About Skin Cancer

Basal cell carcinoma (BCC), the most common type of skin cancer, begins in the basal cells in the deepest layer of skin. BCC can develop anywhere, though it is most commonly found in sun exposed areas. It is possible to have more than one BCC. 

It is rare but possible for BCC to spread, or metastasize – it is estimated that ~1% of BCCs can be classified as advanced BCC. (Mohan SV & Chang ALS. Curr Derm Rep 2014;3:40–5)

For more information please visit our page: About Basal Cell Carcinoma

Squamous cell carcinoma (SCC), which begins in the keratinocyte cells, is the second most common skin cancer. While SCC usually develops in areas that have been exposed to the sun, it can also manifest in burn or wound sites.

SCC is capable of spreading from the surface to deeper layers of skin, lymph nodes or organs. The annual incidence of metastasis of CSCC is approximately 4%. (Burton et al. Am J Clin Dermatol. 2016;17:491-508.)

For more information please visit our page: About Squamous Cell Carcinoma

Melanoma begins as a malignant tumour in the melanocytes, which are the cells that produce melanin or pigment. As a malignant cancer, melanoma can metastasize to other parts of the body. There are several subtypes of melanoma, including cutaneous, mucosal, and ocular melanoma.

Watch our informative video about melanoma here or click here to view and download the NCCN Guidelines for Patients – Melanoma

Medical News Today: How skin cancer becomes invasive

Source: Canadian Cancer Society, “What is Melanoma?“

There are four different types of cutaneous melanoma, which are determined by microscopic examination of a biopsy sample.

• Superficial Spreading Melanoma counts for approximately 70% of melanomas of the skin. Superficial spreading melanoma usually develops from an atypical mole and can be found anywhere on the body.
• Nodular melanoma makes up about 10-15% of melanomas. Nodular melanoma starts growing down into the skin and spreading quickly.
• Lentigo maligna melanoma makes up about 10-15% of melanomas. Lentigo maligna melanoma is most often seen on skin that has been exposed to the sun. These spots are often large.
• Acral lentiginous melanoma occurs as often in African Americans as in Caucasians. Acral lentiginous melanoma grows and spreads rapidly.

Mucosal melanoma develops in the lining of the respiratory, gastrointestinal, and genitourinary tracts. It is a rare form of melanoma, making up only about 1% of melanoma cases and is often diagnosed at an advanced stage in the elderly. Approximately 50% of mucosal melanomas begin in the head and neck region, 25% begin in the ano-rectal region, and 20% begin in the female genital tract. The remaining 5% occur in the esophagus, gallbladder, bowel, conjunctiva, and urethra.

More information about mucosal melanoma can be found on the Melanoma Research Foundation website.

Ocular melanoma is rare, affecting approximately five in a million people. While it represents only 5% of melanomas, ocular melanoma is rapid and aggressive, accounting for 9% of melanoma deaths.

Updated January 15, 2019:  We have expanded our resources and support for patients with ocular melanoma by creating the initiative Ocumel Canada. 

Please click here to see all of the resources we have compiled: About Ocular Melanoma

Actinic keratosis is also called solar keratosis, and is often found on sun-exposed areas of the skin in people middle-aged or older.  A person with one actinic keratosis will often develop more. The number of actinic keratoses often increases with age. The presence of an actinic keratosis indicates that a person’s skin has suffered sun damage.

Actinic keratoses are considered slow growing. They often go away on their own, but may return. Approximately 1% of actinic keratoses develop into squamous cell carcinoma (SCC) if left untreated. Treatment is required because it is difficult to tell which keratoses will develop into cancer.

Watch our informative video about actinic keratosis here.

Risk Factors:

The following risk factors may increase a person’s chance of developing actinic keratosis:

• Overexposure to ultraviolet B (UVB) radiation from the sun
• Increased age
• Fair skin
• Weakened immune system
• Previous PUVA (psoralen + UVA) therapy

Signs and Symptoms:

Actinic keratosis is most often seen on skin that is frequently exposed to the sun, such as the face, the backs of hands or a balding scalp. The signs and symptoms of actinic keratosis may include:

• Small, rough patches that may be pink-red or flesh coloured
• An initially flat surface that becomes slightly raised and wart-like

Diagnosis:

Actinic keratosis is diagnosed during an examination of the growth. If it does not go away with treatment or shows signs of developing into SCC, a skin biopsy will be done.

Treatment:

Treatment options for actinic keratosis depend on the number and location of keratoses. The treatment may include one or a combination of the following:

• Topical chemotherapy
  • 5-fluorouracil (5-FU, Efudex)
  • Ingenol mebutate (Picato)
• Topical biological therapy
  • Imiquimod (Aldara or Zyclara)
• Cryosurgery
  • Often used on single spots
  • May also be used for many small, raised spots
• Surgery
  • Simple surgical excision
  • Curettage and electrodesiccation
    • May be used on many large spots
• Chemical peeling
• Laser surgery
• Photodynamic therapy

Information obtained from the Canadian Cancer Society.

Bowen’s disease is an early form of squamous cell carcinoma (SCC). It may be called squamous cell carcinoma in situ. Bowen’s disease involves cancer cells in the epidermis or outermost layer of the skin. Although it can’t spread to the lymph nodes, Bowen’s disease can spread into the deeper layers of the skin if left untreated. When it spreads, it becomes an invasive SCC that then has the potential to spread into the lymph system.

Risk Factors:

The following risk factors may increase a person’s chance of developing Bowen’s disease:

• Overexposure to ultraviolet B (UVB) radiation from the sun
• Increased age
• Previous radiation therapy
• Weakened immune system
  • Infection with human papillomavirus (HPV) is associated with Bowen’s disease of the anal and genital skin
• Arsenic exposure

Signs and Symptoms:

Bowen’s disease is most often seen on the legs, backs of hands, fingers or face. The signs and symptoms of Bowen’s disease may include:

• A reddish scaly patch, which is sometimes crusted – may be a single patch or multiple areas
• A windblown appearance of the skin
• Larger, redder and scalier patches than actinic keratoses

Diagnosis:

If the signs and symptoms of Bowen’s disease are present, or if the doctor suspects Bowen’s disease, a biopsy will be done to make a diagnosis. The type of biopsy may be:

• Shave biopsy
• Punch biopsy

Treatment:

Treatment options for Bowen’s disease depend on the number and location of spots. The treatment may be one or a combination of the following:

• Surgery
  • Simple surgical excision
  • Curettage and electrodesiccation
• Topical chemotherapy
  • 5-fluorouracil (5-FU, Efudex)
• Topical biological therapy
  • Imiquimod (Aldara or Zyclara)
• Cryosurgery
• Photodynamic therapy

Information obtained from the Canadian Cancer Society.