Skin Cancer

A simple skin check could save your life. 

Skin cancer is the most common form of cancer in the United States. It will affect approximately 1 in 3 Americans during their lifetime. Most skin cancers are related to intense and cumulative sun or ultraviolet (UV) radiation exposure. Fortunately, early detection through routine skin examinations makes most of these skin cancers successfully treatable.

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Types of Skin Cancer

Actinic Keratosis | Basal Cell Carcinoma | Squamous Cell Carcinoma | Melanoma

Actinic Keratosis (AK’s)

Actinic Keratosis is of concern to dermatology providers and patients because AKs are precursor lesions to squamous cell carcinoma. It is estimated that as many as 10% of AKs may develop into squamous cell carcinoma, the second most common form of skin cancer. Actinic keratosis are the most common form of precancerous skin lesions. According to the Skin Cancer Foundation, actinic keratoses affect more than 10 million Americans. Individuals with green or blue eyes, light-colored hair, and freckling are most at risk for the development of AK’s.


Actinic keratosis is directly related to one’s lifetime exposure to the sun or UV radiation. Chronic sun exposure predisposes an individual to AK development. Both men and women are affected. Men are more likely to have AK’s, this is thought to be due to more cumulative sun exposure and a decreased likelihood of using sun protection or sunscreen.


Any area of frequesun exposure may develop actinic keratosis, but the scalp, face, ears, neck, arms, back of the hands and lower legs are most frequently affected. Individuals affected by actinic keratosis are commonly in their 50’s and beyond, but it is not unusual for someone in their 20s or 30s to develop AK’s if they have a history of heavy cumulative sun or UV exposure.


Signs

Actinic keratoses appear as rough, red, and scaly patches, bumps, or horns on the skin. Patients may misdiagnose AK’s for dry skin and often report that they feel like “sandpaper” when the finger is brushed across the area of the lesion. AKs are often felt before they are able to be seen. AK’s may not have symptoms but often have a burning, sensitive, or painful sensation when touched. Actinic keratosis is treated because of the risk of this precancer developing into full-blown squamous cell carcinoma.


AK Treatments

  • Cryosurgery, which involves freezing the skin with liquid nitrogen.
  • Topical therapy is also an option, 5-fluorouracil (5-FU, Carac), imiquimod (Aldara®, Zyclara®) creams may be used to treat visible clinical lesions as well as microscopic lesions that cannot yet be detected.


Basal Cell Carcinoma (BCC)

Basal cell carcinoma (BCC) is the most common form of skin cancer, arising from the bottom (basal) layer of the epidermis. According to the Skin Cancer Foundation, approximately 1 million new cases of basal cell carcinoma are diagnosed each year. Basal cell carcinoma is related to sun exposure, especially when individuals have had a history of sunburns or intense, intermittent sun exposure. Patients with light hair or eye color, and a tendency toward freckling or burns are at highest risk for basal cell carcinomas.


Signs

A pearly, shiny, pink or red bump is the most common appearance for a basal cell carcinoma. BCC may also appear as a red patch, a scar-spot, or an open or bleeding sore. It most commonly occurs on the scalp, face, ears, neck, arms, hands, and legs. Basal cell carcinoma has a low rate of metastasis but can be destructive to the area affected by the tumor. Left untreated, the BCC may destroy fat, muscle, cartilage and even bone, leading to disfiguring results. Basal cell carcinoma’s respond excellently to early treatment.


BCC Treatments

  • Surgical excision
  • Mohs micrographic surgery
  • Electrodessication and curettage
  • Photodynamic therapy
  • Topical treatments
  • Radiation therapy
  • Cryotherapy

Continued sun protection and sunscreen use are necessary to decrease the development of new basal cell carcinomas. Regular, frequent full skin examinations by a dermatology provider are critical in surveying the skin for new or recurrent skin cancers.

Squamous Cell Carcinoma (SCC)

Signs

This form of skin cancer most commonly presents as rough, red, scaly or crusted non-healing spots that form growths that are irritated or painful. SCCs over time may ulcerate or bleed. SCC can occur anywhere on the skin, including mucous membranes and the genital area. Squamous cell carcinoma occurs most commonly in areas of chronic sun exposure including the scalp, face, rim of the ears, lips, neck, arms, hands and legs. SCC may also develop in areas of chronic ulcers, burn scars, or areas of skin exposed to arsenic or chemical carcinogens. At least 40-60% of squamous cell carcinomas can be traced back to a previously existing precancerous lesion called an actinic keratosis.


SCC Treatments

  • Surgical excision
  • Mohs micrographic surgery
  • Electrodessication and curettage, in which the lesion is treated with repeated rounds of scraping and burning, has a cure rate that approaches surgical excision.
  • Cryosurgery (freeze therapy with liquid nitrogen),
  • Radiation therapy
  • Photodynamic therapy may be used in select cases of SCC.
  • Topical treatments may be used before, during, or after treatment of squamous cell carcinoma.
  • Sunblock use, proper photoprotection, and frequent full skin examinations are critical to preventing the development of further squamous cell carcinomas.


Melanoma

Treatment for melanoma depends primarily on what stage it is when discovered. Early stage cancer is the easiest to treat, and will often be treated by surgery alone. However, if the cancer is more advanced,  it may require other treatments such as immunotherapy, chemotherapy or radiation therapy.  Melanoma accounts for only about 1% of skin cancers but causes a large majority of skin cancer deaths. Melanoma is a cancer of the skin that begins in the melanocytes, which are the cells that produce the pigment melanin. It is the leading cause of cancer death in women 25 to 30 years old and the second leading cause of cancer death in women 30 to 35 years old. In some cases, melanoma occurs in melanocytes throughout the body, even if those parts have never been exposed to the sun.


Signs

The most important warning sign of melanoma is a new spot on the skin or a spot that changes in size, shape or color. Another warning sign is a spot that looks different from all of the other spots on your skin.

  • Pigment that spreads from the border of a spot into surrounding skin.
  • Redness or swelling beyond the border of the mole.
  • Itchiness, tenderness or pain.
  • A change in the mole’s surface, such as scaliness, oozing, bleeding or the appearance of a lump or bump.

Who is at risk for Melanoma?​

Since 90% of melanoma cases can be linked to exposure to ultraviolet (UV) rays from natural or artificial sources such as sunlight and indoor tanning beds, people who have extended or frequent exposure to these rays are at greater risk. The World Health Organization has declared indoor tanning devices to be cancer-causing agents in the same category as tobacco. Studies have found a 59% increase in the risk of melanoma in those who have been exposed to UV radiation from indoor tanning. Family history, genetics and environmental factors are also considered strong risk factors for melanoma. People with light eyes, hair, and/or skin, sun sensitivity, a high number of moles, a history of sunburns, a previous melanoma diagnosis or those who have a weakened immune system are also at greater risk. If you have an increased risk of developing melanoma, you must be particularly vigilant and become aware of all of the moles on your body to minimize the risk of melanoma progressing to life-threatening stages.


Melanoma Prevention

Since most melanoma and non-melanoma cases are directly related to sun exposure, the best way to prevent skin cancer is to protect your skin from sunlight. Make smart sun habits a part of your daily healthcare regimen.

  • Limit the amount of time spent outdoors during peak sun hours (10:00 AM to 4:00 PM).
  • Avoid tanning booths and sunburn.
  • Wear a broad spectrum (UVA/UVB) sunscreen with an SPF of 15+ every day.
  • For extended outdoor activity, use a water-resistant, broad-spectrum sunscreen with an SPF of 30+.
  • When outside, cover-up with long pants, a long-sleeved shirt, a broad-brimmed hat and UV-blocking sunglasses.
  • Check your skin head-to-toe every month.

Mohs Micrographic Surgery

After biopsy Some skin cancers qualify for a specialized procedure performed by a Moh's Micrographic Surgeon. 

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