There is an increasing incidence of non-melanoma skin cancers (NMSC), which include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Surprisingly, it is estimated that 1 in 5 Americans will develop skin cancer during their lifetime. Basal cell and squamous cell carcinomas are most commonly found on sun-exposed skin, which includes the head, face, neck, hands, and arms. However, skin cancer can occur anywhere on the body, suggesting that a comprehensive skin exam is very important for early detection. Additionally, BCC is the most common type of skin cancer diagnosed in the United States, whereas SCC is the second most common skin cancer with an increasing incidence of at least 3% every year.
There are many risk factors associated with the development of NMSC. The most important risk factor is UV radiation from sun exposure or tanning bed use. The predominant cause of NMSC correlates with the amount and intensity of UV radiation. Sun exposure early in life appears to have a greater influence on skin cancer risk than at a later age. Similarly, artificial UV exposure through tanning bed use has shown to increase the risk of NMSC and typically will present earlier in life. For basal cell carcinomas, intermittent and intense episodes of UV exposure and sunburns at any age appear to increase this risk. For squamous cell carcinomas, cumulative long-term UV exposure and childhood sunburns increase the risk for development. Having had one or more blistering sunburns as a child or teenager significantly increases your risk of developing SCC as an adult. Those most at risk for the development of BCC and SCC include people who have lighter skin color, red or blond hair, blue eyes, freckles, and those who burn easily. In these individuals, the degree of UV exposure is related to SCC development.
Actinic keratoses are pre-cancerous lesions that develop on the head, neck, and arms, and have a 1-10% chance of advancing into SCC during a 10-year period. Individuals at higher risk of developing actinic keratoses include the elderly, those with lighter skin types, and those with a history of chronic sun exposure. Patients tend to describe actinic keratoses as rough or scaly spots. They can present with redness, but often they are less visible and more tangible to touch. They are typically found in areas of highest sun exposure, such as the ears, upper forehead, nose, hands, forearms, and the bald scalp.
Squamous Cell Carcinoma (SCC)
SCC is the second most common skin cancer. SCC typically appear as thick, rough, scaly patches, a wart-like growth, or crater-like lesion that can bleed, especially if bumped, scratched, or scraped. SCC is easily treatable when diagnosed early. Although less common, if left untreated, SCC can spread or metastasize to other parts of the body. Make an appointment with your dermatologist if you have a persistent sore, scab, or patch of scaly skin that does not heal within two months.
Basal Cell Carcinoma (BCC)
BCC is the most common skin cancer and usually occurs on the face. They often look like open sores, pink growths, or shiny bumps. BCC is typically slow-growing, can be easily treated when diagnosed early, and has a very good prognosis due to it’s low risk of distant spread (metastasis). However, like any cancer, it should not be taken lightly. If left untreated, BCC can be disfiguring by growing into nearby skin regions and invading adjacent structures. The larger the tumor has grown, the more extensive the treatment that is required. A persistent, non-healing sore is a very common sign of a BCC. An open sore that bleeds easily, does not heal, or heals and returns warrants further evaluation by a dermatologist.
NMSC most commonly occur in areas frequently exposed to the sun. It is important to protect your skin from the sun and avoid tanning beds. We encourage daily sun protection with the use of SPF 30 or greater, sun protective clothing and wide-brimmed hats, and avoidance of sun exposure especially when UV radiation is most intense between 10 am and 2 pm. Adopt these habits at an early age to help prevent the development of skin cancer.
- Bolognia. Dermatology. Third edition. 2012;159:2561-71.
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