the sun isn’t just dangerous, it’s also sneaky. Not only can it cause premature aging and skin cancer, it reaches you even when you’re trying to avoid it — penetrating clouds and glass, and bouncing off of snow, water, and sand^[18]. Sun damage accumulates over the years, from prolonged outdoor exposure to simple activities like walking the dog, going from your car to the store, and bringing in the mail^[18].

Risk Factors

Anyone can get skin cancer, regardless of race or sex. However, some people are at higher risk^[4].

You’re at higher risk if you have^[10]:

• Fair (light-colored) skin with freckles
• Skin that burns easily or doesn’t tan easily
• Blond or red hair
• Blue, green, or other light-colored eyes

Additional risk factors for skin cancer include^[15]:

• Sun and UV radiation exposure, including tanning beds
• History of sunburns, especially many blistering sunburns during childhood or adolescence
• Light complexion and eye color
• Personal or family history of skin cancer
• Unusual moles or a large number of moles (more than 50)
• Having certain changes in genes or hereditary syndromes
• Chronic, non-healing wounds or burn injuries
• Radiation therapy
• Exposure to toxic materials, such as arsenic
• Organ transplant patients on immunosuppressant drugs

People with dark skin can also get skin cancer. Anyone can get skin cancer, even people with dark skin — like Black or African American people. People with dark skin may get melanoma on parts of the body you might not expect, like the palms of the hands, the bottoms of the feet, or under the nails^[21].

Signs and Symptoms

The most common warning sign of skin cancer is a change on your skin — typically a new growth or a change in an existing growth or mole^[4]. Skin cancers can look quite different from one person to another due to skin tone, size and type of skin cancer, and location on the body^[1].

Skin cancer symptoms include^[4]:

• A new mole, or a mole that changes in size, shape, or color, or that bleeds
• A pearly or waxy bump on your face, ears, or neck
• A flat, pink/red- or brown-colored patch or bump
• Areas on your skin that look like scars
• Sores that look crusty, have a depression in the middle, or bleed often
• A wound or sore that won’t heal, or that heals but comes back again
• A rough, scaly lesion that might itch, bleed, and become crusty

Thinking of the ABCDE rule tells you what signs to watch for^[4]:

• Asymmetry: Irregular shape
• Border: Blurry or irregularly shaped edges
• Color: Mole with more than one color
• Diameter: Larger than a pencil eraser (6 millimeters)
• Evolution: Enlarging, changing in shape, color, or size (this is the most important sign)

If you’re worried about a mole or another skin lesion, make an appointment and show it to your healthcare provider^[4].

Getting Diagnosed

A healthcare professional might start by asking about your symptoms and looking at your skin^[9]. Tests or procedures that examine the skin are used to diagnose basal cell carcinoma and squamous cell carcinoma of the skin^[10].

To get a piece of skin, a healthcare professional may use a cutting tool to cut away some or all of the worrying skin growth. This procedure is called a biopsy. Often a skin biopsy happens in a healthcare professional’s office. Medicine numbs the area so you won’t feel pain^[9].

The skin tissue sample goes to a lab for testing. Tests can show whether the sample contains cancer cells^[9]. After evaluation by a trained healthcare provider, a biopsy is typically performed, and histopathological evaluation helps confirm the diagnosis and differentiate the type of skin cancer from other conditions^[7].

Some people with skin cancer may need other tests to find out whether the cancer has spread. This is called cancer staging. Not everyone with skin cancer needs cancer staging. Most skin cancers don’t spread^[9].

Treatment Options

The treatment you have will depend on the type of skin cancer, where the cancer is, if it has spread, and your general health^[14]. The good news is that if skin cancer is caught early, your dermatologist can treat it with little or no scarring and high odds of eliminating it entirely^[1].

Most skin cancer is treatable if it’s caught early^[4]. Skin cancer can almost always be cured when it’s found and treated early^[10].

Surgery

Surgery is the main treatment for non-melanoma skin cancer, especially if it’s found early^[13]. Several types of surgery can be used to treat non-melanoma skin cancer, including^[14]:

• Excision — cutting and removing the tumor from the skin
• Curettage and electrodesiccation — scraping along the tumor surface with the use of an electric needle to destroy any cancer cells that might remain in the area
• Mohs surgery — a surgical technique that removes layers of skin until the tumor is removed. This procedure has better cosmetic outcomes and allows for more normal skin to be saved
• Lymph node surgery — certain skin cancers require the removal of lymph nodes in proximity to cancerous areas

Other Treatment Options

Depending on the size and location of the tumor, other treatments may be used^[12]:

• Cryotherapy uses extreme cold to freeze and remove abnormal tissue. Liquid nitrogen is applied and freezes off the affected area^[12].
• Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells^[12].
• Topical chemotherapy involves applying a cancer-fighting chemotherapy drug directly to the skin, where the drug kills off the cancer cells^[12].
• Photodynamic therapy uses light-sensitive medicine and a light source to kill cancer cells^[14].
• Immunotherapy uses specific medications that stimulate your body’s natural defenses (immune system) to help kill the skin cancer cells^[12].
• Targeted medicines aim to stop the cancer growing and may be used if you have skin cancer in more than one place or if the cancer has spread^[13].

Preventing Skin Cancer

Skin cancer is largely preventable^[20]. Since most skin cancers are linked to sun exposure, it’s important to take precautions when spending time outdoors, no matter what time of year^[20].

Skin cancer prevention requires a comprehensive approach to protecting yourself against harmful ultraviolet (UV) radiation^[18]. The Skin Cancer Foundation recommends that you^[18]:

• Seek the shade, especially between 10 AM and 4 PM
• Don’t get sunburned
• Avoid tanning, and never use UV tanning beds
• Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses
• Use a broad-spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher every day
• For extended outdoor activity, use a water-resistant, broad-spectrum sunscreen with an SPF of 50 or higher
• Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside
• Reapply every two hours or after swimming or excessive sweating
• Keep newborns out of the sun. Use sunscreen on babies over the age of six months
• Examine your skin head-to-toe every month
• See a dermatologist at least once a year for a professional skin exam

Remember, the sun’s UV rays are the strongest from mid-morning to late afternoon. Try to stay out of the sun during these hours. If you’re outside, stay in the shade — like under a tree or umbrella^[21].

Protecting your skin from the sun and other UV radiation today may help prevent skin cancer later in life. Most skin cancer appears later in life, but skin damage from the sun can start during childhood^[21].

Living with and After Skin Cancer

From the moment you learn that you, or someone you love, has melanoma, you will face a variety of challenging decisions and at times, overwhelming circumstances. Learning to live and manage this new normal will take time^[23].

Checking Your Skin

When you’ve had skin cancer, you are more at risk of developing another skin cancer. So it’s important to keep an eye on your skin and protect it when out in the sun^[16]. Be aware of what your skin normally looks like. Go to see your doctor if you notice any skin changes or possible symptoms of skin cancer^[16].

You’ll have regular check-ups during and after any treatments. If you have any symptoms or side effects you’re worried about, talk to your specialists. You do not need to wait for your next check-up^[14].

Emotional Well-being

Going through cancer, even when treatment is successful, can leave you with a whirlwind of emotions. It’s absolutely normal to feel scared, anxious, sad, or uncertain about what’s next. Recognizing these feelings is a big step toward healing^[19].

A skin cancer diagnosis can affect your daily life by making you feel numb, anxious, worried, helpless, overwhelmed, angry, or even guilty. These feelings are normal, and it’s important to process your emotions as they arise. Over time, these feelings will become more manageable^[24].

To support your emotional well-being^[19]:

• Acknowledge your feelings without judgment
• Practice self-care through activities that reduce stress and promote calm, such as mindfulness, meditation, gentle exercise, or spending time in nature
• Lean on your support system — talk to trusted friends and family members or consider joining a skin cancer support group
• Seek professional help if needed from a therapist or counselor specializing in cancer survivorship
• Be patient with yourself — emotional healing takes time

Lifestyle Changes

Skin cancer patients who make some lifestyle changes can see improved outcomes, as these changes can help to keep your immune system strong or detect other issues before they have a negative impact^[17]. Recommended changes include^[17]:

• Limiting UV exposure as much as possible
• Adopting a healthier diet
• Adopting behaviors to reduce the risk of infectious disease
• Getting more exercise
• Relying on your support systems
• Quitting smoking, as it can hinder recovery from skin cancer treatment

Many find that they wish to make additional lifestyle changes, including spending less time in the sun, wearing more sunscreen, and asking loved ones to do the same^[24].