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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
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| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| | ==[[Skin cancer overview|Overview]]== |
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| ==Overview== | | ==[[Skin cancer historical perspective|Historical Perspective]]== |
| '''Skin cancer''' is a [[malignant]] growth on the [[skin]] which can have many causes. Skin cancer generally develops in the [[epidermis]] (the outermost layer of skin), so a [[tumor]] is usually clearly visible. This makes most skin cancers detectable in the early stages. There are three common types of skin cancer, each of which is named after the type of skin cell from which it arises. Cancers caused by [[Ultra-violet|UV]] exposure may be prevented by avoiding exposure to sunlight or other UV sources, wearing sun-protective clothes, and using a broad-spectrum sun screen.
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| Skin cancers are the fastest growing type of cancer in the United States. Skin cancer represents the most commonly diagnosed malignancy, surpassing lung, breast, colorectal and prostate cancer. More than 1 million Americans will be diagnosed with skin cancer in 2007.<ref>{{cite web |url=http://www.cancer.gov/cancertopics/commoncancers |title=Common Cancer Types - National Cancer Institute |accessdate=2007-07-21 |format= |work=}}</ref> | | ==[[Skin cancer pathophysiology|Pathophysiology]]== |
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| ==Risk factors== | | ==[[Skin cancer risk factors|Risk factors]]== |
| Skin cancer is most closely associated with chronic inflammation of the skin. This includes:
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| # Sunburn or excessive sun damage, especially early in life. UVA & UVB have both been implicated in causing DNA damage resulting in cancer. Sun exposure between 10AM and 4PM is thought to be most harmful. Natural (sun) & artificial UV exposure (tanning salons) are associated with skin cancer.
| | ==[[Skin cancer epidemiology and demographics|Epidemiology & Demographics]]== |
| # Chronic non-healing wounds, especially burns. These are called [[Marjolin's ulcer]]s based on their appearance and can develop into squamous cell carcinomaand.
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| # Genetic predisposition, including "Congenital Melanocytic Nevi Syndrome". CMNS is characterized by the presence of [[Nevus|"nevi"]] or moles of varying size that either appear at or within 6 months of birth. Nevi larger than 20 mm (3/4") in size are at higher risk for becoming cancerous.
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| Skin can be protected by avoiding sunlight entirely, or wearing protective clothing while outdoors. Skin cancer is usually caused by exposing skin to UV rays excessively.
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| ==Types== | | ==[[Skin cancer causes|Causes]]== |
| The most common types of skin cancer are [[basal cell carcinoma]] (BCC) and [[squamous cell carcinoma]] (SCC) which may be locally disfiguring but are unlikely to [[metastasize]] (spread to other parts of the body). The most dangerous type of skin cancer is [[malignant melanoma]]. This form of skin cancer can be fatal if not treated early but comprises only a small proportion of all skin cancers.
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| More rare types of skin cancer include:
| | ==[[Skin cancer differential diagnosis|Differentiating Skin cancer from other Disorders]]== |
| * [[Dermatofibrosarcoma protuberans]]
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| * [[Merkel cell carcinoma]]
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| * [[Kaposi's sarcoma]]
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| ==Prevalence== | | ==[[Skin cancer natural history|Natural History, Complications, and Prognosis]]== |
| Skin cancer is an increasingly common condition. This is in part attributed to increased exposure to [[ultraviolet radiation]], which in turn is thought to be caused by the increased popularity of [[sun tanning]] ([[Sunlight#Sunbathing|sun bathing]]). Lighter-skinned individuals are more vulnerable. In the [[United States]], about one out of every three new cancers arises from the skin. | |
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| == Signs and symptoms == | | ==Diagnosis== |
| There are a variety of different skin cancer symptoms. These include crabs or changes in the [[skin]] that do not heal, [[ulcer]]s in the skin, discoloration, and changes in existing [[Mole (skin marking)|mole]]s.
| | [[Skin cancer history and symptoms|History and Symptoms]] | [[Skin cancer physical examination|Physical Examination]] | [[Skin cancer laboratory tests|Laboratory Tests]] | [[Skin cancer electrocardiogram | Electrocardiogram]] | [[Skin cancer chest x ray|Chest X Ray]] | [[Skin cancer MRI|MRI]] | [[Skin cancer CT|CT]] | [[Skin cancer echocardiography|Echocardiography]] | [[Skin cancer other imaging findings|Other Imaging Findings]] | [[Skin cancer other diagnostic studies|Other Diagnostic Studies]] |
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| * ''[[Basal cell carcinoma]]'' usually looks like a raised, smooth, pearly bump on the sun-exposed skin of the [[head]], [[neck]] or [[shoulder]]s. Sometimes small [[blood vessel]]s can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. It is often mistaken for a sore that does not heal.
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| * ''[[Squamous cell carcinoma]]'' is commonly a red, scaling, thickened patch on sun-exposed skin. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass.
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| * Most ''[[melanoma]]s'' are brown to black looking lesions. Signs that might indicate a malignant melanoma include change in size, shape, color or elevation of a mole. The appearance of a new mole during adulthood, or new pain, itching, ulceration or bleeding of an existing mole should be checked.
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| ==Treatment== | | ==Treatment== |
| | '''Medical:''' [[Skin cancer medical therapy|Medical Therapy]] |
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| Most skin cancers can be treated by removal of the lesion, making sure that the edges (margins) are free of the tumor cells. These excisions provide the best cure for both early and high-risk disease.
| | '''Surgical:''' [[Skin cancer surgery|Surgery]] |
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| For low-risk disease, radiation therapy and cryotherapy (freezing the cancer off) can provide adequate control of the disease; both, however, have lower overall cure rates than surgery.
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| Moh's Microsurgery is a technique used to remove the cancer with the least amount of surrounding tissue and the edges are checked immediately to see if tumor is found. This provides the opportunity to remove the least amount of tissue and provide the best cosmetically favorable results. This is especially important for areas where excess skin is limited, such as the face. Cure rates are equivalent to wide excision. Special training is required to perform this technique.
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| In the case of disease that has spread (metastasized) further surgical or chemotherapy may be required.<ref name="isbn0-7817-5626-X">{{cite book |author=Doherty, Gerard M.; Mulholland, Michael W. |title=Greenfield's Surgery: Scientific Principles And Practice |publisher=Williams & Wilkins |location=Baltimore |year=2005 |pages= |isbn=0-7817-5626-X |oclc= |doi=}}</ref>
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| ==Reduction of risk==
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| Although it is impossible to completely eliminate the possibility of skin cancer, the risk of developing such a cancer can be reduced significantly with the following steps:
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| * reducing exposure to ultraviolet (UV) radiation, especially in early years
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| * avoiding sunburns
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| * avoiding sun exposure during the day (usually from 10 AM to 3 PM), when the sun is highest in the sky
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| * wearing protective clothing (long sleeves and hats) when outdoors
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| * using a broad-spectrum sunscreen that blocks both UVA and UVB radiation
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| * use SPF sun block of at least 50
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| * reapply sun block every 2 hours and after swimming
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| Although it is generally accepted that UV exposure is the greatest risk factor in melanoma development, some skeptics say that there is no proven data that links moderate sun exposure with the appearance of melanoma.
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| == Pathology ==
| | [[Skin cancer primary prevention|Primary Prevention]] | [[Skin cancer secondary prevention|Secondary Prevention]] | [[Skin cancer cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Skin cancer future or investigational therapies|Future or Investigational Therapies]] |
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| Squamous cell carcinoma is a malignant epithelial tumor which originates in epidermis, squamous mucosa or areas of squamous metaplasia.
| | ==Related Chapters== |
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| Macroscopically, the tumor is often elevated, fungating, or may be ulcerated with irregular borders. Microscopically, tumor cells destroy the [[basement membrane]] and form sheets or compact masses which invade the subjacent connective tissue (dermis). In well differentiated carcinomas, tumor cells are [[pleomorphic]]/atypical, but resembling normal keratinocytes from prickle layer (large, polygonal, with abundant [[eosinophilic]] (pink) cytoplasm and central nucleus). Their disposal tends to be similar to that of normal epidermis: immature/basal cells at the periphery, becoming more mature to the centre of the tumor masses. Tumor cells transform into [[keratinized]] squamous cells and form round nodules with concentric, laminated layers, called "cell nests" or "epithelial/keratinous pearls". The surrounding stroma is reduced and contains inflammatory infiltrate (lymphocytes). Poorly differentiated squamous carcinomas contain more pleomorphic cells and no [[keratinization]].<ref>{{cite web |url=http://www.pathologyatlas.ro/Squamous%20Cell%20Carcinoma.html |title="Squamous cell carcinoma (epidermoid carcinoma) - skin" pathologyatlas.ro |accessdate=2007-07-21 |format= |work=}}</ref>
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| ==See also==
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| *[[Cancer]] | | *[[Cancer]] |
| *[[Mohs surgery]] | | *[[Mohs surgery]] |
| *Sun protective clothing
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
| * American Cancer Society: Cancer Facts and Figures-1999. Atlanta, Ga: American Cancer Society, 1999.
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| {{Tumors}}
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| {{SIB}}
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| [[bs:Rak kože]]
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| [[bg:Рак на кожата]]
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| [[da:Hudkræft]]
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| [[de:Hautkrebs]]
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| [[es:Cáncer de piel]]
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| [[fr:Cancer de la peau]]
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| [[gd:Aillse-craicinn]]
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| [[hr:Rak kože]]
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| [[he:סרטן עור]]
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| [[nl:Huidkanker]]
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| [[ja:皮膚がん]]
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| [[no:Hudkreft]]
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| [[pl:Rak skóry]]
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| [[pt:Câncer de pele]]
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| [[fi:Ihosyöpä]]
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| [[sv:Hudcancer]]
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| [[vi:Ung thư da]]
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