Melanoma (Skin Cancer)

Melanoma and Skin Cancer

 

What’s the Difference Between Melanoma and Skin Cancer?

Many people think that skin cancer and melanoma are the same thing, but actually, melanoma is one type of skin cancer. Other forms of the disease are less aggressive and more common.

Melanoma is the rarest form of skin cancer. It is also the most aggressive skin cancer, and is most likely to spread to other parts of the body.

Squamous cell carcinoma and basal cell carcinoma are two other types of skin cancer. Both are classified as “nonmelanoma” and rarely spread to other parts of the body.
(Source: Dana-Farber.org)

See also:
Questions to ask your Dr.
Steps to Recovery
Other Treatment Options
Treatment Side Effects
Life-saving Tests
Risk of Recurrence

General Information About Melanoma

(Source: National Cancer Institute)

Key Points

  • Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that color the skin).
  • There are different types of cancer that start in the skin.
  • Melanoma can occur anywhere on the skin.
  • Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma.
  • Signs of melanoma include a change in the way a mole or pigmented area looks.
  • Tests that examine the skin are used to detect (find) and diagnose melanoma.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that color the skin).

The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:

  • Squamous cells: Thin, flat cells that form the top layer of the epidermis.
  • Basal cells: Round cells under the squamous cells.
  • Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun or artificial light, melanocytes make more pigment and cause the skin to darken.

The number of new cases of melanoma has been increasing over the last 30 years. Melanoma is most common in adults, but it is sometimes found in children and adolescents.

There are different types of cancer that start in the skin.

There are two forms of skin cancer: melanoma and nonmelanoma.

Melanoma is a rare form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body than other types of skin cancer. When melanoma starts in the skin, it is called cutaneous melanoma. Melanoma may also occur in mucous membranes (thin, moist layers of tissue that cover surfaces such as the lips). The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. They are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body.

Melanoma can occur anywhere on the skin.

In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma forms most often on the arms and legs.

When melanoma occurs in the eye, it is called intraocular or ocular melanoma.

Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for melanoma include the following:

  • Having a fair complexion, which includes the following:
    • Fair skin that freckles and burns easily, does not tan, or tans poorly.
    • Blue or green or other light-colored eyes.
    • Red or blond hair.
  • Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
  • Being exposed to certain factors in the environment (in the air, your home or workplace, and your food and water). Some of the environmental risk factors for melanoma are radiation, solvents, vinyl chloride, and PCBs.
  • Having a history of many blistering sunburns, especially as a child or teenager.
  • Having several large or many small moles.
  • Having a family history of unusual moles (atypical nevus syndrome).
  • Having a family or personal history of melanoma.
  • Being white.
  • Having a weakened immune system.
  • Having certain changes in the genes that are linked to melanoma.

Being white or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.

Signs of melanoma include a change in the way a mole or pigmented area looks.

These and other signs and symptoms may be caused by melanoma or by other conditions. Check with your doctor if you have any of the following:

  • A mole that:
    • changes in size, shape, or color.
    • has irregular edges or borders.
    • is more than one color.
    • is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape).
    • itches.
    • oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the tissue below shows through).
  • A change in pigmented (colored) skin.
  • Satellite moles (new moles that grow near an existing mole).

For pictures and descriptions of common moles and melanoma, see Common Moles, Dysplastic Nevi, and Risk of Melanoma.

Tests that examine the skin are used to detect (find) and diagnose melanoma.

If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help find and diagnose melanoma:

  • Skin exam: A doctor or nurse checks the skin for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.
  • Biopsy : A procedure to remove the abnormal tissue and a small amount of normal tissue around it. A pathologist looks at the tissue under a microscope to check for cancer cells. It can be hard to tell the difference between a colored mole and an early melanoma lesion. Patients may want to have the sample of tissue checked by a second pathologist. If the abnormal mole or lesion is cancer, the sample of tissue may also be tested for certain gene changes.

It is important that abnormal areas of the skin not be shaved off or cauterized (destroyed with a hot instrument, an electric current, or a caustic substance) because cancer cells that remain may grow and spread.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The thickness of the tumor and where it is in the body.
  • How quickly the cancer cells are dividing.
  • Whether there was bleeding or ulceration of the tumor.
  • How much cancer is in the lymph nodes.
  • The number of places cancer has spread to in the body.
  • The level of lactate dehydrogenase (LDH) in the blood.
  • Whether the cancer has certain mutations (changes) in a gene called BRAF.
  • The patient’s age and general health.

Stages of Melanoma

Key Points

  • After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • The stage of melanoma depends on the thickness of the tumor, whether cancer has spread to lymph nodes or other parts of the body, and other factors.
  • The following stages are used for melanoma:
    • Stage 0 (Melanoma in Situ)
    • Stage I
    • Stage II
    • Stage III
    • Stage IV

After melanoma has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.

The process used to find out whether cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following tests and procedures may be used in the staging process:

  • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Lymph node mapping and sentinel lymph node biopsy : Procedures in which a radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through lymph ducts to the sentinel node or nodes (the first lymph node or nodes where cancer cells are likely to spread). The surgeon removes only the nodes with the radioactive substance or dye. A pathologist views a sample of tissue under a microscope to check for cancer cells. If no cancer cells are found, it may not be necessary to remove more nodes.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma, pictures may be taken of the neck, chest, abdomen, and pelvis.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • MRI (magnetic resonance imaging) with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues, such as lymph nodes, or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
  • Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. For melanoma, the blood is checked for an enzyme called lactate dehydrogenase (LDH). High LDH levels may predict a poor response to treatment in patients with metastatic disease.

The results of these tests are viewed together with the results of the tumor biopsy to find out the stage of the melanoma.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if melanoma spreads to the lung, the cancer cells in the lung are actually melanoma cells. The disease is metastatic melanoma, not lung cancer.

The stage of melanoma depends on the thickness of the tumor, whether cancer has spread to lymph nodes or other parts of the body, and other factors.

To find out the stage of melanoma, the tumor is completely removed and nearby lymph nodes are checked for signs of cancer. The stage of the cancer is used to determine which treatment is best. Check with your doctor to find out which stage of cancer you have.

The stage of melanoma depends on the following:

  • The thickness of the tumor. The thickness of the tumor is measured from the surface of the skin to the deepest part of the tumor.
  • Whether the tumor is ulcerated (has broken through the skin).
  • Whether cancer is found in lymph nodes by a physical exam, imaging tests, or a sentinel lymph node biopsy.
  • Whether the lymph nodes are matted (joined together).
  • Whether there are:
    • Satellite tumors: Small groups of tumor cells that have spread within 2 centimeters of the primary tumor.
    • Microsatellite tumors: Small groups of tumor cells that have spread to an area right beside or below the primary tumor.
    • In-transit metastases: Tumors that have spread to lymph vessels in the skin more than 2 centimeters away from the primary tumor, but not to the lymph nodes.
  • Whether the cancer has spread to other parts of the body, such as the lung, liver, brain, soft tissue (including muscle), gastrointestinal tract, and/or distant lymph nodes. Cancer may have spread to places in the skin far away from where it first formed.

The following stages are used for melanoma:

Stage 0 (Melanoma in Situ)

In stage 0, abnormal melanocytes are found in the epidermis. These abnormal melanocytes may become cancer and spread into nearby normal tissue. Stage 0 is also called melanoma in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.

  • Stage IA: The tumor is not more than 1 millimeter thick, with or without ulceration.
  • Stage IB: The tumor is more than 1 but not more than 2 millimeters thick, without ulceration.

Stage II

Stage II is divided into stages IIA, IIB, and IIC.

  • Stage IIA: The tumor is either:
    • more than 1 but not more than 2 millimeters thick, with ulceration; or
    • more than 2 but not more than 4 millimeters thick, without ulceration.
  • Stage IIB: The tumor is either:
    • more than 2 but not more than 4 millimeters thick, with ulceration; or
    • more than 4 millimeters thick, without ulceration.
  • Stage IIC: The tumor is more than 4 millimeters thick, with ulceration.

Stage III

Stage III is divided into stages IIIA, IIIB, IIIC, and IIID.

  • Stage IIIA: The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration. Cancer is found in 1 to 3 lymph nodes by sentinel lymph node biopsy.
  • Stage IIIB:
    • (1) It is not known where the cancer began or the primary tumor can no longer be seen, and one of the following is true:
      • cancer is found in 1 lymph node by physical exam or imaging tests; or
      • there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

or

    • (2) The tumor is not more than 1 millimeter thick, with ulceration, or not more than 2 millimeters thick, without ulceration, and one of the following is true:
      • cancer is found in 1 to 3 lymph nodes by physical exam or imaging tests; or
      • there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

or

    • (3) The tumor is more than 1 but not more than 2 millimeters thick, with ulceration, or more than 2 but not more than 4 millimeters thick, without ulceration, and one of the following is true:
      • cancer is found in 1 to 3 lymph nodes; or
      • there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
  • Stage IIIC:
    • (1) It is not known where the cancer began, or the primary tumor can no longer be seen. Cancer is found:
      • in 2 or 3 lymph nodes; or
      • in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or
      • in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or
      • in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

or

    • (2) The tumor is not more than 2 millimeters thick, with or without ulceration, or not more than 4 millimeters thick, without ulceration. Cancer is found:
      • in 1 lymph node and there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin; or
      • in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or
      • in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

or

    • (3) The tumor is more than 2 but not more than 4 millimeters thick, with ulceration, or more than 4 millimeters thick, without ulceration. Cancer is found in 1 or more lymph nodes and/or in any number of lymph nodes that are matted together. There may be microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

or

    • (4) The tumor is more than 4 millimeters thick, with ulceration. Cancer is found in 1 or more lymph nodes and/or there are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.
  • Stage IIID: The tumor is more than 4 millimeters thick, with ulceration. Cancer is found:
    • in 4 or more lymph nodes, or in any number of lymph nodes that are matted together; or
    • in 2 or more lymph nodes and/or in any number of lymph nodes that are matted together. There are microsatellite tumors, satellite tumors, and/or in-transit metastases on or under the skin.

Stage IV

In stage IV, the cancer has spread to other parts of the body, such as the lung, liver, brain, spinal cord, bone, soft tissue (including muscle), gastrointestinal (GI) tract, and/or distant lymph nodes. Cancer may have spread to places in the skin far away from where it first started.

Recurrent Melanoma

Recurrent melanoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the area where it first started or in other parts of the body, such as the lungs or liver.

Treatment Option Overview

Key Points

  • There are different types of treatment for patients with melanoma.
  • Five types of standard treatment are used:
    • Surgery
    • Chemotherapy
    • Radiation therapy
    • Immunotherapy
    • Targeted therapy
  • New types of treatment are being tested in clinical trials.
    • Vaccine therapy
  • Treatment for melanoma may cause side effects.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be needed.

There are different types of treatment for patients with melanoma.

Different types of treatment are available for patients with melanoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Five types of standard treatment are used:

Surgery

Surgery to remove the tumor is the primary treatment of all stages of melanoma. A wide local excision is used to remove the melanoma and some of the normal tissue around it. Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery.

It is important to know whether cancer has spread to the lymph nodes. Lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, more lymph nodes will be removed and tissue samples will be checked for signs of cancer. This is called a lymphadenectomy.

After the doctor removes all the melanoma that can be seen at the time of the surgery, some patients may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Surgery to remove cancer that has spread to the lymph nodes, lung, gastrointestinal (GI) tract, bone, or brain may be done to improve the patient’s quality of life by controlling symptoms.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

One type of regional chemotherapy is hyperthermic isolated limb perfusion. With this method, anticancer drugs go directly to the arm or leg the cancer is in. The flow of blood to and from the limb is temporarily stopped with a tourniquet. A warm solution with the anticancer drug is put directly into the blood of the limb. This gives a high dose of drugs to the area where the cancer is.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat melanoma, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

The following types of immunotherapy are being used in the treatment of melanoma:

  • Immune checkpoint inhibitor therapy: Some types of immune cells, such as T cells, and some cancer cells have certain proteins, called checkpoint proteins, on their surface that keep immune responses in check. When cancer cells have large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins and the ability of T cells to kill cancer cells is increased. They are used to treat some patients with advanced melanoma or tumors that cannot be removed by surgery.

There are two types of immune checkpoint inhibitor therapy:

    • CTLA-4 inhibitor: CTL4-A is a protein on the surface of T cells that helps keep the body’s immune responses in check. When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow the T cells to kill cancer cells. Ipilimumab is a type of CTLA-4 inhibitor.
    • PD-1 inhibitor: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. Pembrolizumab and nivolumab are types of PD-1 inhibitors.EnlargeImmune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).
  • Interferon: Interferon affects the division of cancer cells and can slow tumor growth.
  • Interleukin-2 (IL-2): IL-2 boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells.
  • Tumor necrosis factor (TNF) therapy: TNF is a protein made by white blood cells in response to an antigen or infection. TNF is made in the laboratory and used as a treatment to kill cancer cells. It is being studied in the treatment of melanoma.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. The following types of targeted therapy are used or being studied in the treatment of melanoma:

  • Signal transduction inhibitor therapy: Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells.
    • Vemurafenib, dabrafenib, trametinib, and cobimetinib are signal transduction inhibitors used to treat some patients with advanced melanoma or tumors that cannot be removed by surgery. Vemurafenib and dabrafenib block the activity of proteins made by mutant BRAF genes. Trametinib and cobimetinib affect the growth and survival of cancer cells.
  • Oncolytic virus therapy: A type of targeted therapy that is used in the treatment of melanoma. Oncolytic virus therapy uses a virus that infects and breaks down cancer cells but not normal cells. Radiation therapy or chemotherapy may be given after oncolytic virus therapy to kill more cancer cells. Talimogene laherparepvec is a type of oncolytic virus therapy made with a form of the herpesvirus that has been changed in the laboratory. It is injected directly into tumors in the skin and lymph nodes.
  • Angiogenesis inhibitors: A type of targeted therapy that is being studied in the treatment of melanoma. Angiogenesis inhibitors block the growth of new blood vessels. In cancer treatment, they may be given to prevent the growth of new blood vessels that tumors need to grow.

New targeted therapies and combinations of therapies are being studied in the treatment of melanoma.

New types of treatment are being tested in clinical trials.

Vaccine therapy

Vaccine therapy uses a substance or group of substances meant to cause the immune system to respond to a tumor and kill it. Vaccine therapy is being studied in the treatment of stage III melanoma that can be removed by surgery.

Treatment for melanoma may cause side effects.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

Stage 0 (Melanoma in Situ)

Treatment of stage 0 is usually surgery to remove the area of abnormal cells and a small amount of normal tissue around it.

Stage I Melanoma

Treatment of stage I melanoma may include the following:

  • Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and removal of lymph nodes is also done.
  • A clinical trial of new ways to find cancer cells in the lymph nodes.

Stage II Melanoma

Treatment of stage II melanoma may include the following:

  • Surgery to remove the tumor and some of the normal tissue around it. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed.
  • Surgery followed by immunotherapy with interferon if there is a high risk that the cancer will come back.
  • A clinical trial of new types of treatment to be used after surgery.

Stage III Melanoma That Can Be Removed By Surgery

Treatment of stage III melanoma that can be removed by surgery may include the following:

  • Surgery to remove the tumor and some of the normal tissue around it. Skin grafting may be done to cover the wound caused by surgery. Sometimes lymph node mapping and sentinel lymph node biopsy are done to check for cancer in the lymph nodes at the same time as the surgery to remove the tumor. If cancer is found in the sentinel lymph node, more lymph nodes may be removed.
  • Surgery followed by immunotherapy with nivolumab, ipilimumab, or interferon if there is a high risk that the cancer will come back.
  • Surgery followed by targeted therapy with dabrafenib and trametinib if there is a high risk that the cancer will come back.
  • A clinical trial of immunotherapy with or without vaccine therapy.
  • A clinical trial of surgery followed by therapies that target specific gene changes.

Stage III Melanoma That Cannot Be Removed By Surgery, Stage IV Melanoma, and Recurrent Melanoma

Treatment of stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma may include the following:

  • Oncolytic virus therapy (talimogene laherparepvec) injected into the tumor.
  • Immunotherapy with ipilimumab, pembrolizumab, nivolumab, or interleukin-2 (IL-2). Sometimes ipilimumab and nivolumab are given together.
  • Targeted therapy with vemurafenib, dabrafenib, trametinib, or cobimetinib. Sometimes vemurafenib and cobimetinib or dabrafenib and trametinib are given together.
  • Chemotherapy.
  • Palliative therapy to relieve symptoms and improve the quality of life. This may include:
    • Surgery to remove lymph nodes or tumors in the lung, gastrointestinal (GI) tract, bone, or brain.
    • Radiation therapy to the brain, spinal cord, or bone.

Treatments that are being studied in clinical trials for stage III melanoma that cannot be removed by surgery, stage IV melanoma, and recurrent melanoma include the following:

  • Immunotherapy alone or in combination with other therapies such as targeted therapy.
  • Targeted therapy, such as signal transduction inhibitors, angiogenesis inhibitors, oncolytic virus therapy, or drugs that target certain gene mutations. These may be given alone or in combination.
  • Surgery to remove all known cancer.
  • Regional chemotherapy (hyperthermic isolated limb perfusion). Some patients may also have immunotherapy with tumor necrosis factor.
  • Systemic chemotherapy.

Updated: September 28, 2018


General Information About Skin Cancer

Key Points

  • Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.
  • Different types of cancer start in the skin.
  • Skin color and being exposed to sunlight can increase the risk of basal cell carcinoma and squamous cell carcinoma of the skin.
  • Basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis often appear as a change in the skin.
  • Tests or procedures that examine the skin are used to detect (find) and diagnose basal cell carcinoma and squamous cell carcinoma of the skin.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.

The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:

  • Squamous cells: Thin, flat cells that form the top layer of the epidermis.
  • Basal cells: Round cells under the squamous cells.
  • Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to darken.

Skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, neck, and hands.

Different types of cancer start in the skin.

Skin cancer may form in basal cells or squamous cells. Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer. They are also called nonmelanoma skin cancer. Actinic keratosis is a skin condition that sometimes becomes squamous cell carcinoma.

Melanoma is less common than basal cell carcinoma or squamous cell carcinoma. It is more likely to invade nearby tissues and spread to other parts of the body.

This summary is about basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis. Kaposi Sarcoma Treatment

Skin color and being exposed to sunlight can increase the risk of basal cell carcinoma and squamous cell carcinoma of the skin.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for basal cell carcinoma and squamous cell carcinoma of the skin include the following:

  • Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
  • Having a fair complexion, which includes the following:
    • Fair skin that freckles and burns easily, does not tan, or tans poorly.
    • Blue, green, or other light-colored eyes.
    • Red or blond hair.

Although having a fair complexion is a risk factor for skin cancer, people of all skin colors can get skin cancer.

  • Having a history of sunburns.
  • Having a personal or family history of basal cell carcinoma, squamous cell carcinoma of the skin, actinic keratosis, familial dysplastic nevus syndrome, or unusual moles.
  • Having certain changes in the genes or hereditary syndromes, such as basal cell nevus syndrome, that are linked to skin cancer.
  • Having skin inflammation that has lasted for long periods of time.
  • Having a weakened immune system.
  • Being exposed to arsenic.
  • Past treatment with radiation.

Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

Basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis often appear as a change in the skin.

Not all changes in the skin are a sign of basal cell carcinoma, squamous cell carcinoma of the skin, or actinic keratosis. Check with your doctor if you notice any changes in your skin.

Signs of basal cell carcinoma and squamous cell carcinoma of the skin include the following:

  • A sore that does not heal.
  • Areas of the skin that are:
    • Raised, smooth, shiny, and look pearly.
    • Firm and look like a scar, and may be white, yellow, or waxy.
    • Raised and red or reddish-brown.
    • Scaly, bleeding, or crusty.

Basal cell carcinoma and squamous cell carcinoma of the skin occur most often in areas of the skin exposed to the sun, such as the nose, ears, lower lip, or top of the hands.

Signs of actinic keratosis include the following:

  • A rough, red, pink, or brown, scaly patch on the skin that may be flat or raised.
  • Cracking or peeling of the lower lip that is not helped by lip balm or petroleum jelly.

Actinic keratosis occurs most commonly on the face or the top of the hands.

Tests or procedures that examine the skin are used to detect (find) and diagnose basal cell carcinoma and squamous cell carcinoma of the skin.

The following procedures may be used:

  • Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Skin exam: An exam of the skin for bumps or spots that look abnormal in color, size, shape, or texture.
  • Skin biopsy : All or part of the abnormal-looking growth is cut from the skin and viewed under a microscope by a pathologist to check for signs of cancer. There are four main types of skin biopsies:
    • Shave biopsy : A sterile razor blade is used to “shave-off” the abnormal-looking growth.
    • Punch biopsy : A special instrument called a punch or a trephine is used to remove a circle of tissue from the abnormal-looking growth.EnlargePunch biopsy. A hollow, circular scalpel is used to cut into a lesion on the skin. The instrument is turned clockwise and counterclockwise to cut down about 4 millimeters (mm) to the layer of fatty tissue below the dermis. A small sample of tissue is removed to be checked under a microscope. Skin thickness is different on different parts of the body.
    • Incisional biopsy : A scalpel is used to remove part of a growth.
    • Excisional biopsy : A scalpel is used to remove the entire growth.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) for squamous cell carcinoma of the skin depends mostly on the following:

  • Stage of the cancer.
  • Whether the patient is immunosuppressed.
  • Whether the patient uses tobacco.
  • The patient’s general health.

Treatment options for basal cell carcinoma and squamous cell carcinoma of the skin depend on the following:

  • The type of cancer.
  • The stage of the cancer, for squamous cell carcinoma.
  • The size of the tumor and what part of the body it affects.
  • The patient’s general health.

Stages of Skin Cancer

Key Points

  • After squamous cell cancer of the skin has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • Staging for basal cell carcinoma and squamous cell carcinoma of the skin depends on where the cancer formed.
  • The following stages are used for basal cell carcinoma and squamous cell carcinoma of the skin that is on the head or neck but not on the eyelid:
    • Stage 0 (Carcinoma in Situ)
    • Stage I
    • Stage II
    • Stage III
    • Stage IV
  • The following stages are used for basal cell carcinoma and squamous cell carcinoma of the skin on the eyelid:
    • Stage 0 (Carcinoma in Situ)
    • Stage I
    • Stage II
    • Stage III
    • Stage IV
  • Treatment depends on the type of skin cancer or other skin condition diagnosed:
    • Basal cell carcinoma
    • Squamous cell carcinoma
    • Actinic keratosis

After squamous cell cancer of the skin has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.

The process used to find out if cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment for squamous cell carcinoma of the skin.

Basal cell carcinoma of the skin rarely spreads to other parts of the body. Staging tests to check whether basal cell carcinoma of the skin has spread are usually not needed.

The following tests and procedures may be used in the staging process for squamous cell carcinoma of the skin:

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the head, neck, and chest, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Sometimes a PET scan and CT scan are done at the same time.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues, such as lymph nodes, or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. An ultrasound exam of the regional lymph nodes may be done for basal cell carcinoma and squamous cell carcinoma of the skin.
  • Eye exam with dilated pupil : An exam of the eye in which the pupil is dilated (opened wider) with medicated eye drops to allow the doctor to look through the lens and pupil to the retina and optic nerve. The inside of the eye, including the retina and the optic nerve, is examined with a light.
  • Lymph node biopsy : For squamous cell carcinoma of the skin, the lymph nodes may be removed and checked to see if cancer has spread to them.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if skin cancer spreads to the lung, the cancer cells in the lung are actually skin cancer cells. The disease is metastatic skin cancer, not lung cancer.

Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

Staging for basal cell carcinoma and squamous cell carcinoma of the skin depends on where the cancer formed.

Staging for basal cell carcinoma and squamous cell carcinoma of the eyelid is different from staging for basal cell carcinoma and squamous cell carcinoma found on other areas of the head or neck. There is no staging system for basal cell carcinoma or squamous cell carcinoma that is not found on the head or neck.

Surgery to remove the primary tumor and abnormal lymph nodes is done so that tissue samples can be studied under a microscope. This is called pathologic staging and the findings are used for staging as described below. If staging is done before surgery to remove the tumor, it is called clinical staging. The clinical stage may be different from the pathologic stage.

The following stages are used for basal cell carcinoma and squamous cell carcinoma of the skin that is on the head or neck but not on the eyelid:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the squamous cell or basal cell layer of the epidermis. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and the tumor is 2 centimeters or smaller.

Stage II

In stage II, the tumor is larger than 2 centimeters but not larger than 4 centimeters.

Stage III

In stage III, one of the following is found:

  • the tumor is larger than 4 centimeters, or cancer has spread to the bone and the bone has little damage, or cancer has spread to tissue covering the nerves below the dermis, or has spread below the subcutaneous tissue. Cancer may have also spread to one lymph node on the same side of the body as the tumor and the node is 3 centimeters or smaller; or
  • the tumor is 4 centimeters or smaller. Cancer has spread to one lymph node on the same side of the body as the tumor and the node is 3 centimeters or smaller.

Stage IV

In stage IV, one of the following is found:

  • the tumor is any size and cancer may have spread to the bone and the bone has little damage, or to tissue covering the nerves below the dermis, or below the subcutaneous tissue. Cancer has spread to the lymph nodes as follows:
    • one lymph node on the same side of the body as the tumor, the affected node is 3 centimeters or smaller, and cancer has spread outside the lymph node; or
    • one lymph node on the same side of the body as the tumor, the affected node is larger than 3 centimeters but not larger than 6 centimeters, and cancer has not spread outside the lymph node; or
    • more than one lymph node on the same side of the body as the tumor, the affected nodes are 6 centimeters or smaller, and cancer has not spread outside the lymph nodes; or
    • one or more lymph nodes on the opposite side of the body as the tumor or on both sides of the body, the affected nodes are 6 centimeters or smaller, and cancer has not spread outside the lymph nodes.
  • the tumor is any size and cancer may have spread to tissue covering the nerves below the dermis or below the subcutaneous tissue or to bone marrow or to bone, including the bottom of the skull. Also:
    • cancer has spread to one lymph node that is larger than 6 centimeters and cancer has not spread outside the lymph node; or
    • cancer has spread to one lymph node on the same side of the body as the tumor, the affected node is larger than 3 centimeters, and cancer has spread outside the lymph node; or
    • cancer has spread to one lymph node on the opposite side of the body as the tumor, the affected node is any size, and cancer has spread outside the lymph node; or
    • cancer has spread to more than one lymph node on one or both sides of the body and cancer has spread outside the lymph nodes.
  • the tumor is any size and cancer has spread to bone marrow or to bone, including the bottom of the skull, and the bone has been damaged. Cancer may have also spread to the lymph nodes; or
  • cancer has spread to other parts of the body, such as the lung.

The following stages are used for basal cell carcinoma and squamous cell carcinoma of the skin on the eyelid:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the epidermis, usually in the basal cell layer. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stages IA and IB.

  • Stage IA: The tumor is 10 millimeters or smaller and may have spread to the edge of the eyelid where the lashes are, to the connective tissue in the eyelid, or to the full thickness of the eyelid.
  • Stage IB: The tumor is larger than 10 millimeters but not larger than 20 millimeters and the tumor has not spread to the edge of the eyelid where the lashes are, or to the connective tissue in the eyelid.

Stage II

Stage II is divided into stages IIA and IIB.

  • In stage IIA, one of the following is found:
    • the tumor is larger than 10 millimeters but not larger than 20 millimeters and has spread to the edge of the eyelid where the lashes are, to the connective tissue in the eyelid, or to the full thickness of the eyelid; or
    • the tumor is larger than 20 millimeters but not larger than 30 millimeters and may have spread to the edge of the eyelid where the lashes are, to the connective tissue in the eyelid, or to the full thickness of the eyelid.
  • In stage IIB, the tumor may be any size and has spread to the eye, eye socket, sinuses, tear ducts, or brain, or to the tissues that support the eye.

Stage III

Stage III is divided into stages IIIA and IIIB.

  • Stage IIIA: The tumor may be any size and may have spread to the edge of the eyelid where the lashes are, to the connective tissue in the eyelid, or to the full thickness of the eyelid, or to the eye, eye socket, sinuses, tear ducts, or brain, or to the tissues that support the eye. Cancer has spread to one lymph node on the same side of the body as the tumor and the node is 3 centimeters or smaller.
  • Stage IIIB: The tumor may be any size and may have spread to the edge of the eyelid where the lashes are, to the connective tissue in the eyelid, or to the full thickness of the eyelid, or to the eye, eye socket, sinuses, tear ducts, or brain, or to the tissues that support the eye. Cancer has spread to lymph nodes as follows:
    • one lymph node on the same side of the body as the tumor and the node is larger than 3 centimeters; or
    • more than one lymph node on the opposite side of the body as the tumor or on both sides of the body.

Stage IV

In stage IV, the tumor has spread to other parts of the body, such as the lung or liver.

Treatment depends on the type of skin cancer or other skin condition diagnosed:

Basal cell carcinoma

Basal cell carcinoma is the most common type of skin cancer. It usually occurs on areas of the skin that have been in the sun, most often the nose. Often this cancer appears as a raised bump that looks smooth and pearly. A less common type looks like a scar or it is flat and firm and may be skin-colored, yellow, or waxy. Basal cell carcinoma may spread to tissues around the cancer, but it usually does not spread to other parts of the body.

Squamous cell carcinoma

Squamous cell carcinoma occurs on areas of the skin that have been damaged by the sun, such as the ears, lower lip, and the back of the hands. Squamous cell carcinoma may also appear on areas of the skin that have been sunburned or exposed to chemicals or radiation. Often this cancer looks like a firm red bump. The tumor may feel scaly, bleed, or form a crust. Squamous cell tumors may spread to nearby lymph nodes. Squamous cell carcinoma that has not spread can usually be cured.

Actinic keratosis

Actinic keratosis is a skin condition that is not cancer, but sometimes changes into squamous cell carcinoma. One or more lesions may occur in areas that have been exposed to the sun, such as the face, the back of the hands, and the lower lip. It looks like rough, red, pink, or brown scaly patches on the skin that may be flat or raised, or as a cracked and peeling lower lip that is not helped by lip balm or petroleum jelly. Actinic keratosis may disappear without treatment.

Treatment Option Overview

Key Points

  • There are different types of treatment for patients with basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis.
  • Eight types of standard treatment are used:
    • Surgery
    • Radiation therapy
    • Chemotherapy
    • Photodynamic therapy
    • Immunotherapy
    • Targeted therapy
    • Chemical peel
    • Other drug therapy
  • New types of treatment are being tested in clinical trials.
  • Treatment for skin cancer may cause side effects.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be needed.

There are different types of treatment for patients with basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis.

Different types of treatment are available for patients with basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Eight types of standard treatment are used:

Surgery

One or more of the following surgical procedures may be used to treat basal cell carcinoma, squamous cell carcinoma of the skin, or actinic keratosis:

  • Simple excision: The tumor, along with some of the normal tissue around it, is cut from the skin.
  • Mohs micrographic surgery: The tumor is cut from the skin in thin layers. During the procedure, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible. It is often used to remove skin cancer on the face, fingers, or genitals and skin cancer that does not have a clear border. EnlargeMohs surgery. A surgical procedure to remove skin cancer in several steps. First, a thin layer of cancerous tissue is removed. Then, a second thin layer of tissue is removed and viewed under a microscope to check for cancer cells. More layers are removed one at a time until the tissue viewed under a microscope shows no remaining cancer. This type of surgery is used to remove as little normal tissue as possible and is often used to remove skin cancer on the face.
  • Shave excision: The abnormal area is shaved off the surface of the skin with a small blade.
  • Curettage and electrodesiccation: The tumor is cut from the skin with a curette (a sharp, spoon-shaped tool). A needle-shaped electrode is then used to treat the area with an electric current that stops the bleeding and destroys cancer cells that remain around the edge of the wound. The process may be repeated one to three times during the surgery to remove all of the cancer. This type of treatment is also called electrosurgery.
  • Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy.
  • Cryosurgery. An instrument with a nozzle is used to spray liquid nitrogen or liquid carbon dioxide to freeze and destroy abnormal tissue.
  • Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
  • Dermabrasion: Removal of the top layer of skin using a rotating wheel or small particles to rub away skin cells.

Simple excision, Mohs micrographic surgery, curettage and electrodesiccation, and cryosurgery are used to treat basal cell carcinoma and squamous cell carcinoma of the skin. Laser surgery is rarely used to treat basal cell carcinoma. Simple excision, shave excision, curettage and desiccation, dermabrasion, and laser surgery are used to treat actinic keratosis.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

  • External radiation therapy uses a machine outside the body to send radiation toward the cancer.
  • Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type of cancer being treated. External radiation therapy is used to treat basal cell carcinoma and squamous cell carcinoma of the skin.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Chemotherapy for basal cell carcinoma, squamous cell carcinoma of the skin, and actinic keratosis is usually topical (applied to the skin in a cream or lotion). The way the chemotherapy is given depends on the condition being treated. Topical fluorouracil (5-FU) is used to treat basal cell carcinoma.

 

Photodynamic therapy

Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein or put on the skin. The drug collects more in cancer cells than in normal cells. For skin cancer, laser light is shined onto the skin and the drug becomes active and kills the cancer cells. Photodynamic therapy causes little damage to healthy tissue.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

Interferon and imiquimod are immunotherapy drugs used to treat skin cancer. Interferon (by injection) may be used to treat squamous cell carcinoma of the skin. Topical imiquimod therapy (a cream applied to the skin) may be used to treat some basal cell carcinomas.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.

Targeted therapy with a signal transduction inhibitor is used to treat basal cell carcinoma. Signal transduction inhibitors block signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Vismodegib and sonidegib are signal transduction inhibitors used to treat basal cell carcinoma.

Chemical peel

A chemical peel is a procedure used to improve the way certain skin conditions look. A chemical solution is put on the skin to dissolve the top layers of skin cells. Chemical peels may be used to treat actinic keratosis. This type of treatment is also called chemabrasion and chemexfoliation.

Other drug therapy

Retinoids (drugs related to vitamin A) are sometimes used to treat squamous cell carcinoma of the skin. Diclofenac and ingenol are topical drugs used to treat actinic keratosis.

New types of treatment are being tested in clinical trials.

Treatment for skin cancer may cause side effects.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Basal cell carcinoma and squamous cell carcinoma are likely to recur (come back), usually within 5 years, or new tumors may form. Talk to your doctor about how often you should have your skin checked for signs of cancer.

Treatment Options for Basal Cell Carcinoma

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of basal cell carcinoma that is localized may include the following:

  • Simple excision.
  • Mohs micrographic surgery.
  • Radiation therapy.
  • Curettage and electrodesiccation.
  • Cryosurgery.
  • Photodynamic therapy.
  • Topical chemotherapy.
  • Topical immunotherapy (imiquimod).
  • Laser surgery (rarely used).

Treatment of basal cell carcinoma that is metastatic or cannot be treated with local therapy may include the following:

  • Targeted therapy with a signal transduction inhibitor (vismodegib or sonidegib).
  • A clinical trial of a new treatment.

Treatment of recurrent basal cell carcinoma that is not metastatic may include the following:

  • Simple excision.
  • Mohs micrographic surgery.

Treatment Options for Squamous Cell Carcinoma of the Skin

Treatment of squamous cell carcinoma that is localized may include the following:

  • Simple excision.
  • Mohs micrographic surgery.
  • Radiation therapy.
  • Curettage and electrodesiccation.
  • Cryosurgery.
  • Photodynamic therapy, for squamous cell carcinoma in situ (stage 0).

Treatment of squamous cell carcinoma that is metastatic or cannot be treated with local therapy may include the following:

  • Chemotherapy.
  • Retinoid therapy and immunotherapy (interferon).
  • A clinical trial of a new treatment.

Treatment of recurrent squamous cell carcinoma that is not metastatic may include the following:

  • Simple excision.
  • Mohs micrographic surgery.
  • Radiation therapy.

Treatment Options for Actinic Keratosis

Actinic keratosis is not cancer but is treated because it may develop into cancer. Treatment of actinic keratosis may include the following:

  • Topical chemotherapy.
  • Topical immunotherapy (imiquimod).
  • Other drug therapy (diclofenac or ingenol).
  • Chemical peel.
  • Simple excision.
  • Shave excision.
  • Curettage and electrodesiccation.
  • Dermabrasion.
  • Photodynamic therapy.
  • Laser surgery.

Updated: August 10, 2018


 

Mole Screening Clinics
If you’re concerned that a mole or skin lesion could be cancerous, you can have it checked out by a dermatologist or other professional trained in early skin cancer detection.

This could save you unnecessary surgery and is painless, fast and very reasonably priced.

In Ireland you can get checked at the following clinics (there are others):

Skincheck Ireland
Tel: 01- 2939148
http://skincheck.ie/

MoleScan Clinic
Tel: 01 685 6569
http://molescan.ie

Outside Ireland:
Check for similar services in your own area.


Other Treatments

Blueberries
 This study says Blueberries inhibit the proliferation of melanoma cells.

Vitamin C and Doxycycline
This study found that antibiotics, such as Doxycycline, could eradicate Cancer Stem Cells in multiple cancer types. These include: DCIS, breast (ER(+) and ER(-)), ovarian, prostate, lung, and pancreatic carcinomas, as well as melanoma and glioblastoma. The study authors propose the combined use of Doxycycline and Vitamin C as a new strategy for eradicating CSCs.

Vitamin D
This study says Vitamin D and its analogs have inhibitory effects on cancer stem cell signaling in various types of human cancer cells and may be promising therapeutic/preventive agents against Cancer Stem Cells.

This study says: Several lines of evidence have demonstrated that vitamin D plays an important role in the regulation of stem cells of the prostate and the skin.
Sunlight spurs the body to make vitamin D.
Food sources:
Fish such as salmon, tuna, and mackerel. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks.

BEC 5 for Skin Cancer

The cancer-fighting health benefits of eggplant extract is a phytochemical called solasodine glycoside, or BEC5 and it is especially potent against skin cancer. Curaderm (BEC5 cream) was developed and tested by Dr. Cham and it can be found online without a prescription.


Treating Basal Cell Carcinoma with Aldara

Aldara
Generic name(s) IMIQUIMOD

Uses
This medication is used to treat certain types of growths on the skin. These are precancerous growths (actinic keratoses), a certain type of skin cancer (superficial basal cell carcinoma), and warts on the outside of the genitals/anus. Treating these conditions can decrease complications from them. Imiquimod belongs to a group of drugs called immune response modifiers. It is believed to work by helping to activate your immune system to fight these abnormal skin growths.

Warning:

Aldara: The Skin Cancer “Cure” That Can Kill
by Elaine Hollingsworth

It takes a courageous person, or publication, to reveal the skullduggery of Big Pharma. Occasionally, however, the truth cannot be suppressed, and when The Wall Street Journal revealed that Merck, the maker of Vioxx, had been burying the serious health risks of their COX-2 inhibitor anti-inflammatory drug as far back as March, 2000, a scandal erupted. As Dr. Richard Horton, editor of The Lancet, wrote, “The licensing of Vioxx and its continued use in the face of unambiguous evidence of harm have been public health catastrophes.”

A health catastrophe even more devastating than Vioxx is Aldara or, more specifically, the chemical imiquimod (IQ). IQ is the only active agent in the popular drug known as Aldara, which is marketed worldwide and promoted very heavily by 3M Pharmaceuticals as a “benign” salve to cure skin cancers. IQ has been known since 1986 to cause cancer. It is so dangerous that the American Cancer Society, The National Cancer Institute, and others have determined it is a carcinogen, and have placed it on their lists of most hazardous chemicals. IQ has even been listed as a laboratory chemical hazard by the US Occupational Safety Health Agency. Yet, doctors worldwide are prescribing it in Aldara, willy-nilly, to “cure” skin cancers, even though there are safe, vegetable-based creams and other proven remedies, including surgery. I foolishly used Aldara, and it didn’t kill my skin cancer, but it nearly killed me, leaving me with a damaged immune system. Read full article at: Townsend Letter

Prescription skin cancer cream Aldara has horrific side effects, say users
by: Dani Veracity

Elaine Hollingsworth put Aldara on her nose thinking that it was the “benign salve” that her dermatologist made it out to be; instead, it was the beginning of her nightmare. After using the pharmaceutical skin cancer treatment for only two weeks, a “disgusting, thick, crusty, black scab” covered her entire nose, not just the one-quarter-inch on which she applied the cream — and this wasn’t even the worst side effect.

Around the same time her nose became covered with the scab, Hollingsworth awoke early one morning with a case of anaphylactic shock.

Continue reading at Natural News


Itraconazole

Itraconazole, may be useful in treating basal cell carcinoma — the most common form of skin cancer, according to a study that was published online Feb. 3 in the Journal of Clinical Oncology.

The study tested itraconazole’s effectiveness in treating patients with multiple basal cell carcinoma tumors. Researchers at the Stanford University School of Medicine carried out a phase-2 clinical trial with 29 patients who had a total of 101 tumors. Within a month, the size and spread of tumors had decreased in most patients, they found.
Source: Stanford Medicine News Center

Itraconazole page


See also

All Your Treatment Options

Tests you need to know about

Vital questions to ask your doctor / oncologist

Steps to Recovery

Source References include:
National Cancer Institute
Townsend Letter
Natural News

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