Basal Cell and Squamous Cell Skin Cancer

Approximately one million people in the United States are diagnosed with skin cancer every year. About 90% of these cases are basal cell cancer. The two most common types of skin cancer are basal cell and squamous cell skin cancer (also called nonmelanoma skin cancer). Basal cell cancer is slow growing and usually does not spread to other parts of the body. Squamous cell cancer will spread to other areas of the body, but does so rarely.


The skin is the body's outer covering and is our largest organ. It is made up of two layers: the outer epidermis and the inner dermis. The epidermis is made up of flat, scale-like cells called squamous cells. Under the squamous cells are round cells called basal cells. The deepest part of the epidermis contains melanocytes, which produce melanin and give skin its color.

People who have fair skin that freckles easily are at highest risk of skin cancer. These people often have red or blond hair and blue or light-colored eyes. Anyone can get skin cancer, however.

Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. Most skin cancer appears after age 40, but damage from UV radiation builds up over a lifetime, with harmful effects beginning in childhood. Sunlamps and tanning booths can also cause skin cancer.

Symptoms

The most common warning sign of skin cancer is a change in the skin. A new growth may appear, or a sore will not heal. It may appear as a small, smooth, shiny, pale or waxy lump or as a firm red lump. The lump may bleed or form a crust. Or, it may start as a flat, red spot that is rough, dry or scaly.

Basal cell and squamous cell cancers are usually found on areas of the skin that are exposed to the sun, such as the head, face, neck, hands and arms. But, they can occur anywhere.

Actinic keratosis, or solar keratosis, appears as rough, red or brown scaly patches on the skin. It used to be considered to be precancerous, but is now considered to be an early form of squamous cell skin cancer by some physicians and researchers, as addressed in the Southern Medical Journal (Lober and Lober, 93:650-655, 2000).

Diagnosis

If skin cancer is detected early, a 100% cure rate can be achieved. In order to do this, people must conduct regular self-exams to find new growths or other changes in the skin. People who have already had skin cancer should have regular exams so that a doctor can check the skin, even areas where skin cancer was not seen before.

Skin cancer is usually divided into two stages: local (only the skin is affected) or metastatic (areas besides the skin are affected). If a growth is large or has been present for a long time, the lymph nodes are examined.

Treatment
The main goal in the treatment of skin cancer is to remove or destroy the cancer completely, leaving as small a scar as possible. The location and size of the cancer, the risk of scarring and the person's age, health and medical history are all considered when treatment is planned.

Surgery is often used to remove the skin cancer. The type of surgery may vary, and may include biopsy alone, electrodissection (using an electric current with a special machine), Mohs' surgery (the cancer is shaved off one layer at a time until the entire tumor is removed) or cryosurgery (liquid nitrogen is used to freeze and kill abnormal cells). For large areas, skin grafts may be used to help close the wound and facilitate healing.

Laser therapy may be used on cancer that involves only the outer layer of skin. Radiation therapy is used on cancers that are hard to treat with surgery, such as cancer on the eyelid, the tip of the nose or the ear.

Topical chemotherapy (anticancer drugs applied to the skin) can be used for actinic keratosis and cancers limited to the top layer of skin. Fluorouracil is applied for several weeks, causing painful irritation, but usually no scarring.

Other treatments being studied in clinical trials include photodynamic therapy (laser light plus drugs that make cells sensitive to the light) and biological therapy (such as, interferon and tumor necrosis factor).

Skin cancer is responsible for only about 1% of all cancer deaths and can be cured in 85 to 90% of all cases, according to the National Cancer Institute. In order to continue these favorable statistics, however, people who have had skin cancer must be followed regularly and take steps to reduce their risk of developing skin cancer again.

Prevention

When possible, people should avoid being outside during the time of most intense UV (10 a.m. to 2 p.m. standard time or 11 a.m. to 3 p.m. daylight time). Tightly woven clothing and hats should be worn to block out harmful rays. Sunscreens of 15 to 30 SPF should be worn and reapplied often when out in the sun. And remember, UV radiation is not felt as heat on the skin, so it is possible to suffer sun damage even on a cool and cloudy day.

Skin Self-Exam

Plan to conduct the skin self-exam after a shower or bath. Check your skin in a well-lighted room using a full-length mirror and a hand-held mirror. Look for anything new, such as a change in the size, texture, or color of a mole, or a sore that does not heal. Make sure to check all areas, including the back, the scalp, between the buttocks, and the genital area.

By checking your skin regularly, you will become familiar with what is normal for you. If you see anything unusual, contact your doctor away. This greatly increases your chances of a cure, if you indeed have skin cancer.

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