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Skin Cancer

Skin Cancer: The Most Common Cancer

Skin cancer is the most common of all cancers, with more than one million cases diagnosed every year. Most diagnosed skin cancers are related to sun exposure.¹ It is estimated that in 2004 more than 10,000 Americans will die of skin cancer – 7,900 from melanoma and 2,300 from other skin cancers. Over the last two decades, the incidence of melanoma has more than triple among Caucasians.²

Skin cancer can occur anywhere on the body, but occurs most often on parts of the body exposed to sunlight, such as the face, ear, neck, and hands.¹ The top layer of skin is called the epidermis, which contains three kinds of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and cells called melanocytes that color the skin. There are two types of skin cancer:

• Non-melanoma (basal or squamous cell) skin cancer is the most common type and can be fast or slow growing but rarely spreads to other parts of the body.
• Melanoma occurs when cancer cells are found in the melanocytes. Melanoma accounts for a small percentage of skin cancer but is far more dangerous and causes the majority of skin cancer deaths. The good news is that it is almost always curable when detected early. For localized melanoma, the 5-year survival rate is 96%.¹

Some of the risk factors for skin cancer include:

• Over-exposure to natural or artificial sunlight;
• Fair complexion (blond or red hair, fair skin, green or blue eyes);
• Northern European heritage;
• Exposure to coal tar, pitch, creosote, arsenic compounds, or radium;
• Multiple or atypical moles;
• Family history; and
• Having actinic keratosis (rough, raised scaly patches on the skin). ^1,3

Routine examinations of the skin increase the chance of finding skin cancer early. If an area of the skin looks abnormal, a doctor may remove all or part of the growth to check for cancer cells.

As with most cancers, early detection is vital to a good outcome. The following symptoms might indicate skin cancer and should be reported to your doctor.

• Changes in the skin, including the size or color of a mole, or a new growth;
• Scaliness, oozing, bleeding, or a change in the appearance of a bump of nodule on the skin;
• The spread of darker pigmentation beyond the edges of a mole; and
• A change in sensation, itchiness, tenderness, or pain.¹

The best way to avoid the risk on non-melanoma skin cancer is to limit exposure to intense sunlight and to practice safe sun exposure. For example:

• Avoid the sun when it is strongest – from 10 a.m. to 4 p.m.;
• Use a sunscreen with a sun protection factor (SPF) of 15 or higher;
• Wear a hat with a wide brim to protect your face;
• Wear sunglasses with 99-100 percent UV absorption to protect your eyes and the surrounding skin; and
• Follow safe sun practices even on cloudy days because UV rays travel through clouds.¹

Treatment for skin cancer depends on several factors including: the stage of the cancer (whether or not it has spread), type of cancer, size and location, and the patient’s general health. Depending on these factors, treatment may include surgery, radiation therapy, chemotherapy, and/or photodynamic therapy (uses drug and certain kind of laser light to kill cancer cells).⁴ The best treatment options should be discussed with your physician.

HSR&D is working to improve prevention and treatment for veterans with skin cancer. For example, through its Research Enhancement Award Program (REAP) at the San Francisco VA Medical Center, investigators are focusing on extremely common but generally non-fatal cancers, such as non-melanoma skin cancer. See below for more specific information about HSR&D studies.

Non-melanoma skin cancer (NMSC) is the most frequent malignancy in older men. Its incidence is increasing dramatically, putting aging veterans at very high risk. The most common treatments for NMSC are excisional surgery (tumor is cut from the skin); electrodessication/curettage (tumor is cut from the skin with a curette, or sharp tool, and a needle-shaped electrode treats the area with an electric current), and Mohs surgery (tumor is cut in thin layers; each layer is then examined through a microscope until all cancer cells are gone). Comprehensive outcomes of NMSC and its therapy, including patient-reported outcomes such as quality of life, have not been measured. This prospective longitudinal, observational study compares outcomes of different treatments for non-melanoma skin cancer for 1500 patients being treated at either a VA Dermatology Clinic in San Francisco or at the Dermatology Department of the University of California at San Francisco. Thus far, results show that there are substantial variations in the performance rates of non-melanoma skin cancers between VA and the private site, and this variation exists for both primary tumors and recurrent tumors. For example, patients with low-risk tumors cared for at the private site were much more likely to be treated with Mohs surgery than patients treated at the VA. The effects of this variation on the outcomes of care at the two sites is unknown, and is the focus of the remaining part of this study.^5,6

Teledermatology has the potential to radically change the delivery of dermatological care for veterans. Pilot studies have shown its clinical effectiveness when teledermatology has been used for a wide variety of skin disorders, but preliminary evidence suggests that this system may be less than optimal for the diagnosis of skin neoplasms (tumor growth; abnormal tissue). This ongoing study – the first of its kind – will determine the diagnostic accuracy of store-forward imaging system for skin neoplasms. Researchers will obtain digital photographs and a standardized patient history that will be electronically forwarded to one of four dermatologists. Their diagnostic accuracy will then be compared to the accuracy of clinic dermatologists who have examined the patients. Outcome measures to be assessed will include the appropriateness of treatment plans. If the relatively inexpensive store-forward imaging system is effective, it may be a cost-effective intervention that can be used throughout the VA healthcare system.⁷

For more information about skin cancer, visit the National Cancer Institute website at http://www.cancer.gov/ or visit the American Cancer Society website at http://www.cancer.org/

References:

1. Skin Cancer Facts. American Cancer Society
2. Skin Cancer (PDQ®): Screening. National Cancer Institute
3. Skin Cancer (PDQ®): Treatment. National Cancer Institute
4. Chren MM, Lasek RJ, Sahay AP, Sands LP. Measurement properties of skindex-16: A brief quality of life measure for patients with skin disease. Journal of Cutaneous Medicine and Surgery 2001;5:105-110.
5. Chren MM, Sahay, AP, Sands LP. Variation in performance rates of therapies for non-melanoma skin cancers [abstract]. Society of Investigative Dermatology Annual Meeting, Chicago, IL 2000; Journal of Investigative Dermatology 114:744.
6. Evaluation of Store-Forward Teledermatology for Skin Neoplasms. HSR&D study #IIR 01-072. Principal Investigator: Erin Warshaw, MD

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