Skin cancer
Classification and external resources
A basal cell carcinoma. Note the pearly appearance and telangiectasia.
ICD-10	C43-C44
ICD-9	172, 173
ICD-O:	8010-8720
OMIM	2890-1
MedlinePlus	001442
eMedicine	article/276624, article/870538, article/1100753, article/1965430
MeSH	D012878

Skin neoplasms (also known as "skin cancer") are skin growths with differing causes and varying degrees of malignancy. The three most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma, each of which is named after the type of skin cell from which it arises. Skin cancer generally develops in the epidermis (the outermost layer of skin), so a tumor can usually be seen. This means that it is often possible to detect skin cancers at an early stage. Unlike many other cancers, including those originating in the lung, pancreas, and stomach, only a small minority of those affected will actually die of the disease,^[1] though it can be disfiguring. Melanoma survival rates are poorer than for non-melanoma skin cancer, although when melanoma is diagnosed at an early stage, treatment is easier and more people survive.^[2]

Skin cancer is the most commonly diagnosed type of cancer. Melanoma and non-melanoma skin cancers combined are more common than lung, breast, colorectal, and prostate cancer.^[1] Melanoma is less common than both basal cell carcinoma and squamous cell carcinoma, but it is the most serious — for example, in the UK there were over 11,700 new cases of melanoma in 2008, and over 2,000 deaths.^[3] It is the second most common cancer in young adults aged 15–34 in the UK.^[4] Most cases are caused by over-exposure to UV rays from the sun or sunbeds.^[5] Non-melanoma skin cancers are the most common skin cancers. The majority of these are basal cell carcinomas. These are usually localized growths caused by excessive cumulative exposure to the sun and do not tend to spread.

Classification[link]

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

Cancer	Description	Illustration
Basal cell carcinoma	Note the pearly translucency to fleshy color, tiny blood vessels on the surface, and sometime ulceration which can be characteristics. The key term is translucency.
Squamous cell carcinoma	Commonly presents as a red, crusted, or scaly patch or bump. Often a very rapid growing tumor, pain is a common characteristic.
Malignant melanoma	The common appearance is an asymmetrical area, with an irregular border, color variation, and often greater than 6 mm diameter.[6]

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

Less common skin cancers include: Dermatofibrosarcoma protuberans, Merkel cell carcinoma, Kaposi's sarcoma, keratoacanthoma, spindle cell tumors, sebaceous carcinomas, microcystic adnexal carcinoma, Pagets's disease of the breast, atypical fibroxanthoma, leimyosarcoma, and angiosarcoma.

The BCC and the SCC often carry a UV-signature mutation indicating that these cancers are caused by UV-B radiation via the direct DNA damage. However the malignant melanoma is predominantly caused by UV-A radiation via the indirect DNA damage.The indirect DNA damage is caused by free radicals and reactive oxygen species. Research indicates that the absorption of three sunscreen ingredients into the skin, combined with a 60-minute exposure to UV, leads to an increase of free radicals in the skin, if applied in too little quantities and too infrequently.^[7] However, the researchers add that newer creams often do not contain these specific compounds, and that the combination of other ingredients tends to retain the compounds on the surface of the skin. They also add the frequent re-application reduces the risk of radical formation.

Signs and symptoms[link]

There are a variety of different skin cancer symptoms. These include changes in the skin that do not heal, ulcering in the skin, discolored skin, and changes in existing moles, such as jagged edges to the mole and enlargement of the mole.

Basal cell carcinoma[link]

Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders. Sometimes small blood vessels can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring.

Squamous cell carcinoma[link]

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

Melanoma[link]

Most melanomas are brown to black looking lesions. Unfortunately, a few melanomas are pink, red or fleshy in color; these are called amelanotic melanomas. These tend to be more aggressive. Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or new pain, itching, ulceration or bleeding. An often-used mnemonic is "ABCDE", where A= asymmetrical, B= "borders" (irregular= "Coast of Maine sign"), C= "color" (variegated), D= "diameter" (larger than 6 mm—the size of a pencil eraser) and E= "evolving."

Other[link]

Merkel cell carcinomas are most often rapidly growing, non-tender red, purple or skin colored bumps that are not painful or itchy. They may be mistaken for a cyst or other type of cancer.^[8]

Causes[link]

Ultraviolet radiation from sun exposure is the primary cause of skin cancer.^[9][10] Other factors that play a role include:

• Smoking tobacco^[10]
• HPV infections increase the risk of squamous cell carcinoma.^[10]
• Some genetic syndromes^[10] including congenital melanocytic nevi syndrome which is characterized by the presence of nevi (birthmarks or moles) of varying size which are either present at birth, or appear within 6 months of birth. Nevi larger than 20 mm (3/4") in size are at higher risk for becoming cancerous.
• Chronic non-healing wounds.^[10] These are called Marjolin's ulcers based on their appearance, and can develop into squamous cell carcinoma.
• Ionizing radiation, environmental carcinogens, artificial UV radiation (e.g. tanning beds), aging, and light skin color.^[10]

Pathophysiology[link]

Micrograph of melanoma. FNA specimen. Field stain.

Squamous cell carcinoma is a malignant epithelial tumor which originates in epidermis, squamous mucosa or areas of squamous metaplasia.^{[citation needed]}

Macroscopically, the tumor is often elevated, fungating, or may be ulcerated with irregular borders. Microscopically, tumor cells destroy the basement membrane and form sheets or compact masses which invade the subjacent connective tissue (dermis). In well differentiated carcinomas, tumor cells are pleomorphic/atypical, but resembling normal keratinocytes from prickle layer (large, polygonal, with abundant eosinophilic (pink) cytoplasm and central nucleus). Their disposal tends to be similar to that of normal epidermis: immature/basal cells at the periphery, becoming more mature to the centre of the tumor masses. Tumor cells transform into keratinized squamous cells and form round nodules with concentric, laminated layers, called "cell nests" or "epithelial/keratinous pearls". The surrounding stroma is reduced and contains inflammatory infiltrate (lymphocytes). Poorly differentiated squamous carcinomas contain more pleomorphic cells and no keratinization.^[11]

Prevention[link]

Sunscreen is effective and thus recommended to prevent melanoma^[12] and squamous cell carcinoma.^[13] There is little evidence that it is effective in preventing basal cell carcinoma.^[14] Other advice to reduce rates of skin cancer includes: avoiding sunburning, wearing protective clothing, sunglasses and hats, and attempting to avoid periods of peak sun exposure.^[15] The U.S. Preventive Services Task Force recommends that people aged between 9 and 25 years of age are advised to avoid ultraviolet light.^[16]

The risk of developing skin cancer can be reduced through a number of measures including: Decreasing indoor tanning and mid day sun exposure and increasing the use of sunscreen^[17] Avoiding the use of tobacco products

There is insufficient evidence to recommend for or against screening for skin cancer.^[18] Vitamins and antioxidants have not been found to have an effect in prevention.^[19]

Management[link]

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

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

Mohs' micrographic surgery (Mohs surgery) is a technique used to remove the cancer with the least amount of surrounding tissue and the edges are checked immediately to see if tumor is found. This provides the opportunity to remove the least amount of tissue and provide the best cosmetically favorable results. This is especially important for areas where excess skin is limited, such as the face. Cure rates are equivalent to wide excision. Special training is required to perform this technique. An alternative method is CCPDMA and can be performed by a pathologist not familiar with Mohs surgery.

In the case of disease that has spread (metastasized), further surgical procedures or chemotherapy may be required.^[20]

Reconstruction[link]

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

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

Skin grafting is patching of a defect with skin that is removed from another site in the body. The skin graft is sutured to the edges of the defect, and a bolster is placed atop the graft for seven to ten days, to immobilize the graft as it heals in place. There are two forms of skin grafting: split thickness and full thickness. In a split thickness skin graft, a shaver is used to shave a layer of skin from the abdomen or thigh. The donor site, regenerates skin and heals over a period of two weeks. In a full thickness skin graft, a segment of skin is totally removed and the donor site needs to be sutured closed.^[21] Split thickness grafts can be used to repair larger defects, but the grafts are inferior in their cosmetic appearance. Full thickness skin grafts are more acceptable cosmetically. However, full thickness grafts can only be used for small or moderate sized defects.

Local skin flaps are a method of closing defects with tissue that closely matches the defect in color and quality. Skin from the periphery of the defect site is mobilized and repositioned to fill the deficit. Various forms of local flaps can be designed to minimize disruption to surrounding tissues and maximize cosmetic outcome of the reconstruction. Pedicled skin flaps are a method of transferring skin with an intact blood supply from a nearby region of the body. An example of such reconstruction is a pedicled forehead flap for repair of a large nasal skin defect. Once the flap develops a source of blood supply form its new bed, the vascular pedicle can be detached.^[22]

Prognosis[link]

The mortality rate of basal cell and squamous cell carcinoma are around 0.3% causing 2000 deaths per year in the US. In comparison the mortality rate of melanoma is 15-20% and it causes 6500 deaths per year.^[23]:29,31 Even though it is much less common, malignant melanoma is responsible for 75% of all skin cancer-related deaths.^[24]

Epidemiology[link]

Age-standardized death from melanoma and other skin cancers per 100,000 inhabitants in 2004.^[25]

no data   <0.7   0.7-1.4   1.4-2.1   2.1-2.8   2.8-3.5   3.5-4.2

4.2-4.9   4.9-5.6   5.6-6.3   6.3-7   7-7.7   >7.7

A study of the incidence of non-melanoma skin cancer from 1992 to 2006 in the United States was performed by the dermatologist Howard Rogers, MD, PhD, and his colleagues based on the evaluation of Medicare databases. The results of their research showed that cases of non-melanoma skin cancer rose an average of 4.2% a year.^[26]

More than 3.5 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in that country. According to the Skin Cancer Foundation, one in five Americans will develop skin cancer at some point of their lives. The first most common form of skin cancer is basal cell carcinoma, followed by the squamous cell carcinoma. Although the incidence of many cancers in the United States is falling, the incidence of melanoma keeps growing, with approximately 68,729 melanomas diagnosed in 2004 according to reports of the National Cancer Institute.^[27]

The survival rate for patients with melanoma depends upon when they start treatment. The cure rate is very high when melanoma is detected in early stages, when it can easily be removed surgically. The prognosis is less favorable if the melanoma has spread to other parts of the body.^[28]

In the UK, 84,500 non-melanoma skin cancers were registered in 2007 although a study estimated that at least 100,000 cases are diagnosed each year. Most NMSCs were basal cell carcinomas or squamous cell carcinomas. In 2007, 10,672 cases of malignant melanoma were diagnosed.^[29]

According to the British Association of Dermatologists children, from 0 to 14 years, and teenagers, from 15 to 19 years, exhibit the highest rates of skin cancers of any European country. Furthermore, incidence of melanoma increased four times in UK teenagers from 1978 to 1997.^[30]

Australia and New Zealand exhibits one of the highest rates of skin cancer incidence in the world, almost four times the rates registered in the United States, the UK and Canada. Around 434,000 people receive treatment for non-melanoma skin cancers and 10,300 are treated for melanoma. Melanoma is the common type of cancer in people between 15–44 years in both countries.^[31] This is largely due to the ozone hole located over the Tasman Sea, making prolonged unprotected outdoor sun exposure very dangerous.

References[link]

External links[link]

Wikimedia Commons has media related to: Skin cancers

• Skin cancer at the Open Directory Project

This article has multiple issues. Please help improve it or discuss these issues on the talk page. It includes a list of references, related reading or external links, but its sources remain unclear because it lacks inline citations. Tagged since August 2008. It is written like an advertisement and needs to be rewritten from a neutral point of view. Tagged since November 2010. Very few or no other articles link to it. Please help introduce links to this page from other articles related to it. Tagged since February 2009.

Shonda Schilling (born November 23, 1967 in Dundalk, Maryland) is founder of the Shade Foundation of America. She is married to professional baseball player Curt Schilling.

Biography[link]

Personal life[link]

Shonda graduated from Towson State College majoring in journalism, member of the Iota Delta chapter of Zeta Tau Alpha. She worked in television production for Home Team Sports in Baltimore until marrying Curt Schilling in 1992. They have four children: Gehrig (5/27/95); Gabriella (5/22/97); Grant (10/13/99); and Garrison (6/27/02). The family resides in Medfield, Massachusetts.^{[citation needed]}

Skin Cancer[link]

Schilling was diagnosed with stage 2 malignant melanoma in February 2001. A total of five surgeries left 25 scars crisscrossing her back, arms, legs and chest.^{[citation needed]} The media picked up on her skin cancer scare during the 2001 World Series, when her husband Curt won the World Series co-MVP honor for the Arizona Diamondbacks. Her story was featured in People Magazine, Glamour, Family Circle, Pregnancy, Good Housekeeping and ABC's "The View." Shonda invited Good Morning America into the operating room to witness her fifth and final surgery in order to inspire others to have their skin checked and to alter their sun habits. In 2002, she accepted the Melanoma Monday national spokeswoman role with the American Academy of Dermatology (AAD). An overwhelming response from fellow melanoma survivors^{[citation needed]} resulted in Shonda creating the Shade Foundation of America.

Shade Foundation of America[link]

Shonda Schilling founded the Shade Foundation of America in 2002 with the goal of changing society's attitude towards sun exposure. The wife of major league baseball pitcher Curt Schilling, she has traveled all over the United States promoting sun-safety awareness.

Schilling’s dedication to promote sun safety has been expressed through many partnerships and appearances. In 2003, the Shade Foundation joined with the Environmental Protection Agency (EPA) to launch the annual SunWise Poster Contest in conjunction with the Arizona Diamondbacks and the Arizona Department of Health to implement sun-safety curriculum in schools. Schilling testified before the Arizona state legislatures in an effort to help pass the current law requiring schools to teach the SunWise curriculum in the state of Arizona. The launch of this partnership was heard by 20 million people through media exposure and hundreds of school principals across the country signed up to teach the SunWise program in their classrooms. Thousands of kids have learned skin cancer prevention techniques through the program by drawing a SunWise poster for the contest. When the Schillings were relocated to Boston, Shonda partnered the program with the Dana Faber Cancer Institute in Massachusetts where it continues to result in overwhelming success.^{[citation needed]}

Schilling aligned the Shade Foundation with Major League Baseball and the Play it Smart When it Comes to the Sun Program in 2005, generating awareness in MLB Parks around the country and at the MLB All-Star Game in Detroit. The program continues to reach millions of Americans with a sun-safety message through media appearances with Geraldo At Large, Women's World Magazine among other local channels across the country.

Since 2005, Schilling has participated in running the Boston Marathon every year to raise money for the Shade Foundation. She also ran the PF Chang's Rock N Roll Marathon in 2005 on behalf of the Shade Foundation.

Schilling’s involvement with the Shade Foundation has garnered intense media attention since its inception. The Schilling family appeared in a public service print advertisement promoting sun-safety in Sports Illustrated's popular swimsuit issue as well as a television PSA that aired in New England and around the country. Through all of Schilling’s hard work, she has been recognized for her commitment to the community and promoting sun safety numerous times. Shade’s partnership with the EPA earned Shonda and the Shade Foundation the "Excellence in Cancer Awareness" award in 2003 from the Congressional Families Program of the Cancer Research and Prevention Foundation in Washington, DC. That same year, she was presented with the Girl Scout World of Humanity Award by the Arizona Cactus- Pine Girl Scout Council and in her honor they created the Shade Badge for scouts to earn. Also in 2003, Shonda accepted the Outstanding Fundraiser Award by the Association of Professional Fundraisers.^{[citation needed]}

She was recognized nationally with the Speaker Thomas J. "Tip" O'Neill, Jr. Award for Public Service by the Greater Boston Federal Executive Board in 2004.^{[citation needed]} That same year, the American Academy of Dermatology acknowledged Shonda's awareness efforts with an individual achievement Gold Triangle Award. She was also given the Alumni of the Year Award from Zeta Tau Alpha Sorority. In 2005, Schilling picked up an honorary doctorate degree in public service from Framingham State College. She was also presented with the exceptional women's award for community service by Boston radio station Magic 106.7. Merrimack College gave Shonda an honorary Doctor of Humane Letters degree in 2006 and that same year she was awarded the Lady Baden Powell Good Scout Award by the Boston Minuteman Council. Schilling continues to serve as a commencement speaker at high school and college graduations.

The Wellness Community-Greater Boston recognized Schilling with the 2007 Gilda Radner Award as an individual who demonstrated courage, determination and hope in the face of cancer. She was named host of Facing Cancer Together, a television program produced by the Wellness Community which aired on cable stations around the country. The Massachusetts Interscholastic Athletic Association presented her with the 2007 Partners in Prevention "Making a Difference" Award during the 11th Annual MIAA Wellness Summit held in Milford, MA.^{[citation needed]}

Work with the ALS Association[link]

Shonda and Curt have been active with the [ALS Association] since 1992 in developing public awareness and fundraising campaigns to improve the services of the ALS Association. Both have appeared in numerous public service announcements featuring Curt's Pitch'n to Win campaign that joins the ALS Association and Shaw's Supermarkets in which people can donate $1.38 or $3.38 to benefit the ALS Association. Together they have donated and raised more than $9 million for ALS. Shonda serves on the Board of Directors for the Philadelphia, Arizona and Massachusetts chapters. She represents ALS at numerous functions including lobbying in Washington D.C. for government funding and before the Food and Drug Administration to get the first trial drugs approved. Shonda regularly visits ALS patients, their family members and caregivers, and is involved in helping with a variety of events associated with ALS.

She chaired the "The Shonda Schilling Say It with Flowers" Luncheon in Arizona which raised more than $250,000 spanning three years (2002–04). When the Schillings relocated to Boston, Shonda and Dawn Timlin, wife of Red Sox pitcher Mike Timlin, implemented the “Say it with Flowers” campaign in the Boston area which raises over $200,000 annually to benefit the ALS.

The Schilling family participated in ALSA's National ALS Awareness Month public service announcement in 2004 and received the “Telly Award” for excellence in a national television commercial. Schilling and her husband received the 2002 Catfish Hunt Award from the North Carolina Chapter of the ALS Association and she was also presented the All-Star Award by ALSA. In 2001, ALS Association National Office presented Shonda with the Lawrence A. RAND Award recognizing her nationally for continued service and dedication.^[1][2]

Aspergers Syndrome[link]

Shonda and Curt have a son with Aspergers Syndrome (Grant) which has been a struggle for many years, but as Shonda describes in her book, "The Best Kind Of Different" it has been well worth it. Shonda has partnered with The Aspergers Association of New England (AANE) and Autisim speaks Also has done some work with Youth Care.

^[3]

References[link]