©
2013 City of Hope
1500 East Duarte Road
Duarte, CA 91010
626-256-HOPE (4673)
1500 East Duarte Road
Duarte, CA 91010
626-256-HOPE (4673)
A National Cancer Institute-designated Comprehensive Cancer Center
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Skin Cancer
Skin Cancer
City of Hope
combines advanced diagnostics, aggressive, new treatments and the expertise of a closely coordinated group of specialists to provide the latest in care for patients with different types of skin cancer, including melanoma.
Skin cancer patients can also often access novel therapies not available elsewhere through our extensive clinical trials program.
Understanding the Difference Between Melanoma and Other Skin Cancers
Skin cancer is the most common type of cancer in this country. Melanoma is only one type of skin cancer. There are several types of skin cancer, and each is named for the location in the skin where cancer forms.
Skin cancer is the most common type of cancer in this country. Melanoma is only one type of skin cancer. There are several types of skin cancer, and each is named for the location in the skin where cancer forms.
Melanoma Risk Factors
Several risk factors are associated with developing melanoma, find out who is at risk and learn ways to reduce your risk of developing melanoma.
Several risk factors are associated with developing melanoma, find out who is at risk and learn ways to reduce your risk of developing melanoma.
News Summary
Cancer Prevention “Clip Tips”
Renewed wedding vows affirm life even as cancer takes its toll
Chaplain brings heartfelt gift to City of Hope patient
A traditional Chinese cancer remedy leads researchers to a potential melanoma fighter
City of Hope melanoma expert helps ground TV doctors and medical storylines in reality
City of Hope awarded $4 million in National Institutes of Health research grants
B is worse than A when it comes to the sun’s rays
City of Hope in the News
City of Hope patient inspires firefighters, local community
Team probes DNA repair in search for roots of inflammation-associated lung cancers
About Melanoma
Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).
Melanocytes are found throughout the lower part of the epidermis. They make melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment, causing the skin to tan, or darken.
The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. The skin has two main layers: the epidermis (upper or outer layer) and the dermis (lower or inner layer).
When melanoma starts in the skin, the disease is called cutaneous melanoma.
There are three types of skin cancer:
Melanoma
Basal cell skin cancer
Squamous cell skin cancer.
Recurrent Melanoma
Recurrent melanoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the original site or in other parts of the body, such as the lungs or liver.
Recurrent melanoma is cancer that has recurred (come back) after it has been treated. The cancer may come back in the original site or in other parts of the body, such as the lungs or liver.
Skin Cancer Risk Factors
Several factors increase the risk of developing skin cancer, including:
- Light skin that freckles easily
- Red or blond hair
- Chronic exposure to natural sunlight
- History of three or more blistering sunburns before age 20
- Exposure to artificial ultraviolet light (tanning booth)
- Occupational exposure (working outside, exposure to coal tar pitch, creosote, arsenic compounds or radium
- Having many moles
- Unusual moles
- Family or personal history of melanoma
- Blue eyes
Decrease Your Risk
- Take steps to lower your chances of developing skin cancer:
- Avoid sun exposure between 10 a.m. and 4 p.m.
- Always apply sunscreen with a sun protection factor (SPF) of 15 or higher before going outdoors. When working outdoors, wear long sleeves, a hat and gloves. Reapply sunscreen throughout the day.
- Keep infants out of the sun, and protect children at all times. Apply SPF 15 sunscreen or higher to infants over six months of age.
- Avoid tanning booths. There is no “safe” tan that involves ultraviolet light exposure.
Genetic Risk Assessment
For patients with a family history of melanoma or related skin disorders, a comprehensive genetic risk assessment can be provided by the Cancer Screening & Prevention ProgramSM in City of Hope ’s Division of Clinical Cancer Genetics.
For patients with a family history of melanoma or related skin disorders, a comprehensive genetic risk assessment can be provided by the Cancer Screening & Prevention ProgramSM in City of Hope ’s Division of Clinical Cancer Genetics.
Melanoma Symptoms
Melanoma can develop two ways:
In existing moles (also called nevi), even those present since birth or childhood in new growths appearing on the skin.
It can occur anywhere on the body, but is most often found on women's arms and legs, and on the head and neck or trunk (the portion of the body beginning from the hips and extending upward to the shoulders) of men. Melanoma can also develop on the feet (both tops and soles, and between toes) and hands (including between fingers and beneath the nail bed), and on the genitals.
Since developed melanoma is difficult to treat in later stages, it is extremely important to detect melanoma early. Regardless of skin cancer history, everyone should examine his or her own skin once monthly in addition to an annual skin examination performed by a physician. (Follow this helpful guide to learn how to perform a monthly self-examination.)
Those with a prior history of melanoma or other types of skin cancer may need to be examined by a physician more regularly. Any changing moles or new growths should be mentioned to a physician during each visit so that the physician can focus on those areas of the body specifically in addition to a complete skin exam.
Skin Self Examination
How to perform a skin self-examination
Stand in front of a full-length mirror, and use a hand-held mirror along with the full mirror for areas that are hard to see. Examine all areas of your body, including the lower back, buttocks, back of shoulders, and backs of the thighs.
Stand in front of a full-length mirror, and use a hand-held mirror along with the full mirror for areas that are hard to see. Examine all areas of your body, including the lower back, buttocks, back of shoulders, and backs of the thighs.
Any unusual sore, lump, spot, marking, or change in the way an area of the skin looks or feels may be a sign of skin cancer, or a warning that it might develop.
The skin might become scaly or crusty or it may ooze and bleed. It may feel itchy, tender, or painful. It may become red and swollen.
If you notice any spots on the skin that are changing in size, shape, or color, you should speak with your doctor as soon as possible.
Quick Location Guide
Enlist the help of a friend or family member to examine the areas that are difficult to see yourself, such as earlobes and the back of the head.
Diagnosing Skin Cancer
Diagnosing melanoma can be challenging both physician and patient, but there is a simple way to remember what to look for in new growths or changes to existing skin marks: the "ABCDEs of Melanoma." The ABCDEs is a helpful tool in evaluating a skin mark's growth, size, shape, color and symmetry.
Not all moles are cancerous and may show some of the above ABCDE characteristics that are also present in melanoma, but the more ABCDE features a mole has the more likely it could be melanoma. It is always wise to be overcautious when evaluating suspected melanoma. While pictures are helpful to self-examine your skin, only a physician will be able to diagnose melanoma.
- Asymmetrical moles are disproportionate with less well-defined edges instead of forming a symmetrical round circle with more well-defined edges.
- Borders are irregular. A typical non-cancerous mole has smooth borders whereas melanoma may have more jagged, uneven borders that can vary in thickness.
- Instead of being one uniform color, melanoma lesions or moles often show multiple colors, such as brown, black, red, gray, white or pink.
- Diameter greater than 6mm—about the size of a pencil eraser.
- A melanoma will grow rapidly and change, and may take on an elevated appearance compared to the surrounding healthy skin.
Tests and Procedures
A variety of tests and procedures may be used to detect skin cancer, including:
Skin examination A doctor or nurse examines the skin for moles, birthmarks or other pigmented areas that look abnormal in color, size, shape or texture.
Laboratory tests
Chest X-ray
BiopsyTissue samples are examined under a microscope to determine what types of cells are present.
Wide local excisionIn this surgical procedure, some of the normal tissue surrounding the area where melanoma was located is removed and checked for cancer cells.
Lymph node mapping and sentinel lymph node biopsy During surgery to remove a melanoma or related skin tumor, a radioactive substance and/or blue dye is injected which flows through lymph ducts to the sentinel node or nodes. Cancer cells are likely to spread to these nodes first. Nodes containing the radioactive substance or dye are removed and checked for cancer cells. If no cancer is detected, it may not be necessary to remove additional nodes.
CT or CAT (computerized axial tomography) scanThis procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
MRI (magnetic resonance imaging) MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.
PET (positron emission tomography) scanThis scan is used to identify malignant cells even before an actual “lump or bump” can be detected in a physical exam, or on CAT or MRI scans. A small amount of radionuclide glucose (sugar) is injected into a vein. Because cancer cells divide more rapidly than normal cells, they take up more glucose than normal cells and therefore appear brighter in the scan.
Understanding Skin Cancer
What is Skin Cancer?
Skin cancer is the most common type of cancer in this country, with approximately one million Americans developing it each year. Skin cells, the building blocks that make up the skin, mature and die daily and new skin cells are formed to take their place when healthy skin cells grow and divide.
But when this orderly process goes wrong, new cells form before the skin needs them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Through examination and
biopsy
, growths or tumors can be diagnosed as either benign or malignant:
Benign growths are not cancer:
- Benign growths are rarely life-threatening.
- Generally, benign growths can be removed. They usually do not grow back.
- Cells from benign growths do not invade the tissues around them.
- Cells from benign growths do not spread to other parts of the body.
Malignant growths are cancer:
- Malignant growths are generally more serious than benign growths.
- They may be life-threatening. However, the two most common types of skin cancer cause only about one out of every thousand deaths from cancer.
- Malignant growths often can be removed. But sometimes they grow back.
- Cells from malignant growths can invade and damage nearby tissues and organs.
- Cells from some malignant growths can spread to other parts of the body. The spread of cancer is called metastasis.
How Does Skin Cancer Differ from Melanoma?
Melanoma is only one type of skin cancer. There are several types of skin cancer, and each is named for the location in the skin where cancer forms:
Basal Cell Carcinoma
The most common type of skin cancer, basal cell carcinoma is also the most treatable, especially if found early. This slow-growing cancer rarely spreads (metastasizes) to other parts of the body. It tends to appear as a skin-colored or reddish bump on the head, neck or hands that bleeds and scabs over repeatedly.
Squamous Cell Carcinoma
The second most common skin cancer, squamous cell carcinoma grows faster than basal cell carcinoma, although it is also highly treatable when detected early. Squamous cell carcinoma is typically found on the rim of the ear, face, lips and mouth. While unusual, it can spread to other parts of the body. It also tends to be skin-colored or red, and bleeds and scabs over repeatedly.
Melanoma
The least common but most serious type of skin cancer, melanoma, begins in pigment-producing cells called melanocytes, which give the skin its color. It is also called malignant melanoma, because it can spread to other organs. Melanoma may begin as a change in a mole or birthmark, or arise as a new mole-like growth. Rarely, melanomas can form in parts of the body not covered by skin such as the eyes, mouth, vagina, large intestine, and other internal organs.
Rare Skin Cancers
The least common types of skin cancers include Merkel cell carcinoma, clear cell carcinomas and sebaceous carcinomas. These behave like melanoma, but arise from other parts of the skin such as the sensory corpuscles and oil glands.
Treatments Options
City of Hope takes a multidisciplinary approach to the treatment of skin cancerwhich may include surgery, chemotherapy, and immunotherapy. Discover the widerange of progressivetreatment options at City of Hope that are designed to meet theindividual needs of each patient.
Basal Cell and Squamous Cell Carcinomas
Treatment of basal cell carcinoma and squamous cell carcinoma may include:
Excisional skin surgery
After numbing the area, a specially skilled surgeon removes the growth and the border of skin around the growth with a scalpel.
Basal Cell and Squamous Cell Carcinomas
Treatment of basal cell carcinoma and squamous cell carcinoma may include:
Excisional skin surgery
After numbing the area, a specially skilled surgeon removes the growth and the border of skin around the growth with a scalpel.
Electrodesiccation and curettage
Typically a fast and simple process, this is often used to remove small basal cell skin cancers. The doctor numbs the area to be treated, removes the cancer with a sharp tool called a curette, and then sends an electric current to the site to kill any remaining cancer cells.
Typically a fast and simple process, this is often used to remove small basal cell skin cancers. The doctor numbs the area to be treated, removes the cancer with a sharp tool called a curette, and then sends an electric current to the site to kill any remaining cancer cells.
Mohs micrographic surgery
This means removing a skin cancer one layer at a time, with immediate examination by the pathologist under the microscope. The surgeon continues to have layers of skin removed until no cancer cells are seen under examination.
This means removing a skin cancer one layer at a time, with immediate examination by the pathologist under the microscope. The surgeon continues to have layers of skin removed until no cancer cells are seen under examination.
Radiation Therapy
This procedure uses high-energy rays to kill cancer cells.
This procedure uses high-energy rays to kill cancer cells.
Laser surgery
This surgery uses a narrow beam of light to remove or destroy cancer cells. Cryosurgery Often used for people who are not able to have other types of surgery, it uses extreme cold to treat early stage or very thin skin cancer.
This surgery uses a narrow beam of light to remove or destroy cancer cells. Cryosurgery Often used for people who are not able to have other types of surgery, it uses extreme cold to treat early stage or very thin skin cancer.
Topical chemotherapy
Chemotherapy uses anticancer drugs to kill skin cancer cells. When a drug is put directly on the skin, the treatment is topical chemotherapy. It is most often used when the skin cancer is too large for surgery.
Chemotherapy uses anticancer drugs to kill skin cancer cells. When a drug is put directly on the skin, the treatment is topical chemotherapy. It is most often used when the skin cancer is too large for surgery.
Melanoma
City of Hope takes a multidisciplinary approach to the treatment of melanoma. The departments of General Oncologic Surgery and Plastic and Reconstructive Surgery provide primary surgical management and sentinel node
biopsy
procedures for melanoma patients. A medical oncologist works as part of the team from the earliest stages to ensure comprehensive care.
Surgery
Like basal cell and squamous cell carcinomas, treating melanoma begins during the staging process, with surgical excision.
Like basal cell and squamous cell carcinomas, treating melanoma begins during the staging process, with surgical excision.
Lymph nodes near the tumor may be removed because cancer can spread through the lymphatic system. If the pathologist finds cancer cells in the lymph nodes, it may mean that the disease has also spread to other parts of the body.
Sentinel lymph node biopsy
Surgeons have recently discovered a method that may help determine whether small, normal appearing lymph nodes may contain melanoma cells, called "sentinel lymph node biopsy." This biopsy technique uses radioactive particles and/or colored dyes injected into the previous melanoma biopsy site. This test often can determine which lymph node may be involved with tumor (i.e., the sentinel lymph node), thereby limiting the number of lymph nodes removed and significantly reducing the chance of unnecessary surgery.
Surgeons have recently discovered a method that may help determine whether small, normal appearing lymph nodes may contain melanoma cells, called "sentinel lymph node biopsy." This biopsy technique uses radioactive particles and/or colored dyes injected into the previous melanoma biopsy site. This test often can determine which lymph node may be involved with tumor (i.e., the sentinel lymph node), thereby limiting the number of lymph nodes removed and significantly reducing the chance of unnecessary surgery.
If the sentinel lymph node does not contain tumor cells, additional lymph nodes are not removed. Alternately, if the sentinel lymph node contains melanoma it is presumed that other lymph nodes in the area may also be contaminated with melanoma cells; in which case all nearby lymph nodes are removed (therapeutic lymph node dissection).Radiation Therapy for Melanoma Radiation therapy uses high-energy X-rays or other types of radiation to destroy cancer cells, or keep them from growing. City of Hope was the first center in the western U.S. to provide treatment for melanoma using the Helical TomoTherapy system. This system combines radiation delivery with real-time imaging, allowing doctors to create a higher dose of energy that more precisely targets the cancer. TomoTherapy not only provides more effective treatment, it reduces the unwanted exposure of normal tissues and reduces potential complications.
Chemotherapy for Melanoma Chemotherapy drugs destroy cancer cells by interfering with their growth and multiplication. There are several methods by which these cancer-fighting medicines are delivered. Some involve an infusion of drugs through an IV.
Immunotherapy for Melanoma City of Hope is a leader in the use of immunotherapy, which employs the body’s own defense system to fight the cancer cells.
Resources
All of our patients have access to the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs.
Additional Resources
American Cancer Society
: Skin Cancer-Melanoma
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
American Academy of Dermatology (AAD)
866-503-SKIN (7546)
The AAD represents virtually all practicing dermatologists in the United States and promotes excellence in eduation and research, clinical practice and surgical standards, and patient care and public interest.
Clinical Trials
Get up-to-date information on how to locate federally and privately supported clinical trials for a wide range of diseases and conditions, including melanoma.
Get up-to-date information on how to locate federally and privately supported clinical trials for a wide range of diseases and conditions, including melanoma.
Melanoma
Learn more about melanoma diagnoses, treatments and insights on melanoma management, and find out how to protect you and your family from melanoma in the future.
Melanoma International Foundation
866-463-6663
Provides information for melanoma patients and their families on patient support, early detection, education and advocacy.
866-463-6663
Provides information for melanoma patients and their families on patient support, early detection, education and advocacy.
Melanoma Patients' Information Page
A nonprofit site founded to provide the support and information needed for melanoma patients and those who care for them to be proactive participants in treatment.
National Cancer Institute (NCI)
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
National Comprehensive Cancer Network ( NCCN )
888-909-NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
Skin Care Physicians
SkinCarePhysicians.com was developed by the American Academy of Dermatology specifically for patients and health professionals to use as a resource for up-to-date information on the treatment and management of skin diseases.
SkinCarePhysicians.com was developed by the American Academy of Dermatology specifically for patients and health professionals to use as a resource for up-to-date information on the treatment and management of skin diseases.
Society for Melanoma Research (SMR)
505-272-6513
The SMR is a diverse organization of scientific and medical investigators devoted to alleviating the suffering of people with melanoma.
Clinical Trials and Research
City of Hope
actively conducts research into finding more effective drug treatments for melanoma, including additional therapies given after initial treatment to reduce the chance of cancer recurrence.
With our extensive program of clinical trials, City of Hope provides melanoma patients access to promising new therapies that are not yet available elsewhere.
Skin Cancer Team
People
http://forms.cityofhope.org/directorysearch/
/physician-bio
Ask the Experts - Skin Cancer
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Watch more Ask the Experts videos on YouTube >>
Watch more Ask the Experts videos on YouTube >>
Skin Cancer Care
Treatments and Clinics
A national leader in cancer treatment and prevention, City of Hope is steadfast in its drive to offer more positive outcomes to patients everywhere. Our research innovations become advances in patient care without delay, because people fighting cancer need better options – now.
To make an appointment for yourself, a family member or a friend, please complete and submit our Become a Patient Request Form, or call City of Hope at
800-826-HOPE (4673).
The
Sheri & Les Biller Patient and Family Resource Center
embodies the heart and soul of City of Hope’s mission to care for the whole person.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials. Last year, City of Hope conducted more than 300 studies enrolling almost 5,000 patients. Find out more about City of Hope's Clinical Trials.
NEWS & UPDATES
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