Skin cancer

Symptoms

Where skin cancer develops

Skin cancer develops primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it can also form on areas that rarely see the light of day — your palms, beneath your fingernails, the spaces between your toes or under your toenails, and your genital area.

Skin cancer affects people of all skin tones, including those with darker complexions. When melanoma occurs in those with dark skin tones, it's more likely to occur in areas not normally considered to be sun-exposed.

Basal cell carcinoma signs and symptoms

Basal cell carcinoma usually occurs in sun-exposed areas of your body, such as your face, ears or scalp. Basal cell carcinoma may appear as:

• A pearly or waxy bump
• A flat, flesh-colored or brown scar-like lesion

Squamous cell carcinoma signs and symptoms

Most often, squamous cell carcinoma occurs on sun-exposed areas of your body, such as your face, lips, ears and hands. Squamous cell carcinoma may appear as:

• A firm, red nodule
• A flat lesion with a scaly, crusted surface

Melanoma signs and symptoms

Melanoma can develop anywhere on your body, in otherwise normal skin or in an existing mole that becomes cancerous. Melanoma most often appears on the trunk, head or neck of affected men. In women, this type of cancer most often develops on the lower legs. In both men and women, melanoma can occur on skin that hasn't been exposed to the sun. Melanoma can affect people of any skin tone. In people with darker skin tones, melanoma tends to occur on the palms or soles, or under the fingernails or toenails.

Melanoma signs include:

• A large brownish spot with darker speckles
• A mole that changes in color, size or feel or that bleeds
• A small lesion with an irregular border and portions that appear red, white, blue or blue-black
• Dark lesions on your palms, soles, fingertips or toes, or on mucous membranes lining your mouth, nose, vagina or anus

Signs and symptoms of less common skin cancers

Other, less common types of skin cancer include:

• Kaposi sarcoma. This rare form of skin cancer develops in the skin's blood vessels and causes red or purple patches on the skin or mucous membranes. Kaposi sarcoma mainly occurs in people with weakened immune systems, such as people with AIDS, and in people taking medications that suppress their natural immunity, such as people who've undergone organ transplants. Kaposi sarcoma can also occur in older adults of Mediterranean heritage.
• Merkel cell carcinoma. Merkel cell carcinoma causes firm, shiny nodules that occur on or just beneath the skin and in hair follicles. Merkel cell carcinoma is usually found on sun-exposed areas on the head, neck, arms and legs.
• Sebaceous gland carcinoma. This uncommon and aggressive cancer originates in the oil glands in the skin. Sebaceous gland carcinomas — which usually appear as hard, painless nodules — can develop anywhere, but most occur on the eyelid, where they're frequently mistaken for other eyelid problems. 

Causes

Skin cancer occurs when errors (mutations) form the in the DNA of healthy skin cells. The mutations cause the cells to grow out of control and form a mass of cancer cells.

Cells involved in skin cancer

Skin cancer begins in your skin's top layer — the epidermis. The epidermis is a thin layer that provides a protective cover of skin cells that your body continually sheds. The epidermis contains three main types of cells:

• Squamous cells lie just below the outer surface and function as the skin's inner lining.
• Basal cells, which produce new skin cells, sit beneath the squamous cells.
• Melanocytes — which produce melanin, the pigment that gives skin its normal colour — are located in the lower part of your epidermis. Melanocytes produce more melanin when you're in the sun to help protect the deeper layers of your skin. Extra melanin produces the darker color of tanned skin.

Where your skin cancer begins determines its type and your treatment options.

Ultraviolet light and other potential causes

Much of the damage to DNA in skin cells results from ultraviolet (UV) radiation found in sunlight and in commercial tanning lamps and tanning beds. But sun exposure doesn't explain skin cancers that develop on skin not ordinarily exposed to sunlight. This indicates that other factors may contribute to your risk of skin cancer, such as being exposed to toxic substances or having a condition that weakens your immune system. 

Risk factors

Factors that may increase your risk of skin cancer include:

• Fair skin. Having less pigment (melanin) in your skin provides less protection from damaging UV radiation. If you have blond or red hair and light-colored eyes, and you freckle or sunburn easily, you're much more likely to develop skin cancer than is a person with darker features.
• A history of sunburns. Every time you get sunburned, you damage your skin cells and increase your risk of developing skin cancer. After a sunburn, your body works to repair the damage. Having multiple blistering sunburns as a child or teenager increases your risk of developing skin cancer as an adult. Sunburns in adulthood also are a risk factor.
• Excessive sun exposure. Anyone who spends considerable time in the sun may develop skin cancer, especially if the skin isn't protected by sunscreen or clothing. Tanning, including exposure to tanning lamps and beds, also puts you at risk. A tan is your skin's injury response to excessive UV radiation.
• Sunny or high-altitude climates. People who live in sunny, warm climates are exposed to more sunlight than are people who live in colder climates. Living at higher elevations, where the sunlight is strongest, also exposes you to more radiation.
• Moles. People who have many moles or abnormal moles called dysplastic nevi are at increased risk of skin cancer. These abnormal moles — which look irregular and are generally larger than normal moles — are more likely than others to become cancerous. If you have a history of abnormal moles, watch them regularly for changes.
• Precancerous skin lesions. Having skin lesions known as actinic keratoses can increase your risk of developing skin cancer. These precancerous skin growths typically appear as rough, scaly patches that range in colour from brown to dark pink. They're most common on the face, lower arms and hands of fair-skinned people whose skin has been sun damaged.
• A family history of skin cancer. If one of your parents or a sibling has had skin cancer, you may have an increased risk of the disease.
• A personal history of skin cancer. If you developed skin cancer once, you're at risk of developing it again. Even basal cell and squamous cell carcinomas that have been successfully removed can recur.
• A weakened immune system. People with weakened immune systems have a greater risk of developing skin cancer. This includes people living with HIV/AIDS or leukemia and those taking immunosuppressant drugs after an organ transplant.
• Exposure to certain substances. Exposure to certain substances, such as arsenic, may increase your risk of skin cancer.
• Increasing age. The risk of developing skin cancer increases with age, primarily because many skin cancers develop slowly. The damage that occurs during childhood or adolescence may not become apparent until middle age. Still, skin cancer isn't limited to older people and can occur at any age.

Diagnosis

Diagnosing skin cancer

To diagnose skin cancer, your doctor may:

• Examine your skin. Your doctor may look at your skin to determine whether your skin changes are likely to be skin cancer. Further testing may be needed to confirm that diagnosis.
• Remove a sample of suspicious skin for testing (skin biopsy). Your doctor may remove a small sample of suspicious-looking skin for laboratory testing. A biopsy can determine whether you have skin cancer and, if so, what type of skin cancer you have.

Determining the extent of the skin cancer

If your doctor determines you have skin cancer, he or she may recommend additional tests to determine the extent, or stage, of the skin cancer. Because superficial skin cancers such as basal or squamous cell carcinoma rarely spread, a biopsy often is the only test needed to determine the cancer stage. But if you have a large growth or one that's existed for some time, your doctor may recommend further tests to determine the extent of the cancer.

Skin cancer is generally divided into two stages:

• Local. In this stage, cancer affects only the skin.
• Metastatic. At this point, cancer has spread beyond the skin.

The skin cancer's stage helps determine which treatment options will be most effective. 

References

http://www.medicinenet.com/skin_cancer_overview/article.htm

https://www.hse.ie/eng/health/az/C/Cancer,-skin-melanoma-/

http://www.webmd.com/melanoma-skin-cancer/

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61320-9/fulltext?rss%3Dyes