I am simply so excited by how my life has changed and by what I learned about myself since being diagnosed." John Garner, Survivor
Skin cancer remains the most prevalent of all cancers in the United States, more common than all other cancer diagnoses combined. And while melanoma makes up just a small portion of those cases (about 1 percent), it is also the most deadly.
Getting treated for skin cancer at City of Hope gives you access to exceptional, coordinated care and makes you the focus of a comprehensive care team, including dermatologists, surgeons, medical oncologists, dermatopathologists and radiation oncologists, who are internationally recognized for their expertise and for shaping guidelines that are advancing the treatment of melanoma and other skin cancers.
- What is skin cancer?
- What are the different types of skin cancer?
- What are the stages of skin cancer?
- What are the risk factors for skin cancer?
- What are the signs and symptoms of skin cancer?
- What tests are needed to diagnose skin cancer?
- What are the treatments for skin cancer?
- Meet our skin cancer team
- What clinical trials are being offered for skin cancer?
- Living with skin cancer and melanoma
Request a consultation
If you have been diagnosed with skin cancer or melanoma or are looking for a second opinion consultation about your treatment, request an appointment online or contact us at 800-826-4673. Please visit Making Your First Appointment for more information.
City of Hope is internationally recognized for its research and breakthrough treatments, has been named one of America’s top cancer hospitals by U.S. News & World Report for more than a decade and is a National Cancer Institute-designated comprehensive cancer center.
It is one of only a few dozen centers in the country that treat skin cancer and melanoma using a comprehensive approach - by a multidisciplinary team whose sole focus is treating this type of cancer. Your care includes regular interaction and input from a team that includes oncologists, surgeons, radiation oncologists, dermatologists and pathologists, along with nurses, social workers and specially trained support staff. This team brings together deep experience and diverse perspectives - shaped by seeing and treating skin cancer every day - to arrive at the ideal treatment for every patient.
Our commitment to providing exceptional care includes
- Promising new therapies as part of our clinical trials program, including novel intralesional injection therapies. These include commercially approved agents such as TVEC, an oncolytic virus, that directly targets melanoma tumors and is being studied in combination with other therapies.
- Collaboration with the Melanoma Research Foundation, National Clinical Trials Network, Cytokine Working Group and Cancer Immunotherapy Trials Network, providing quick access to the newest therapies and clinical trials.
- Deep experience with immunotherapy-based treatments — including involvement in pivotal clinical trials for now-widely-used drugs ipilimumab, nivolumab and pembrolizumab.
- Expertise with isolated limb infusion, a focused chemotherapy treatment not currently available at most cancer centers.
- Internationally-trained dermatopathologist who combines clinical experience with leading-edge technology to provide the most accurate diagnosis.
- Genetic testing and customized drug therapy tailored to the molecular profile of specific skin cancers.
- Expertise in advanced facial reconstructive and microvascular procedures for patients with complex skin cancers.
- Survivorship clinics — including physical therapy for lymphedema-related side effects — that provide support and monitoring throughout the course of the disease.
NEWS & BREAKTHROUGHS
What is skin cancer?
Skin cancer is the most commonly diagnosed cancer and, in most cases, it is not life-threatening nor does it spread to other parts of the body. The exception is melanoma, the rarest and most aggressive form of skin cancer.
According to the American Cancer Society, more than 5 million nonmelanoma skin cancers (basal and squamous cell cancers) were diagnosed in 2012. In 2018, melanoma will be diagnosed in approximately 91,270 people. Although melanoma is potentially deadlier, if caught and treated early, it has a nearly 100 percent cure rate.
Basal cell carcinoma
- Most often develops on sun-exposed sites of the skin (face, neck, shoulders) as pink and shiny bumps that grow and have a tendency to erode and/or bleed.
- Typically affects only the skin but can lead to significant disfigurement.
Squamous cell carcinoma
- Most often develops in sun-exposed sites of the skin as pink and scaly bumps that grow and have a tendency to erode and/or bleed.
- Early detection is critical since these skin cancers can spread to other parts of the body and lead to death.
- An estimated 9,320 people will die of melanoma in 2018.
- The majority of melanoma is caused by the sun, while genetics may also play a role.
- Early detection is critical, as the survival rates worsen with later detection. (The five-year survival rate of Stage 1 melanoma is 98 percent; five-year survival rate is 63 percent for Stage 3 disease and 17 percent for Stage 4 disease.)
Less common skin cancers
- Merkel cell carcinoma is a rare and aggressive type of skin cancer that develops in sun-exposed skin areas and has a high likelihood of spreading to other body parts.
- Skin lymphoma, also called cutaneous lymphoma, is a type of non-Hodgkin lymphoma that starts in the skin.
- Kaposi sarcoma is a type of cancer that starts in lymph or blood vessel cells, and tends to appear in the mouth and as lesions on the skin, but may also develop in the lungs, liver and digestive tract.
- Skin adnexal tumors are tumors that start in hair follicles or skin glands.
- Sarcomas are soft tissue tumors that can begin in deep skin tissue.
Other skin conditions, such as actinic keratosis and squamous cell carcinoma in situ (meaning does not spread to other organs) are precancerous lesions. Early detection is critical to prevent them from becoming skin cancer.
Benign (noncancerous) skin tumors
- Seborrheic keratosis is the most common type of benign skin tumor. Because it may have an asymmetric and evolving shape or irregular edges, it is often confused for a cancerous tumor.
- Moles, also called nevi, are common benign (noncancerous) skin growths. Most moles remain benign, but some may evolve into cancers.
- Hemangiomas are raised tumors made up of abnormal collections of blood vessels.
- Lipomas are soft, fatty lumps that develop just under the skin.
- Warts are skin growths caused by the human papillomavirus, also known as HPV.
How Skin Cancer Develops
Skin is an elastic organ — the largest in the body. Its main functions include protecting internal organs, controlling body temperature, shielding the body from ultraviolet (UV) radiation from the sun and helping the body make vitamin D. Skin cancer develops when abnormal cells in the skin’s layers grow uncontrollably — most commonly because of too much exposure to UV light from the sun or other sources, like tanning beds and sun lamps.
The most common types of skin cancer — basal cell and squamous cell carcinomas — tend to appear on areas of the body exposed to the sun, such as the face, neck, ears and hands.
Melanoma starts in melanocytes
Melanoma starts in cells called melanocytes, which are responsible for giving skin its color. This skin pigmentation functions as a shield against harmful ultraviolet (UV) light exposure from the sun, which can lead to mutations in DNA. With enough DNA damage in critical genes the cells of the skin, including melanocytes, begin to grow uncontrollably and spread locally and to distant organs.
Skin cancer stages depend on which structures are involved:
- T-stage describes how deeply the tumor has invaded the skin and nearby tissues.
- N-stage is the tumor’s involvement in nearby lymph nodes.
- M-stage describes whether or not the cancer cells have spread to distant organs.
In early skin cancers, the tumors are small, contained within the top layers of skin and have not spread to distant organs. As the cancer progresses, the tumor grows larger and more deeply into the skin layers, spreading to lymph nodes and blood vessels and, potentially, distant organs.
Basal and squamous cell skin cancers are much less likely to spread to lymph nodes and distant organs than melanomas.
Things that put you at higher risk for getting skin cancer are called risk factors. The main risk factor for developing skin cancer is exposure to ultraviolet (UV) radiation from:
- Tanning beds
- Sun lamps
Other factors that may contribute to developing skin cancer include:
- Having a history of severe, blistering sunburns
- Having many, or unusual, moles
- Being a blonde or redhead, having fair skin that easily freckles or sunburns
- Exposure to large amounts of toxic substances such as paraffin oil, coal tar and arsenic compounds
- Family history of skin cancer
- Previously being diagnosed with skin cancer
- Being older, male
- Having a weakened immune system
- Having a rare inherited condition called xeroderma pigmentosum
People with darker complexions have a much lower risk of most types of skin cancer. When they do develop melanoma, people with darker skin types are much more likely to have rare types of melanoma such as acral lentiginous melanoma, an aggressive type affecting the palms of the hands, soles of the feet and nail bed. Melanoma can also develop in nonsun-exposed area such as the membranes of the mouth, gastrointestinal tract and female genital tract.
Skin cancer signs and symptoms are different from person to person, and for this reason it is one of the more difficult cancers to detect. Most of the time melanoma has no symptoms, although itching may occur and, when it is advanced, so may bleeding.
The most important warning sign of skin cancer is a new spot on the skin, especially if that spot changes shape, color or size. Another potential symptom is a spot that looks different from all the others on your skin (known as the “ugly duckling sign”).
Other signs include:
- Red or pink patches with shiny, pearly-white raised edges
- Nonhealing open sores that bleed or develop a crust
- Red scaly patches of skin that may bleed
- Wart-like growths with crusted surfaces
- Hard, waxy skin lumps with visible blood cells
- A newly itchy, tender or painful sore
If you notice any of these skin changes, contact your doctor.
Skin cancer prevention
UV damage is cumulative, meaning it begins building up in childhood, so prevention should start young.
The best ways to lower your risk for skin cancer include shielding the skin as much as possible from UV radiation:
- Use sunscreen and reapply at least every two hours
- Wear protective clothing, including fabrics not easily penetrated by UV light
- Wear other protective items such as hats and sunglasses
- Stay in the shade during peak hours when the sun’s UV rays are most intense (from 10 a.m. to 4 p.m.)
- Avoid tanning salons
Skin cancer is a disease that is challenging to accurately diagnose and stage. City of Hope’s team of internationally trained dermatologists and dermatopathologists use their clinical experience and expertise, and leading-edge technology, to provide you with the most accurate diagnosis — and the most effective treatment.
This powerful combination of experience, technology and talent is why City of Hope is known for transforming melanoma patients with advanced disease and dire diagnoses — into survivors.
Tests to diagnose skin cancer
Skin exam, the first test to diagnose skin cancer, is a thorough check of the skin for moles, spots or bumps that appear to be abnormal.
Skin biopsy involves removing tissue that appears abnormal to be viewed later under a microscope by a pathologist. There are several types of skin biopsy, including:
- Shave biopsy, used to remove the abnormal growth using a razor blade.
- Punch biopsy uses a special round instrument to remove a circular tissue sample.
- Incisional biopsy involves removing a section of an abnormal growth.
- Excisional biopsy involves removing all of an abnormal growth.
Determining whether a growth is benign or cancerous is a subtle process, requiring a trained eye and deep experience. As part of the diagnostic process, our specially trained dermatopathologist performs wide-ranging molecular testing of most melanomas, for the most accurate diagnosis.
Testing for specific mutations — such as BRAF and KIT — may also be performed by molecular pathologists, leading to more specific and individualized treatment options.
At least as important as the new drugs being developed is the much deeper understanding we now have of the biology of melanomas." Kim Margolin, M.D., medical oncologist
What are the treatments for skin cancer?
City of Hope’s approach to treating skin cancer starts with a coordinated, multidisciplinary care team whose main goal is offering you the best, most individualized treatment plan. Your plan includes the newest therapies — including immunotherapies — and innovative treatment combinations effective for even the most advanced melanoma patients.
We treat patients at all stages of disease including those with:
- Recurrent disease
- Metastatic disease
- Disease that has spread to lymph nodes
The goal for everyone we treat revolves around options, starting with the important opportunity to participate in clinical trials at every stage of your cancer. This provides you with leading-edge treatments and access to studies that will define the next generation of best treatments. Our treatment approach involves:
- Consultation with a specially trained comprehensive dermatology group
- A layered, thorough and accurate diagnostic process led by deeply experienced pathology staff
- Regular input from experts in various subspecialties at every stage of your treatment
- Near-constant refinement of therapies designed to adapt to changes in your disease
- Best practice prevention and management of all treatment-related side effects
Isolated limb infusion
City of Hope is the only center on the west coast performing isolated limb infusion (ILI) for extremity melanomas — a focused method of delivering chemotherapy (isolated to the affected limb) that greatly reduces side effects common with whole body chemotherapy. ILI is effective for melanoma patients with multiple tumors and/or recurrences in a specific limb.
Clinical trials for Melanoma
City of Hope clinical trials include access to the latest drug therapies and combinations to treat melanoma. Many are based on the genetic changes driving tumors so that therapies may be tailored to specific mutations — others use unique combinations of immunotherapy agents.
City of Hope patients also benefit from our collaboration with various groups, providing access to the newest therapies and clinical trials, including the Cancer Immunotherapy Trials Network.
Time is the most important thing so my patients understand that I have their best interests at heart. Once they understand I am their advocate, they don't have to question my motives and it is an easy path." Vijay Trisal, M.D., surgical oncologist
Surgery is the most common treatment for both melanoma and nonmelanoma skin cancer. The goal of surgery is to completely remove the cancer while trying to preserve healthy tissue.
Nonmelanoma skin cancer surgery
- Curettage and electrodessication involves numbing the cancerous area and using a spoon-shaped instrument (curette) to remove the cancer.
- Simple excision is a procedure in which cancer, along with surrounding normal tissue (called a margin), are removed using a scalpel.
- Shave excision involves removing tumors affecting only the top skin layers. A small blade is used to remove the tumor at its base.
- Cryosurgery uses cold to destroy cancer cells and involves spraying liquid nitrogen onto the tumor. This process freezes and destroys the cells, which eventually fall off.
- Laser therapy uses a narrow beam of intense light to remove cancer cells.
- Dermabrasion removes layers of skin using particles or a device that rubs away skin cells.
- Sentinel node biopsy is a procedure in which lymph nodes are checked for cancer cells. In a group of lymph nodes, one tends to be the primary channel into which cancer will drain. If that lymph node, called the sentinel, tests negative for cancer, the rest are left intact. However, if tests on the sentinel node reveal cancer cells, that and other lymph nodes are removed.
- Lymph node dissection is surgery to remove lymph nodes when melanoma is found in the sentinel and other lymph nodes.
- Wide local excision involves removing melanoma, along with normal tissue surrounding it. If a large swath of skin is removed during the procedure, a skin graft may be required to replace it.
City of Hope’s skin cancer surgery team routinely performs complex operations for advanced skin cancers — and uses advanced minimally invasive technologies, such as robotic sentinel lymph node biopsy, to accurately identify whether and how far cancer has spread.
And frequent collaborations between our melanoma and plastic surgery teams ensure that procedures are performed that minimize deformity and complications; restore appearance; and preserve quality of life.
For melanomas that have spread, our experienced surgical team performs minimally invasive procedures such as pulmonary metastatectomy, a robotic surgery procedure designed to remove tumors that have spread to the lungs.
Skin Excision Clinic
The Skin Cancer Excision Clinic is located in the Women’s Center, lower level of the Geri & Richard Brawerman Ambulatory Care Center at the Duarte campus of City of Hope.
Wai-Yee Li, M.D., Ph.D., performs many types of reconstructive procedures including:
- Skin cancer excisions
- Burn and scar revisions
- Skin grafting, full and split thickness
- Local tissue rearrangement
- Transfer of muscle and skin for breast, chest, abdominal wall, head and neck reconstruction
WHAT TO EXPECT
Arranging your visit
Once your dermatologist determines you need a surgical procedure, he or she should refer you to Dr. Li for a consultation. You may also call 626-218-5015 to schedule a visit or 626-471-7100, extension 88541.
Before your procedure
Dr. Li will perform a complete history and physical exam to let you know whether or not you are a suitable candidate for same day excision. If you are, she will explain the procedure to you and you will be moved to another room for the procedure.
During your procedure
- The area for excision is marked out and numbed using local anesthetic, similar to a dental procedure.
- The skin is prepped using antiseptic solution and sterile towels are used to isolate the surgical site.
- Once the area is ready, Dr. Li will remove your skin cancer together with a ‘margin’ of tissue. This margin is essential to reduce the risk of the cancer coming back.
- After the cancer is removed, it is sent to the lab for further testing by a pathologist.
- Dr. Li will close your wound using dissolvable suture material.
- A special dressing is placed over your sutures, which allows you to shower the same day.
After your procedure
A nurse will provide home care instructions. You will be given a follow up visit with Dr. Li or a member of her plastic surgery team within seven to 10 days for a wound check. The dressing may stay on during this time. A printed copy of your pathology testing report will be provided during this follow-up visit.
Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. Radiation therapy is involved in melanoma treatment when:
- Surgery is not a good option.
- Melanoma is not completely removed by surgery.
- Lymph nodes have been removed but cancer is at high risk of returning.
- Melanoma returns and begins growing again on skin or in lymph nodes.
- Pain or other symptoms can be reduced by radiation therapy.
- Melanoma has spread to the brain or spinal cord.
City of Hope offers advanced and highly targeted radiation treatments for melanoma. In addition to using techniques that direct radiation to tumor tissue while sparing normal tissue, our experienced radiology team works closely with surgeons, oncologists and others members of our multidisciplinary team to perform advanced procedures such as isolated limb infusion and robotic sentinel lymph node biopsy.
If you have been diagnosed with skin cancer or melanoma, or are looking for a second opinion about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.
- Surgical Oncology
- Liver Cancer and Metastases
- Pancreas Cancer
- Gallbladder Cancer and Bile Duct Cancer
- Robotic Minimally Invasive Surgery
- Surgical Oncology
- Surgical Oncology
Skin Cancer Research at City of Hope
Getting treated for skin cancer at City of Hope means you are steps away from labs where new treatments for cancer are being developed every day. That proximity means you benefit from something unique in cancer care — bench to bedside treatment. “Bench to bedside” means innovative research we are conducting in our labs is moved quickly to the bedside to treat our patients.
Cancers are able to survive and thrive because of genetic abnormalities that keep them from being detected and destroyed by the body’s immune system. Research is revealing the specific mutations (problems within the DNA in a cell) causing these abnormalities and using that information to tailor therapies to specific patients’ tumor cells.
For example, with melanoma, recent advances have revealed specific genetic pathways that drive melanoma development. Our genetics team is on the forefront of new discoveries about why people develop melanoma — and precision medicine techniques allow them to target those problems within cells, and disrupt the process that leads to cancer.
Clinical trials at City of Hope
Melanoma is a disease that can act many different ways in the body. Research at City of Hope — driven by patient-specific, individualized treatment strategies — is focused on those differences, and on designing therapies that affect how melanoma develops, progresses and spreads. Click here to learn more about clinical research at City of Hope.
Living with skin cancer and melanoma
When you come to City of Hope, you have access to a strong network of support services and staff to help you and your family along your cancer journey. That support includes everything from talk therapy to meditation to being paired up with a patient navigator. Learn more about the resources listed below at our Living with Cancer or Supportive Care Medicine sites.
- Managing pain, fatigue, nausea
- Your emotional, social and spiritual well-being
- Palliative care for pain and stress
- Staying healthy and active
- Caregiver skills
- Improving communication with family, partners and loved ones
- Navigating the health care system
- Restoring normalcy after cancer
Lymphedema, a condition involving abnormal swelling, may occur after procedures involving the lymph nodes. City of Hope has robust resources designed to minimize your risk of long-term lymphedema including:
- Preoperative evaluation
- Sleeves, exercises designed to lower risk of swelling
- Range of motion, other exercise programs postsurgery
- Download our ABCDE Guide to Potentially Cancerous Moles infographic.
- National Cancer Institute’s skin cancer site
- American Cancer Society’s skin cancer site
- Skin Cancer Foundation