What is skin cancer?

Skin cancer happens when skin cells grow and

multiply in an uncontrolled, unorderly way.

Normally, new skin cells form when cells grow old

and die or when they become damaged. When
this process doesn’t work as it should, a rapid
growth of cells (some of which may be abnormal
cells) results. This collection of cells may be
noncancerous (benign), which don’t spread or
cause harm, or cancerous, which may spread to
nearby tissue or other areas in your body if not
caught early and treated.

Skin cancer is often caused by ultraviolet (UV)

light exposure from the sun.

There are three main types of skin

cancer:
 1. Basal cell carcinoma.
2. Squamous cell carcinoma.
3. Melanoma.

Basal cell carcinoma and squamous cell carcinoma

are the most common types of skin cancer and
are sometimes called “non-melanoma skin
cancer.”

Melanoma is not as common as basal cell or

squamous cell carcinomas but is the most
dangerous form of skin cancer. If left untreated or
caught in a late-stage, melanomas are more likely
to spread to organs beyond the skin, making them
difficult to treat and potentially life-limiting.

Fortunately, if skin cancer is identified and treated

early, most are cured. This is why it is important
to take a few safeguards and to talk with your
healthcare provider if you think you have any
signs of skin cancer.

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How common is skin cancer?

Skin cancer is the most common cancer diagnosed

in the U.S.

Other skin cancer facts:

Around 20% of Americans develop skin cancer

sometime in their life.
Approximately 9,500 Americans are diagnosed
with skin cancer every day.
Having five or more sunburns in your life doubles
your chance of developing melanoma. The good
news is that the five-year survival rate is 99% if
caught and treated early.
Non-Hispanic white persons have almost a 30
times higher rate of skin cancer than non-Hispanic
Black or Asian/Pacific Islander persons.
Skin cancer in people with skin of color is often
diagnosed in later stages when it’s more difficult
to treat. Some 25% of melanoma cases in African
Americans are diagnosed when cancer has spread
to nearby lymph nodes.

Who is most at risk for skin cancer?

Although anyone can develop skin cancer, you’re

at increased risk if you:

Spend a considerable amount of time working or

playing in the sun.
Get easily sunburned; have a history of sunburns.
Live in a sunny or high-altitude climate.
Tan or use tanning beds.
Have light-colored eyes, blond or red hair and fair
or freckled skin.
Have many moles or irregular-shaped moles.
Have actinic keratosis (precancerous skin growths
that are rough, scaly, dark pink-to-brown
patches).

Have a family history of skin cancer.

Have had an organ transplant.

Take medications that suppress or weaken your

immune system.

Have been exposed to ultraviolet light therapy for

treating skin conditions such as eczema or
psoriasis.

Where does skin cancer develop?

Skin cancer is most commonly seen in sun-

exposed areas of your skin — your face (including
your lips), ears, neck, arms, chest, upper back,
hands and legs. However, it can also develop in
less sun-exposed and more hidden areas of skin,
including between your toes, under your
fingernails, on the palms of your hands, soles of
your feet and in your genital area.

Where, within the skin layers, does skin

cancer develop?

Where skin cancer develops — specifically, in

which skin cells — is tied to the types and names
of skin cancers.

Most skin cancers begin in the epidermis, your

skin’s top layer. The epidermis contains three
main cell types:

Squamous cells: These are flat cells in the outer

part of the epidermis. They constantly shed as
new cells form. The skin cancer that can form in
these cells is called squamous cell carcinoma.
Basal cells: These cells lie beneath the squamous
cells. They divide, multiply and eventually get
flatter and move up in the epidermis to become
new squamous cells, replacing the dead
squamous cells that have sloughed off. Skin
cancer that begins in basal cells is called basal cell
carcinoma.
Melanocytes: These cells make melanin, the
brown pigment that gives skin its color and
protects your skin against some of the sun’s
damaging UV rays. Skin cancer that begins in
melanocytes is called melanoma.

Does skin cancer affect people with skin of color?

People of all skin tones can develop skin cancer. If
you are a person of color, you may be less likely to
get skin cancer because you have more of the
brown pigment, melanin, in your skin.

Although less prevalent than in nonwhite people,

when skin cancer does develop in people of color,
it’s often found late and has a worse prognosis. If
you’re Hispanic, the incidence of melanoma has
risen by 20% in the past two decades. If you’re
Black and develop melanoma, your five-year
survival rate is 25% lower than it is for white
people (67% vs 92%). Part of the reason may be
that it develops in less typical, less sun-exposed
areas (it develops mostly on palms of hands or
soles of feet) and it’s often in late-stage when
diagnosed.

SYMPTOMS AND CAUSES

What causes skin cancer?

The main cause of skin cancer is overexposure to

sunlight, especially when it results in sunburn and
blistering. Ultraviolet (UV) rays from the sun
damage DNA in your skin, causing abnormal cells
to form. These abnormal cells rapidly divide in a
disorganized manner, forming a mass of cancer
cells.
Another cause of skin cancer is frequent skin
contact with certain chemicals, such as tar and
coal.

Many other factors can increase your risk of

developing skin cancer. See question, “Who is
most at risk for skin cancer?”

What are the signs of skin cancer?

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. The signs
and symptoms of common and less common
types of skin cancers are described below.

Basal cell carcinoma

Basal cell cancer is most commonly seen on sun-
exposed areas of skin including your hands, face,
arms, legs, ears, mouths, and even bald spots on
the top of your head. Basal cell cancer is the most
common type of skin cancer in the world. In most
people, it’s slow growing, usually doesn’t spread
to other parts of the body and is not life-
threatening.

Signs and symptoms of basal cell carcinoma

include:

A small, smooth, pearly or waxy bump on the

face, ears, and neck.
A flat, pink/red- or brown-colored lesion on the
trunk or arms and legs.
Areas on the skin that look like scars.
Sores that look crusty, have a depression in the
middle or bleed often.
Squamous cell carcinoma
Squamous cell cancer is most commonly seen on
sun-exposed areas of skin including your hands,
face, arms, legs, ears, mouths, and even bald
spots on the top of your head. This skin cancer
can also form in areas such as mucus membranes
and genitals.

Signs and symptoms of squamous cell carcinoma

include:

A firm pink or red nodule.

A rough, scaly lesion that might itch, bleed and
become crusty.

Melanoma

Melanoma can develop in any area of your body.

It can even form on your eyes and internal organs.
The upper back is a common site in men; legs are
a common site in women. This is the most serious
type of skin cancer because it can spread to other
areas of your body.
Signs and symptoms of melanoma include:

A brown-pigmented patch or bump.

A mole that changes in color, size or that bleeds.
Thinking of the ABCDE rule tells you what signs to
watch for:

Asymmetry: irregular shape.

Border: blurry or irregularly shaped edges.
Color: mole with more than one color.
Diameter: larger than a pencil eraser (6 mm).
Evolution: enlarging, changing in shape, color, or
size. (This is the most important sign.)
Be alert to pre-cancerous skin lesions that can
develop into non-melanoma skin cancer. They
appear as small scaly, tan or red spots, and are
most often found on surfaces of the skin
chronically exposed to the sun, such as the face
and backs of the hands.

If you have a mole or other skin lesion that is

causing you concern, make an appointment and
show it to your healthcare provider. They will
check your skin and may ask you to see a
dermatologist and have the lesion further
evaluated.

What are some of the lesser-known skin cancers?

Some of the less common skin cancers include the
following:

Kaposi sarcoma

Kaposi sarcoma is a rare cancer most commonly

seen in people who have weakened immune
systems, those who have human
immunodeficiency virus (HIV)/AIDS and people
who are taking immunosuppressant medications
who have undergone organ or bone marrow
transplant.

Signs and symptoms of Kaposi sarcoma are:

Blue, black, pink, red or purple flat or bumpy

blotches or patches on your arms, legs and face.
Lesions might also appear in your mouth, nose
and throat.
Merkel cell carcinoma
Merkel cell carcinoma is a rare cancer that begins
at the base of the epidermis, the top layer of your
skin. This cancer starts in Merkel cells, which
share of the features of nerve cells and hormone-
making cells and are very close to the nerve
ending in your skin. Merkel cell cancer is more
likely to spread to other parts of the body than
squamous or basal cell skin cancer.

Signs and symptoms of Merkel cell carcinoma are:

A small reddish or purplish bump or lump on sun-
exposed areas of skin.
Lumps are fast-growing and sometimes open up
as ulcers or sores.
Sebaceous gland carcinoma
Sebaceous gland carcinoma is a rare, aggressive
cancer that usually appears on your eyelid. This
cancer tends to develop around your eyes
because there’s a large number of sebaceous
glands in that area.

Signs and symptoms of sebaceous gland

carcinoma are:

A painless, round, firm, bump or lump on or

slightly inside your upper or lower eyelid.
Dermatofibrosarcoma protuberans (DFSP)
DFSP is a rare skin cancer that begins in your
dermis, the middle layer of your skin. It grows
slowly, rarely spreads and has a high survival rate.
Signs and symptoms of DFSP are:

A purple, pink, red, or brown scar-like bump or

rough raised plaque on your skin.
A birthmark-looking appearance in newborns and
children.

DIAGNOSIS AND TESTS

How is skin cancer diagnosed?

First, your dermatologist may ask you if you have

noticed any changes in any existing moles,
freckles or other skin spots or if you’ve noticed
any new skin growths. Next, your dermatologist
will examine all of your skin, including your scalp,
ears, palms of your hands, soles of your feet,
between your toes, around your genitals and
between your buttocks.

If a skin lesion is suspicious, a biopsy may be

performed. In a biopsy, a sample of tissue is
removed and sent to a laboratory to be examined
under a microscope by a pathologist. Your
dermatologist will tell you if your skin lesion is
skin cancer, what type you have and discuss
treatment options.
MANAGEMENT AND TREATMENT

How is skin cancer treated?

Treatment depends upon the stage of cancer.

Stages of skin cancer range from stage 0 to stage
IV. The higher the number, the more cancer has
spread.
Sometimes a biopsy alone can remove all the
cancer tissue if the cancer is small and limited to
your skin’s surface only. Other common skin
cancer treatments, used alone or in combination,
include:

Cryotherapy

Cryotherapy uses liquid nitrogen to freeze skin

cancer. The dead cells slough off after treatment.
Precancerous skin lesions, called actinic keratosis,
and other small, early cancers limited to the skin’s
top layer can be treated with this method.

Excisional surgery

This surgery involves removing the tumor and

some surrounding healthy skin to be sure all
cancer has been removed.
Mohs surgery
With this procedure, the visible, raised area of the
tumor is removed first. Then your surgeon uses a
scalpel to remove a thin layer of skin cancer cells.
The layer is examined under a microscope
immediately after removal. Additional layers of
tissue continue to be removed, one layer at a
time, until no more cancer cells are seen under
the microscope.

Mohs surgery removes only diseased tissue,

saving as much surrounding normal tissue as
possible. It’s most often used to treat basal
cell and squamous cell cancers and near
sensitive or cosmetically important areas,
such as eyelids, ears, lips, forehead, scalp,
fingers or genital area.
Curettage and electrodesiccation

The technique uses an instrument with a sharp

looped edge to remove cancer cells as it scrapes
across the tumor. The area is then treated with an
electric needle to destroy any remaining cancer
cells. This technique is often used for basal cell
and squamous cell cancers and precancerous skin
tumors.

Chemotherapy and immunotherapy

Chemotherapy uses medications to kill cancer

cells. Anticancer medications can be applied
directly on the skin (topical chemotherapy) if
limited to your skin’s top layer or provided
through pills or an IV if cancer has spread to other
parts of your body. Immunotherapy uses your
own body’s immune system to kill cancer cells.

Radiation therapy
Radiation therapy is a form of cancer treatment
that uses radiation (strong beams of energy) to kill
cancer cells or keep them from growing and
dividing.

Photodynamic therapy

In this therapy, your skin is coated with

medication and a blue or red fluorescent light
then activates the medication. Photodynamic
therapy destroys precancerous cells while leaving
normal cells alone.

PREVENTION
Can skin cancer be prevented?
In most cases, skin cancer can be prevented. The
best way to protect yourself is to avoid too much
sunlight and sunburns. Ultraviolet (UV) rays from
the sun damage your skin, and over time this may
lead to skin cancer.

Ways to protect yourself from skin cancer

include:

Use a broad-spectrum sunscreen with a skin

protection factor (SPF) of 30 or higher. Broad-
spectrum sunscreens protect against both UV-B
and UV-A rays. Apply the sunscreen 30 minutes
before you go outside. Wear sunscreen every day,
even on cloudy days and during the winter
months.
Wear hats with wide brims to protect your face
and ears.
Wear long-sleeved shirts and pants to protect
your arms and legs. Look for clothing with an
ultraviolet protection factor label for extra
protection.
Wear sunglasses to protect your eyes. Look for
glasses that block both UV-B and UV-A rays.
Use a lip balm with sunscreen.
Avoid the sun between 10 a.m. and 4 p.m.
Avoid tanning beds. If you want a tanned look,
use a spray-on tanning product.
Ask your healthcare provider or pharmacist if any
of the medications you take make your skin more
sensitive to sunlight. Some medications known to
make your skin more sensitive to the sun include
tetracycline and fluoroquinolone antibiotics,
tricyclic antibiotics, the antifungal agent
griseofulvin, and statin cholesterol-lowering
drugs.
Check all the skin on your body and head for any
changes in size, shape or color of skin growths or
the development of new skin spots. Don’t forget
to check your scalp, ears, the palms of your hands,
soles of your feet, between your toes, your genital
area and between your buttocks. Use mirrors and
even take pictures to help identify changes in your
skin over time. Make an appointment with your
dermatologist if you notice any changes in a mole
or other skin spot.

OUTLOOK / PROGNOSIS

What is the outlook for people with skin cancer?

Nearly all skin cancers can be cured if they are
treated before they have a chance to spread. The
earlier skin cancer is found and removed, the
better your chance for a full recovery. Ninety
percent of those with basal cell skin cancer are
cured. It is important to continue following up
with a dermatologist to make sure cancer does
not return. If something seems wrong, call your
doctor right away.

Most skin cancer deaths are from melanoma. If

you are diagnosed with melanoma:
The five-year survival rate if it’s detected before it
spreads to the lymph nodes is 99%.
The five-year survival rate if it has spread to
nearby lymph nodes is 66%.
The five-year survival rate if it has spread to
distant lymph nodes and other organs is 27%.
When should I see my healthcare provider?
Make an appointment to see your healthcare
provider or dermatologist as soon as you notice:

Any changes to your skin or changes in the size,

shape or color of existing moles or other skin
lesions.
The appearance of a new growth on your skin.
A sore that doesn’t heal.
Spots on your skin that are different from others.
Any spots that change, itch or bleed.
Your provider will check your skin, take a biopsy
(if needed), make a diagnosis and discuss
treatment. Also, see your dermatologist annually
for a full skin review.
What questions should I ask my
healthcare provider?

Questions to ask your dermatologist may include:

 What type of skin cancer do I have?

 What stage is my skin cancer?
 What tests will I need?
 What’s the best treatment for my skin
cancer?
 What are the side effects of that treatment?
 What are the potential complications of this
cancer and the treatment for it?
 What outcome can I expect?
 Do I have an increased risk of additional skin
cancers?
How often should I be seen for follow-up
checkups?
FREQUENTLY ASKED QUESTIONS
How does skin cancer become a life-
threatening cancer?

You may wonder how cancer on the surface of

your skin becomes a life-threatening cancer. It
seems logical to think you could just scrape off the
skin with the cancer cells or even remove the
cancerous skin lesion with a minor skin surgery
and that’s all that would be needed. These
techniques are successfully used if cancer is
caught early.

But if skin cancer isn’t caught early, something

that’s “just on my skin” can grow and spread
beyond the immediate area. Cancer cells break
away and travel through the bloodstream or
lymph system. The cancer cells settle in other
areas of your body and begin to grow and develop
into new tumors. This travel and spread is called
metastasis.
The type of cancer cell where cancer first started
— called primary cancer — determines the type
of cancer. For example, if malignant melanoma
metastasized to the lungs, the cancer would still
be called malignant melanoma. This is how that
superficial skin cancer can turn into life-
threatening cancer.

Why does skin cancer occur in more non-sun-

exposed body areas in people of color?

Scientists don’t fully know why people of skin with

color develop cancer in non-sun-exposed areas,
such as their hands and feet. They think that the
sun is less of a factor though. However,
dermatologists still see plenty of UV sunlight-
induced melanomas and squamous cell skin
cancer in people of color, in skin tones ranging
from fair to very dark.
Are all moles cancerous?

Most moles are not cancerous. Some moles are

present at birth, others develop up to about age
40. Most adults have between 10 and 40 moles.

In rare cases, a mole can turn into melanoma. If

you have more than 50 moles, you have an
increased chance of developing melanoma.

A note from Cleveland Clinic

Your skin is the largest organ in your body. It

needs as much attention as any other health
concern. What may seem like an innocent
cosmetic imperfection, may not be. Performing
regular skin self-checks is important for everyone
and is especially important if you are a person at
increased risk of skin cancer. Skin cancer is also
color-blind. If you are a person of color, skin
cancer can happen to you. Check your skin every
month for any changes in skin spots or any new
skin growths. Consider taking “skin selfies” so you
can easily see if spots change over time. If you’re
a person of color, be sure to check areas more
prone to cancer development, such as the palms
of your hands, soles of your feet, between your
toes, your genital area and under your nails. Takes
steps to protect your skin. Always wear sunscreen
with SPF of at least 30 every day of the year. Wear
UV-A/UV-B protective sunglasses, wide-brimmed
hats and long-sleeve shirts and pants. See your
dermatologist at least once a year for a
professional skin check.