Skin Cancer

By Jefferson M. Trupp, M.D., radiation oncologist at Alliance Cancer Care

May is National Skin Cancer Awareness Month.  Skin cancer is the most common type of cancer in the United States, with more cases annually than ALL other cancers combined.  There are 10,000 new skin cancers diagnosed every day.  Skin cancers can affect any skin color or skin type and can occur in areas that are sun-exposed and not sun-exposed.  You should have your skin checked for possible cancerous lesions at least once a year with a dermatologist or your primary care physician.

Skin cancers are divided into melanoma and nonmelanoma skin cancers.  The top layer of the skin contains three main types of cells: squamous, basal, and melanocytes.  Mutations of these cells result in the following cancers:  squamous cell carcinoma, basal cell carcinoma, and melanoma.  Skin cancers are diagnosed with a biopsy, which is taking a small sample of the cancer for a pathologist to view under a microscope.

Nonmelanoma skin cancers, which include basal cell carcinoma and squamous cell carcinoma, are more prevalent than all other cancers combined.  Over 5 million patients were treated in the U.S. in 2021 for skin cancers.  Studies suggest squamous cell carcinoma is becoming more prevalent than basal cell carcinoma.

Skin cancers can cause extensive destruction and disfigurement if left untreated.  Nonmelanoma skin cancers are rarely metastatic.  Rates of nodal spread of squamous cell carcinoma is about 2%.  Nodal spread of basal cell carcinoma is less than 2%.  If the cancer spreads, it can be life-threatening.

Fair skin, prior sunburns, sunny climates, high elevation, proximity to the equator, family history, and individuals who are immunocompromised, all have risk factors for skin cancers, especially patients who are on immunosuppressive drugs, as seen in transplant patients.

Ultraviolet radiation from the sun, as well as tanning beds, cause mutations, which lead to skin cancers.  A study revealed a 67% increased risk of squamous cell carcinoma with any exposure to a tanning bed.  Approximately 35% of adults have utilized tanning beds, with 13% using them in the last year.   A recent study of university students reveals that 59% have been exposed to tanning beds, with 43% being in the last year.

It is recommended to minimize sun exposure.  If you are out in the sun, you should wear protective clothing or sunscreen.  The American Academy of Dermatology recommends wearing sunscreen with at least SPF 30.  Sunscreen should be applied before exposure and every two hours, after swimming, exercising or sweating.  It is also recommended to wear a broad-brim hat to protect the face and ears.  It is important to check your skin regularly and report any changes to your doctor.   A skin lesion that does not heal deserves a further evaluation and possible biopsy.

The two main modalities of treatment for skin cancer are surgery and radiation.  Cure rates are approximately equal.  Surgery involves removing skin cancer with a rim of normal tissue.  This is often done with a special technique called Mohs microsurgery, where the skin cancer is removed in thin layers of tissue until all cancer has been removed.

Radiation therapy is used instead if removal of the skin would result in significant cosmetic defects (eyelids, nose, lips, ears), or when skin cancers are located in areas of poor blood supply, like the lower leg, which may not heal after surgery.  Radiation treatment is also utilized for skin cancers that are too advanced to be removed.  In some cases, radiation treatment is given after surgery if margins are not clear or there is an invasion around microscopic nerves.

Before radiation treatment, you will meet with a radiation oncologist for evaluation.  This visit includes a careful discussion of your skin cancer, your general health, as well as possible risk factors for skin cancers.  An examination of the lesion is performed to determine the extent of the cancer.  Sometimes additional imaging is required, particularly in advanced cancers.

Radiation treatment for skin cancer results in excellent cure rates and cosmetic results.  Treatments are typically given daily, over a few weeks of treatment, depending on your individual situation, and patients can continue their normal activity during treatment, including driving and working.

The American Academy of Dermatology has some helpful resources for doing a self-skin exam and helpful hints on what to look for that may be concerning for melanoma, a more aggressive form of cancer.

If you, or a loved one, have been diagnosed with skin cancer and are interested in learning more about radiation therapy, please contact our center today.