Skin cancer has a better prognosis, or likely outcome, than most other types of cancer. Although skin cancer is the most common type of cancer in this country, it accounts for less than 1 percent of all cancer deaths.
When diagnosed at a stage that is still localized, the five-year relative survival rate for all types of skin cancer is 94 percent. Seventy-four percent of all skin cancers are diagnosed at this stage. For skin cancers that are not localized, five-year relative survival rates drop significantly (to 49 percent if the cancer has spread regionally and 6 percent if the cancer has spread to distant sites).
A study released in 1996 by the U.S. Centers for Disease Control and Prevention and the American Academy of Dermatology indicates that 42 percent of the adults surveyed had no knowledge of melanoma, the deadliest form of skin cancer. The level of awareness was lowest among people ages 18 to 24 years.
The survey also found that awareness of melanoma is related to income. Of people with annual incomes of less than $20,000, 60 percent reported that they did not recognize the term "melanoma." Only 31 percent of people with annual incomes of $75,000 or more reported no knowledge of the disease.
The most important risk factors for developing skin cancer are excessive exposure to ultraviolet (UV) light, fair complexion, occupational exposure to radium or certain chemicals (for example, arsenic compounds), and family history.
Although anyone can get skin cancer, the risk is greatest for people who have fair skin that freckles easily - often those people with red or blond hair and blue or light-colored eyes.
UV radiation from the sun is the main cause of skin cancer. In particular, childhood sunburns are linked to an increased later risk of melanoma. Some experts estimate that one blistering sunburn will double a person's chance of developing skin cancer.
Artificial sources of UV radiation, such as sun lamps and tanning booths, also can cause skin cancer. Contrary to some people's beliefs, suntan is not a protective measure against skin cancer. In fact, tanning is evidence of the same damage occurring in skin cells that causes sunburn. Tanning also is associated with irreversible skin damage (such as early aging).
The chance of developing skin cancer is related to lifetime exposure to UV radiation. People who live in areas that get high levels of UV radiation from the sun are more likely to get skin cancer than people who live in other areas. In the United States, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, areas that receive high amounts of UV radiation.
Elevation (or altitude) also affects UV exposure. Generally, UV exposure is greater at higher elevations (for example, in the mountains) than at lower elevations. Skiing carries a particular risk of significant UV exposure because of the high elevation and the great exposure to sunlight, both direct and reflected from the snow.
Because the chance of developing skin cancer is related to lifetime exposure to UV radiation, protection should start in childhood to prevent skin cancer later in life. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age.
Even though most skin cancers are cured, the disease can recur in the same place. Also, people who have been treated for skin cancer have a higher-than-average risk of developing a new cancer elsewhere on the skin. That is why it is so important for them to continue to examine themselves regularly, to visit their doctor for regular check-ups, and to follow the doctor's instructions on how to reduce the risk of developing skin cancer again.
People can improve their chances of finding skin cancer promptly by regularly performing a simple skin self-exam. The best time to do this is after a shower or bath. The best way to examine one's skin is in a well-lighted room using a full-length mirror and a hand-held mirror. Begin by learning where normal birthmarks, moles, and blemishes are and what they usually look like. People also should check for anything new: a change in the size, texture, or color of a mole, or a sore that has not healed.
It is important to check all areas, including the back, scalp, between the buttocks, and genital area.
The most common warning sign of skin cancer is a change on the skin, especially a new growth or a sore that doesn't heal. Skin cancers don't all look the same. For example, the cancer may start as a small, smooth, shiny, pale, or waxy lump. Or it can appear as a firm, red lump. Sometimes, the lump bleeds or develops a crust. Skin cancer can also start as a flat, red spot that is rough, dry, or scaly.
Both basal and squamous cell cancers are found mainly on areas of the skin that are exposed to the sun: the head, face, neck, hands, and arms. However, skin cancer can occur anywhere.
Actinic keratosis (shown here), which appears as rough, red or brown, scaly patches on the skin, is known as a precancerous condition because it sometimes develops into squamous cell cancer. Like skin cancer, it usually appears on sun-exposed areas, but can be found elsewhere.
Changes in the skin are not sure signs of cancer; however, it is important to see a doctor if any symptom lasts longer than 2 weeks. People should not wait for an area to hurt - skin cancers seldom cause pain.
A doctor's main goal in treating skin cancer is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history.
Treatment for skin cancer usually involves some type of surgery. In some cases, doctors suggest radiation therapy or chemotherapy. Sometimes, a combination of these methods is used. Many skin cancers can be cut from the skin quickly and easily. In fact, the cancer is sometimes completely removed at the time of the biopsy, and no further treatment is needed.
Doctors commonly use a type of surgery called curettage. After a local anesthetic numbs the area, the cancer is scooped out with a curette, an instrument with a sharp, spoon-shaped end. The area is also treated by electrodesiccation. An electric current from a special machine may be used to control bleeding and kill and cancer cells remaining around the edge of the wound. Most patients develop a flat, white scar.
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