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Skin Cancer

Written By Walter Leonard 12/5/2015
Skin is common in the young adult cancer (AYA) community. Up Cancer is working to educate the community in learning the symptoms of skin cancer and understand the different types of skin cancer.  
Skin cancer is the most common form of cancer in the United States; one in five Americans will develop skin cancer before the age of 70, and 58 million Americans are already affected by pre-cancer actinic keratosis (Rogers; The Lewin Group). It has become an epidemic, and is particularly on the rise due to the popularity of tanning and excessive exposure to UV rays. It is primarily characterized as either melanoma or non-melanoma cancer, of which there are multiple subdivisions; it is important to know the sub category in order to receive the most effective treatment.

The Structure of the Skin
Before delving into the types of skin cancer, it is important to understand the structure of the layers of the skin. Our skin is divided into three main layers: the epidermis, where there are five extra subdivisions that contain specialized cells such as keratinocytes and melanocytes; the dermis, which contains connective tissue, sweat glands, and hair follicles; and finally, the hypodermis which is made of subcutaneous tissue and fat. The more benign forms of cancer typically emerge in the epidermis, and more serious stages appear from the deeper layers. This makes sense as melanocytes, which darken the pigment of the skin, are present in the uppermost epidermal layer; they react with carcinogenic UV rays which lead to the presence of cancerous cells, and are within the first line of defense in the skin. Thus, it is important to pay special attention to any new moles or marks on the skin, as they may be harbingers of a greater abscess to come.

Basal Cell Carcinoma (BCC)
The most common variant of skin cancer, BCC is characterized by growths or lesions that emerge from the basal layer of the skin in the epidermis. These lesions are usually red patches or open sores, though they may sometimes appear as scar-like bumps. This cancer normally does not metastasize (spread to other parts of the body), however it can be disfiguring and spread across the skin if not excised. It is most effectively treated through Mohs surgery, where the cancerous tissue is excised by a surgeon.
Squamous Cell Carcinoma (SCC)
SCC is the second most common type of skin cancer and is usually characterized by scaly patches, growths, or warts that may crust or bleed. Since it often looks similar to other skin afflictions, it may be difficult to identify SCC. It arises from the squamous cells in the epidermis, which make up the outermost layer. It can also be treated with Mohs surgery, however it is crucial for this variant to be quickly excised since if it spreads it can quickly become deadly.
This is the most deadly form of skin cancer because it is triggered by UV damage to DNA. After long-term exposure to UV rays, mutations occur in the genome of skin cells that cause them to replicate rapidly and uncontrollably. These mutations affect the telomeres in DNA, which are stretches of genetic material which protect the ends of DNA during replication. Excessive exposure makes it more difficult for DNA to preserve their telomere lengths, and so replication can occur uninhibitedly. The tumors occur from melanocytes in the epidermis, and can often look simply like moles. Any new mole should be investigated for possibly cancerous growth; however, if caught early on melanoma can almost always be effectively treated and cured.

The ABCDE’s of Melanoma
In order to distinguish any new moles as possible cancerous growth, it is important to access them according to the ABCDE guideline:
A: Asymmetry
A mole that is asymmetric, or not a perfect circle is abnormal. A standard mole should have two halves that match each other perfectly if reflected onto itself, and a mole deviating from this should be taken as a warning sign.
B: Border
Similar to asymmetry, a mole with a jagged border as opposed to a smooth, circular circumference could be abnormal. Melanoma tumors usually manifest with ‘wavy’ edges, and do not look like perfect circles around the perimeter.
C: Color
A standard mole will usually be a single shade of brown, however melanoma moles are usually varying shades of brown/black/gray, and occasionally even blue or pink.
D: Diameter
Melanoma moles are usually quite large. Any mole that is larger than ¼ inch or 6 mm is usually too large to be a standard mole, excluding birthmarks.
E: Evolving
The moles we are born with usually do not change much in terms of shape or size; however, one of the largest warning signs of melanoma is a mole that rapidly changes in appearance. It may change its elevation (become a larger bump), color, size, or shape -- any noticeable change to a mole should be immediately assessed.

Looking out for Precancers: Actinic Keratosis
While not generally viewed as a type of skin cancer, actinic keratosis is a sign of UV damage and could be a predecessor to a more serious type of skin cancer. It is a scaly, pink-reddish or multicolored growth that appears on parts of the skin that are most often exposed to the sun. Such growths often occur on the face, arms, back, or neck, and while they may appear to be merely dry patches or warts they should be investigated if they grow in size or elevation (similar to the ABCDE guidelines). Any change in skin texture or appearance, especially to highly UV exposed areas, should be examined.

Skin cancer is incredibly common, and fortunately there are many methods of treatment. If you or a loved one is diagnosed with skin cancer or a precancerous growth, know that you are not alone and that medical advancements have made this type of cancer highly treatable. It is important to be armed with information to better understand the causes and severity of this cancer, and it is extremely crucial to take prevention steps. Always protect the skin from UV rays with SPF/sunblock, hats, sunglasses, and long-sleeved clothing. Refrain from any type of tanning other than spray-tanning, and try to stay out of the sun on particularly sunny days. The UV rays from the sun have incredibly mutagenic effects on our DNA, and it is vital to be aware of them to prevent this vile disease.