Skin Cancer

Skin Cancer Background Research How You Can Help All About Skin Cancer Background More than 2 million people are diagnosed with skin cancer every year in the United States, including non-melanoma and melanoma. Melanoma is the most serious form of skin cancer that can be fatal if it spreads to distant sites in the body. Among those skin cancer patients, it is estimated that more than 70,000 will be diagnosed with melanoma this year. Although most skin cancers are curable, a serious type known as melanoma is estimated to claim more than 9,180 American people's lives in 2012 alone, accounting for 75% of all skin cancer deaths. Melanoma is more difficult to prevent because, unlike in other types of skin cancer, heredity plays a major role in melanoma development. It is also more aggressive in spreading (metastasizing) to distant body parts, and treatment is often ineffective once metastasis occurs. Studies show that only 15 to 20% of patients with metastatic melanoma could survive for 5 years or longer. Better treatment strategies are in high demand for this lethal skin cancer. Research NFCR funds leading cancer researchers who are dedicated to finding new and better strategies for skin cancer prevention and treatment. Below are three examples of outstanding NFCR research programs, each holding great promise in the effort to fight skin cancer and save more lives: Searching for "A Second Layer of Sunscreen" NFCR Fellow Helmut Sies, M.D., from Heinrich Heine Universitat, Germany Back in the 1980s, Dr. Helmut Sies discovered the powerful anti-oxidation activity of lycopene, the famous red pigment in tomatoes and other fruits and vegetables. His recent research with volunteers showed that lycopene and other carotenoids (natural pigments) effectively ameliorated UV-induced skin damage (erythma) in humans, which consequently helped reduce the risk of skin cancer. Dr. Sies' discovery increases the possibilities of using dietary intervention for skin cancer protection, and helps the development of functional foods that may enable humans to create a second layer of powerful sunscreen from inside out. Recently, NFCR scientist Dr. Helmut Sies, a leading researcher on cancer prevention, demonstrated with human volunteers that lycopene, the carotenoid in tomatoes and other fruits and in some vegetables, and flavanols from cocoa, red wine, and green tea, effectively ameliorated UV-induced skin damage (erythma), which can help reduce the risk of skin cancer. To understand how these dietary micronutrients control cell metabolism and work to prevent skin cancer, Dr. Sies is forging ahead to define molecular targets of these nutrients. This vital information will guide researchers in identifying molecular biomarkers of skin cancer that may depend on an individual's metabolism. In the era of personalized medicine, NFCR supports this important research that will further increase the possibilities of using dietary intervention for skin cancer protection on an individual level. Ancient Enzymes May Offer a New, Modern Way to Target Melanoma NFCR Fellow Paul Schimmel, Ph.D., The Scripps Research Institute, California tRNA synthetases, which are among the first enzymes to arise in the early stages of the evolution of life, build all proteins from the genetic-code-carrying molecule mRNA. Dr. Paul Schimmel, an NFCR scientist who has devoted almost his entire career to studying tRNA synthetases, is demonstrating that these enzymes also have anti-cancer functions in cells. Recently, his research showed that one tRNA synthetase has robust activity in slowing and stopping melanoma growth in tumor models. In fact, when the enzyme is given with chemotherapy, tumor suppression activity is greater than either agent alone. With continued research, this tRNA synthetase may provide the basis for a new therapy against malignant melanoma. Stopping the Lethal Spread of Melanoma NFCR Center of Metastasis Research, University of Kansas Medical Center, Kansas, directed by Danny Welch, Ph.D Melanoma can take a patient's life within 4-6 months once it has spread. NFCR scientist Dr. Danny Welch and his team are leading the metastasis research field to develop effective ways to keep it from being so lethal. In fact, they have discovered six "metastasis suppressor genes" including BRMS1 and KISS1 genes that stop the spread of melanoma. Their current research is identifying the cell proteins that normally interact with KISS1 proteins, an important next step that will reveal just how KISS1 proteins mediate suppression of metastasis. Once the scientists know the partners of KISS1 proteins, they can design molecules that mimic them, leading to the development of novel anti-cancer therapies to prevent metastasis from happening or keep it dormant. If this can be achieved, it could bring the cancer under control and give patients more hope for a cure and a longer life. How You Can Help These NFCR-supported research projects hold great promise in developing more effective skin cancer prevention strategies for the general public and in bringing new and better treatments to save more patients' lives. What our scientists need is funding to keep their very promising research moving forward. Click here to make a contribution today, and help us continue the search for a cure. All About Skin Cancer Skin-Cancer-Stages Treatment for Non-melanoma Skin Cancer Overview Non-melanoma skin cancer refers to all types of skin cancer other than melanoma. The two most common types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma. Treatment for non-melanoma skin cancer most often involves surgery, but there are non-surgical approaches that may be considered in certain circumstances. About this Non-Melanoma Skin Cancer Treatment Information The following is a general overview of treatment for non-melanoma skin cancer. Treatment may consist of surgery, radiation therapy, or topical therapy. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Treatments that may be available through clinical trials are discussed in the section titled Strategies to Improve Treatment. Circumstances unique to each patient’s situation influence which treatment or treatments are utilized. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their physician. * Surgery * Non-surgical Treatment * Treatment of Metastatic Cancer * Treatment of Actinic Keratoses * Strategies to Improve Treatment Surgery for Non-Melanoma Skin Cancer Mohs micrographic surgery: This procedure is complicated and requires expertise, but is often recommended for the treatment of high-risk basal cell carcinoma or squamous cell carcinoma.[1] In this procedure, a doctor removes thin layers of skin one at a time and evaluates them for cancer while the patient waits. The doctor keeps removing layers of skin until he or she reaches a layer that is cancer-free. This procedure removes the least amount of normal tissue, and also has the highest cure rates for both primary and recurrent cancers. The procedure generally requires less than four hours to complete, but can take longer if the cancer is extensive. Surgical excision: Surgical excision involves the use of a scalpel to remove the cancerous area and a small margin of surrounding normal tissue. Electrodesiccation and Curettage: This is a commonly used treatment for basal cell carcinoma. It may also be used for very small squamous cell carcinoma.[1] Electrodesiccation and curettage involves scraping and cauterizing (burning) the abnormal area of skin. Cryosurgery: Cryosurgery involves the destruction of abnormal tissue through freezing. It may be used for patients with small basal cell carcinoma or in situ (stage 0) squamous cell carcinoma, particularly for patients who are debilitated and cannot tolerate other procedures.[1] Laser surgery: This procedure uses a laser to destroy cancer tissue. It may be used to treat superficial basal cell carcinoma (a subtype of basal cell carcinoma) or in situ (stage 0) squamous cell carcinoma.[1] Non-Surgical Treatment of Non-Melanoma Skin Cancer Radiation therapy: Radiation therapy uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. This treatment may be appropriate for older, debilitated patients who cannot tolerate extensive surgery or in cases where surgery may be very disfiguring.[2]Radiation therapy is generally considered more appropriate for older patients than for younger patients because of the risk of poor long-term cosmetic results or later cancer.[3] Topical Therapy: Topical therapy involves the application of medications such as fluorouracil (5-FU) or Aldara® (imiquimod) to the skin. Fluorouracil, a chemotherapy drug, may be used to treat selected patients with superficial basal cell carcinoma or in situ (stage 0) squamous cell carcinoma.[1] Aldara was approved by the Food and Drug Administration (FDA) for the treatment of actinic keratoses, as well as treatment of certain patients with small, superficial basal cell carcinoma. Aldara acts as an immune response modifier, meaning that it stimulates the immune system to help fight “foreign” material, such as bacteria, viruses, and cancer cells. Treatment of Metastatic Non-Melanoma Skin Cancer For squamous cell carcinoma that has spread to nearby lymph nodes, treatment may involve surgical removal of the lymph nodes, radiation therapy, or both.[4] The optimal approach to treatment of non-melanoma skin cancer that has spread to distant sites in the body is still being evaluated. Patients with metastatic cancer may wish to consider participating in a clinical trial of promising therapeutic approaches. Treatment of Actinic Keratoses Actinic keratoses are precancerous changes to the skin. Treatment of actinic keratoses may reduce the risk of squamous cell carcinoma. Treatments include topical medications, cryosurgery, electrodessication and curettage, laser surgery, photodynamic therapy, shave excision (use of a blade to shave off the abnormal area), and dermabrasion (use of a tool or particles to rub away the top layer of skin).[1] Strategies to Improve Treatment of Non-Melanoma Skin Cancer The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of non-melanoma skin cancer will result from the continued evaluation of new treatments in clinical trials. Patients may gain access to better treatments by participating in a clinical trial. Participation in a clinical trial also contributes to the cancer community’s understanding of optimal cancer care and may lead to better standard treatments. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active investigation aimed at improving the treatment of non-melanoma skin cancer include the following: Aldara® (imiquimod): Aldara was approved by the Food and Drug Administration (FDA) for the treatment of actinic keratoses, as well as the treatment of certain patients with small, superficial basal cell carcinoma. Researchers are exploring whether it is also effective against other types of basal cell carcinoma and squamous cell carcinoma. Photodynamic therapy: Photodynamic therapy involves the use of a drug (generally one that is applied directly to the skin) that collects in cells and makes them sensitive to particular wavelengths of light.[5] Cancer cells tend to absorb more of the drug than normal cells. When light is then shined on the treated area, it leads to the destruction of the cancer cells. Photodynamic therapy is approved in the US for treatment certain of types of actinic keratoses on the face or scalp. Although it has not been approved in the US for the treatment of basal cell carcinoma or squamous cell carcinoma, studies suggest that it can be effective in patients with an early stage of squamous cell carcinoma (particularly patients with large or multiple lesions, or with lesions in difficult-to-treat areas) or superficial basal cell carcinoma.[5] Interferon-alfa: Interferon-alfa is a drug that stimulates the immune system to fight cancer cells. Though FDA approved for other uses, interferon alfa is still being evaluated in the treatment of basal cell carcinoma and squamous cell carcinoma. References: [1]National Cancer Institute. Skin Cancer (PDQ®): Treatment. Health Professional Version. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional (accessed December 4, 2007). [2] Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nature Clinical Practice Oncology. 2007; 4:462-469. [3]Rubin AI, Chen EH, Ratner D. Basal-Cell Carcinoma. New England Journal of Medicine. 2005;353:2262-2269. [4]Alam M, Ratner D. Cutaneous Squamous-Cell Carcinoma. New England Journal of Medicine. 2001;344:975-983. [5] Fien SM, Oseroff AR. Photodynamic therapy for non-melanoma skin cancer. Journal of the National Comprehensive Cancer Network. 2007;5:531-540. Copyright © 2012 Omni Health Media Skin Cancer Information Center. All Rights Reserved. Skin Cancer Screening and Prevention Overview Physicians and individuals alike recognize that the best “treatment” of cancer is preventing its occurrence in the first place or detecting it early when it may be most treatable. The chance of an individual developing cancer depends on both genetic and non-genetic factors. A genetic factor is an inherited, unchangeable trait such as eye color. Non-genetic factors include behaviors such as diet and exercise, as well as exposure to substances in the environment. Many non-genetic factors are modifiable, allowing us to take steps to reduce our risk of cancer. Hereditary or Genetic Factors The frequency of skin cancer varies by skin, eye, and hair color. Fair-skinned individuals; those with blue, green, or grey eyes; and those with red or blonde hair are at increased risk.[1],[2] Skin cancer can also develop in individuals with darker skin or eye color, which suggests that that prevention is important for everyone. Individuals with a family history of skin cancer are also more likely to develop skin cancer. In rare cases, this is due to a known familial cancer syndrome such as xeroderma pigmentosum, oculocutaneous albinism, or basal cell nevus syndrome. Individuals with xeroderma pigmentosum are extremely sensitive to ultraviolet radiation and have a very high probability of developing skin cancer. Oculocutaneous albinism involves a defect in melanin production, and results in complete or partial absence of pigment in the skin, hair, and eyes. Basal cell nevus syndrome causes disorders of the skin as well as other parts of the body, including the bones and nervous system. Environmental or Non-Genetic Factors Exposure to ultraviolet radiation is the most important risk factor for both basal cell carcinoma and squamous cell carcinoma.[1],[2] The ultraviolet radiation from the sun that reaches the earth includes both ultraviolet B (UVB) and ultraviolet A (UVA). Both types of ultraviolet radiation are thought to increase skin cancer risk. Exposure to ultraviolet radiation from the sun is greatest at latitudes closer to the equator, at high altitude, and when the sun in highest in the sky. Tanning beds and sun lamps also provide exposure to ultraviolet radiation, and are believed to increase the risk of skin cancer.[3] Actinic keratoses are a type of precancerous change to the skin that is caused by sun exposure. They are signs of damage to the skin and in some cases progress to squamous cell carcinoma. Infection with certain types of human papillomavirus may also increase the risk of non-melanoma skin cancer. These viruses are very common, and are responsible for conditions ranging from warts to cervical cancer. Though relatively few studies have evaluated a link with skin cancer, there is some suggestion that a certain class of HPV known as beta HPV plays a role in squamous cell carcinoma.[4] This class of HPV includes HPV types 5,8,9,15,20,24,36, and 38. Patients who are immunosuppressed, such as those undergoing organ transplantation, have a greatly increased risk of developing non-melanoma skin cancer.[1],[2] Immunsuppression may also influence the type of skin cancer that develops–in contrast to the general population, organ transplant recipients are more likely to develop squamous cell carcinoma than basal cell carcinoma.[2] Other factors linked with non-melanoma skin cancer include ionizing radiation (such as radiation from x-rays), arsenic, oral methoxsalen, and ultraviolet A therapy for psoriasis, ulcers or inflammation of the skin, and smoking.[1],[2] Prevention Though common, non-melanoma skin cancer is a largely preventable disease. Sun protection over the course of a lifetime is the most important aspect of prevention. You can protect yourself from the sun by using a high-SPF sunscreen that protects against UVB and UVA, wearing sun-protective clothing (such as hats, long-sleeved shirts, and long pants) with a tight weave, wearing sunglasses, and by staying in the shade. When using sunscreen, apply a large amount and reapply frequently. It’s also important not to use sunscreen as an excuse for longer sun exposure. Individuals who use sunscreen to extend their time in the sun expose themselves to the same amount of UV radiation as if they had remained outside for a shorter period of time without sunscreen. Keep in mind that that UV radiation can be reflected off of snow, water, and sand. UV radiation is also more intense at high altitudes, at latitudes closer to the equator, and when the sun is higher in the sky. Because sun lamps and tanning booths also expose you to ultraviolet radiation, use of these tanning devices is best avoided.[3] For individuals with actinic keratoses, a precursor to squamous cell carcinoma, removal of the lesions may decrease the risk of developing squamous cell carcinoma. Because actinic keratoses are a sign that the skin has been damaged by sun exposure, individuals with actinic keratoses will also need to take special care to protect their skin from further sun damage. Screening and Early Detection Though the U.S. Preventive Services Task Force has concluded that there is insufficient evidence to recommend routine skin cancer screening or skin self-exam,[5] individuals and their physicians should be aware of changes to the skin that may signal cancer. The most common signs of non-melanoma skin cancer involve changes to the skin, such as a new growth, changes in an old growth, or a sore that doesn’t heal. Self Exam: Performing skin self-examinations on a monthly basis may help you monitor changes to your skin. Use a mirror to examine your entire body for skin changes. It may be helpful to have someone with you to help examine hard-to-see areas such as your back. If you notice suspicious changes to your skin, you should promptly notify your physician. Routine check-up: Depending on your age and personal and family history, a skin examination may be conducted as part of your regular health exams. Careful follow-up: Within the first five years of a diagnosis of non-melanoma skin cancer, an estimated 30% to 50% of patients will develop another non-melanoma skin cancer.[6] Patients who have had non-melanoma skin cancer are also at increased risk of developing melanoma.[7] Because of this high risk, individuals with a history of skin cancer should follow their physician’s recommendation regarding ongoing follow-up exams. References [1] Rubin AI, Chen EH, Ratner D. Basal-Cell Carcinoma. New England Journal of Medicine. 2005;353:2262-2269. [2] Alam M, Ratner D. Cutaneous Squamous-Cell Carcinoma. New England Journal of Medicine. 2001;344:975-983. [3] World Health Organization. Sunbeds, Tanning, and UV Exposure. Fact Sheet No. 287. March 2005. Available at http://www.who.int/mediacentre/factsheets/fs287/en/# (Accessed April 17, 2006) [4] Karagas MR, Nelson HH, Sehr P et al. Human Papillomavirus Infection and Incidence of Squamous Cell and Basal Cell Carcinomas of the Skin. Journal of the National Cancer Institute. 2006;98:389-95. [5] U.S. Preventive Services Task Force. Screening for Skin Cancer: Recommendations and Rationale. American Journal of Preventive Medicine. 2001;20(3S):44-6. [6] National Comprehensive Cancer Network. Basal Cell and Squamous Cell Skin Cancers. Clinical Practice Guidelines in Oncology – v.2.2005. © National Comprehensive Cancer Network, Inc. 2001, 2002, 2003, 2004, 2005. NCCN and NATIONAL COMPREHENSIVE CANCER NETWORK are registered trademarks of National Comprehensive Cancer Network, Inc. [7] Rosenberg CA, Khandekar J, Greenland P et al. Cutaneous Melanoma in Postmenopausal Women After Nonmelanoma Skin Carcinoma: The Women’s Health Initiative Observational Study. Cancer. 2006;106:654-63 Copyright © 2012 Omni Health Media Skin Cancer Information Center. All Rights Reserved. Overview of Non-Melanoma Skin Cancer Non-melanoma skin cancer refers to all types of skin cancer other than melanoma. Although there are several different types of non-melanoma skin cancer, the two most common types are basal cell carcinoma and squamous cell carcinoma. Basal Cell Carcinoma Basal cell carcinoma accounts for roughly 80% of all cases of non-melanoma skin cancer.[1] It most commonly develops on sun-exposed skin, with the head (particularly the nose) and neck being the most common sites. The appearance of basal cell carcinoma varies. It often appears as a raised bump with a smooth, pearly or waxy appearance. It may also look like a firm, flat scar.[2] Basal cell carcinoma very rarely metastasizes, but it can cause extensive local damage to the skin and surrounding tissues. Squamous Cell Carcinoma Squamous cell carcinoma accounts for roughly 20% of all cases of non-melanoma skin cancer.[3] Squamous cell carcinoma commonly involves the head or neck. The tumor may appear as a red bump or as a rough or scaly area on the skin.[2] Squamous cell carcinoma is more likely than basal cell carcinoma to spread to lymph nodes or distant parts of the body, though this happens infrequently. Other Types of Non-Melanoma Skin Cancer * Kaposi’s sarcoma * Merkel cell carcinoma * Cutaneous lymphoma * Adnexal carcinoma Actinic Keratoses Actinic keratoses, also known as solar keratoses because of their link with sun exposure, are a type of precancerous change to the skin.[2] They often appear as rough scaly patches on the skin or as a cracked and peeling area on the lower lip. Actinic keratoses are a warning sign that the skin has been damaged. Without treatment, some actinic keratoses will develop into squamous cell carcinoma. Diagnosis of Non-Melanoma Skin Cancer A change to the skin is likely to be the first sign of skin cancer. This may be a sore that doesn’t heal, a new growth, or a change in an old growth. When non-melanoma skin cancer is suspected, a patient will commonly undergo a complete skin examination. Information about medical history and history of sun exposure will also be collected. If the skin inspection identifies areas that are suspicious for cancer, a physician will conduct a biopsy to remove a sample of the tissue for further examination. A biopsy allows the physician to determine whether cancer is present. There are several different types of skin biopsies:[2] * Shave biopsy–a razor is used to shave off the abnormal area * Punch biopsy–a circle of tissue is removed from the abnormal area using a special instrument * Excisional biopsy–a scalpel is used to remove the abnormal area A physician may also examine lymph nodes, since squamous cell carcinoma sometimes spreads to lymph nodes. Staging of Non-Melanoma Skin Cancer Stage describes the extent of cancer. Determining cancer stage allows a physician to pick the most appropriate treatment. Skin cancer stage is based on the size of the cancer, the depth of the cancer, and the extent of spread to lymph nodes and beyond.[2] Stage 0: The cancer involves only the top layer of the skin. This is also called carcinoma in situ. Stage I: The cancer is 2 cm in diameter or smaller. Stage II: The cancer is larger than 2 cm in diameter. Stage III: The cancer has spread below the skin to cartilage, muscle, bone, or nearby lymph nodes, but has not spread to other parts of the body. Stage IV: The cancer has spread to other parts of the body. Prognosis of Non-Melanoma Skin Cancer Because non-melanoma skin cancer very rarely metastasizes, the prognosis is generally very good. There are certain cancer characteristics, however, that are linked with an increased risk of cancer recurrence or metastasis. Characteristics that are linked with an increased risk of cancer recurrence or metastasis include large tumor size (greater than two centimeters) or greater tumor depth; poorly defined tumor border; tumor location on the head or neck; a suppressed immune system; tumor invasion near a nerve; tumor location at a site of previous radiation therapy; or an aggressive tumor growth pattern. Recurrent tumors also have a higher risk of recurrence or metastasis. For patients with squamous cell carcinoma, high-risk tumor locations also include the genitals and sites of chronic inflammation or scarring.[4] During the first five years after a diagnosis of non-melanoma skin cancer, between 30% and 50% of patients will develop another non-melanoma skin cancer.[4] Individuals who have had non-melanoma skin cancer are also at increased risk of developing melanoma.[5] Treatment Overview Surgery is the mainstay of treatment for non-melanoma skin cancers. There are several different types of surgery, and the choice of which to use will depend in part on the location and characteristics of the cancer. Other treatment options include radiation therapy, photodynamic therapy, and topical therapy. For more detailed information about treatment of non-melanoma skin cancer, go to Treatment of Non-melanoma Skin Cancer References [1] Rubin AI, Chen EH, Ratner D. Basal-Cell Carcinoma. New England Journal of Medicine. 2005;353:2262-2269. [2] National Cancer Institute. Skin Cancer (PDQ®): Treatment. Patient Version. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/skin/patient (accessed April 17, 2006) [3] Alam M, Ratner D. Cutaneous Squamous-Cell Carcinoma. New England Journal of Medicine. 2001;344:975-983. [4] National Comprehensive Cancer Network. Basal Cell and Squamous Cell Skin Cancers. Clinical Practice Guidelines in Oncology – v.2.2005. © National Comprehensive Cancer Network, Inc. 2001, 2002, 2003, 2004, 2005. NCCN and NATIONAL COMPREHENSIVE CANCER NETWORK are registered trademarks of National Comprehensive Cancer Network, Inc. [5] Rosenberg CA, Khandekar J, Greenland P et al. Cutaneous Melanoma in Postmenopausal Women After Nonmelanoma Skin Carcinoma: The Women’s Health Initiative Observational Study. Cancer. 2006;106:654-63. Copyright © 2012 Omni Health Media Melanoma Information Center. All Rights Reserved.