Skin Cancer

Skin cancer is the most prevalent type of cancer and is predominantly caused by exposure to ultraviolet (UV) light. Brachytherapy is a non-invasive cancer treatment available that offers superior results.

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Skin Cancer & Melanoma Overview

Skin cancer is the most prevalent type of cancer in the United States, originating in the outermost layer of skin known as the epidermis. It is predominantly caused by exposure to ultraviolet (UV) light, whether from sunlight or artificial sources such as tanning beds. Nonetheless, skin cancer can manifest in areas of the body that may not have been heavily exposed to UV light.

There are two main categories of skin cancer: Melanoma and Non-melanoma skin cancers.

As you prepare for your initial appointment, please take the time to review this essential information regarding skin cancer risk factors, signs and symptoms, staging, and treatment options. At El Portal Comprehensive Cancer Centers, we are here to assist you and your family in making informed treatment decisions. Throughout this journey, you will gain the knowledge and confidence to effectively manage your cancer while continuing your daily activities.

Types of Skin Cancer

Understanding the specific type of skin cancer you have is crucial, as it will impact your treatment options. Most skin cancers develop on areas frequently exposed to the sun, such as the head, face, neck, hands, and arms; however, they can also occur in areas shielded from sunlight.

There are three primary types of skin cancers under the two main categories:

  • Non-melanoma skin cancers:
  • Basal cell carcinoma (BCC)
  • Squamous cell carcinoma (SCC)
  • Melanoma: The most aggressive type of skin cancer.
  • Non-melanoma Skin Cancers


Basal cell carcinoma and squamous cell carcinoma represent the two most common forms of skin cancer. These cancers typically arise in sun-exposed regions, including the head, face, neck, hands, and arms.

BCCs are characterized by abnormal and uncontrolled growths that develop in the basal cells, the cells located in the lowest layer of the epidermis. These tumors often appear in sun-exposed areas and may manifest as open sores, red patches, shiny bumps, pink growths, or scars. While BCCs grow slowly and rarely metastasize to other parts of the body, they can invade surrounding tissues if left untreated, potentially affecting bones and other structures beneath the skin.

SCC is the uncontrolled growth of abnormal cells occurring predominantly in areas of sun exposure, mainly within the upper layers of the epidermis. Common locations include the rim of the ear, lower lip, face, balding scalp, neck, hands, arms, and legs. However, SCC can also occur in regions not typically exposed to sunlight, such as the mouth and genital areas. Symptoms may include scaly red patches, open sores, elevated growths with central depressions, or warts. Though seldom life-threatening, untreated SCC can spread to lymph nodes and internal organs, leading to serious complications.

If cancer spreads from its original site to another part of the body, the growth will still bear the same name as the primary tumor, regardless of where it has spread.

Melanoma, while significantly less common than BCC and SCC, is the deadliest form of skin cancer and its incidence has been increasing annually. It poses a greater risk of metastasis if not detected early. In the past three decades, the percentage of individuals developing melanoma has more than doubled in the United States. However, if identified and treated promptly, melanoma is often curable. If left untreated, it can progress and spread to other areas of the body, complicating treatment.

Melanoma originates in melanocytes, the cells that produce pigment in the skin and are found between the dermis and epidermis. These tumors often resemble moles, and some may develop from existing moles.

The growth of melanoma is triggered when UV radiation induces genetic mutations in skin cells, leading to uncontrolled cell multiplication that forms malignant tumors. While most melanomas are black or brown, they can also be skin-colored, pink, red, purple, blue, or white.

Melanomas can develop anywhere on the skin; however, they are more frequently found on the trunk (chest and back) in men and on the legs in women. Other common areas include the neck and face.

It’s essential to stay vigilant. If you observe new spots on your skin or notice changes in existing moles, make sure to inform your doctor or dermatologist. We provide resources, including photos, to help you identify potential signs of cancerous moles, but it is always best to consult with a healthcare professional who can conduct a thorough examination and perform a biopsy if necessary.

Skin Cancer Symptoms

The most critical warning sign of skin cancer is the appearance of a new spot on the skin or changes in an existing spot that seem abnormal.

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Skin Cancer Diagnosis

Skin cancer is typically identified first by an examination of the skin. Determining whether it is cancerous requires removal and testing, known as a biopsy.

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Staging Skin Cancer and Melanoma

Staging involves an assessment to determine how thick the tumor is and whether it has metastasized to other parts of the body. Understanding the stage of your cancer is crucial.

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Skin Cancer Treatment Based on Type

There are various approaches to treating skin cancer, and your oncologist will work closely with you to determine the most effective combination of therapies based on the stage of cancer and your overall health

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HDR Brachytherapy

The BEST non-invasive cancer treatment available that offers superior results.

Effective

Few Side Effects

Little to no scarring

HDR Brachytherapy is a method of treating cancer using radiation that is delivered from small devices placed very close to or inside the tumor. This approach is careful and focused to make sure that the radiation targets the cancer while protecting the healthy tissue around it.

During this treatment, tiny tubes are put into the tumor temporarily. Before each session, we check that these tubes are in the right place. Then, small pellets that emit radiation are placed inside these tubes. A computer helps control how deep the pellets go and how long they stay to ensure the radiation is delivered exactly where it’s needed.

This treatment is usually quick and can often be done in just a few minutes. Many patients can complete their treatment in one to two days, compared to several weeks for other types of radiation therapy. Depending on the cancer type and how advanced it is, HDR Brachytherapy might be used along with other treatments, which can affect how long the overall treatment lasts.

Skin Cancer Treatment Chart
Each treatment has advantages and disadvantages. These should be considered and discussed with your healthcare professional when planning your treatment.

Treatment

Advantages

Disadvantages

Surgery (such as excision and Mohs surgery)

  • High efficacy, margin control possible, single-day procedure
  • Healthy tissue is also removed.
  • Often restriction of activity to allow wound healing.
  • Scarring
  • Often need for reconstructive procedures.
  • Risk of wound healing complications.

External beam radiation theerapy (EBRT)

  • Non-invasive, painless
  • Efficacy is comparable to surgery. Allows patient to continue taking prescribed medications.
  • The treatment course can be long (4-6 weeks). Not suitable for all patients.

Brachytherapy

  • High efficacy, excellent functional and cosmetic outcomes. Allows patients to continue taking prescribed medications.
  • Less fractions than EBRT course (2-3 times a week rather than daily,, which translates particularly useful for elderly and frail patients.
  • Not available at all hospitals.
  • Multiple (usually 20-30) fractions.

Other Therapies

  • Often non-invasive, safe and effective alternative to traditional treatment.
  • Not suitable for all patients: factors such as tumor location, size, and cell type should be taken in consideration.
  • More studies are required to prove the efficacy of treatment.

Skin Cancer Treatment Chart
Each treatment has advantages and disadvantages. These should be considered and discussed with your healthcare professional when planning your treatment.

Treatment

Advantages

Disadvantages

Surgery (such as excision and Mohs surgery)

• High efficacy, margin control possible, single-day procedure.

• Healthy tissue is also removed.
• Often restriction of activity to allow wound healing.
• Scarring
• Often need for reconstructive procedures.
• Risk of wound healing complications.

External beam radiation theerapy (EBRT)

• Non-invasive, painless

• Efficacy is comparable to surgery. Allows patient to continue taking prescribed medications.

• The treatment course can be long (4-6 weeks). Not suitable for all patients.

Brachytherapy

• High efficacy, excellent functional and cosmetic outcomes. Allows patients to continue taking prescribed medications.

• Less fractions than EBRT course (2-3 times a week rather than daily,, which translates particularly useful for elderly and frail patients.

• Not available at all hospitals.

• Multiple (usually 20-30) fractions.

Other Therapies

• Often non-invasive, safe and effective alternative to traditional treatment.

• Not suitable for all patients: factors such as tumor location, size, and cell type should be taken in consideration.

• More studies are required to prove the efficacy of treatment.

“America’s health care system is in crisis precisely because we systematically neglect wellness and prevention.”
— Tom Harkin

Skin Cancer Symptoms

The most critical warning sign of skin cancer is the appearance of a new spot on the skin or changes in an existing spot that seem abnormal. Following the A B C D E guidelines can help you identify the common signs of skin cancer:

  • Asymmetry:One half of a mole (or birthmark) does not match the other half.
  • Border:Edges are irregular, ragged, notched, or blurred.
  • Color:The color is uneven, often featuring different shades of brown or black, along with patches of pink, red, white, or blue.
  • Diameter:The spot is larger than 6 millimeters across (about the size of a pencil eraser).
  • Evolving:The mole is changing in size, shape, color, or elevation. 

Skin Cancer Diagnosis

Skin cancer is typically identified first by a healthcare professional during an examination of an unusual area on the skin. However, determining whether it is cancerous requires removal and subsequent testing, known as a biopsy. This is the only reliable method to confirm a skin cancer diagnosis.

You may have your biopsy performed in a dermatologist’s office or as an outpatient procedure in a hospital or clinic, depending on the size and location of the abnormal area. Local anesthesia is usually administered to ensure your comfort.

There are four common types of skin biopsies:

  • Punch Biopsy:A sharp, hollow tool is used to remove a circle of tissue from the abnormal area.
  • Incisional Biopsy:A scalpel is employed to remove a portion of the growth.
  • Excisional Biopsy:The entire growth and some surrounding tissue are removed with a scalpel.
  • Shave Biopsy:A thin, sharp blade is used to shave off the abnormal growth.


If there is a possibility of melanoma, dermatologists will generally avoid simply shaving or cauterizing the growth. Instead, an excisional biopsy will be performed, or if the growth is too large, a tissue sample will be collected.

Staging Skin Cancer and Melanoma

Upon receiving a biopsy confirmation of skin cancer, you will be referred to a specialized oncologist for further evaluation and care. Understanding the extent, or stage, of your cancer is crucial, whether you have melanoma or nonmelanoma skin cancer. Staging involves a meticulous assessment to determine how thick the tumor is and whether it has metastasized to other parts of the body. If the tumor is particularly thick, your doctor may recommend chest x-rays, blood tests, and imaging scans of the liver, bones, and brain.

Knowing the stage of your cancer enables your oncologist to:

  • Assess the seriousness of your cancer and your chances for survival
  • Formulate the most effective treatment plan for your unique situation
  • Identify clinical trials that may present additional treatment options


In some cases, your oncologist may need to examine your lymph nodes to accurately stage the cancer. Surgical procedures may be part of the treatment plan to remove cancerous lymph nodes, which can aid in managing the disease.

Staging Criteria
Staging is based on several key factors:

  • The size of the tumor
  • How deeply it has penetrated below the surface of the skin
  • Whether it has spread to nearby lymph nodes or other organs


Oncologists utilize Roman numerals I through IV to designate the cancer stage. Stage I indicates small tumors that are confined to their original site, while Stage IV signifies advanced cancer that has spread to distant sites in the body.


Nonmelanoma Skin Cancer Staging
The stages of nonmelanoma skin cancer are as follows:

  • Stage 0: The cancer is localized to the top layer of skin, classified as carcinoma in situ.
  • Stage I: The tumor measures 2 centimeters (approximately three-quarters of an inch) or smaller.
  • Stage II: The tumor exceeds 2 centimeters in diameter.
  • Stage III: The cancer has spread beyond the skin to underlying tissues such as cartilage, muscle, or bone, or to nearby lymph nodes, but not to distant locations.
  • Stage IV: The cancer has metastasized to other areas in the body.


Melanoma Staging
The staging for melanoma specifically is defined as follows:

  • Stage 0: Melanoma cells are confined to the outer layer of skin (epidermis) and have not invaded deeper tissues.
  • Stage I: In Stage I, the melanoma is considered thin:
    • The tumor is no thicker than 1 millimeter (1/25 inch) and may show signs of ulceration (a scraped appearance).
    • Alternatively, the tumor measures between 1 and 2 millimeters thick without ulceration, and melanoma cells have not spread to nearby lymph nodes.
  • Stage II: At this stage, the tumor is at least 1 millimeter thick:
    • It may be between 1 and 2 millimeters thick and present with ulceration.
    • Alternatively, the tumor may be greater than 2 millimeters thick, potentially with ulceration, but has not yet spread to nearby lymph nodes.
  • Stage III: This indicates that melanoma has spread to nearby lymph nodes or to tissues just outside the original tumor without affecting the lymph nodes.
  • Stage IV: At this advanced stage, melanoma cells have metastasized to other organs, lymph nodes, or distant skin areas.
  • Recurrent: Recurrent disease indicates that cancer has returned after treatment, either in the original site or in a new location within the body.

Skin Cancer Treatment Based on Type

There are various approaches to treating skin cancer, and your oncologist will work closely with you to determine the most effective combination of therapies based on the stage of cancer and your overall health. We at El Portal Comprehensive Cancer Centers are dedicated to providing you with comprehensive care tailored to your needs, ensuring you receive the support, guidance, and treatment necessary for your journey toward recovery.


Nonmelanoma Skin Cancer Treatments

In some cases, the entire nonmelanoma skin cancer may be removed during the biopsy, which means no further treatment is necessary. However, if additional treatment is required, your doctor will outline the available options.

There are six primary types of nonmelanoma skin cancer treatments, which may be used individually or in combination:

  1. Surgery
  2. Chemotherapy
  3. Photodynamic therapy
  4. Radiation therapy
  5. Biologic therapy
  6. Targeted therapy


Melanoma Skin Cancer Treatments

Melanoma treatment encompasses nearly all the same options as nonmelanoma skin cancer, with the exception of photodynamic therapy.


Skin Cancer Treatment Options

Your oncologist can provide detailed explanations of the following surgical techniques:

  • Wide-Local Excision (WLE): This common approach involves numbing the area and surgically removing the cancer along with a margin of surrounding healthy skin. The margin is examined microscopically to ensure all cancer cells have been excised, and the required margin size will depend on the tumor’s dimensions. In some cases, nearby lymph nodes may also be removed.
  • Mohs Surgery: This technique is particularly beneficial for skin cancer treatment. The surgeon numbs the area and removes thin layers of the tumor, examining each layer under a microscope for cancer cells. The process continues until no cancerous cells are detected, ensuring complete tumor removal while preserving as much healthy tissue as possible.
  • Electrodesiccation and Curettage: This method is ideal for small basal cell skin cancers. The doctor numbs the area, removes the cancer using a curette (a spoon-shaped surgical instrument), and then employs an electric current to control bleeding and eliminate any remaining cancer cells. This procedure tends to be quick and straightforward.
  • Cryosurgery: This option is suitable for patients who may not tolerate other surgical methods. Cryosurgery employs extreme cold, typically generated from liquid nitrogen, to treat early-stage or very thin skin cancer lesions. While effective, this approach may cause swelling and could damage nerves in the area, leading to temporary loss of sensation.
  • Laser Surgery: This technique involves using a focused beam of light to target and destroy cancer cells. It is primarily utilized for superficial growths confined to the outer layer of skin.
  • Skin Grafting: Occasionally, grafts are necessary to cover openings left by surgical removal. In this procedure, the surgeon numbs the area and removes a patch of healthy skin from another part of your body, such as the thigh, to cover the excised area. It is important to provide special care to the graft site during the healing process.
  • Lymphadenectomy: This surgical procedure may be employed in the case of melanoma, wherein lymph nodes are removed for evaluation. The removed tissue is examined under a microscope for cancer cells.
  • Sentinel Lymph Node Biopsy: During this procedure, the sentinel lymph node—the first node likely to receive cancer spread from the tumor—is surgically removed. A radioactive substance and/or blue dye is injected near the tumor site to track the flow to the lymph nodes. If no cancer cells are found in the sentinel node, additional nodes may not need to be excised, making this a useful technique within melanoma treatment plans.