Here's What you Need to Know About the 3 Types of Skin Cancer
Basal Cell Carcinoma
This type starts in your basal cells, which line your epidermis (the outer layer of skin). According to the Skin Cancer Foundation, more than 4 million cases of basal cell carcinoma are diagnosed each year in the United States, making it the most common form of skin cancer. Anyone with a history of sun exposure can be diagnosed, though it’s most common in those with fair skin, blond or red hair, and green, blue, or gray eyes. Generally, basal cell is the least dangerous of the skin cancers, and it rarely metastasizes.
What to look for: An open sore, an irritated red patch, a pink growth, a shiny bump, or a scar-like area. It usually develops on sun-exposed areas of your body, like your face, neck, back, or shoulders.
Treatment: If it’s on your head, neck, hands, feet, or genitalia, or if it’s larger than 2 cm anywhere else on your body, the gold standard is Mohs surgery, where a derm removes the cancer cells layer by layer, checking them under a microscope until all cancerous cells are gone. “This allows the entire cancer to be removed while taking away the least amount of healthy tissue possible,” explains Dendy Engelman, MD, a New York City dermatologist. As a result, scarring is minimized. If it’s small and on your body, your doctor can just cut it out. Other options in early stages include destroying it through radiation, freezing it off (cryotherapy), or using one of two FDA-approved creams: imiquimod or 5-Fluorouracil (5-FU), says Debra Jaliman, MD, assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. Your dermatologist can help guide you through the best treatment option.
Squamous Cell Carcinoma
This is the second most common type, with more than one million cases diagnosed each year in the United States. It starts in your squamous cells, which make up your outer layer of skin. Cumulative, long-term exposure to the sun or tanning-bed usage is what leads to most cases. This type of skin cancer doesn’t usually metastasize, though the longer it is left untreated, the more that risk increases.
What to look for: Scaly red patches, open sores, warts, or elevated growths that could crust or bleed. They can develop anywhere but most often show up in sun-exposed areas, like ears, lips, face, scalp, arms, and legs.
Treatment: Assuming it hasn’t metastasized, squamous cell carcinoma is treated in the same way as basal cell.
Melanoma develops in melanocytes—those are the cells that produce the pigment that gives your skin color. If you have a first degree relative (like a parent or sibling) who has had melanoma, you have a 50 percent greater chance of developing it yourself. An estimated 192,310 cases of melanoma will be diagnosed in the U.S. in 2019 (up about 8 percent from 2018), according to the Skin Cancer Foundation. Here are some positive findings: The mortality rate associated with this type of skin cancer is expected to decrease by 22 percent—likely because more people are getting screened for skin cancer than ever before.
What to look for: Most often, it appears as a black or brown mole, but it can also be skin-colored, pink, red, purple, blue, or white. “We still rely on the ABCDEs of melanoma: asymmetry, irregular borders, changes in color, diameter (larger than about one-quarter of an inch), and evolving, meaning it changes over time,” says Dr. Engelman. It can also develop in hard to-see spots, like under nails, in your vagina, in your mouth, or in your eye.
Treatment: Early-stage melanoma can usually be treated with surgery—either Mohs surgery or excision, says Lisa Chipps, MD, director of dermatologic surgery at the Harbor-UCLA Medical Center. But once it’s spread to the lymph nodes (Stage III) or to other parts of the body (Stage IV), you’ll need additional therapies. There are new medications, such as ipilimumab (Yervoy), nivolumab (Opdivo), or pembrolizumab (Keytruda). These drugs boost your immune system to help fight the melanoma, explains Dr. Chipps.
Catch It Early
“Most cases of skin cancer are curable if they’re caught early,” says Dr. Chipps. Following these rules can help with detection.
Do annual skin checks
You have to see your derm for yearly skin exams. If you have other risk factors, such as a family history, you may need to be seen more frequently. Self-exams are also a must—the Skin Cancer Foundation suggests doing them monthly. Also, about 5 percent of all melanomas in the United States are ocular melanomas, which means they occur in your eye—so staying up-to date on your eye exams is also crucial.
Enlist other help
“I tell my patients that anyone who is looking at your body—like a gynecologist or hairdresser—can help spot a skin cancer,” says Dr. Engelman. “So ask them to be on the lookout.” One Harvard study published in Archives of Dermatology, for example, found that more than half of all hairdressers surveyed had urged a client to see a medical pro to check out a mole. “Your hairdresser is a really good person to spot anything on your scalp, because they separate your hair systematically,” explains Jaliman.
Be your own advocate
If you show a spot to your dermatologist and she doesn’t seem concerned, monitor it on your own and let her know if it changes. “It is also OK to get a second opinion,” reassures Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. Your derm can either shave off the top layer of skin or do a punch biopsy. The tissue is then sent to a laboratory for analysis.
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