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{{Short description|Medical condition involving uncontrolled growth of skin cells}}
{{For|the book|Skin Cancer: Recognition and Management}}
{{cs1 config|name-list-style=vanc}}
{{Use dmy dates|date=March 2020}}
{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Skin cancer
| name = Skin cancer
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| caption = A [[basal-cell skin cancer]]. Note the pearly appearance and [[telangiectasia]].
| caption = A [[basal-cell skin cancer]]. Note the pearly appearance and [[telangiectasia]].
| field = [[Oncology]] and [[dermatology]]
| field = [[Oncology]] and [[dermatology]]
| symptoms = '''Basal-cell''': painless raised area of skin that may be shiny with [[telangiectasia|small blood vessel running over it]] or [[ulceration]]<ref name=NCI2013TxPro/><br>'''Squamous-cell''': hard lump with a scaly top<ref name=Lyn2011/><br>'''Melanoma''': [[melanocytic nevus|mole]] that has changed in size, shape, color, or has irregular edges<ref name=Mel2014/>
| symptoms = '''Basal-cell''': painless raised area of skin that may be shiny with [[telangiectasia|small blood vessel running over it]] or [[ulceration]]<ref name="NCI2013TxPro" /><br />'''Squamous-cell''': hard lump with a scaly top<ref name="Lyn2011" /><br />'''Melanoma''': [[melanocytic nevus|mole]] that has changed in size, shape, color, or has irregular edges<ref name="Mel2014" />
| complications =
| complications =
| onset =
| onset =
| duration =
| duration =
| types = [[Basal-cell skin cancer]] (BCC), [[squamous-cell carcinoma|squamous-cell skin cancer]] (SCC), [[melanoma]]<ref name=NCI2013TxPro/>
| types = [[Basal-cell skin cancer]] (BCC), [[squamous-cell carcinoma|squamous-cell skin cancer]] (SCC), [[melanoma]]<ref name="NCI2013TxPro" />
| causes = [[Ultraviolet radiation]] from the [[Sun]] or [[tanning beds]]<ref name=UV2010/>
| causes = [[Ultraviolet radiation]] from the [[Sun]] or [[tanning beds]]<ref name="UV2010" />
| risks = Light skin, [[poor immune function]]<ref name=NCI2013TxPro/><ref name=Cak2012/>
| risks = Light skin, [[poor immune function]]<ref name="NCI2013TxPro" /><ref name="Cak2012" />
| diagnosis = [[Tissue biopsy]]<ref name=Mel2014/>
| diagnosis = [[Tissue biopsy]]<ref name="Mel2014" />
| differential =
| differential =
| prevention = Decreasing exposure to ultraviolet radiation, [[sunscreen]]<ref name=WCR2014/><ref name=Jou2012/>
| prevention = Decreasing exposure to ultraviolet radiation, [[sunscreen]]<ref name="WCR2014" /><ref name="Jou2012" />
| treatment = Surgery, [[radiation therapy]], [[fluorouracil]]<ref name=NCI2013TxPro/>
| treatment = Surgery, [[radiation therapy]], [[fluorouracil]]<ref name="NCI2013TxPro" />
| medication =
| medication =
| prognosis =
| prognosis =
| frequency = 5.6 million (2015)<!-- prevalence --><ref name=GBD2015Pre>{{cite journal|last1=GBD 2015 Disease and Injury Incidence and Prevalence|first1=Collaborators.|title=Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.|journal=Lancet|date=8 October 2016|volume=388|issue=10053|pages=1545–1602|pmid=27733282|doi=10.1016/S0140-6736(16)31678-6|pmc=5055577}}</ref>
| frequency = 5.6 million (2015)<!-- prevalence --><ref name=GBD2015Pre>{{cite journal | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 |doi-access=free | collaboration = GBD 2015 Disease Injury Incidence Prevalence Collaborators }}</ref>
| deaths = 111,700 (2015)<ref name=GBD2015De>{{cite journal|last1=GBD 2015 Mortality and Causes of Death|first1=Collaborators.|title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.|journal=Lancet|date=8 October 2016|volume=388|issue=10053|pages=1459–1544|pmid=27733281|doi=10.1016/s0140-6736(16)31012-1|pmc=5388903}}</ref>
| deaths = 111,700 (2015)<ref name=GBD2015De>{{cite journal | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 |doi-access=free | collaboration = GBD 2015 Mortality Causes of Death Collaborators }}</ref>
}}
}}
<!-- Definition and Symptoms -->
<!-- Definition and Symptoms -->
'''Skin cancers''' are [[cancer]]s that arise from the [[skin]]. They are due to the development of abnormal [[cells (biology)|cells]] that have the ability to invade or [[metastasis|spread]] to other parts of the body.<ref>{{cite web|title=Defining Cancer|url=http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer|website=National Cancer Institute|accessdate=10 June 2014|deadurl=no|archiveurl=https://web.archive.org/web/20140625220940/http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer|archivedate=25 June 2014|df=dmy-all}}</ref> There are three main types of skin cancers: [[basal-cell skin cancer]] (BCC), [[squamous-cell skin cancer]] (SCC) and [[melanoma]].<ref name=NCI2013TxPro>{{cite web|title=Skin Cancer Treatment (PDQ®)|url=http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional/page1/AllPages|website=NCI|accessdate=30 June 2014|date=2013-10-25|deadurl=no|archiveurl=https://web.archive.org/web/20140705234200/http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional/page1/AllPages|archivedate=5 July 2014|df=dmy-all}}</ref> The first two, along with a number of less common skin cancers, are known as nonmelanoma skin cancer (NMSC).<ref name=Cak2012/><ref name=ABC2008>{{cite book|last1=Marsden|first1=edited by Sajjad Rajpar, Jerry|title=ABC of skin cancer|date=2008|publisher=Blackwell Pub.|location=Malden, Mass.|isbn=9781444312508|pages=5–6|url=https://books.google.com/books?id=aRE_YuXmaFoC&pg=PA5|deadurl=no|archiveurl=https://web.archive.org/web/20160429172638/https://books.google.com/books?id=aRE_YuXmaFoC&pg=PA5|archivedate=29 April 2016|df=dmy-all}}</ref> Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death.<ref name=Cak2012/> It often appears as a painless raised area of skin, that may be shiny with [[telangiectasia|small blood vessels running over it]] or may present as a raised area with an [[ulcer]].<ref name=NCI2013TxPro/> Squamous-cell skin cancer is more likely to spread.<ref name=Cak2012/> It usually presents as a hard lump with a scaly top but may also form an ulcer.<ref name=Lyn2011>{{cite book|author1=Lynne M Dunphy|title=Primary Care: The Art and Science of Advanced Practice Nursing|date=2011|publisher=F.A. Davis|isbn=9780803626478|page=242|url=https://books.google.com/books?id=RR1hAQAAQBAJ&pg=PA242|deadurl=no|archiveurl=https://web.archive.org/web/20160520044442/https://books.google.com/books?id=RR1hAQAAQBAJ&pg=PA242|archivedate=20 May 2016|df=dmy-all}}</ref> Melanomas are the most aggressive. Signs include a [[melanocytic nevus|mole]] that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.<ref name=Mel2014>{{cite web|title=General Information About Melanoma|url=http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient/page1/AllPages|website=NCI|accessdate=30 June 2014|date=2014-04-17|deadurl=no|archiveurl=https://web.archive.org/web/20140705115020/http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient/page1/AllPages|archivedate=5 July 2014|df=dmy-all}}</ref>
'''Skin cancers''' are [[cancer]]s that arise from the [[Human skin|skin]]. They are due to the development of abnormal [[cells (biology)|cells]] that have the ability to invade or [[metastasis|spread]] to other parts of the body.<ref>{{cite web|title=Defining Cancer|url=http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer|website=National Cancer Institute|access-date=10 June 2014|url-status=live|archive-url=https://web.archive.org/web/20140625220940/http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer|archive-date=25 June 2014|date=17 September 2007}}</ref> It occurs when skin cells grow uncontrollably, forming malignant tumors. The primary cause of skin cancer is prolonged exposure to ultraviolet (UV) radiation from the sun or tanning devices. Skin cancer is the most commonly diagnosed form of cancer in humans.<ref>{{cite journal | vauthors = Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Ioannides D | title = Epidemiological trends in skin cancer | journal = Dermatology Practical & Conceptual | volume = 7 | issue = 2 | pages = 1–6 | date = April 2017 | pmid = 28515985 | pmc = 5424654 | doi = 10.5826/dpc.0702a01 |doi-access=free }}</ref><ref>{{cite journal | vauthors = Hu W, Fang L, Ni R, Zhang H, Pan G | title = Changing trends in the disease burden of non-melanoma skin cancer globally from 1990 to 2019 and its predicted level in 25 years | journal = BMC Cancer | volume = 22 | issue = 1 | pages = 836 | date = July 2022 | pmid = 35907848 | pmc = 9339183 | doi = 10.1186/s12885-022-09940-3 | doi-access = free }}</ref><ref>{{cite journal |last1=Lyakhov |first1=Pavel A. |last2=Lyakhova |first2=Ulyana A. |last3=Kalita |first3=Diana I. |date=2023 |title=Multimodal Analysis of Unbalanced Dermatological Data for Skin Cancer Recognition |journal=IEEE Access |volume=11 |pages=131487–131507 |doi=10.1109/ACCESS.2023.3336289 |issn=2169-3536 |quote="To date, skin cancer is the most frequently diagnosed form of oncopathology in humans and represents a wide range of malignancies. More than 40% of the total number of diagnosed cancers in the world are skin cancer."|doi-access=free }}</ref> There are three main types of skin cancers: [[basal-cell skin cancer]] (BCC), [[squamous-cell skin cancer]] (SCC) and [[melanoma]].<ref name=NCI2013TxPro>{{cite web|title=Skin Cancer Treatment (PDQ®)|url=http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional/page1/AllPages|website=NCI|access-date=30 June 2014|date=2013-10-25|url-status=live|archive-url=https://web.archive.org/web/20140705234200/http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional/page1/AllPages|archive-date=5 July 2014}}</ref> The first two, along with a number of less common skin cancers, are known as nonmelanoma skin cancer (NMSC).<ref name="Cak2012" /><ref name=ABC2008>{{cite book| vauthors = Marsden J | veditors = Rajpar S |title=ABC of skin cancer|date=2008|publisher=Blackwell Pub.|location=Malden, MA|isbn=978-1-4443-1250-8|pages=5–6|url=https://books.google.com/books?id=aRE_YuXmaFoC&pg=PA5|url-status=live|archive-url=https://web.archive.org/web/20160429172638/https://books.google.com/books?id=aRE_YuXmaFoC&pg=PA5|archive-date=29 April 2016}}</ref> Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death.<ref name="Cak2012" /> It often appears as a painless raised area of skin that may be shiny with [[telangiectasia|small blood vessels running over it]] or may present as a raised area with an [[ulcer]].<ref name="NCI2013TxPro" /> Squamous-cell skin cancer is more likely to spread.<ref name="Cak2012" /> It usually presents as a hard lump with a scaly top but may also form an ulcer.<ref name=Lyn2011>{{cite book| vauthors = Dunphy LM |title=Primary Care: The Art and Science of Advanced Practice Nursing|date=2011|publisher=F.A. Davis|isbn=978-0-8036-2647-8|page=242|url=https://books.google.com/books?id=RR1hAQAAQBAJ&pg=PA242|url-status=live|archive-url=https://web.archive.org/web/20160520044442/https://books.google.com/books?id=RR1hAQAAQBAJ&pg=PA242|archive-date=20 May 2016}}</ref> Melanomas are the most aggressive. Signs include a [[melanocytic nevus|mole]] that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.<ref name=Mel2014>{{cite web|title=General Information About Melanoma|url=http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient/page1/AllPages|website=NCI|access-date=30 June 2014|date=2014-04-17|url-status=live|archive-url=https://web.archive.org/web/20140705115020/http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient/page1/AllPages|archive-date=5 July 2014}}</ref>


<!-- Cause and Diagnosis -->
<!-- Cause and Diagnosis -->
Greater than 90% of cases are caused by exposure to [[ultraviolet radiation]] from the [[Sun]].<ref name=UV2010>{{cite journal|last1=Gallagher|first1=RP|last2=Lee|first2=TK|last3=Bajdik|first3=CD|last4=Borugian|first4=M|title=Ultraviolet radiation.|journal=Chronic Diseases in Canada|date=2010|volume=29 Suppl 1|pages=51–68|pmid=21199599}}</ref> This exposure increases the risk of all three main types of skin cancer.<ref name=UV2010/> Exposure has increased partly due to a thinner [[ozone layer]].<ref name=Cak2012/><ref>{{cite journal |vauthors=Maverakis E, Miyamura Y, Bowen MP, Correa G, Ono Y, Goodarzi H | title = Light, including ultraviolet | journal = J Autoimmun | volume = 34 | issue = 3 | pages = J247–57 | year = 2010 | pmid = 20018479 | doi = 10.1016/j.jaut.2009.11.011 | pmc=2835849}}</ref> [[Tanning beds]] are becoming another common source of ultraviolet radiation.<ref name=UV2010/> For melanomas and basal-cell cancers exposure during childhood is particularly harmful.<ref name=WCR2014/> For squamous-cell skin cancers total exposure, irrespective of when it occurs, is more important.<ref name=UV2010/> Between 20% and 30% of melanomas develop from moles.<ref name=WCR2014/> People with light skin are at higher risk<ref name=NCI2013TxPro/><ref>{{cite book|last1=Leiter|first1=U|last2=Garbe|first2=C|title=Epidemiology of melanoma and nonmelanoma skin cancer—the role of sunlight.|journal=Advances in Experimental Medicine and Biology|date=2008|volume=624|pages=89–103|pmid=18348450|doi=10.1007/978-0-387-77574-6_8|isbn=978-0-387-77573-9}}</ref> as are those with poor immune function such as from medications or [[HIV/AIDS]].<ref name=Cak2012/><ref>{{cite journal|last1=Chiao|first1=EY|last2=Krown|first2=SE|title=Update on non-acquired immunodeficiency syndrome-defining malignancies.|journal=Current Opinion in Oncology|date=September 2003|volume=15|issue=5|pages=389–97|pmid=12960522|doi=10.1097/00001622-200309000-00008}}</ref> Diagnosis is by [[biopsy]].<ref name=Mel2014/>
More than 90% of cases are caused by exposure to [[ultraviolet radiation]] from the [[Sun]].<ref name=UV2010>{{cite journal | vauthors = Gallagher RP, Lee TK, Bajdik CD, Borugian M | title = Ultraviolet radiation | journal = Chronic Diseases in Canada | volume = 29 | issue = Suppl 1 | pages = 51–68 | date = 2010 | pmid = 21199599 | doi = 10.24095/hpcdp.29.S1.04 |doi-access=free }}</ref> This exposure increases the risk of all three main types of skin cancer.<ref name="UV2010" /> Exposure has increased, partly due to a thinner [[ozone layer]].<ref name="Cak2012" /><ref>{{cite journal | vauthors = Maverakis E, Miyamura Y, Bowen MP, Correa G, Ono Y, Goodarzi H | title = Light, including ultraviolet | journal = Journal of Autoimmunity | volume = 34 | issue = 3 | pages = J247–J257 | date = May 2010 | pmid = 20018479 | pmc = 2835849 | doi = 10.1016/j.jaut.2009.11.011 }}</ref> [[Tanning beds]] are another common source of ultraviolet radiation.<ref name="UV2010" /> For melanomas and basal-cell cancers, exposure during childhood is particularly harmful.<ref name="WCR2014" /> For squamous-cell skin cancers, total exposure, irrespective of when it occurs, is more important.<ref name="UV2010" /> Between 20% and 30% of melanomas develop from moles.<ref name="WCR2014" /> People with lighter skin are at higher risk<ref name="NCI2013TxPro" /><ref>{{cite book | vauthors = Leiter U, Garbe C | title = Sunlight, Vitamin D and Skin Cancer | chapter = Epidemiology of Melanoma and Nonmelanoma Skin Cancer—The Role of Sunlight | series = Advances in Experimental Medicine and Biology | volume = 624 | pages = 89–103 | date = 2008 | pmid = 18348450 | doi = 10.1007/978-0-387-77574-6_8 |doi-access=free | isbn = 978-0-387-77573-9 }}</ref> as are those with poor immune function such as from medications or [[HIV/AIDS]].<ref name="Cak2012" /><ref>{{cite journal | vauthors = Chiao EY, Krown SE | title = Update on non-acquired immunodeficiency syndrome-defining malignancies | journal = Current Opinion in Oncology | volume = 15 | issue = 5 | pages = 389–397 | date = September 2003 | pmid = 12960522 | doi = 10.1097/00001622-200309000-00008 | s2cid = 33259363 }}</ref> Diagnosis is by [[biopsy]].<ref name="Mel2014" />


<!-- Prevention and Treatment -->
<!-- Prevention and Treatment -->
Decreasing exposure to ultraviolet radiation and the use of [[sunscreen]] appear to be effective methods of preventing melanoma and squamous-cell skin cancer.<ref name=WCR2014/><ref name=Jou2012>{{cite journal|last1=Jou|first1=PC|last2=Feldman|first2=RJ|last3=Tomecki|first3=KJ|title=UV protection and sunscreens: what to tell patients.|journal=Cleveland Clinic Journal of Medicine|date=June 2012|volume=79|issue=6|pages=427–36|pmid=22660875|doi=10.3949/ccjm.79a.11110}}</ref> It is not clear if sunscreen affects the risk of basal-cell cancer.<ref name=Jou2012/> Nonmelanoma skin cancer is usually curable.<ref name=Cak2012/> Treatment is generally by surgical removal but may less commonly involve [[radiation therapy]] or topical medications such as [[fluorouracil]].<ref name=NCI2013TxPro/> Treatment of melanoma may involve some combination of surgery, [[chemotherapy]], [[radiation therapy]], and [[targeted therapy]].<ref name=Mel2014/> In those people whose disease has spread to other areas of their bodies, [[palliative care]] may be used to improve quality of life.<ref name=Mel2014/> Melanoma has one of the higher survival rates among cancers, with over 86% of people in the UK and more than 90% in the United States [[5 year survival rate|surviving more than 5 years]].<ref>{{cite web|title=SEER Stat Fact Sheets: Melanoma of the Skin|url=http://seer.cancer.gov/statfacts/html/melan.html|website=NCI|accessdate=18 June 2014|deadurl=no|archiveurl=https://web.archive.org/web/20140706134347/http://seer.cancer.gov/statfacts/html/melan.html|archivedate=6 July 2014|df=dmy-all}}</ref><ref>{{cite web|title=Release: Cancer Survival Rates, Cancer Survival in England, Patients Diagnosed 2005–2009 and Followed up to 2010|url=http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-239726|website=Office for National Statistics|accessdate=30 June 2014|date=15 November 2011|deadurl=no|archiveurl=https://web.archive.org/web/20141017061743/http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-239726|archivedate=17 October 2014|df=dmy-all}}</ref>
Decreasing exposure to ultraviolet radiation and the use of [[sunscreen]] appear to be effective methods of preventing melanoma and squamous-cell skin cancer.<ref name="WCR2014" /><ref name=Jou2012>{{cite journal | vauthors = Jou PC, Feldman RJ, Tomecki KJ | title = UV protection and sunscreens: what to tell patients | journal = Cleveland Clinic Journal of Medicine | volume = 79 | issue = 6 | pages = 427–436 | date = June 2012 | pmid = 22660875 | doi = 10.3949/ccjm.79a.11110 | doi-access = free }}</ref> It is not clear if sunscreen affects the risk of basal-cell cancer.<ref name="Jou2012" /> Nonmelanoma skin cancer is usually curable.<ref name="Cak2012" /> Treatment is generally by surgical removal but may, less commonly, involve [[radiation therapy]] or topical medications such as [[fluorouracil]].<ref name="NCI2013TxPro" /> Treatment of melanoma may involve some combination of surgery, [[chemotherapy]], [[radiation therapy]] and [[targeted therapy]].<ref name="Mel2014" /> In those people whose disease has spread to other areas of the body, [[palliative care]] may be used to improve quality of life.<ref name="Mel2014" /> Melanoma has one of the higher survival rates among cancers, with over 86% of people in the UK and more than 90% in the United States [[Five-year survival rate|surviving more than 5 years]].<ref>{{cite web|title=SEER Stat Fact Sheets: Melanoma of the Skin|url=http://seer.cancer.gov/statfacts/html/melan.html|website=NCI|access-date=18 June 2014|url-status=live|archive-url=https://web.archive.org/web/20140706134347/http://seer.cancer.gov/statfacts/html/melan.html|archive-date=6 July 2014}}</ref><ref>{{cite web|title=Release: Cancer Survival Rates, Cancer Survival in England, Patients Diagnosed 2005–2009 and Followed up to 2010|url=http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-239726|website=Office for National Statistics|access-date=30 June 2014|date=15 November 2011|url-status=live|archive-url=https://web.archive.org/web/20141017061743/http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-239726|archive-date=17 October 2014}}</ref>


<!-- Epidemiology -->
<!-- Epidemiology -->
Skin cancer is the most common form of cancer, globally accounting for at least 40% of cases.<ref name=Cak2012>{{cite journal|last1=Cakir|first1=|last2=Adamson|first2=P|last3=Cingi|first3=C|title=Epidemiology and economic burden of nonmelanoma skin cancer.|journal=Facial Plastic Surgery Clinics of North America|date=November 2012|volume=20|issue=4|pages=419–22|pmid=23084294|doi=10.1016/j.fsc.2012.07.004}}</ref><ref>{{cite journal|last1=Dubas|first1=LE|last2=Ingraffea|first2=A|title=Nonmelanoma skin cancer.|journal=Facial Plastic Surgery Clinics of North America|date=February 2013|volume=21|issue=1|pages=43–53|pmid=23369588|doi=10.1016/j.fsc.2012.10.003}}</ref> The most common type is nonmelanoma skin cancer, which occurs in at least 2-3 million people per year.<ref name=WCR2014/><ref>{{cite web|title=How common is skin cancer?|url=http://www.who.int/uv/faq/skincancer/en/index1.html|website=World Health Organization|accessdate=30 June 2014|deadurl=no|archiveurl=https://web.archive.org/web/20100927065836/http://www.who.int/uv/faq/skincancer/en/index1.html|archivedate=27 September 2010|df=dmy-all}}</ref> This is a rough estimate, however, as good statistics are not kept.<ref name=NCI2013TxPro/> Of nonmelanoma skin cancers, about 80% are basal-cell cancers and 20% squamous-cell skin cancers.<ref name=ABC2008/> Basal-cell and squamous-cell skin cancers rarely result in death.<ref name=WCR2014/> In the United States they were the cause of less than 0.1% of all cancer deaths.<ref name=NCI2013TxPro/> Globally in 2012 melanoma occurred in 232,000 people, and resulted in 55,000 deaths.<ref name=WCR2014/> [[White people]] in [[Australia]], [[New Zealand]] and [[South Africa]] have the highest rates of melanoma in the world.<ref name=WCR2014/><ref>{{cite book |last1=Harris |first1=Randall E. |title=Epidemiology of Chronic Disease |date=2013 |publisher=Jones & Bartlett Publishers |isbn=9780763780470 |page=271 |url=https://books.google.ca/books?id=KJLEIvX4wzoC&pg=PA271 |language=en}}</ref> The three main types of skin cancer have become more common in the last 20 to 40 years, especially in those areas which are mostly [[White people|Caucasian]].<ref name=Cak2012/><ref name=WCR2014>{{cite book|title=World Cancer Report 2014.|date=2014|publisher=World Health Organization|isbn=978-9283204299|pages=Chapter 5.14}}</ref>
Skin cancer is the most common form of cancer, globally accounting for at least 40% of cancer cases.<ref name=Cak2012>{{cite journal | vauthors = Cakir , Adamson P, Cingi C | title = Epidemiology and economic burden of nonmelanoma skin cancer | journal = Facial Plastic Surgery Clinics of North America | volume = 20 | issue = 4 | pages = 419–422 | date = November 2012 | pmid = 23084294 | doi = 10.1016/j.fsc.2012.07.004 }}</ref><ref>{{cite journal | vauthors = Dubas LE, Ingraffea A | title = Nonmelanoma skin cancer | journal = Facial Plastic Surgery Clinics of North America | volume = 21 | issue = 1 | pages = 43–53 | date = February 2013 | pmid = 23369588 | doi = 10.1016/j.fsc.2012.10.003 }}</ref> The most common type is nonmelanoma skin cancer, which occurs in at least 2–3 million people per year.<ref name="WCR2014" /><ref>{{cite web|title=How common is skin cancer?|url=https://www.who.int/uv/faq/skincancer/en/index1.html|website=World Health Organization|access-date=30 June 2014|url-status=live|archive-url=https://web.archive.org/web/20100927065836/http://www.who.int/uv/faq/skincancer/en/index1.html|archive-date=27 September 2010}}</ref> This is a rough estimate; good statistics are not kept.<ref name="NCI2013TxPro" /> Of nonmelanoma skin cancers, about 80% are basal-cell cancers and 20% squamous-cell skin cancers.<ref name="ABC2008" /> Basal-cell and squamous-cell skin cancers rarely result in death.<ref name="WCR2014" /> In the United States, they were the cause of less than 0.1% of all cancer deaths.<ref name="NCI2013TxPro" /> Globally in 2012, melanoma occurred in 232,000 people and resulted in 55,000 deaths.<ref name="WCR2014" /> White people in [[Australia]], [[New Zealand]] and [[South Africa]] have the highest rates of melanoma in the world.<ref name="WCR2014" /><ref>{{cite book | vauthors = Harris RE | title=Epidemiology of Chronic Disease |date=2013 |publisher=Jones & Bartlett Publishers |isbn=978-0-7637-8047-0 |page=271 |url=https://books.google.com/books?id=KJLEIvX4wzoC&pg=PA271 }}</ref> The three main types of skin cancer have become more common in the last 20 to 40 years, especially regions where the population is predominantly White.<ref name="Cak2012" /><ref name=WCR2014>{{cite book|title=World Cancer Report 2014.|date=2014|publisher=World Health Organization|isbn=978-9283204299|pages=Chapter 5.14}}</ref>
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==Classification==
== Classification ==


There are three main types of skin cancer: [[basal-cell skin cancer]] (basal-cell carcinoma) (BCC), [[squamous-cell skin cancer]] (squamous-cell carcinoma) (SCC) and [[malignant melanoma]].
There are three main types of skin cancer: [[basal-cell skin cancer]] (basal-cell carcinoma) (BCC), [[squamous-cell skin cancer]] (squamous-cell carcinoma) (SCC) and [[malignant melanoma]].
{| class="wikitable" style="margin:1em auto;"
<center>
{| class="wikitable"
|-
! Cancer
! Cancer
! Description
! Description
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|-
|-
| [[Basal-cell carcinoma]]
| [[Basal-cell carcinoma]]
| Note the pearly translucency to fleshy color, tiny blood vessels on the surface, and sometime ulceration which can be characteristics. The key term is translucency.
| Note the pearly translucency to fleshy color, tiny blood vessels on the surface, and sometimes ulceration which can be characteristics. The key term is translucency.
| [[Image:Basal cell carcinoma3.JPG|center|150px]]
| [[File:Basal cell carcinoma3.JPG|center|150px]]
|-
|-
| [[Squamous-cell skin carcinoma]]
| [[Squamous-cell skin carcinoma]]
| Commonly presents as a red, crusted, or scaly patch or bump. Often a very rapid growing tumor.
| Commonly presents as a red, crusted, or scaly patch or bump. Often a very rapidly growing tumor.
| [[Image:Squamous Cell Carcinoma1.jpg|center|150px]]
| [[File:Squamous Cell Carcinoma1.jpg|center|150px]]
|-
|-
| [[melanoma|Malignant melanoma]]
| [[Melanoma|Malignant melanoma]]
| The common appearance is an asymmetrical area, with an irregular border, color variation, and often greater than 6&nbsp;mm diameter.<ref>{{cite journal|url=http://emedicine.medscape.com/article/1100753-overview|title=Malignant Melanoma: eMedicine Dermatology|format=|website=|accessdate=|deadurl=no|archiveurl=https://web.archive.org/web/20101007220016/http://emedicine.medscape.com/article/1100753-overview|archivedate=7 October 2010|df=dmy-all|date=2019-01-31}}</ref>
| These are commonly asymmetrical in shape and/or pigment distribution, with an irregular border, color variation, and often greater than 6&nbsp;mm diameter.<ref>{{cite web | vauthors = Swetter SM | date = 30 August 2010 |url= http://emedicine.medscape.com/article/1100753-overview |title=Malignant Melanoma | work = eMedicine Dermatology|url-status=live|archive-url=https://web.archive.org/web/20101007220016/http://emedicine.medscape.com/article/1100753-overview|archive-date=7 October 2010 }}</ref>
| [[Image:Melanoma.jpg|center|150px]]
| [[File:Melanoma.jpg|center|150px]]
|}
|}</center>


Basal-cell carcinomas are present on sun-exposed areas of the skin, especially the face. They rarely metastasize and rarely cause death. They are easily treated with surgery or radiation. Squamous-cell skin cancer are common, but much less common than basal-cell cancers. They metastasize more frequently than BCCs. Even then, the metastasis rate is quite low, with the exception of SCC of the lip, ear, and in people who are immunosuppressed. Melanoma are the least frequent of the 3 common skin cancers. They frequently metastasize, and could potentially cause death once they spread.
Basal-cell carcinomas are most commonly present on sun-exposed areas of the skin, especially the face. They rarely metastasize and rarely cause death. They are easily treated with surgery or radiation. Squamous-cell skin cancers are also common, but much less common than basal-cell cancers. They metastasize more frequently than BCCs. Even then, the metastasis rate is quite low, with the exception of SCC of the lip or ear, and in people who are immunosuppressed. Melanoma are the least frequent of the three common skin cancers. They frequently metastasize, and can cause death once they spread.


Less common skin cancers include: [[dermatofibrosarcoma protuberans]], [[Merkel cell carcinoma]], [[Kaposi's sarcoma]], [[keratoacanthoma]], spindle cell tumors, [[sebaceous carcinoma]]s, [[microcystic adnexal carcinoma]], [[Paget's disease of the breast]], atypical fibroxanthoma, [[leiomyosarcoma]], and [[angiosarcoma]].
Less common skin cancers include: [[Merkel cell carcinoma]], [[Paget's disease of the breast]], atypical fibroxanthoma, [[porocarcinoma]], spindle cell tumors, [[sebaceous carcinoma]]s, [[microcystic adnexal carcinoma]], [[keratoacanthoma]], and [[skin sarcoma]]s, such as [[angiosarcoma]], [[dermatofibrosarcoma protuberans]], [[Kaposi's sarcoma]], [[leiomyosarcoma]].


BCC and SCC often carry a UV-signature mutation indicating that these cancers are caused by [[UVB]] radiation via direct DNA damage. However malignant melanoma is predominantly caused by UVA radiation via indirect DNA damage. The indirect DNA damage is caused by free radicals and reactive oxygen species. Research indicates that the absorption of three sunscreen ingredients into the skin, combined with a 60-minute exposure to UV, leads to an increase of [[free radicals]] in the skin, if applied in too little quantities and too infrequently.<ref name="Hanson">{{cite journal |author1=Hanson Kerry M. |author2=Gratton Enrico |author3=Bardeen Christopher J | title = Sunscreen enhancement of UV-induced reactive oxygen species in the skin | journal = Free Radical Biology and Medicine | volume = 41 | issue = 8 | pages = 1205–1212 | year = 2006 | pmid = 17015167 | doi = 10.1016/j.freeradbiomed.2006.06.011 }}</ref> However, the researchers add that newer creams often do not contain these specific compounds, and that the combination of other ingredients tends to retain the compounds on the surface of the skin. They also add the frequent re-application reduces the risk of radical formation.
BCC and SCC often carry a UV-signature mutation indicating that these cancers are caused by [[UVB]] radiation via direct DNA damage. However malignant melanoma is predominantly caused by UVA radiation via indirect DNA damage. The indirect DNA damage is caused by free radicals and reactive oxygen species. Research indicates that the absorption of three sunscreen ingredients into the skin, combined with a 60-minute exposure to UV, leads to an increase of [[free radicals]] in the skin, if applied in too little quantity and too infrequently.<ref name="Hanson">{{cite journal | vauthors = Hanson KM, Gratton E, Bardeen CJ | title = Sunscreen enhancement of UV-induced reactive oxygen species in the skin | journal = Free Radical Biology & Medicine | volume = 41 | issue = 8 | pages = 1205–1212 | date = October 2006 | pmid = 17015167 | doi = 10.1016/j.freeradbiomed.2006.06.011 | s2cid = 13999532 | url = https://escholarship.org/content/qt9f14s2dd/qt9f14s2dd.pdf?t=oe9hj9 }}</ref> However, the researchers add that newer creams often do not contain these specific compounds, and that the combination of other ingredients tends to retain the compounds on the surface of the skin. They also add that frequent re-application reduces the risk of radical formation.


== Signs and symptoms ==
== Signs and symptoms ==
There are a variety of different skin cancer symptoms. These include changes in the [[skin]] that do not heal, [[Ulcer (dermatology)|ulcering]] in the skin, discolored skin, and changes in existing [[Mole (skin marking)|mole]]s, such as jagged edges to the mole and enlargement of the mole.
There are a variety of different skin cancer symptoms. These include changes in the [[Human skin|skin]] that do not heal, [[Ulcer (dermatology)|ulcering]] in the skin, discolored skin, and changes in existing [[Mole (skin marking)|moles]], such as jagged edges to the mole, enlargement of the mole, changes in color, the way it feels or if it bleeds. Other common signs of skin cancer can be painful lesion that itches or burns and large brownish spot with darker speckles.<ref>Mayo Clinic (2020). Skin Cancer: Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/skin-cancer/symptoms-causes/syc-20377605</ref>


===Basal-cell skin cancer===
=== Basal-cell skin cancer ===
Basal-cell skin cancer (BCC) usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the [[head]], [[neck]] or [[shoulder]]s. Sometimes small [[blood vessel]]s (called [[telangiectasia]]) 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. This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring.
Basal-cell skin cancer (BCC) usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the [[Human head|head]], [[neck]], [[torso]] or [[shoulder]]s. Sometimes small [[blood vessel]]s (called [[telangiectasia]]) 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. This form of skin cancer is the least deadly, and with proper treatment can be eliminated, often without significant scarring.


===Squamous-cell skin cancer===
=== Squamous-cell skin cancer ===
Squamous-cell skin cancer (SCC) is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped like [[keratoacanthoma]]s. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous-cell is the second most common skin cancer. It is dangerous, but not nearly as dangerous as a melanoma.
Squamous-cell skin cancer (SCC) is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped like [[keratoacanthoma]]s. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous-cell is the second most common skin cancer. It is dangerous, but not nearly as dangerous as a melanoma.


===Melanoma===
=== Melanoma ===
Most melanoma consist of various colours from shades of brown to black. A small number of melanoma are pink, red or fleshy in colour; these are called amelanotic melanoma and tend to be more aggressive. Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around the site, or bleeding at the site. An often-used mnemonic is "ABCDE", where A is for "asymmetrical", B for "borders" (irregular: "Coast of Maine sign"), C for "color" (variegated), D for "diameter" (larger than 6&nbsp;mm – the size of a pencil eraser) and E for "evolving."<ref>{{Cite web|url = http://www.cancer.gov/cancertopics/wyntk/skin.pdf|title = What You Need To Know About: Melanoma and Other Skin Cancers|publisher = National Cancer Institute|deadurl = no|archiveurl = https://web.archive.org/web/20130318041656/http://www.cancer.gov/cancertopics/wyntk/skin.pdf|archivedate = 18 March 2013|df = dmy-all}}</ref><ref>{{Cite web|url = http://www.cancer.org/acs/groups/cid/documents/webcontent/003120-pdf.pdf|title = Melanoma Skin Cancer|publisher = American Cancer Society|year = 2012|deadurl = no|archiveurl = https://web.archive.org/web/20130909230623/http://www.cancer.org/acs/groups/cid/documents/webcontent/003120-pdf.pdf|archivedate = 9 September 2013|df = dmy-all}}</ref>
Most melanoma consist of various colours from shades of brown to black. A small number of melanoma are pink, red or fleshy in colour; these are called amelanotic melanoma and tend to be more aggressive. Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around the site, or bleeding at the site. An often-used mnemonic is "ABCDE", where A is for "asymmetrical", B for "borders" (irregular: "Coast of Maine sign"), C for "color" (variegated), D for "diameter" (larger than 6&nbsp;mm – the size of a pencil eraser) and E for "evolving."<ref>{{cite web|url = http://www.cancer.gov/cancertopics/wyntk/skin.pdf|title = What You Need To Know About: Melanoma and Other Skin Cancers|publisher = National Cancer Institute|url-status = live|archive-url = https://web.archive.org/web/20130318041656/http://www.cancer.gov/cancertopics/wyntk/skin.pdf|archive-date = 18 March 2013}}</ref><ref>{{cite web|url = http://www.cancer.org/acs/groups/cid/documents/webcontent/003120-pdf.pdf|title = Melanoma Skin Cancer|publisher = American Cancer Society|year = 2012|url-status = live|archive-url = https://web.archive.org/web/20130909230623/http://www.cancer.org/acs/groups/cid/documents/webcontent/003120-pdf.pdf|archive-date = 9 September 2013}}</ref>


===Other===
=== Other ===
[[Merkel cell]] carcinomas are most often rapidly growing, non-tender red, purple or skin colored bumps that are not painful or itchy. They may be mistaken for a cyst or another type of cancer.<ref>{{cite journal | author = Bickle K, Glass, LF, Messina, JL, Fenske, NA, Siegrist, K | title = Merkel cell carcinoma: a clinical, histopathologic, and immunohistochemical review. | journal = Seminars in Cutaneous Medicine and Surgery | volume = 23 | issue = 1 | pages = 46–53 |date=March 2004 | pmid = 15095915 | doi = 10.1016/s1085-5629(03)00087-7}}</ref>
[[Merkel cell]] carcinomas are most often rapidly growing, non-tender red, purple or skin colored bumps that are not painful or itchy. They may be mistaken for a cyst or another type of cancer.<ref>{{cite journal | vauthors = Bickle K, Glass LF, Messina JL, Fenske NA, Siegrist K | title = Merkel cell carcinoma: a clinical, histopathologic, and immunohistochemical review | journal = Seminars in Cutaneous Medicine and Surgery | volume = 23 | issue = 1 | pages = 46–53 | date = March 2004 | pmid = 15095915 | doi = 10.1016/s1085-5629(03)00087-7 | doi-broken-date = 2 November 2024 }}</ref>


==Causes==
== Causes ==
Ultraviolet radiation from sun exposure is the primary environmental cause of skin cancer.<ref>{{cite journal | author = Narayanan DL, Saladi, RN, Fox, JL | title = Ultraviolet radiation and skin cancer. | journal = International Journal of Dermatology | volume = 49 | issue = 9 | pages = 978–86 |date=September 2010 | pmid = 20883261 | doi = 10.1111/j.1365-4632.2010.04474.x }}</ref><ref name=Review05>{{cite journal | author = Saladi RN, Persaud, AN | title = The causes of skin cancer: a comprehensive review. | journal = Drugs of Today (Barcelona, Spain : 1998) | volume = 41 | issue = 1 | pages = 37–53 |date=January 2005 | pmid = 15753968 | doi = 10.1358/dot.2005.41.1.875777 }}</ref><ref>{{Cite journal|last=Gordon|first=Randy|date=2013-08-01|title=Skin cancer: an overview of epidemiology and risk factors|journal=Seminars in Oncology Nursing|volume=29|issue=3|pages=160–169|doi=10.1016/j.soncn.2013.06.002|issn=1878-3449|pmid=23958214}}</ref> This can occur in professions such as farming. Other risk factors that play a role include:
Ultraviolet radiation from sun exposure is the primary environmental cause of skin cancer.<ref>{{cite journal | vauthors = Narayanan DL, Saladi RN, Fox JL | title = Ultraviolet radiation and skin cancer | journal = International Journal of Dermatology | volume = 49 | issue = 9 | pages = 978–986 | date = September 2010 | pmid = 20883261 | doi = 10.1111/j.1365-4632.2010.04474.x | s2cid = 22224492 | doi-access = free }}</ref><ref name=Review05>{{cite journal | vauthors = Saladi RN, Persaud AN | title = The causes of skin cancer: a comprehensive review | journal = Drugs of Today | volume = 41 | issue = 1 | pages = 37–53 | date = January 2005 | pmid = 15753968 | doi = 10.1358/dot.2005.41.1.875777 }}</ref><ref>{{cite journal | vauthors = Gordon R | title = Skin cancer: an overview of epidemiology and risk factors | journal = Seminars in Oncology Nursing | volume = 29 | issue = 3 | pages = 160–169 | date = August 2013 | pmid = 23958214 | doi = 10.1016/j.soncn.2013.06.002 }}</ref><ref>{{cite journal | vauthors = Mata DA, Williams EA, Sokol E, Oxnard GR, Fleischmann Z, Tse JY, Decker B | title = Prevalence of UV Mutational Signatures Among Cutaneous Primary Tumors | journal = JAMA Network Open | volume = 5 | issue = 3 | pages = e223833 | date = March 2022 | pmid = 35319765 | pmc = 8943639 | doi = 10.1001/jamanetworkopen.2022.3833 | s2cid = 247616874 }}</ref> This can occur in professions such as farming. Other risk factors that play a role include:
* Light skin color <ref name="Review05" />
* Age <ref name="Review05" />
* Smoking [[tobacco]]<ref name="Review05" />
* [[HPV]] infections increase the risk of squamous-cell skin cancer.<ref name="Review05" />
* Some genetic syndromes<ref name="Review05" /> including [[congenital melanocytic nevi syndrome]] which is characterized by the presence of [[Nevus|nevi]] (birthmarks or moles) of varying size which are either present at birth, or appear within 6 months of birth. Nevi larger than 20&nbsp;mm (3/4") in size are at higher risk for becoming cancerous.
* Chronic non-healing wounds.<ref name="Review05" /> These are called [[Marjolin's ulcer]]s based on their appearance, and can develop into squamous-cell skin cancer.
* [[Ionizing radiation]] such as X-rays, environmental [[carcinogens]], and artificial UV radiation (e.g. [[tanning beds]]).<ref name="Review05" /> It is believed that tanning beds are the cause of hundreds of thousands of basal and squamous-cell skin cancer.<ref>{{cite journal | vauthors = Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E | title = Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis | journal = BMJ | volume = 345 | pages = e5909 | date = October 2012 | pmid = 23033409 | pmc = 3462818 | doi = 10.1136/bmj.e5909 }}</ref> The World Health Organization now places people who use artificial tanning beds in its highest risk category for skin cancer.<ref>{{cite book | vauthors = Arndt KA | date = 2010 | title = Skin Care and Repair | location = Chestnut Hill, MA | publisher = Harvard Health Publications }}</ref>
* Alcohol consumption, specifically excessive drinking increase the risk of sunburns.<ref>{{cite journal | vauthors = Saladi RN, Nektalova T, Fox JL | title = Induction of skin carcinogenicity by alcohol and ultraviolet light | journal = Clinical and Experimental Dermatology | volume = 35 | issue = 1 | pages = 7–11 | date = January 2010 | pmid = 19778305 | doi = 10.1111/j.1365-2230.2009.03465.x | s2cid = 35392237 }}</ref>
* The use of many [[immunosuppressive drug|immunosuppressive]] medications increases the risk of skin cancer.<ref>{{cite journal | vauthors = Roche CD, Dobson JS, Williams SK, Quante M, Popoola J, Chow JW | title = Malignant and noninvasive skin tumours in renal transplant recipients | journal = Dermatology Research and Practice | volume = 2014 | pages = 409058 | date = 2014 | pmid = 25302063 | pmc = 4180396 | doi = 10.1155/2014/409058 | doi-access = free }}</ref> [[Cyclosporin A]], a [[calcineurin inhibitor]] for example increases the risk approximately 200 times, and [[azathioprine]] about 60 times.<ref>{{cite journal | vauthors = Kuschal C, Thoms KM, Schubert S, Schäfer A, Boeckmann L, Schön MP, Emmert S | title = Skin cancer in organ transplant recipients: effects of immunosuppressive medications on DNA repair | journal = Experimental Dermatology | volume = 21 | issue = 1 | pages = 2–6 | date = January 2012 | pmid = 22151386 | doi = 10.1111/j.1600-0625.2011.01413.x | s2cid = 25776283 | doi-access = free }}</ref>
* Deliberate exposure of sensitive skin not normally exposed to sunlight during [[wellness (alternative medicine)|alternative wellness]] behaviors such as [[perineum]] sunning.


===UV-induced DNA damage===
*Smoking [[tobacco]]<ref name=Review05/>

*[[HPV]] infections increase the risk of squamous-cell skin cancer.<ref name=Review05/>
[[ultraviolet|UV-irradiation]] of skin cells causes [[DNA damage (naturally occurring)|damage to DNA]] through [[photochemistry|photochemical reactions]].<ref name="lee">{{cite journal | vauthors = Lee JW, Ratnakumar K, Hung KF, Rokunohe D, Kawasumi M | title = Deciphering UV-induced DNA Damage Responses to Prevent and Treat Skin Cancer | journal = Photochemistry and Photobiology | volume = 96 | issue = 3 | pages = 478–499 | date = May 2020 | pmid = 32119110 | pmc = 7651136 | doi = 10.1111/php.13245 }}</ref> Cyclobutane [[pyrimidine dimer]]s formed by adjacent thymine bases, or by adjacent cytosine bases, are frequent types of DNA damage induced by UV.<ref name=lee/> Human skin cells are capable of repairing most UV-induced damage by [[nucleotide excision repair]], a process that protects against skin cancer, but may be inadequate at high levels of exposure.<ref name=lee/>
*Some genetic syndromes<ref name=Review05/> including [[congenital melanocytic nevi syndrome]] which is characterized by the presence of [[Nevus|nevi]] (birthmarks or moles) of varying size which are either present at birth, or appear within 6 months of birth. Nevi larger than 20&nbsp;mm (3/4") in size are at higher risk for becoming cancerous.
*Chronic non-healing wounds.<ref name=Review05/> These are called [[Marjolin's ulcer]]s based on their appearance, and can develop into squamous-cell skin cancer.
*[[Ionizing radiation]] such as X-rays, environmental [[carcinogens]], artificial UV radiation (e.g. [[tanning beds]]), aging, and light skin color.<ref name=Review05/> It is believed that tanning beds are the cause of hundreds of thousands of basal and squamous-cell skin cancer.<ref>{{cite journal|last=Wehner|first=MR|author2=Shive, ML |author3=Chren, MM |author4=Han, J |author5=Qureshi, AA |author6= Linos, E |title=Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis.|journal=BMJ (Clinical Research Ed.)|date=October 2, 2012|volume=345|pages=e5909|pmid=23033409|pmc=3462818|doi=10.1136/bmj.e5909}}</ref> The World Health Organization now places people who use artificial tanning beds in its highest risk category for skin cancer.<ref>Arndt, K.A. (2010).''Skin Care and Repair''.Chestnut Hill, MA:Harvard Health Publications.</ref> Alcohol consumption, specifically excessive drinking increase the risk of sunburns.<ref>{{Cite journal|last=Saladi|first=R. N.|last2=Nektalova|first2=T.|last3=Fox|first3=J. L.|date=2010-01-01|title=Induction of skin carcinogenicity by alcohol and ultraviolet light|journal=Clinical and Experimental Dermatology|volume=35|issue=1|pages=7–11|doi=10.1111/j.1365-2230.2009.03465.x|issn=1365-2230|pmid=19778305}}</ref>
*The use of many [[immunosuppressive drug|immunosuppressive]] medications increases the risk of skin cancer. [[Cyclosporin A]], a [[calcineurin inhibitor]] for example increases the risk approximately 200 times, and [[azathioprine]] about 60 times.<ref>{{cite journal |author1=Kuschal C, Thoms, KM |author2=Schubert, S |author3=Schäfer, A |author4=Boeckmann, L |author5=Schön, MP |author6=Emmert, S | title = Skin cancer in organ transplant recipients: effects of immunosuppressive medications on DNA repair. | journal = Experimental Dermatology | volume = 21 | issue = 1 | pages = 2–6 |date=January 2012 | pmid = 22151386 | doi = 10.1111/j.1600-0625.2011.01413.x}}</ref>


== Pathophysiology ==
== Pathophysiology ==
[[Image:Melanoma - cytology field stain.jpg|thumb|right|[[Micrograph]] of [[melanoma]], [[fine-needle aspiration]] (FNA), [[field stain]]]]
[[File:Melanoma - cytology field stain.jpg|thumb|[[Micrograph]] of [[melanoma]], [[fine-needle aspiration]] (FNA), [[field stain]]]]
A malignant epithelial tumor that primarily originates in the epidermis, in squamous mucosa or in areas of squamous metaplasia is referred to as a squamous-cell carcinoma.<ref name="pathologyatlas.ro"/>
A malignant epithelial tumor that primarily originates in the epidermis, in squamous mucosa or in areas of squamous metaplasia is referred to as a squamous-cell carcinoma.<ref name="pathologyatlas.ro" />


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 [[pleomorphism (cytology)|pleomorphic]]/atypical, but resembling normal keratinocytes from prickle layer (large, polygonal, with abundant [[eosinophilic]] (pink) cytoplasm and central nucleus).<ref name="pathologyatlas.ro">{{cite web|url=http://www.pathologyatlas.ro/squamous-cell-carcinoma-skin.php|title="Squamous cell carcinoma (epidermoid carcinoma) skin" pathologyatlas.ro|accessdate=2007-07-21|format=|website=|deadurl=no|archiveurl=https://web.archive.org/web/20090310035400/http://www.pathologyatlas.ro/squamous-cell-carcinoma-skin.php|archivedate=10 March 2009|df=dmy-all}}</ref>
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 [[pleomorphism (cytology)|pleomorphic]]/atypical, but resembling normal keratinocytes from prickle layer (large, polygonal, with abundant [[eosinophilic]] (pink) cytoplasm and central nucleus).<ref name="pathologyatlas.ro">{{cite web |url= http://www.pathologyatlas.ro/squamous-cell-carcinoma-skin.php |title= Squamous cell carcinoma (epidermoid carcinoma) skin | work = Atlas of Pathology | publisher = Universitatii St., Iasi, Romania | edition = 3rd |access-date=2007-07-21 |url-status=live|archive-url= https://web.archive.org/web/20090310035400/http://www.pathologyatlas.ro/squamous-cell-carcinoma-skin.php |archive-date=10 March 2009}}</ref>


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 name="pathologyatlas.ro"/>
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 name="pathologyatlas.ro" />


A molecular factor involved in the disease process is mutation in gene [[PTCH1]] that plays an important role in the [[Sonic hedgehog]] signaling pathway.<ref>{{cite journal|last1=Kormi|first1=Seyed Mohammad Amin|last2=Ardehkhani|first2=Shima|title=Non-melanoma Skin Cancer: Mini Review|journal=Cancer|date=2012|volume=166|issue=5|pages=1069–80|doi=10.15562/tcp.40|accessdate=}}</ref>
A molecular factor involved in the disease process is mutation in gene [[PTCH1]] that plays an important role in the [[Sonic hedgehog]] signaling pathway.<ref>{{cite journal| vauthors = Kormi SM, Ardehkhani S |title=Non-melanoma Skin Cancer: Mini Review|journal=Cancer|date=2012|volume=166|issue=5|pages=1069–80|doi=10.15562/tcp.40|doi-access=free}}</ref>


== Diagnosis ==
== Diagnosis ==
Diagnosis is by [[biopsy]] and [[histopathology|histopathological examination]].<ref name=Mel2014/>
Diagnosis is by [[biopsy]] and [[histopathology|histopathological examination]].<ref name="Mel2014" />


Non-invasive skin cancer detection methods include photography, dermoscopy, sonography, [[Confocal microscopy|confocal microscopy]], Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis.<ref>{{Cite journal|last=Narayanamurthy|first=Vigneswaran|last2=Padmapriya|first2=P.|last3=Noorasafrin|first3=A.|last4=Pooja|first4=B.|last5=Hema|first5=K.|last6=Firus Khan|first6=Al'aina Yuhainis|last7=Nithyakalyani|first7=K.|last8=Samsuri|first8=Fahmi|date=2018|title=Skin cancer detection using non-invasive techniques|journal=RSC Advances|language=en|volume=8|issue=49|pages=28095–28130|doi=10.1039/c8ra04164d|issn=2046-2069}}</ref>
Non-invasive skin cancer detection methods include photography, dermatoscopy, sonography, [[confocal microscopy]], Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis.<ref>{{cite journal | vauthors = Narayanamurthy V, Padmapriya P, Noorasafrin A, Pooja B, Hema K, Firus Khan AY, Nithyakalyani K, Samsuri F | display-authors = 6 | title = Skin cancer detection using non-invasive techniques | journal = RSC Advances | volume = 8 | issue = 49 | pages = 28095–28130 | date = August 2018 | pmid = 35542700 | pmc = 9084287 | doi = 10.1039/c8ra04164d | doi-access = free | bibcode = 2018RSCAd...828095N }}</ref>

Dermatoscopy may be useful in diagnosing basal cell carcinoma in addition to skin inspection.<ref>{{cite journal | vauthors = Dinnes J, Deeks JJ, Chuchu N, Matin RN, Wong KY, Aldridge RB, Durack A, Gulati A, Chan SA, Johnston L, Bayliss SE, Leonardi-Bee J, Takwoingi Y, Davenport C, O'Sullivan C, Tehrani H, Williams HC | display-authors = 6 | title = Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 12 | pages = CD011901 | date = December 2018 | pmid = 30521688 | pmc = 6516870 | doi = 10.1002/14651858.CD011901.pub2 | collaboration = Cochrane Skin Group }}</ref>

There is insufficient evidence that optical coherence tomography (OCT) is useful in diagnosing melanoma or squamous cell carcinoma. OCT may have a role in diagnosing basal cell carcinoma but more data is needed to support this.<ref>{{cite journal | vauthors = Ferrante di Ruffano L, Dinnes J, Deeks JJ, Chuchu N, Bayliss SE, Davenport C, Takwoingi Y, Godfrey K, O'Sullivan C, Matin RN, Tehrani H, Williams HC | display-authors = 6 | title = Optical coherence tomography for diagnosing skin cancer in adults | journal = The Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD013189 | date = December 2018 | pmid = 30521690 | pmc = 6516952 | doi = 10.1002/14651858.CD013189 | collaboration = Cochrane Skin Group }}</ref>

Computer-assisted diagnosis devices have been developed that analyze images from a [[dermatoscopy|dermatoscope]] or spectroscopy and can be used by a diagnostician to aid in the detection of skin cancer. CAD systems have been found to be highly sensitive in the detection of melanoma, but have a high false-positive rate. There is not yet enough evidence to recommend CAD as compared to traditional diagnostic methods.<ref>{{cite journal | vauthors = Ferrante di Ruffano L, Takwoingi Y, Dinnes J, Chuchu N, Bayliss SE, Davenport C, Matin RN, Godfrey K, O'Sullivan C, Gulati A, Chan SA, Durack A, O'Connell S, Gardiner MD, Bamber J, Deeks JJ, Williams HC | display-authors = 6 | title = Computer-assisted diagnosis techniques (dermoscopy and spectroscopy-based) for diagnosing skin cancer in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 12 | pages = CD013186 | date = December 2018 | pmid = 30521691 | pmc = 6517147 | doi = 10.1002/14651858.cd013186 }}</ref>

[[High-frequency ultrasound]] (HFUS) is of unclear usefulness in the diagnosis of skin cancer.<ref>{{cite journal | vauthors = Dinnes J, Bamber J, Chuchu N, Bayliss SE, Takwoingi Y, Davenport C, Godfrey K, O'Sullivan C, Matin RN, Deeks JJ, Williams HC | display-authors = 6 | title = High-frequency ultrasound for diagnosing skin cancer in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 12 | pages = CD013188 | date = December 2018 | pmid = 30521683 | pmc = 6516989 | doi = 10.1002/14651858.cd013188 }}</ref> There is insufficient evidence for reflectance confocal microscopy to diagnose basal cell or squamous cell carcinoma or any other skin cancers.<ref>{{cite journal | vauthors = Dinnes J, Deeks JJ, Chuchu N, Saleh D, Bayliss SE, Takwoingi Y, Davenport C, Patel L, Matin RN, O'Sullivan C, Patalay R, Williams HC | display-authors = 6 | title = Reflectance confocal microscopy for diagnosing keratinocyte skin cancers in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 12 | pages = CD013191 | date = December 2018 | pmid = 30521687 | pmc = 6516892 | doi = 10.1002/14651858.CD013191 | collaboration = Cochrane Skin Group }}</ref>


== Prevention ==
== Prevention ==
[[Sunscreen]] is effective and thus recommended to prevent melanoma<ref name=SunM>{{cite journal |vauthors=Kanavy HE, Gerstenblith MR | title = Ultraviolet radiation and melanoma | journal = Semin Cutan Med Surg | volume = 30 | issue = 4 | pages = 222–8 |date=December 2011 | pmid = 22123420 | doi = 10.1016/j.sder.2011.08.003 }}</ref> and squamous-cell carcinoma.<ref name=SunS>{{cite journal |vauthors=Burnett ME, Wang SQ | title = Current sunscreen controversies: a critical review | journal = Photodermatol Photoimmunol Photomed | volume = 27 | issue = 2 | pages = 58–67 |date=April 2011 | pmid = 21392107 | doi = 10.1111/j.1600-0781.2011.00557.x }}</ref> There is little evidence that it is effective in preventing basal-cell carcinoma.<ref>{{cite journal |vauthors=Kütting B, Drexler H | title = UV-induced skin cancer at workplace and evidence-based prevention | journal = Int Arch Occup Environ Health | volume = 83 | issue = 8 | pages = 843–54 |date=December 2010 | pmid = 20414668 | doi = 10.1007/s00420-010-0532-4 }}</ref> Other advice to reduce rates of skin cancer includes avoiding sunburning, wearing protective clothing, sunglasses and hats, and attempting to avoid sun exposure or periods of peak exposure.<ref>{{cite journal | author = Council on Environmental H, Section on, Dermatology, Balk, SJ | title = Ultraviolet radiation: a hazard to children and adolescents. | journal = Pediatrics | volume = 127 | issue = 3 | pages = 588–97 |date=March 2011 | pmid = 21357336 | doi = 10.1542/peds.2010-3501}}</ref> The [[U.S. Preventive Services Task Force]] recommends that people between 9 and 25 years of age be advised to avoid ultraviolet light.<ref>{{cite journal | author = Lin JS, Eder, M, Weinmann, S | title = Behavioral counseling to prevent skin cancer: a systematic review for the U.S. Preventive Services Task Force. | journal = Annals of Internal Medicine | volume = 154 | issue = 3 | pages = 190–201 |date=February 2011 | pmid = 21282699 | doi = 10.7326/0003-4819-154-3-201102010-00009 | citeseerx = 10.1.1.690.6405 }}</ref>
[[Sunscreen]] is effective and thus recommended to prevent melanoma<ref name=SunM>{{cite journal | vauthors = Kanavy HE, Gerstenblith MR | title = Ultraviolet radiation and melanoma | journal = Seminars in Cutaneous Medicine and Surgery | volume = 30 | issue = 4 | pages = 222–228 | date = December 2011 | pmid = 22123420 | doi = 10.1016/j.sder.2011.08.003 | doi-broken-date = 1 November 2024 }}</ref> and squamous-cell carcinoma.<ref name=SunS>{{cite journal | vauthors = Burnett ME, Wang SQ | title = Current sunscreen controversies: a critical review | journal = Photodermatology, Photoimmunology & Photomedicine | volume = 27 | issue = 2 | pages = 58–67 | date = April 2011 | pmid = 21392107 | doi = 10.1111/j.1600-0781.2011.00557.x | s2cid = 29173997 | doi-access = }}</ref> There is little evidence that it is effective in preventing basal-cell carcinoma.<ref>{{cite journal | vauthors = Kütting B, Drexler H | title = UV-induced skin cancer at workplace and evidence-based prevention | journal = International Archives of Occupational and Environmental Health | volume = 83 | issue = 8 | pages = 843–854 | date = December 2010 | pmid = 20414668 | doi = 10.1007/s00420-010-0532-4 | s2cid = 40870536 | bibcode = 2010IAOEH..83..843K }}</ref> Other advice to reduce rates of skin cancer includes avoiding sunburn, wearing protective clothing, sunglasses and hats, and attempting to avoid sun exposure or periods of peak exposure.<ref>{{cite journal | vauthors = Balk SJ | title = Ultraviolet radiation: a hazard to children and adolescents | journal = Pediatrics | volume = 127 | issue = 3 | pages = 588–597 | date = March 2011 | pmid = 21357336 | doi = 10.1542/peds.2010-3501 | s2cid = 24739322 | doi-access = }}</ref> The [[U.S. Preventive Services Task Force]] recommends that people between 9 and 25 years of age be advised to avoid ultraviolet light.<ref name="Behavioral counseling to prevent sk">{{cite journal | vauthors = Lin JS, Eder M, Weinmann S | title = Behavioral counseling to prevent skin cancer: a systematic review for the U.S. Preventive Services Task Force | journal = Annals of Internal Medicine | volume = 154 | issue = 3 | pages = 190–201 | date = February 2011 | pmid = 21282699 | doi = 10.7326/0003-4819-154-3-201102010-00009 | s2cid = 13796237 | citeseerx = 10.1.1.690.6405 }}</ref>


The risk of developing skin cancer can be reduced through a number of measures including decreasing [[indoor tanning]] and mid day sun exposure, increasing the use of [[sunscreen]],<ref>{{cite journal | author = Lin JS, Eder, M, Weinmann, S | title = Behavioral counseling to prevent skin cancer: a systematic review for the U.S. Preventive Services Task Force. | journal = Annals of Internal Medicine | volume = 154 | issue = 3 | pages = 190–201 | year = 2011 | pmid = 21282699 | doi = 10.7326/0003-4819-154-3-201102010-00009 | citeseerx = 10.1.1.690.6405 }}</ref> and avoiding the use of [[tobacco products]].
The risk of developing skin cancer can be reduced through a number of measures including decreasing [[indoor tanning]] and mid-day sun exposure, increasing the use of [[sunscreen]],<ref name="Behavioral counseling to prevent sk" /> and avoiding the use of [[tobacco products]].


It is important to limit sun exposure and to avoid tanning beds, because they both involve UV light. UV light is known to damage skin cells by mutating their DNA. The mutated DNA can cause tumors and other growths to form on the skin. Further, there are other risk factors beside just UV exposure. Fair skin, prolonged history of sunburns, moles, and family history of skin cancer are just a few.<ref>{{cite web |url=https://www.mayoclinic.org/diseases-conditions/skin-cancer/symptoms-causes/syc-20377605 |website=Mayo Clinic|title=Skin cancer – Symptoms and causes}}</ref>
There is insufficient evidence either for or against screening for skin cancers.<ref>{{cite journal|last1=[[Kirsten Bibbins-Domingo|Bibbins-Domingo]]|first1=Kirsten|last2=Grossman|first2=David C.|last3=Curry|first3=Susan J.|last4=Davidson|first4=Karina W.|last5=Ebell|first5=Mark|last6=Epling|first6=John W.|last7=García|first7=Francisco A. R.|last8=Gillman|first8=Matthew W.|last9=Kemper|first9=Alex R.|last10=Krist|first10=Alex H.|last11=Kurth|first11=Ann E.|last12=Landefeld|first12=C. Seth|last13=Mangione|first13=Carol M.|last14=Phillips|first14=William R.|last15=Phipps|first15=Maureen G.|last16=Pignone|first16=Michael P.|last17=Siu|first17=Albert L.|title=Screening for Skin Cancer|journal=JAMA|date=26 July 2016|volume=316|issue=4|pages=429–35|doi=10.1001/jama.2016.8465|pmid=27458948}}</ref> [[Vitamin supplements]] and [[antioxidant supplements]] have not been found to have an effect in prevention.<ref>{{cite journal | author = Chang YJ, Myung, SK, Chung, ST, Kim, Y, Lee, EH, Jeon, YJ, Park, CH, Seo, HG, Huh, BY | title = Effects of vitamin treatment or supplements with purported antioxidant properties on skin cancer prevention: a meta-analysis of randomized controlled trials. | journal = Dermatology | volume = 223 | issue = 1 | pages = 36–44 | year = 2011 | pmid = 21846961 | doi = 10.1159/000329439 }}</ref> Evidence for reducing melanoma risk from dietary measures is tentative, with some supportive epidemiological evidence, but no clinical trials.<ref>{{cite journal|last=Jensen|first=JD|author2=Wing, GJ |author3=Dellavalle, RP |title=Nutrition and melanoma prevention.|journal=Clinics in Dermatology|date=November–December 2010|volume=28|issue=6|pages=644–9|pmid=21034988|doi=10.1016/j.clindermatol.2010.03.026}}</ref>


There is insufficient evidence either for or against screening for skin cancers.<ref>{{cite journal | vauthors = Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Ebell M, Epling JW, García FA, Gillman MW, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phillips WR, Phipps MG, Pignone MP, Siu AL | display-authors = 6 | title = Screening for Skin Cancer: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 316 | issue = 4 | pages = 429–435 | date = July 2016 | pmid = 27458948 | doi = 10.1001/jama.2016.8465 | doi-access = free }}</ref> [[Vitamin supplements]] and [[antioxidant supplements]] have not been found to have an effect in prevention.<ref>{{cite journal | vauthors = Chang YJ, Myung SK, Chung ST, Kim Y, Lee EH, Jeon YJ, Park CH, Seo HG, Huh BY | display-authors = 6 | title = Effects of vitamin treatment or supplements with purported antioxidant properties on skin cancer prevention: a meta-analysis of randomized controlled trials | journal = Dermatology | volume = 223 | issue = 1 | pages = 36–44 | year = 2011 | pmid = 21846961 | doi = 10.1159/000329439 | s2cid = 12333832 }}</ref> Evidence for reducing melanoma risk from dietary measures is tentative, with some supportive epidemiological evidence, but no clinical trials.<ref>{{cite journal | vauthors = Jensen JD, Wing GJ, Dellavalle RP | title = Nutrition and melanoma prevention | journal = Clinics in Dermatology | volume = 28 | issue = 6 | pages = 644–649 | date = November–December 2010 | pmid = 21034988 | doi = 10.1016/j.clindermatol.2010.03.026 }}</ref>
[[Zinc oxide]] and [[titanium oxide]] are often used in sun screen to provide broad protection from UVA and UVB ranges.<ref>{{Cite journal|title = Titanium dioxide and zinc oxide nanoparticles in sunscreens: focus on their safety and effectiveness|journal = Nanotechnology, Science and Applications|date = 2011-10-13|issn = 1177-8903|pmc = 3781714|pmid = 24198489|pages = 95–112|volume = 4|doi = 10.2147/NSA.S19419|first = Threes G|last = Smijs|first2 = Stanislav|last2 = Pavel}}</ref>


[[Zinc oxide]] and [[titanium oxide]] are often used in sunscreen to provide broad protection from UVA and UVB ranges.<ref>{{cite journal | vauthors = Smijs TG, Pavel S | title = Titanium dioxide and zinc oxide nanoparticles in sunscreens: focus on their safety and effectiveness | journal = Nanotechnology, Science and Applications | volume = 4 | pages = 95–112 | date = October 2011 | pmid = 24198489 | pmc = 3781714 | doi = 10.2147/NSA.S19419 | doi-access = free }}</ref>
Eating certain foods may decrease the risk of sunburns but this is much less than the protection provided by sunscreen.<ref>{{cite journal|last1=Stahl|first1=W|last2=Sies|first2=H|title=β-Carotene and other carotenoids in protection from sunlight.|journal=The American Journal of Clinical Nutrition|date=November 2012|volume=96|issue=5|pages=1179S–84S|pmid=23053552|doi=10.3945/ajcn.112.034819}}</ref>


Eating certain foods may decrease the risk of sunburns but this is much less than the protection provided by sunscreen.<ref>{{cite journal | vauthors = Stahl W, Sies H | title = β-Carotene and other carotenoids in protection from sunlight | journal = The American Journal of Clinical Nutrition | volume = 96 | issue = 5 | pages = 1179S–1184S | date = November 2012 | pmid = 23053552 | doi = 10.3945/ajcn.112.034819 | doi-access = free }}</ref>
A meta-analysis of skin cancer prevention in high risk individuals found evidence that topical application of T4N5 liposome lotion reduced the rate of appearance of basal cell carcinomas in people with [[xeroderma pigmentosum]], and that [[acitretin]] taken by mouth may have a skin protective benefit in people following [[kidney transplant]].<ref>{{Cite journal|last=Bath-Hextall|first=Fiona J|last2=Leonardi-Bee|first2=Jo|last3=Somchand|first3=Neal|last4=Webster|first4=Angela C|last5=Dellit|first5=Jim|last6=Perkins|first6=William|date=2007-10-17|title=Interventions for preventing non-melanoma skin cancers in high-risk groups|url=http://www.cochrane.org/CD005414/SKIN_interventions-for-preventing-of-non-melanoma-skin-cancers-in-high-risk-groups|journal=Cochrane Database of Systematic Reviews|language=en|doi=10.1002/14651858.CD005414.pub2|pmid=17943854|issn=1465-1858}}</ref>


A meta-analysis of skin cancer prevention in high risk individuals found evidence that topical application of T4N5 liposome lotion reduced the rate of appearance of basal cell carcinomas in people with [[xeroderma pigmentosum]], and that [[acitretin]] taken by mouth may have a skin protective benefit in people following [[kidney transplant]].<ref>{{cite journal | vauthors = Bath-Hextall F, Leonardi-Bee J, Somchand N, Webster A, Delitt J, Perkins W | title = Interventions for preventing non-melanoma skin cancers in high-risk groups | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD005414 | date = October 2007 | volume = 2015 | pmid = 17943854 | doi = 10.1002/14651858.CD005414.pub2 | pmc = 10799667 | hdl-access = free | hdl = 2123/22258 }}</ref>
==Treatment==
Treatment is dependent on the specific type of cancer, location of the cancer, age of the person, and whether the cancer is primary or a recurrence. For a small [[basal-cell cancer]] in a young person, the treatment with the best cure rate ([[Mohs surgery]] or [[CCPDMA]]) might be indicated. In the case of an elderly frail man with multiple complicating medical problems, a difficult to excise basal-cell cancer of the nose might warrant radiation therapy (slightly lower cure rate) or no treatment at all. Topical chemotherapy might be indicated for large superficial basal-cell carcinoma for good cosmetic outcome, whereas it might be inadequate for invasive nodular [[basal-cell carcinoma]] or invasive [[squamous-cell carcinoma]].{{Citation needed|date=January 2010}} In general, melanoma is poorly responsive to radiation or chemotherapy.


A paper published in January 2022 showed that a vaccine that stimulates the production of a protein critical to the skin's antioxidant network could reinforce people's defenses against skin cancer.<ref>{{cite web|title=Possibility of vaccine to prevent skin cancer|url=https://www.sciencedaily.com/releases/2022/01/220112093811.htm|access-date=2022-01-16|website=ScienceDaily|language=en}}</ref>
For low-risk disease, radiation therapy ([[external beam radiotherapy]]<ref>{{cite journal|last1=Hill|first1=R|last2=Healy|first2=B|last3=Holloway|first3=L|last4=Kuncic|first4=Z|last5=Thwaites|first5=D|last6=Baldock|first6=C|title=Advances in kilovoltage x-ray beam dosimetry.|journal=Physics in Medicine and Biology|date=21 March 2014|volume=59|issue=6|pages=R183–231|pmid=24584183|doi=10.1088/0031-9155/59/6/r183|bibcode=2014PMB....59R.183H}}</ref> or [[brachytherapy]]), topical chemotherapy ([[imiquimod]] or 5-fluorouracil) and cryotherapy (freezing the cancer off) can provide adequate control of the disease; all of them, however, may have lower overall cure rates than certain type of surgery. Other modalities of treatment such as photodynamic therapy, topical chemotherapy, [[electrodesiccation and curettage]] can be found in the discussions of [[basal-cell carcinoma]] and [[squamous-cell carcinoma]].

== Treatment ==
Treatment is dependent on the specific type of cancer, location of the cancer, age of the person, and whether the cancer is primary or a recurrence. For a small [[basal-cell cancer]] in a young person, the treatment with the best cure rate ([[Mohs surgery]] or [[CCPDMA]]) might be indicated. In the case of an elderly frail man with multiple complicating medical problems, a difficult to excise basal-cell cancer of the nose might warrant radiation therapy (slightly lower cure rate) or no treatment at all. Topical chemotherapy might be indicated for large superficial basal-cell carcinoma for good cosmetic outcome, whereas it might be inadequate for invasive nodular [[basal-cell carcinoma]] or invasive [[squamous-cell carcinoma]].{{Citation needed|date=January 2010}} In general, melanoma is poorly responsive to radiation or chemotherapy.

For low-risk disease, radiation therapy ([[external beam radiotherapy]]<ref>{{cite journal | vauthors = Hill R, Healy B, Holloway L, Kuncic Z, Thwaites D, Baldock C | title = Advances in kilovoltage x-ray beam dosimetry | journal = Physics in Medicine and Biology | volume = 59 | issue = 6 | pages = R183–R231 | date = March 2014 | pmid = 24584183 | doi = 10.1088/0031-9155/59/6/r183 | s2cid = 18082594 | bibcode = 2014PMB....59R.183H }}</ref> or [[brachytherapy]]), topical chemotherapy ([[imiquimod]] or 5-fluorouracil) and cryotherapy (freezing the cancer off) can provide adequate control of the disease; all of them, however, may have lower overall cure rates than certain type of surgery. Other modalities of treatment such as photodynamic therapy, [[epidermal radioisotope therapy]],<ref>{{cite book | vauthors = Cipriani C, Sedda AF | chapter = Epidermal Radionuclide Therapy: Dermatological High-Dose-Rate Brachytherapy for the Treatment of Basal and Squamous Cell Carcinoma |date=2012| chapter-url=http://link.springer.com/10.1007/174_2012_778| title = Therapeutic Nuclear Medicine| series = Medical Radiology |pages=725–734| veditors = Baum RP |place=Berlin, Heidelberg |publisher=Springer Berlin Heidelberg|doi=10.1007/174_2012_778|isbn=978-3-540-36718-5|access-date=2021-01-15}}</ref> topical chemotherapy, [[electrodesiccation and curettage]] can be found in the discussions of [[basal-cell carcinoma]] and [[squamous-cell carcinoma]].


Mohs' micrographic surgery ([[Mohs surgery]]) 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. An alternative method is [[CCPDMA]] and can be performed by a pathologist not familiar with [[Mohs surgery]].
Mohs' micrographic surgery ([[Mohs surgery]]) 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. An alternative method is [[CCPDMA]] and can be performed by a pathologist not familiar with [[Mohs surgery]].


In the case of disease that has spread (metastasized), further surgical procedures or [[chemotherapy]] may be required.<ref name="isbn0-7817-5626-X">{{cite book |author1=Doherty, Gerard M. |author2=Mulholland, Michael W. |title=Greenfield's Surgery: Scientific Principles And Practice |publisher=Williams & Wilkins |location=Baltimore |year=2005 |pages= |isbn=978-0-7817-5626-6 |oclc= |doi=}}</ref>
In the case of disease that has spread (metastasized), further surgical procedures or [[chemotherapy]] may be required.<ref name="isbn0-7817-5626-X">{{cite book | vauthors = Doherty GM, Mulholland MW |title=Greenfield's Surgery: Scientific Principles And Practice |publisher=Williams & Wilkins |location=Baltimore |year=2005 |isbn=978-0-7817-5626-6 }}</ref>

Treatments for metastatic melanoma include biologic immunotherapy agents [[ipilimumab]], [[pembrolizumab]], [[nivolumab]], [[cemiplimab]]; [[BRAF inhibitor]]s, such as [[vemurafenib]] and [[dabrafenib]]; and a [[MEK inhibitor]] [[trametinib]].<ref>{{cite journal | vauthors = Maverakis E, Cornelius LA, Bowen GM, Phan T, Patel FB, Fitzmaurice S, He Y, Burrall B, Duong C, Kloxin AM, Sultani H, Wilken R, Martinez SR, Patel F | display-authors = 6 | title = Metastatic melanoma - a review of current and future treatment options | journal = Acta Dermato-Venereologica | volume = 95 | issue = 5 | pages = 516–524 | date = May 2015 | pmid = 25520039 | doi = 10.2340/00015555-2035 | doi-access = free }}</ref>


In February 2024, the Food and Drug Administration approved the first cancer treatment that uses tumor-infiltrating lymphocytes, also called TIL therapy, specifically for melanomas that have not improved with other treatments. Additionally, scientists are testing a vaccine designed to match the unique genetic details of a patient's cancer in an advanced clinical trial.<ref>{{Cite news |last=Alcorn |first=Ted |date=April 15, 2024 |title=How to Avoid One of the Deadliest Forms of Skin Cancer |url=https://www.nytimes.com/article/melanoma-skin-cancer-symptoms-risk.html |work=The New York Times}}</ref>
Treatments for metastatic melanoma include biologic immunotherapy agents [[ipilimumab]], pembrolizumab, and nivolumab; [[BRAF inhibitor]]s, such as [[vemurafenib]] and [[dabrafenib]]; and a [[MEK inhibitor]] [[trametinib]].<ref>{{cite journal |vauthors=Maverakis E, Cornelius LA, Bowen GM, Phan T, Patel FB, Fitzmaurice S, He Y, Burrall B, Duong C, Kloxin AM, Sultani H, Wilken R, Martinez SR, Patel F | title = Metastatic melanoma a review of current and future treatment options | journal = Acta Derm Venereol | volume = 95 | issue = 5 | pages = 516–524 | year = 2015 | pmid = 25520039 | doi = 10.2340/00015555-2035| url = http://digitalcommons.wustl.edu/cgi/viewcontent.cgi?article=4849&context=open_access_pubs }}</ref>


===Reconstruction===
=== Reconstruction ===
Currently, surgical excision is the most common form of treatment for skin cancers. The goal of reconstructive surgery is restoration of normal appearance and function. The choice of technique in reconstruction is dictated by the size and location of the defect. Excision and reconstruction of facial skin cancers is generally more challenging due to presence of highly visible and functional anatomic structures in the face.
Currently, surgical excision is the most common form of treatment for skin cancers. The goal of reconstructive surgery is the restoration of normal appearance and function. The choice of technique in reconstruction is dictated by the size and location of the defect. Excision and reconstruction of facial skin cancers are generally more challenging due to the presence of highly visible and functional anatomic structures in the face.


When skin defects are small in size, most can be repaired with simple repair where skin edges are approximated and closed with sutures. This will result in a linear scar. If the repair is made along a natural skin fold or wrinkle line, the scar will be hardly visible. Larger defects may require repair with a skin graft, local skin flap, pedicled skin flap, or a microvascular free flap. Skin grafts and local skin flaps are by far more common than the other listed choices.
When skin defects are small in size, most can be repaired with simple repair where skin edges are approximated and closed with sutures. This will result in a linear scar. If the repair is made along a natural skin fold or wrinkle line, the scar will be hardly visible. Larger defects may require repair with a skin graft, local skin flap, pedicled skin flap, or a microvascular free flap. Skin grafts and local skin flaps are by far more common than the other listed choices.


Skin grafting is patching of a defect with skin that is removed from another site in the body. The skin graft is sutured to the edges of the defect, and a bolster dressing is placed atop the graft for seven to ten days, to immobilize the graft as it heals in place. There are two forms of skin grafting: split thickness and full thickness. In a split thickness skin graft, a shaver is used to shave a layer of skin from the abdomen or thigh. The donor site regenerates skin and heals over a period of two weeks. In a full thickness skin graft, a segment of skin is totally removed and the donor site needs to be sutured closed.<ref>{{cite journal|title=Skin Grafts, Full-Thickness|author=Maurice M Khosh, MD, FACS|url=http://emedicine.medscape.com/article/876379-overview|publisher=''[[eMedicine]]''|deadurl=no|archiveurl=https://web.archive.org/web/20090309151726/http://emedicine.medscape.com/article/876379-overview|archivedate=9 March 2009|df=dmy-all|date=2019-02-02}}</ref>
Skin grafting is patching of a defect with skin that is removed from another site in the body. The skin graft is sutured to the edges of the defect, and a bolster dressing is placed atop the graft for seven to ten days, to immobilize the graft as it heals in place. There are two forms of skin grafting: split thickness and full thickness. In a split thickness skin graft, a shaver is used to shave a layer of skin from the abdomen or thigh. The donor site regenerates skin and heals over a period of two weeks. In a full thickness skin graft, a segment of skin is totally removed and the donor site needs to be sutured closed.<ref>{{cite web|title=Skin Grafts, Full-Thickness| vauthors = Khosh MM |url= http://emedicine.medscape.com/article/876379-overview |website=[[eMedicine]] |url-status=live |archive-url=https://web.archive.org/web/20090309151726/http://emedicine.medscape.com/article/876379-overview |archive-date=9 March 2009|date=2019-02-02 }}</ref>


Split thickness grafts can be used to repair larger defects, but the grafts are inferior in their cosmetic appearance. Full thickness skin grafts are more acceptable cosmetically. However, full thickness grafts can only be used for small or moderate sized defects.
Split thickness grafts can be used to repair larger defects, but the grafts are inferior in their cosmetic appearance. Full thickness skin grafts are more acceptable cosmetically. However, full thickness grafts can only be used for small or moderate sized defects.


Local skin flaps are a method of closing defects with tissue that closely matches the defect in color and quality. Skin from the periphery of the defect site is mobilized and repositioned to fill the deficit. Various forms of local flaps can be designed to minimize disruption to surrounding tissues and maximize cosmetic outcome of the reconstruction. Pedicled skin flaps are a method of transferring skin with an intact blood supply from a nearby region of the body. An example of such reconstruction is a pedicled forehead flap for repair of a large nasal skin defect. Once the flap develops a source of blood supply form its new bed, the vascular pedicle can be detached.<ref>[http://facedoctornyc.com/cancer-reconstruction.php Skin Cancer Reconstruction] {{webarchive|url=https://archive.is/20110710215630/http://facedoctornyc.com/cancer-reconstruction.php |date=10 July 2011 }}</ref>
Local skin flaps are a method of closing defects with tissue that closely matches the defect in color and quality. Skin from the periphery of the defect site is mobilized and repositioned to fill the deficit. Various forms of local flaps can be designed to minimize disruption to surrounding tissues and maximize cosmetic outcome of the reconstruction. Pedicled skin flaps are a method of transferring skin with an intact blood supply from a nearby region of the body. An example of such reconstruction is a pedicled forehead flap for the repair of a large nasal skin defect. Once the flap develops a source of blood supply form its new bed, the vascular pedicle can be detached.<ref>{{cite web | url = http://facedoctornyc.com/cancer-reconstruction.php | title = Skin Cancer Reconstruction | work = FaceDoctorNYC.com | archive-url = https://archive.today/20110710215630/http://facedoctornyc.com/cancer-reconstruction.php | archive-date = 10 July 2011 }}</ref>


==Prognosis==
== Prognosis ==
The mortality rate of basal-cell and squamous-cell carcinoma is around 0.3%, causing 2000 deaths per year in the US. In comparison, the mortality rate of melanoma is 15–20% and it causes 6500 deaths per year.<ref name=BoringCC>{{cite journal |author1=C. C. Boring |author2=T. S. Squires |author3=T. Tong | title = Cancer statistics, 1991 | journal = SA Cancer Journal for Clinician | volume = 41 | issue = 1 | pages = 19–36 | year = 1991 | pmid = 1984806 | doi = 10.3322/canjclin.41.1.19 }}</ref>{{rp|29,31}} Even though it is much less common, malignant melanoma is responsible for 75% of all skin cancer-related deaths.<ref name=AAFP>{{cite journal | vauthors = Jerant AF, Johnson JT, Sheridan CD, Caffrey TJ | title = Early Detection and Treatment of Skin Cancer | journal = American Family Physician | volume = 62 | issue = 2 | pages = 357–68, 375–6, 381–2 | date = July 2000 | pmid = 10929700 | doi = | url = http://www.aafp.org/afp/20000715/357.html | deadurl = no | archiveurl = https://web.archive.org/web/20080724153613/http://www.aafp.org/afp/20000715/357.html | archivedate = 24 July 2008 | df = dmy-all }}</ref>
The mortality rate of basal-cell and squamous-cell carcinoma is around 0.3%, causing 2000 deaths per year in the US. In comparison, the mortality rate of melanoma is 15–20% and it causes 6500 deaths per year.<ref name=BoringCC>{{cite journal | vauthors = Boring CC, Squires TS, Tong T | title = Cancer statistics, 1991 | journal = CA | volume = 41 | issue = 1 | pages = 19–36 | year = 1991 | pmid = 1984806 | doi = 10.3322/canjclin.41.1.19 | s2cid = 40987916 | doi-access = free }}</ref>{{rp|29,31}} Even though it is much less common, malignant melanoma is responsible for 75% of all skin cancer-related deaths.<ref name=AAFP>{{cite journal | vauthors = Jerant AF, Johnson JT, Sheridan CD, Caffrey TJ | title = Early detection and treatment of skin cancer | journal = American Family Physician | volume = 62 | issue = 2 | pages = 357–68, 375–6, 381–2 | date = July 2000 | pmid = 10929700 | url = http://www.aafp.org/afp/20000715/357.html | url-status = live | archive-url = https://web.archive.org/web/20080724153613/http://www.aafp.org/afp/20000715/357.html | archive-date = 24 July 2008 }}</ref>


The survival rate for people with melanoma depends upon when they start treatment. The cure rate is very high when melanoma is detected in early stages, when it can easily be removed surgically. The prognosis is less favorable if the melanoma has spread to other parts of the [[Human body|body]].<ref>{{cite web|url=http://www.skincancerjournal.com/melanoma/|title=Malignant Melanoma Cancer|accessdate=2010-07-02|deadurl=no|archiveurl=https://web.archive.org/web/20100323064318/http://www.skincancerjournal.com/melanoma/|archivedate=23 March 2010|df=dmy-all}}</ref> As of 2003 the overall five year cure rate with Mohs' micrographic surgery was around 95 percent for recurrent basal cell carcinoma.<ref>{{cite journal|last1=Wong|first1=C S M|title=Basal cell carcinoma|journal=BMJ|date=4 October 2003|volume=327|issue=7418|pages=794–798|doi=10.1136/bmj.327.7418.794|pmid=14525881|pmc=214105}}</ref>
The survival rate for people with melanoma depends upon when they start treatment. The cure rate is very high when melanoma is detected in early stages, when it can easily be removed surgically. The prognosis is less favorable if the melanoma has spread to other parts of the [[Human body|body]].<ref>{{cite web|url=http://www.skincancerjournal.com/melanoma/|title=Malignant Melanoma Cancer | work = Skin Cancer Journal | date = 2009 |access-date=2010-07-02|url-status=live|archive-url=https://web.archive.org/web/20100323064318/http://www.skincancerjournal.com/melanoma/|archive-date=23 March 2010}}</ref> As of 2003 the overall five-year cure rate with Mohs' micrographic surgery was around 95 percent for recurrent basal cell carcinoma.<ref>{{cite journal | vauthors = Wong CS, Strange RC, Lear JT | title = Basal cell carcinoma | journal = BMJ | volume = 327 | issue = 7418 | pages = 794–798 | date = October 2003 | pmid = 14525881 | pmc = 214105 | doi = 10.1136/bmj.327.7418.794 }}</ref>


[[Australia]] and [[New Zealand]] exhibit one of the highest rates of skin cancer incidence in the world, almost four times the rates registered in the United States, the [[UK]] and [[Canada]]. Around 434,000 people receive treatment for non-melanoma skin cancers and 10,300 are treated for melanoma. Melanoma is the most common type of cancer in people between 15–44 years in both countries. The incidence of skin cancer has been increasing.<ref>{{cite web|url=http://www.cancer.org.au/cancersmartlifestyle/SunSmart/Skincancerfactsandfigures.htm|title=Skin Cancer Facts and Figures|accessdate=2013-12-01|quote=From 1982 to 2007 melanoma diagnoses increased by around 50%. From 1998 to 2007, GP consultations to treat non-melanoma skin cancer increased by 14%, to reach 950,000 visits each year.|deadurl=no|archiveurl=https://web.archive.org/web/20120810071104/http://www.cancer.org.au/cancersmartlifestyle/SunSmart/Skincancerfactsandfigures.htm|archivedate=10 August 2012|df=dmy-all}}</ref> The incidence of melanoma among [[Auckland]] residents of European descent in 1995 was 77.7 cases per 100,000 people per year, and was predicted to increase in the 21st century because of "the effect of local stratospheric ozone depletion and the time lag from sun exposure to melanoma development."<ref>{{cite journal | url=http://www.kmc.co.nz/ViewArticle.aspx?id=32744 | title=Incidence of malignant melanoma in Auckland, New Zealand: The highest rates in the world | vauthors=Jones WO, Harman CR, Ng AK, Shaw JH | journal=World Journal of Surgery | year=1999 | volume=23 | issue=7 | pages=732–5 | doi=10.1007/pl00012378 | pmid=10390596 | deadurl=yes | archiveurl=https://web.archive.org/web/20131203031716/http://www.kmc.co.nz/ViewArticle.aspx?id=32744 | archivedate=3 December 2013 | df=dmy-all }}</ref>
[[Australia]] and [[New Zealand]] exhibit one of the highest rates of skin cancer incidence in the world, almost four times the rates registered in the United States, the [[UK]] and [[Canada]]. Around 434,000 people receive treatment for non-melanoma skin cancers and 10,300 are treated for melanoma. Melanoma is the most common type of cancer in people between 15 and 44 years in both countries. The incidence of skin cancer has been increasing.<ref>{{cite web |url= http://www.cancer.org.au/cancersmartlifestyle/SunSmart/Skincancerfactsandfigures.htm |title=Skin Cancer Facts and Figures | date = 3 May 2012 | work = Cancer Council Australia |access-date=2013-12-01|quote=From 1982 to 2007 melanoma diagnoses increased by around 50%. From 1998 to 2007, GP consultations to treat non-melanoma skin cancer increased by 14%, to reach 950,000 visits each year.|url-status=live|archive-url=https://web.archive.org/web/20120810071104/http://www.cancer.org.au/cancersmartlifestyle/SunSmart/Skincancerfactsandfigures.htm|archive-date=10 August 2012}}</ref> The incidence of melanoma among [[Auckland]] residents of European descent in 1995 was 77.7 cases per 100,000 people per year, and was predicted to increase in the 21st century because of "the effect of local stratospheric ozone depletion and the time lag from sun exposure to melanoma development."<ref>{{cite journal | vauthors = Jones WO, Harman CR, Ng AK, Shaw JH | title = Incidence of malignant melanoma in Auckland, New Zealand: highest rates in the world | journal = World Journal of Surgery | volume = 23 | issue = 7 | pages = 732–735 | date = July 1999 | pmid = 10390596 | doi = 10.1007/pl00012378 | url = http://www.kmc.co.nz/ViewArticle.aspx?id=32744 | url-status = dead | s2cid = 11995057 | archive-url = https://web.archive.org/web/20131203031716/http://www.kmc.co.nz/ViewArticle.aspx?id=32744 | archive-date = 3 December 2013 }}</ref>


==Epidemiology==
== Epidemiology ==
[[Image:Melanoma and other skin cancers world map - Death - WHO2004.svg|thumb|[[Age adjustment|Age-standardized]] death from [[melanoma]] and other skin cancers per 100,000&nbsp;inhabitants in 2004<ref>{{cite web |url=http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2009 |work=World Health Organization |accessdate=November 11, 2009 |deadurl=no |archiveurl=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archivedate=11 November 2009 |df=dmy-all }}</ref>
[[File:Melanoma and other skin cancers world map - Death - WHO2004.svg|thumb|[[Age adjustment|Age-standardized]] death from [[melanoma]] and other skin cancers per 100,000&nbsp;inhabitants in 2004<ref>{{cite web |url=https://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2009 |work=World Health Organization |access-date=11 November 2009 |url-status=live |archive-url=https://web.archive.org/web/20091111101009/http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |archive-date=11 November 2009}}</ref>
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Skin cancers result in 80,000 deaths a year as of 2010, 49,000 of which are due to melanoma and 31,000 of which are due to non-melanoma skin cancers.<ref name=Loz2012>{{cite journal|last=Lozano|first=R|title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.|journal=Lancet|date=December 15, 2012|volume=380|issue=9859|pages=2095–128|pmid=23245604|doi=10.1016/S0140-6736(12)61728-0}}</ref> This is up from 51,000 in 1990.<ref name=Loz2012/>
Skin cancers result in 80,000 deaths a year as of 2010, 49,000 of which are due to melanoma and 31,000 of which are due to non-melanoma skin cancers.<ref name=Loz2012>{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, etal | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–2128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | hdl-access = free | s2cid = 1541253 | hdl = 10536/DRO/DU:30050819 | url = https://zenodo.org/record/2557786 }}</ref> This is up from 51,000 in 1990.<ref name="Loz2012" />


More than 3.5 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in that country. One in five Americans will develop skin cancer at some point of their lives. The most common form of skin cancer is basal-cell carcinoma, followed by squamous cell carcinoma. Unlike for other cancers, there exists no basal and squamous cell skin cancers [[Cancer registry|registry]] in the United States.<ref name=":0" />
More than 3.5 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in that country. One in five Americans will develop skin cancer at some point of their lives. The most common form of skin cancer is basal-cell carcinoma, followed by squamous cell carcinoma. Unlike for other cancers, there exists no basal and squamous cell skin cancers [[Cancer registry|registry]] in the United States.<ref name=":0" />


===Melanoma===
=== Melanoma ===
In the US in 2008, 59,695 people were diagnosed with melanoma, and 8,623 people died from it.<ref name="cdc.gov">[https://www.cdc.gov/cancer/skin/statistics/index.htm CDC Skin Cancer Statistics<!-- Bot generated title -->] {{webarchive|url=https://web.archive.org/web/20120908062143/http://www.cdc.gov/cancer/skin/statistics/index.htm |date=8 September 2012 }}</ref> In Australia more than 12,500 new cases of melanoma are reported each year, out of which more than 1,500 die from the disease. Australia has the highest per capita incidence of melanoma in the world.<ref>{{cite web |url=http://www.melanoma.org.au/about-melanoma/melanoma-skin-cancer-facts.html |title=Archived copy |accessdate=2014-05-18 |deadurl=yes |archiveurl=https://web.archive.org/web/20140518185825/http://www.melanoma.org.au/about-melanoma/melanoma-skin-cancer-facts.html |archivedate=18 May 2014 |df=dmy-all }} Melanoma facts and statistics</ref>
In the US in 2008, 59,695 people were diagnosed with melanoma, and 8,623 people died from it.<ref name="cdc.gov">{{cite web | url = https://www.cdc.gov/cancer/skin/statistics/index.htm | work = U.S. Centers for Disease Control and Prevention (CDC) | title = Skin Cancer Statistics | archive-url = https://web.archive.org/web/20120908062143/http://www.cdc.gov/cancer/skin/statistics/index.htm | archive-date = 8 September 2012 }}</ref> In Australia more than 12,500 new cases of melanoma are reported each year, out of which more than 1,500 die from the disease. Australia has the highest per capita incidence of melanoma in the world.<ref>{{cite web | title = Melanoma facts and statistics | work = Melanoma Institute Australia |url=http://www.melanoma.org.au/about-melanoma/melanoma-skin-cancer-facts.html |access-date=2014-05-18 |url-status=dead |archive-url=https://web.archive.org/web/20140518185825/http://www.melanoma.org.au/about-melanoma/melanoma-skin-cancer-facts.html |archive-date=18 May 2014}}</ref>

Although the rates of many cancers in the United States is falling, the incidence of melanoma keeps growing, with approximately 68,729 melanomas diagnosed in 2004 according to reports of the [[National Cancer Institute]].<ref>{{cite web|url=http://www.skincancer.org/Skin-Cancer-Facts/|title=Skin Cancer Facts|access-date=2010-07-02|url-status=live|archive-url=https://web.archive.org/web/20100630225659/http://www.skincancer.org/Skin-Cancer-Facts/|archive-date=30 June 2010| work = Skin Cancer Foundation }}</ref>


Although the rates of many cancers in the United States is falling, the incidence of melanoma keeps growing, with approximately 68,729 melanomas diagnosed in 2004 according to reports of the [[National Cancer Institute]].<ref>{{cite web|url=http://www.skincancer.org/Skin-Cancer-Facts/|title=Skin Cancer Facts|accessdate=2010-07-02|deadurl=no|archiveurl=https://web.archive.org/web/20100630225659/http://www.skincancer.org/Skin-Cancer-Facts/|archivedate=30 June 2010|df=dmy-all}}</ref>
Melanoma is the fifth most common cancer in the UK (around 13,300 people were diagnosed with melanoma in 2011), and the disease accounts for 1% all cancer deaths (around 2,100 people died in 2012).<ref>{{cite web|title=Skin cancer statistics|url=http://www.cancerresearchuk.org/cancer-info/cancerstats/types/skin/|website=Cancer Research UK|access-date=28 October 2014|url-status=live|archive-url=https://web.archive.org/web/20140116071810/http://www.cancerresearchuk.org/cancer-info/cancerstats/types/skin/|archive-date=16 January 2014}}</ref>


=== Non-melanoma ===
Melanoma is the fifth most common cancer in the UK (around 13,300 people were diagnosed with melanoma in 2011), and the disease accounts for 1% all cancer deaths (around 2,100 people died in 2012).<ref>{{cite web|title=Skin cancer statistics|url=http://www.cancerresearchuk.org/cancer-info/cancerstats/types/skin/|website=Cancer Research UK|accessdate=28 October 2014|deadurl=no|archiveurl=https://web.archive.org/web/20140116071810/http://www.cancerresearchuk.org/cancer-info/cancerstats/types/skin/|archivedate=16 January 2014|df=dmy-all}}</ref>
Approximately 2,000 people die from basal or squamous cell skin cancers (non-melanoma skin cancers) in the United States each year. The rate has dropped in recent years. Most of the deaths happen to people who are elderly and might not have seen a doctor until the cancer had spread; and people with immune system disorders.<ref name=":0">{{cite web|url=http://www.cancer.org/cancer/skincancer-basalandsquamouscell/detailedguide/skin-cancer-basal-and-squamous-cell-key-statistics|title=Key statistics for basal and squamous cell skin cancers|website=www.cancer.org|publisher=American Cancer Society|access-date=2017-01-09|url-status=live|archive-url=https://web.archive.org/web/20170110103347/http://www.cancer.org/cancer/skincancer-basalandsquamouscell/detailedguide/skin-cancer-basal-and-squamous-cell-key-statistics|archive-date=10 January 2017}}</ref>


== Veterinary medicine ==
===Non-melanoma===
{{excerpt|Skin cancer in cats and dogs}}
Approximately 2,000 people die from basal or squamous cell skin cancers (non-melanoma skin cancers) in the United States each year. The rate has dropped in recent years. Most of the deaths happen to people who are elderly and might not have seen a doctor until the cancer had spread; and people with immune system disorders.<ref name=":0">{{Cite web|url=http://www.cancer.org/cancer/skincancer-basalandsquamouscell/detailedguide/skin-cancer-basal-and-squamous-cell-key-statistics|title=Key statistics for basal and squamous cell skin cancers|last=|first=|date=|website=www.cancer.org|publisher=American Cancer Society|access-date=2017-01-09|deadurl=no|archiveurl=https://web.archive.org/web/20170110103347/http://www.cancer.org/cancer/skincancer-basalandsquamouscell/detailedguide/skin-cancer-basal-and-squamous-cell-key-statistics|archivedate=10 January 2017|df=dmy-all}}</ref>


== See also ==
== Risk factors ==
[[White people]] and people with [[light skin]] are prone to skin cancer.<ref>{{cite web|url=https://www.medicalnewstoday.com/articles/skin-cancer-by-race|title=Skin cancer by race and ethnicity}}</ref><ref>{{cite web|url=https://www.cdc.gov/skin-cancer/risk-factors/index.html|title=Skin Cancer Risk Factors - CDC}}</ref>
* [[Physical hazard]]


== References ==
== References ==
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== External links ==
== External links ==
{{Medical resources
{{Medical resources
| DiseasesDB =
| DiseasesDB =
| ICD10 = {{ICD10|C|43||c|43}}-{{ICD10|C|44||c|43}}
| ICD10 = {{ICD10|C|43||c|43}}-{{ICD10|C|44||c|43}}
| ICD9 = {{ICD9|172}}, {{ICD9|173}}
| ICD9 = {{ICD9|172}}, {{ICD9|173}}
| ICDO = 8010–8720
| ICDO = 8010–8720
| OMIM =
| OMIM =
| MedlinePlus = 001442
| MedlinePlus = 001442
| eMedicine_mult = {{eMedicine2|article|276624}}, {{eMedicine2|article|870538}}, {{eMedicine2|article|1100753}}, {{eMedicine2|article|1965430}}
| eMedicine_mult = {{eMedicine2|article|276624}}, {{eMedicine2|article|870538}}, {{eMedicine2|article|1100753}}, {{eMedicine2|article|1965430}}
| MeshID = D012878
| MeshID = D012878
}}
}}
{{commons category|Skin cancers}}
{{Commons category|Skin cancers}}
* [http://www.oncolex.org/en/Skin-cancer Skin cancer procedures: text, images and videos] {{Webarchive|url=https://web.archive.org/web/20131207034706/http://www.oncolex.org/en/Skin-cancer |date=7 December 2013 }}
*{{DMOZ|Health/Conditions_and_Diseases/Cancer/Skin}}
*[http://www.oncolex.org/en/Skin-cancer Skin cancer procedures: text, images and videos]


{{Tumors}}
{{Tumors}}
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{{Skin tumors, dermis}}
{{Skin tumors, dermis}}
{{Tumors of skin appendages}}
{{Tumors of skin appendages}}
{{Authority control}}
{{Use dmy dates|date=January 2011}}


{{DEFAULTSORT:Skin Cancer}}
{{DEFAULTSORT:Skin Cancer}}
[[Category:Integumentary neoplasia]]
[[Category:Integumentary neoplasia]]
[[Category:Sun tanning]]
[[Category:Sun tanning]]
[[Category:RTT]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Medical mnemonics]]
[[Category:Medical mnemonics]]

Latest revision as of 20:52, 6 December 2024

Skin cancer
A basal-cell skin cancer. Note the pearly appearance and telangiectasia.
SpecialtyOncology and dermatology
SymptomsBasal-cell: painless raised area of skin that may be shiny with small blood vessel running over it or ulceration[1]
Squamous-cell: hard lump with a scaly top[2]
Melanoma: mole that has changed in size, shape, color, or has irregular edges[3]
TypesBasal-cell skin cancer (BCC), squamous-cell skin cancer (SCC), melanoma[1]
CausesUltraviolet radiation from the Sun or tanning beds[4]
Risk factorsLight skin, poor immune function[1][5]
Diagnostic methodTissue biopsy[3]
PreventionDecreasing exposure to ultraviolet radiation, sunscreen[6][7]
TreatmentSurgery, radiation therapy, fluorouracil[1]
Frequency5.6 million (2015)[8]
Deaths111,700 (2015)[9]

Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body.[10] It occurs when skin cells grow uncontrollably, forming malignant tumors. The primary cause of skin cancer is prolonged exposure to ultraviolet (UV) radiation from the sun or tanning devices. Skin cancer is the most commonly diagnosed form of cancer in humans.[11][12][13] There are three main types of skin cancers: basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma.[1] The first two, along with a number of less common skin cancers, are known as nonmelanoma skin cancer (NMSC).[5][14] Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death.[5] It often appears as a painless raised area of skin that may be shiny with small blood vessels running over it or may present as a raised area with an ulcer.[1] Squamous-cell skin cancer is more likely to spread.[5] It usually presents as a hard lump with a scaly top but may also form an ulcer.[2] Melanomas are the most aggressive. Signs include a mole that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.[3]

More than 90% of cases are caused by exposure to ultraviolet radiation from the Sun.[4] This exposure increases the risk of all three main types of skin cancer.[4] Exposure has increased, partly due to a thinner ozone layer.[5][15] Tanning beds are another common source of ultraviolet radiation.[4] For melanomas and basal-cell cancers, exposure during childhood is particularly harmful.[6] For squamous-cell skin cancers, total exposure, irrespective of when it occurs, is more important.[4] Between 20% and 30% of melanomas develop from moles.[6] People with lighter skin are at higher risk[1][16] as are those with poor immune function such as from medications or HIV/AIDS.[5][17] Diagnosis is by biopsy.[3]

Decreasing exposure to ultraviolet radiation and the use of sunscreen appear to be effective methods of preventing melanoma and squamous-cell skin cancer.[6][7] It is not clear if sunscreen affects the risk of basal-cell cancer.[7] Nonmelanoma skin cancer is usually curable.[5] Treatment is generally by surgical removal but may, less commonly, involve radiation therapy or topical medications such as fluorouracil.[1] Treatment of melanoma may involve some combination of surgery, chemotherapy, radiation therapy and targeted therapy.[3] In those people whose disease has spread to other areas of the body, palliative care may be used to improve quality of life.[3] Melanoma has one of the higher survival rates among cancers, with over 86% of people in the UK and more than 90% in the United States surviving more than 5 years.[18][19]

Skin cancer is the most common form of cancer, globally accounting for at least 40% of cancer cases.[5][20] The most common type is nonmelanoma skin cancer, which occurs in at least 2–3 million people per year.[6][21] This is a rough estimate; good statistics are not kept.[1] Of nonmelanoma skin cancers, about 80% are basal-cell cancers and 20% squamous-cell skin cancers.[14] Basal-cell and squamous-cell skin cancers rarely result in death.[6] In the United States, they were the cause of less than 0.1% of all cancer deaths.[1] Globally in 2012, melanoma occurred in 232,000 people and resulted in 55,000 deaths.[6] White people in Australia, New Zealand and South Africa have the highest rates of melanoma in the world.[6][22] The three main types of skin cancer have become more common in the last 20 to 40 years, especially regions where the population is predominantly White.[5][6]

Classification

[edit]

There are three main types of skin cancer: basal-cell skin cancer (basal-cell carcinoma) (BCC), squamous-cell skin cancer (squamous-cell carcinoma) (SCC) and malignant melanoma.

Cancer Description Illustration
Basal-cell carcinoma Note the pearly translucency to fleshy color, tiny blood vessels on the surface, and sometimes ulceration which can be characteristics. The key term is translucency.
Squamous-cell skin carcinoma Commonly presents as a red, crusted, or scaly patch or bump. Often a very rapidly growing tumor.
Malignant melanoma These are commonly asymmetrical in shape and/or pigment distribution, with an irregular border, color variation, and often greater than 6 mm diameter.[23]

Basal-cell carcinomas are most commonly present on sun-exposed areas of the skin, especially the face. They rarely metastasize and rarely cause death. They are easily treated with surgery or radiation. Squamous-cell skin cancers are also common, but much less common than basal-cell cancers. They metastasize more frequently than BCCs. Even then, the metastasis rate is quite low, with the exception of SCC of the lip or ear, and in people who are immunosuppressed. Melanoma are the least frequent of the three common skin cancers. They frequently metastasize, and can cause death once they spread.

Less common skin cancers include: Merkel cell carcinoma, Paget's disease of the breast, atypical fibroxanthoma, porocarcinoma, spindle cell tumors, sebaceous carcinomas, microcystic adnexal carcinoma, keratoacanthoma, and skin sarcomas, such as angiosarcoma, dermatofibrosarcoma protuberans, Kaposi's sarcoma, leiomyosarcoma.

BCC and SCC often carry a UV-signature mutation indicating that these cancers are caused by UVB radiation via direct DNA damage. However malignant melanoma is predominantly caused by UVA radiation via indirect DNA damage. The indirect DNA damage is caused by free radicals and reactive oxygen species. Research indicates that the absorption of three sunscreen ingredients into the skin, combined with a 60-minute exposure to UV, leads to an increase of free radicals in the skin, if applied in too little quantity and too infrequently.[24] However, the researchers add that newer creams often do not contain these specific compounds, and that the combination of other ingredients tends to retain the compounds on the surface of the skin. They also add that frequent re-application reduces the risk of radical formation.

Signs and symptoms

[edit]

There are a variety of different skin cancer symptoms. These include changes in the skin that do not heal, ulcering in the skin, discolored skin, and changes in existing moles, such as jagged edges to the mole, enlargement of the mole, changes in color, the way it feels or if it bleeds. Other common signs of skin cancer can be painful lesion that itches or burns and large brownish spot with darker speckles.[25]

Basal-cell skin cancer

[edit]

Basal-cell skin cancer (BCC) usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck, torso or shoulders. Sometimes small blood vessels (called telangiectasia) 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. This form of skin cancer is the least deadly, and with proper treatment can be eliminated, often without significant scarring.

Squamous-cell skin cancer

[edit]

Squamous-cell skin cancer (SCC) is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped like keratoacanthomas. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous-cell is the second most common skin cancer. It is dangerous, but not nearly as dangerous as a melanoma.

Melanoma

[edit]

Most melanoma consist of various colours from shades of brown to black. A small number of melanoma are pink, red or fleshy in colour; these are called amelanotic melanoma and tend to be more aggressive. Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around the site, or bleeding at the site. An often-used mnemonic is "ABCDE", where A is for "asymmetrical", B for "borders" (irregular: "Coast of Maine sign"), C for "color" (variegated), D for "diameter" (larger than 6 mm – the size of a pencil eraser) and E for "evolving."[26][27]

Other

[edit]

Merkel cell carcinomas are most often rapidly growing, non-tender red, purple or skin colored bumps that are not painful or itchy. They may be mistaken for a cyst or another type of cancer.[28]

Causes

[edit]

Ultraviolet radiation from sun exposure is the primary environmental cause of skin cancer.[29][30][31][32] This can occur in professions such as farming. Other risk factors that play a role include:

  • Light skin color [30]
  • Age [30]
  • Smoking tobacco[30]
  • HPV infections increase the risk of squamous-cell skin cancer.[30]
  • Some genetic syndromes[30] including congenital melanocytic nevi syndrome which is characterized by the presence of nevi (birthmarks or moles) of varying size which are either present at birth, or appear within 6 months of birth. Nevi larger than 20 mm (3/4") in size are at higher risk for becoming cancerous.
  • Chronic non-healing wounds.[30] These are called Marjolin's ulcers based on their appearance, and can develop into squamous-cell skin cancer.
  • Ionizing radiation such as X-rays, environmental carcinogens, and artificial UV radiation (e.g. tanning beds).[30] It is believed that tanning beds are the cause of hundreds of thousands of basal and squamous-cell skin cancer.[33] The World Health Organization now places people who use artificial tanning beds in its highest risk category for skin cancer.[34]
  • Alcohol consumption, specifically excessive drinking increase the risk of sunburns.[35]
  • The use of many immunosuppressive medications increases the risk of skin cancer.[36] Cyclosporin A, a calcineurin inhibitor for example increases the risk approximately 200 times, and azathioprine about 60 times.[37]
  • Deliberate exposure of sensitive skin not normally exposed to sunlight during alternative wellness behaviors such as perineum sunning.

UV-induced DNA damage

[edit]

UV-irradiation of skin cells causes damage to DNA through photochemical reactions.[38] Cyclobutane pyrimidine dimers formed by adjacent thymine bases, or by adjacent cytosine bases, are frequent types of DNA damage induced by UV.[38] Human skin cells are capable of repairing most UV-induced damage by nucleotide excision repair, a process that protects against skin cancer, but may be inadequate at high levels of exposure.[38]

Pathophysiology

[edit]
Micrograph of melanoma, fine-needle aspiration (FNA), field stain

A malignant epithelial tumor that primarily originates in the epidermis, in squamous mucosa or in areas of squamous metaplasia is referred to as a squamous-cell carcinoma.[39]

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).[39]

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.[39]

A molecular factor involved in the disease process is mutation in gene PTCH1 that plays an important role in the Sonic hedgehog signaling pathway.[40]

Diagnosis

[edit]

Diagnosis is by biopsy and histopathological examination.[3]

Non-invasive skin cancer detection methods include photography, dermatoscopy, sonography, confocal microscopy, Raman spectroscopy, fluorescence spectroscopy, terahertz spectroscopy, optical coherence tomography, the multispectral imaging technique, thermography, electrical bio-impedance, tape stripping and computer-aided analysis.[41]

Dermatoscopy may be useful in diagnosing basal cell carcinoma in addition to skin inspection.[42]

There is insufficient evidence that optical coherence tomography (OCT) is useful in diagnosing melanoma or squamous cell carcinoma. OCT may have a role in diagnosing basal cell carcinoma but more data is needed to support this.[43]

Computer-assisted diagnosis devices have been developed that analyze images from a dermatoscope or spectroscopy and can be used by a diagnostician to aid in the detection of skin cancer. CAD systems have been found to be highly sensitive in the detection of melanoma, but have a high false-positive rate. There is not yet enough evidence to recommend CAD as compared to traditional diagnostic methods.[44]

High-frequency ultrasound (HFUS) is of unclear usefulness in the diagnosis of skin cancer.[45] There is insufficient evidence for reflectance confocal microscopy to diagnose basal cell or squamous cell carcinoma or any other skin cancers.[46]

Prevention

[edit]

Sunscreen is effective and thus recommended to prevent melanoma[47] and squamous-cell carcinoma.[48] There is little evidence that it is effective in preventing basal-cell carcinoma.[49] Other advice to reduce rates of skin cancer includes avoiding sunburn, wearing protective clothing, sunglasses and hats, and attempting to avoid sun exposure or periods of peak exposure.[50] The U.S. Preventive Services Task Force recommends that people between 9 and 25 years of age be advised to avoid ultraviolet light.[51]

The risk of developing skin cancer can be reduced through a number of measures including decreasing indoor tanning and mid-day sun exposure, increasing the use of sunscreen,[51] and avoiding the use of tobacco products.

It is important to limit sun exposure and to avoid tanning beds, because they both involve UV light. UV light is known to damage skin cells by mutating their DNA. The mutated DNA can cause tumors and other growths to form on the skin. Further, there are other risk factors beside just UV exposure. Fair skin, prolonged history of sunburns, moles, and family history of skin cancer are just a few.[52]

There is insufficient evidence either for or against screening for skin cancers.[53] Vitamin supplements and antioxidant supplements have not been found to have an effect in prevention.[54] Evidence for reducing melanoma risk from dietary measures is tentative, with some supportive epidemiological evidence, but no clinical trials.[55]

Zinc oxide and titanium oxide are often used in sunscreen to provide broad protection from UVA and UVB ranges.[56]

Eating certain foods may decrease the risk of sunburns but this is much less than the protection provided by sunscreen.[57]

A meta-analysis of skin cancer prevention in high risk individuals found evidence that topical application of T4N5 liposome lotion reduced the rate of appearance of basal cell carcinomas in people with xeroderma pigmentosum, and that acitretin taken by mouth may have a skin protective benefit in people following kidney transplant.[58]

A paper published in January 2022 showed that a vaccine that stimulates the production of a protein critical to the skin's antioxidant network could reinforce people's defenses against skin cancer.[59]

Treatment

[edit]

Treatment is dependent on the specific type of cancer, location of the cancer, age of the person, and whether the cancer is primary or a recurrence. For a small basal-cell cancer in a young person, the treatment with the best cure rate (Mohs surgery or CCPDMA) might be indicated. In the case of an elderly frail man with multiple complicating medical problems, a difficult to excise basal-cell cancer of the nose might warrant radiation therapy (slightly lower cure rate) or no treatment at all. Topical chemotherapy might be indicated for large superficial basal-cell carcinoma for good cosmetic outcome, whereas it might be inadequate for invasive nodular basal-cell carcinoma or invasive squamous-cell carcinoma.[citation needed] In general, melanoma is poorly responsive to radiation or chemotherapy.

For low-risk disease, radiation therapy (external beam radiotherapy[60] or brachytherapy), topical chemotherapy (imiquimod or 5-fluorouracil) and cryotherapy (freezing the cancer off) can provide adequate control of the disease; all of them, however, may have lower overall cure rates than certain type of surgery. Other modalities of treatment such as photodynamic therapy, epidermal radioisotope therapy,[61] topical chemotherapy, electrodesiccation and curettage can be found in the discussions of basal-cell carcinoma and squamous-cell carcinoma.

Mohs' micrographic surgery (Mohs surgery) 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. An alternative method is CCPDMA and can be performed by a pathologist not familiar with Mohs surgery.

In the case of disease that has spread (metastasized), further surgical procedures or chemotherapy may be required.[62]

Treatments for metastatic melanoma include biologic immunotherapy agents ipilimumab, pembrolizumab, nivolumab, cemiplimab; BRAF inhibitors, such as vemurafenib and dabrafenib; and a MEK inhibitor trametinib.[63]

In February 2024, the Food and Drug Administration approved the first cancer treatment that uses tumor-infiltrating lymphocytes, also called TIL therapy, specifically for melanomas that have not improved with other treatments. Additionally, scientists are testing a vaccine designed to match the unique genetic details of a patient's cancer in an advanced clinical trial.[64]

Reconstruction

[edit]

Currently, surgical excision is the most common form of treatment for skin cancers. The goal of reconstructive surgery is the restoration of normal appearance and function. The choice of technique in reconstruction is dictated by the size and location of the defect. Excision and reconstruction of facial skin cancers are generally more challenging due to the presence of highly visible and functional anatomic structures in the face.

When skin defects are small in size, most can be repaired with simple repair where skin edges are approximated and closed with sutures. This will result in a linear scar. If the repair is made along a natural skin fold or wrinkle line, the scar will be hardly visible. Larger defects may require repair with a skin graft, local skin flap, pedicled skin flap, or a microvascular free flap. Skin grafts and local skin flaps are by far more common than the other listed choices.

Skin grafting is patching of a defect with skin that is removed from another site in the body. The skin graft is sutured to the edges of the defect, and a bolster dressing is placed atop the graft for seven to ten days, to immobilize the graft as it heals in place. There are two forms of skin grafting: split thickness and full thickness. In a split thickness skin graft, a shaver is used to shave a layer of skin from the abdomen or thigh. The donor site regenerates skin and heals over a period of two weeks. In a full thickness skin graft, a segment of skin is totally removed and the donor site needs to be sutured closed.[65]

Split thickness grafts can be used to repair larger defects, but the grafts are inferior in their cosmetic appearance. Full thickness skin grafts are more acceptable cosmetically. However, full thickness grafts can only be used for small or moderate sized defects.

Local skin flaps are a method of closing defects with tissue that closely matches the defect in color and quality. Skin from the periphery of the defect site is mobilized and repositioned to fill the deficit. Various forms of local flaps can be designed to minimize disruption to surrounding tissues and maximize cosmetic outcome of the reconstruction. Pedicled skin flaps are a method of transferring skin with an intact blood supply from a nearby region of the body. An example of such reconstruction is a pedicled forehead flap for the repair of a large nasal skin defect. Once the flap develops a source of blood supply form its new bed, the vascular pedicle can be detached.[66]

Prognosis

[edit]

The mortality rate of basal-cell and squamous-cell carcinoma is around 0.3%, causing 2000 deaths per year in the US. In comparison, the mortality rate of melanoma is 15–20% and it causes 6500 deaths per year.[67]: 29, 31  Even though it is much less common, malignant melanoma is responsible for 75% of all skin cancer-related deaths.[68]

The survival rate for people with melanoma depends upon when they start treatment. The cure rate is very high when melanoma is detected in early stages, when it can easily be removed surgically. The prognosis is less favorable if the melanoma has spread to other parts of the body.[69] As of 2003 the overall five-year cure rate with Mohs' micrographic surgery was around 95 percent for recurrent basal cell carcinoma.[70]

Australia and New Zealand exhibit one of the highest rates of skin cancer incidence in the world, almost four times the rates registered in the United States, the UK and Canada. Around 434,000 people receive treatment for non-melanoma skin cancers and 10,300 are treated for melanoma. Melanoma is the most common type of cancer in people between 15 and 44 years in both countries. The incidence of skin cancer has been increasing.[71] The incidence of melanoma among Auckland residents of European descent in 1995 was 77.7 cases per 100,000 people per year, and was predicted to increase in the 21st century because of "the effect of local stratospheric ozone depletion and the time lag from sun exposure to melanoma development."[72]

Epidemiology

[edit]
Age-standardized death from melanoma and other skin cancers per 100,000 inhabitants in 2004[73]

Skin cancers result in 80,000 deaths a year as of 2010, 49,000 of which are due to melanoma and 31,000 of which are due to non-melanoma skin cancers.[74] This is up from 51,000 in 1990.[74]

More than 3.5 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in that country. One in five Americans will develop skin cancer at some point of their lives. The most common form of skin cancer is basal-cell carcinoma, followed by squamous cell carcinoma. Unlike for other cancers, there exists no basal and squamous cell skin cancers registry in the United States.[75]

Melanoma

[edit]

In the US in 2008, 59,695 people were diagnosed with melanoma, and 8,623 people died from it.[76] In Australia more than 12,500 new cases of melanoma are reported each year, out of which more than 1,500 die from the disease. Australia has the highest per capita incidence of melanoma in the world.[77]

Although the rates of many cancers in the United States is falling, the incidence of melanoma keeps growing, with approximately 68,729 melanomas diagnosed in 2004 according to reports of the National Cancer Institute.[78]

Melanoma is the fifth most common cancer in the UK (around 13,300 people were diagnosed with melanoma in 2011), and the disease accounts for 1% all cancer deaths (around 2,100 people died in 2012).[79]

Non-melanoma

[edit]

Approximately 2,000 people die from basal or squamous cell skin cancers (non-melanoma skin cancers) in the United States each year. The rate has dropped in recent years. Most of the deaths happen to people who are elderly and might not have seen a doctor until the cancer had spread; and people with immune system disorders.[75]

Veterinary medicine

[edit]
Many types of skin tumors, both benign (noncancerous) and malignant (cancerous), exist in cats and dogs. Approximately 20–40% of primary skin tumors are malignant in dogs and 50–65% are malignant in cats. Not all forms of skin cancer in cats and dogs are caused by sun exposure, but it can happen occasionally. On dogs, the nose and pads of the feet contain sensitive skin and no fur to protect from the sun. Also, cats and dogs with thin or light-colored coats are at a higher risk of sun damage over their entire bodies.[80]

Risk factors

[edit]

White people and people with light skin are prone to skin cancer.[81][82]

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