Skin Cancer

The most common cancer

More than 800,000 new cases of skin cancer are diagnosed every year, making it the most common form of cancer in the United States. Luckily, it is fairly easy to diagnose, and if treated in its early stages, it is highly curable.

There are three common types of skin cancer: basal cell carcinoma (BCC); squamous cell carcinoma (SCC); and melanoma. Melanoma, the most serious form, is also the rarest, accounting for only about 5% of all cases. Melanoma spreads more readily to other parts of the body, unlike non-melanoma types of skin cancer (BCC and SCC), which rarely spread.

Although skin cancer is largely preventable by avoiding ultraviolet (UV) exposure, most of us have already spent lots of time in the sun. While many studies indicate that exposure in childhood and adolescence can lead to the development of skin cancer later in life, it is never too late to start prevention. Avoiding the sun is the best defense, and wearing a broad-spectrum sunscreen of at least SPF 15 can help.

Since skin cancer can be cured if treated in an early stage, early detection is critical. Monthly skin self-exams can alert you to possible symptoms of cancer. In most cases, the cancer can be thoroughly removed and complete recovery is likely. In some instances, the cancer may recur, and if the cancer invades distant parts of the body, it can be fatal.

Synonyms

    • Basal cell carcinoma
    • Squamous cell carcinoma
    • Melanoma of the skin

Detailed Description

The skin is the largest organ of the body. It serves as a barrier to protect your vital organs, bones, and tissues from injury, temperature extremes, and infectious agents. Nerves in the skin also transmit critical information from the environment (temperature, pressure, and pain messages, for example) to the brain. While the skin protects the body, it is not immune to damage within its own tissues. The skin itself can be bruised, cut, chapped, or inflamed, but a bigger threat comes from skin cancer.

Skin cancer is the broad term used to describe various cancers in skin tissue. Skin has several layers, and skin cancer is classified according to which cells the cancer develops within. The skin's outer layer is called the epidermis, composed of squamous cells, basal cells, and melanocytes. Squamous cell carcenoma (SCC) occurs in the skin's flat squamous cells, the uppermost layer of the epidermis. Basal cell carcinoma (BCC) arises in the round basal cells, located beneath the squamous cells. Melanoma develops in the melanocytes, the cells that produce the skin pigment called melanin. Melanin not only gives skin its color, but it also helps to protect the tissue from UV radiation. Darker-skinned people have more protective melanin than lighter-skinned people. That's why skin cancer is common among Caucasians but rare in African-Americans.

It is widely accepted that skin cancer is caused by exposure to UV radiation, most commonly from sunlight. Avoiding UV exposure can prevent skin cancer, but most people have already spent lots of time in the sun. Studies show that sun exposure in childhood and the teen years can lead to skin cancer later in life, but it is never too late to start prevention tactics. Avoiding the sun is the best defense, and wearing a broad-spectrum sunscreen of at least SPF 15 can help. Occupational exposure to coal, tar, pitch, creosote, arsenic, and radium may also increase risk, so it's best to minimize your contact with any of these substances.

Characteristics of Skin Cancer

The main features of skin cancers include the following:

    • Most common type of cancer in the United States
    • Incidence is steadily increasing
    • Divided into three types: melanoma basal cell carcinoma and squamous cell carcinoma
    • Melanoma is the most serious type, and has causes other than sun exposure as well
    • All forms are highly curable if treated early
    • Preventable by avoiding sun exposure

How Common Is Skin Cancer?

Roughly 20% of Americans who live to age 65 will develop skin cancer, making it the most common form of cancer in the United States. Approximately 800,000 cases are diagnosed every year. Skin cancer can occur at any age, but older adults are the most at risk. Males and females are at approximately the same risk for skin cancer.

In recent years, skin cancer has been on the rise in this country. Melanoma cases alone have jumped by 4% each year since 1973. While this increase may be due to improved public awareness and detection, most researchers believe that increased UV exposure is also to blame. Despite knowing about the dangers of sun exposure, many Americans still strive to get the perfect tan. Atmospheric changes may be another contributing factor to higher skin cancer rates. The ozone layer, which shields out UV rays from the sun, has steadily diminished in recent years, allowing more UV radiation to reach the earth.

What You Can Expect

If detected early and treated completely, skin cancer can be cured. Surgery is highly effective at removing cancerous lesions, and in some cases, radiation and chemotherapy will also be used.

As with all forms of cancer, the main concern is that the cancer does not metastasize (spread to distant sites in the body). Squamous cell carcinoma and basal cell carcinoma rarely metastasize, but SCC may invade nearby organs. Melanoma is more likely to metastasize than the SCC or BCC types of skin cancer. If a melanoma tumor penetrates the skin and reaches the bloodstream and lymph vessels, it can spread to other organs and tissues in the body. In fact, if not treated in its early stage, melanoma is one of the deadliest forms of cancer.

Skin cancer cure and recurrence rates vary. Much depends upon the type, site, and extent of the cancerous lesions.

Established Causes

It is widely believed that ultraviolet (UV) radiation exposure causes skin cancer, but the exact mechanism is still under investigation.

Theoretical Causes

It is thought that skin cancer arises when UV radiation from sunlight passes through the skin and damages the DNA within skin cells. Researchers theorize that sometimes the body's attempt to repair the DNA goes awry, leading to excessive cell growth and tumor formation. Exposure to environmental pollutants such as coal, tar, pitch, creosote, arsenic, and radium may also contribute to skin cancer.

Drugs That Can Cause or Aggravate Skin Cancer

A few drugs such as Oxsoralen (methoxsalen) and Neoral (cyclosporine) may be linked to cases of skin cancer.

Risk Factors

    • Age: older adults are particularly at risk
    • Fair skin: especially skin that burns or freckles easily
    • Personal or family history of melanoma
    • Residence in sunny regions (e.g., Hawaii, California, Sun Belt states)
    • Chronic or repeated sun exposure in childhood and/or adolescence
    • Episodes of blistering sunburn in childhood
    • Blue eyes and red or blond hair
    • Moles present at birth
    • Presence of any Dysplastic Nevi
    • Occupational exposure to arsenic, radium, coal, tar, pitch, or creosote

Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.

Symptoms

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) can occur anywhere on the body, but are most often found on the head, face, neck, arms and hands -- the areas most exposed sunlight. Skin cancers usually do not hurt, so don't wait for pain to happen before you see a doctor. Make a visit right away if you have any of the following symptoms:

    • New skin growths (not all skin cancers look alike: a growth may be a smooth, pale, shiny or waxy lump; a hard red lump; a flat, rough, scaly red spot; or a flat, scar-like lesion on the chest or back)
    • Any sores or spots that don't heal, especially those that itch, hurt, bleed, scab, or crust
    • Sores or spots that change size, color, shape, or texture
    • Sores or spots that arise on skin areas that have been exposed to previous radiation treatments

Melanoma can arise from moles or from normal skin. Check all the skin on your body closely for the "ABCDE" warning signs of melanoma:

    • Asymmetry: one side of a mole or skin spot does not match the other side
    • Border: irregular, notched, jagged edges
    • Color: different colors within a mole, such as tan, brown, blue, black, red, or white
    • Diameter: any change in size or any mole greater than six millimeters (about the size of a pencil eraser)
    • Elevation: any growth that rises above the skin surface

Other signs include a change in skin texture (such as scaling, crusting, or oozing) or consistency (such as hardening or softening of skin). You should also see your doctor if a mole feels hard, lumpy, swollen or itchy, or if it begins to bleed or ooze.

Actinic keratosis: a precancer

Also be on the lookout for scaly red or brown patches on the skin. These lesions may be actinic keratosis, a precancerous condition that can turn into squamous cell cancer. Actinic keratosis can be found anywhere on the body, but most often appears on areas most exposed to the sun.

Conditions That May Be Mistaken for Skin Cancer

The following conditions may be confused with skin cancer:

    • Noncancerous moles or warts
    • Noncancerous vascular skin tumors
    • Psoriasis (a benign skin condition marked by scaly patches)
    • Dermatitis (a benign skin condition marked by red, inflamed skin)
    • Solar lentigines (tan-colored spots, often called liver spots or age spots)

How Skin Cancer Is Diagnosed

Your doctor will physically check your skin for any signs of cancer. If a spot, sore, or mole looks suspicious, he or she will perform a skin biopsy, in which all or part of the growth is removed. Then a pathologist or dermatologist (a medical doctor who specializes in skin disorders) will look at the tissue sample under a microscope to check for cancer cells. A biopsy is the only sure way to diagnose skin cancer.

Staging skin cancer

If your doctor diagnoses skin cancer, he or she will check whether the cancer remains confined to the skin (local skin cancer) or has spread beyond the skin (metastatic skin cancer).

Tracking the extent of the disease is called "staging" the cancer. It's an important way for your doctor to assess your chances of recovery and to plan the best treatment.

Basal cell carcinomas rarely spread to other parts of the body, unless you fail to get medical attention. Then the cancer may spread to nearby tissues, as well as nerves, bones, and the brain. Squamous cell cancers are more aggressive and may spread to lymph nodes or organs, although this, too, happens only rarely. Often, your doctor can tell whether skin cancer has spread simply through biopsy results. No other tests are needed. But if the cancer is very large or has been on the skin for a long time, your doctor may need to run more tests to check for spread to nearby lymph nodes or to other parts of the body.

As for melanoma, it too may remain confined to the skin in the early stages. But it tends to spread much more readily than SCC and BCC, making it a more serious form of skin cancer. In later stages, it can spread downward to nearby lymph nodes, blood vessels, and tissues, then to other organs. Fortunately, melanoma is also the least common of the three.

To check for the spread of cancer, you may need several tests, among them: blood and urine tests, liver function tests, chest X-rays, CT scans, magnetic resonance imaging tests (MRIs), and bone scans.

Goals of Treatment

Skin cancer is highly curable if detected and treated before it spreads to other parts of the body. If basal and squamous cell carcinomas are caught early, about 95% of people are still alive five years later. Among melanoma cases, about 85% can be cured if found early. If melanoma has spread to regional lymph nodes, though, the cure rate drops to about 30%.

If you have skin cancer, your doctor will aim to remove the entire tumor with as little scarring as possible. If your cancer has spread beyond the skin, your doctor will also prescribe treatments to destroy any remaining cancer cells in your body.

Many effective skin cancer treatments are available, among them surgery (the most common treatment), radiation therapy, chemotherapy, and immunotherapy. Depending on the type and stage of cancer, you may need only one type of therapy or perhaps a combination of therapies. For instance, in early stage cancers, surgery alone may be able to cure the disease. But in cases in which the cancer has spread, your doctor may prescribe other treatments, such as chemotherapy after surgery, to kill remaining cancer cells.

Treatment Overview

Surgery

Many forms of surgery are used to treat skin cancer. Some methods are appropriate for certain forms of skin cancer, but not for others. Your doctor can help you to choose the best method for your particular tumor.

If your tumor is large, you may also need a skin graft taken from another part of your body to cover the wound and to reduce scarring. To improve appearance, a plastic surgeon can also reconstruct areas that have been operated upon. Here are the various forms of surgery:

    • Simple excision: The entire tumor is cut from the skin, along with a margin of healthy tissue around the cancer. This surgery is sometimes done at the time of biopsy.
    • Curettage and electrodessication: During a form of surgery called curettage, your doctor numbs the affected skin with a local anesthetic, then uses a sharp, spoon-shaped instrument called a curette to carve out the cancer. Then a special machine delivers an electrical current to stop the bleeding and to destroy any cancer cells that remain around the wound. This process is called electrodessication because it uses the electrical current to burn the tissue. You may have a flattened white scar after this type of surgery. Curettage and electrodessication is appropriate only for certain forms of SCC and BCC, not for melanoma.
    • Mohs' micrographic surgery: This is a shaving form of surgery that doctors often use if they're unsure of how far and deep the tumor has grown. It's also helpful for large tumors and skin cancers that have recurred. After you receive a local anesthetic, your doctor will shave off thin layers of cancer, one layer at a time. Each layer is checked under a microscope for cancer cells until the whole tumor is removed, as evidenced by a layer of normal cells. If you have Mohs' surgery, be sure to find a doctor who is specially trained in this procedure.
    • Cryosurgery: Your doctor applies extremely cold liquid nitrogen to your skin cancer to freeze the cells to death. This procedure is less invasive than conventional surgery, but you may need more than one cryosurgery to destroy the tumor completely. It is not an appropriate treatment for melanoma. This method is also used to treat precancerous actinic keratosis.
    • Laser therapy: For cancers that affect only the outer layer of skin, your doctor may use a laser, a narrow, highly focused beam of light energy, to destroy the cancer cells. This procedure is less painful than conventional surgery, but you still may have some scarring.

Radiation therapy

If your skin cancer is in an area that is hard to operate upon, for example, the eyelid or the ear, your doctor may use radiation therapy to shrink the tumor or to stop its growth. Radiation may also be used to relieve cancer symptoms in people with metastatic melanoma.

Radiation may be delivered from outside the body through a machine that sends high-energy x-rays to the tumor. Or the therapy may be given internally by implanting thin plastic tubes filled with radiation materials into the affected area.

Chemotherapy

Chemotherapy, or anti-cancer drugs, are used in several ways, among them, topical chemotherapy to treat precancers and local skin cancers; and systemic chemotherapy to treat skin cancer that has spread to other parts of the body or to prevent recurrence.

    • Topical chemotherapy: If you have precancerous actinic keratosis or a tumor confined to the top layer of skin, your doctor may prescribe chemotherapy drugs in a cream or lotion that you place on your skin daily for several weeks. Use in high doses can lead to liver function problems and extreme dryness of the skin. A drug called fluorouracil (also called 5-FU) is often used.
    • Systemic chemotherapy: If your cancer has metastasized, or if your doctor suspects it may have spread despite any firm evidence, you may need systemic chemotherapy after surgery. You can take systemic chemotherapy in pill or shot form. Once the drugs are in your bloodstream, they circulate throughout the body to destroy cancer cells, and hopefully prevent recurrence. If you have melanoma in an arm or leg, chemotherapy drugs may be injected directly into the artery that supplies blood to the limb. Cure rates are low when chemotherapy is used for melanoma that has spread, so many doctors are looking toward newer treatments, such as immunotherapy, to improve survival rates.

      Systemic chemotherapy drugs include:
      • Platinol (cisplatin)
      • Adriamycin (doxorubicin)
      • DTIC (dacarbazine)
      • BiCNU (carmustine)
      • Alkeran (melphalan)
      • CeeNU (lomustine)
      • Hydrea (hydroxyurea)
      • Mutamycin (mitomycin)
      • Actinomycin D (dactinomycin)

Newer Therapies in Development

Medical researchers are developing new skin cancer treatments that include:

    • Immunotherapy (also called biological therapy): This type of therapy uses injections of substances to boost the immune system's ability to fight cancer. For instance, interferon (a protein which is produced by the body, but also made in the lab for cancer treatment) can slow tumor growth by interfering with cancer cell division. Clinical trials show that this therapy has a good response rate, but many patients find the side effects troubling, for example, flu-like symptoms, hair loss, and possible liver damage.
    • Photodynamic therapy: In this promising therapy, patients are given certain drugs that make cancer cells more sensitive to light. Then a laser beam is focused on the tumor and the cancer cells absorb the light, causing them to die.
    • Retinoid therapy: This experimental technique involves using vitamin A derivatives called retinoids to fight BCC lesions. Patients are given high doses to cause tumors to regress, but side effects from this therapy can be severe. Some research shows that retinoid therapy may be helpful in preventing skin cancer, either for the first time or for recurrence.
    • Electrochemotherapy: This new treatment for basal cell cancer combines chemotherapy with the application of electrical pulses. First, a chemotherapy drug is injected into the tumor. Then needle electrodes send pulses of electricity into the cancerous tissue. The pulses open up skin pores so that the drugs can better target the cancer cells.

Appropriate Healthcare Settings

Treatment for skin cancer usually takes place on an outpatient basis. If the case is severe, or if cancer has metastasized, inpatient surgery and other treatments may be needed.

Healthcare Professionals Who May Be Involved

    • Family doctors
    • Radiologists
    • General surgeons
    • Plastic surgeons
    • Pathologists
    • Medical oncologists
    • Surgical oncologists
    • Radiation oncologists
    • Dermatologists

Activity & Diet Recommendations

There is no special diet for skin cancer. However, if you're receiving skin cancer treatment, it's important to eat enough calories and protein to help your tissues to heal, as well as to keep up your general strength and health.

Because you're at higher risk of getting another skin tumor, it's important to limit exposure to ultraviolet (UV) radiation from sunlight or from artificial sources such as tanning salons. As much as you can, try to stay indoors from 10 a.m. to 3 p.m., when the sun's rays are strongest. Remember that sand, water, and snow can reflect and intensify the sun's rays.

If you go outside in the sun, be sure to wear a hat and pants or long-sleeved clothing to cover up exposed skin. Also, use a use a sunblock with a sun protection factor (SPF) of 15 or more.

Monitoring the Condition

Once you've had skin cancer, you stand a greater chance of getting a new skin tumor than someone who has never had the disease. Even if you've been cured, cancer can come back in the same area as the original tumor. For these reasons, it's crucial to keep up with regular self-exams of your skin, to report any changes to your doctor right away, and to go in for regular checkups.

Talk to your doctor about a schedule of follow-up appointments. If you have had BCC or SCC, you may need to be checked every month for the first year following diagnosis, every three months for the next year, and once every six months thereafter.

If you have had melanoma, weekly self-exams are advised, as well as a doctor's exam every three to six months. If the disease has metastasized (spread to distant sites in the body), it is critical to monitor the cancer's spread closely: liver function tests and chest X-rays may be done every three months and CT and MRI scans may be performed every six months.

Possible Complications

With any cancer treatments, you may have complications and side effects:

Surgery:

    • Scarring. Skin grafts and plastic surgery can improve the appearance of the affected area.
    • Wound infection. To lessen chances of infection, keep the wound clean and dry. Your doctor may prescribe an antibiotic ointment as well.

Radiation therapy:

    • Rash
    • Red or dry skin
    • Changes in skin color or texture, which may become more pronounced after several years

Chemotherapy:

    • For topical chemotherapy:
      • Inflamed skin
    • For systemic chemotherapy:
      • Nausea and vomiting
      • Hair loss
      • Increased risk of infection

Quality of Life

If treated early, skin cancer should not disrupt your life to a large degree. Treatment can usually be done on an outpatient basis and generally works well to cure the disease.

One concern you may have, though, is how scarring may affect your appearance, especially if the cancer occurred on your face. Doctors try to remove the cancer while causing as little scarring as possible, and skin grafts and plastic surgery may be used to further minimize damage.

If your skin cancer has spread, the disease will have a greater impact on your life. You may need invasive treatments with substantial side effects. You may find it hard to live with pain, and you may feel frustrated if your illness interferes with daily activities. Talk to your doctor about suggestions for coping with pain and other side effects. For instance, if chemotherapy makes you nauseated, antinausea drugs may help.

Being diagnosed with cancer can also make you feel frightened and depressed. It may help to talk with a friend or counselor about how the disease is affecting you. Some people also find support and valuable information about their illness within a cancer support group. If you're interested in finding a group, ask your doctor or hospital for recommendations.

Considerations for Women

Pregnancy

Melanoma is one of the few cancers that can cross the placenta and spread from a pregnant woman to her fetus, though this is rare. Chemotherapy may be an option during pregnancy, but only during the second and third trimesters. Surgery is usually possible.

Nursing mother

Avoid nursing during chemotherapy because your infant will swallow the drugs in your breast milk. Wean your baby onto formula before you start treatment.

Considerations for Children and Adolescents

Skin cancer is rarely seen in children or adolescents, but that doesn't mean that young people don't have to worry about sun exposure. It is thought that in most cases, 10 to 20 years pass between sun damage and detectable signs of skin cancer.

Since sun damage that occurs in childhood and adolescence has been linked to skin cancer in adulthood, it is especially important to protect kids from UV exposure. If children learn to wear a hat, sun-protective clothing, and sunscreen, and to avoid excessive sun, they can get a head start in warding off skin cancer.

Considerations for Older People

As your skin accumulates sun damage during the course of a lifetime, you become more prone to developing skin cancer.

Two types of melanoma, lentigo maligna melanoma and acral lentiginous melanoma, affect older people in particular.

Lentigo maligna melanoma, which is linked to older skin that has been heavily sun-damaged, appears most often on an older person's face, ears, or the back of the hands. You may notice a flat tan or brownish spot that may stay benign for many years before turning darker and cancerous.

Acral lentiginous melanoma, an unusual form of skin cancer that is not caused by sun damage, often appears as a dark growth on the palms of the hands or soles of the feet, the undersides of the fingers or toes, or as a dark streak along the underside of the nails. When this type of melanoma appears in the nail, it may be mistaken for a fungal infection.

Since any cancer can potentially be a serious health threat, conventional therapies should be viewed as the primary form of treatment. Alternative therapies can be useful in controlling pain, boosting the immune system, and reducing stress and anxiety.

Yoga and meditation

These techniques, along with breathing exercises, hypnosis, and biofeedback, can help to decrease stress and feelings of anxiety. They may also be of some use in controlling pain.

Nutrition therapy

Some sources say that certain vitamins can help prevent skin damage following sun exposure. Topical applications of vitamins C and E may protect skin, but check with your doctor before applying anything to a cancerous lesion. Oral supplementation of selenium and vitamins A and E may help protect against cancer. Fish oil tablets or other supplements containing omega-3 or gamma linoleic acid may also offer some benefit.

Guided imagery and visualization

Many cancer centers teach these techniques to help patients cope with cancer. Some practitioners think that these methods may even help mobilize the body's immune defenses, enabling the body to better fight off cancerous growths.

Preventing Skin Cancer

The best way to prevent skin cancer is to avoid exposure to ultraviolet radiation.

    • Avoid going out from 10:00 a.m. to 3:00 p.m., when the sun's rays are strongest.
    • Wear broad-brimmed hats and protective clothing when going outside.
    • Use sunscreen daily. Experts recommend using one with a sun protection factor (SPF) of 15 or higher, re-applying it often.
    • Don't use sunlamps or go to tanning salons -- these are also sources of UV radiation.
    • Keep in mind that snow, sand, and water all reflect the sun's rays.
    • Some sources say that certain vitamins can help prevent skin damage following sun exposure. Learn more in Skin Cancer: Alternative Care.
    • Certain chemicals, called psoralens, may increase sun-sensitivity in some individuals. Psoralens are found in carrots, celery, parsley, parsnips, and limes. Not everyone is affected by these chemicals, but those who are may want to avoid eating or even handling psoralen-containing foods before going out into the sun.

Skin Self-Exam

Avoiding UV exposure is the only way to prevent skin cancer, but most skin cancer is treatable if detected early. Experts recommend that you do a skin self-exam every month. A thorough exam takes about 15 minutes and could help you detect cancerous growths before they spread to other parts of your body. Make sure to do your self-exam in a well-lighted place. A large hand mirror can help you look at skin in hard-to-see places, or you might want to ask a family member or good friend to help.

The first time you check your skin, locate all moles, warts, birthmarks, scars, freckles, and spots. You will want to note the color, size, and shape of each. It might help to write down or make a drawing of all the information for future reference.

Every month, do a routine check that includes a visual exam and a touch exam. The visual exam includes the following steps:

    • Look for any changes in moles, warts, birthmarks, scars, and spots. Look for any new markings.
    • Examine your scalp by lifting up your hair and parting it in various places. Men with facial hair should also look at the skin under the hair.
    • Examine all skin surfaces. Don't forget the backs and fronts of your hands, the bottom of your feet, your fingernails, buttocks, and genitalia. Also, take extra care in examining your face, neck, and ears, which are common sites of skin cancer.

After the visual exam, do a touch exam:

    • Run your fingers over your entire body, noting any bumps or rough, scaly patches. Don't forget your scalp, and be especially careful with the skin on your back and shoulders.
    • Closely feel each mole, noting any tenderness, itching, pain, or bleeding.

Call your doctor if you note any suspicious findings.

Websites & Organizations

American Cancer Society
625 North Court
Palatine, IL 60067
Phone: 800-ACS-2345 (800-ACS-2345)

American Melanoma Foundation
USC Cancer Center
9500 Gilman Drive
P.O. Box 0658
La Jolla, CA 92093
Phone: 619-534-3840

American Skin Association
150 East 58th Street, 32nd Floor
New York, NY 10155-0002
Phone: 212-753-8260

Cancer Care

Comprehensive Cancer Center University of Michigan
1500 E. Medical Center Dr.
Ann Arbor, MI 48109
Cancer Information Line: 800-865-1125
Email wwwcancer@umich.edu

Nevoid Basal Cell Carcinoma Syndrome Support Network
162 Clover Hill Ct.
Marlboro, MA 01752
Phone: 508-485-4873

Office of Cancer Communications
National Cancer Institute (NCI)
Bldg. 31, room 101-18
9000 Rockville Pike
Bethesda, MD 20205
Phone: 800-638-6694 or 800-4-CANCER (800-422-6237)

Skin Cancer Foundation
245 Fifth Avenue, Suite 1403
New York, NY 10016
Phone: 800-SKIN-440 (800-754-6440)
Fax: 212-725-5751
Email: info@skincancer.org

Skin Cancer Zone

Sources for This Article

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Fauci, Anthony J. et. al. Harrison's Principles of Internal Medicine, eds. New York: McGraw-Hill, 1998.

Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw-Hill, 1996.

Hurst, J. Willis. Medicine for the Practicing Physician eds. Stamford, CT: Appleton & Lange 1996.

Noble, John. Primary Care Medicine ed. St. Louis: Mosby, 1996.

Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.

Rakel, Robert E. Conn's Current Therapy eds. Philadelphia: W.B. Saunders, 1998.

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Tierney, LM, McPhee, SJ, and Papadakis, MA. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.


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Cummings, SR, Tripp, MK, Herrmann, NB. "Approaches to the Prevention and Control of Skin Cancer." Cancer Metastasis Rev. 309-27. Sep-Dec 1997.

Everett, SA, Colditz, GA. "Skin Cancer Prevention: A Time for Action." J Community Health. 175-83. Jun 1997.

Gloster, HM Jr, Brodland, DG. "The Epidemiology of Skin Cancer. Dermatol Surg. 217-26. Mar 1996.

Halpern, JN. "Radiation Therapy in Skin Cancer. A Historical Perspective and Current Applications." Dermatol Surg. 1089-93. Nov 1997.

Kricker, A, Armstrong, BK, English, DR. "Sun Exposure and Non-Melanocytic Skin Cancer." Cancer Causes Control. 367-92. Jul 1994.

Ley, RD, Reeve, VE. "Chemoprevention of Ultraviolet Radiation-Induced Skin Cancer." Environ Health Perspect. 981-4. Jun 1997.

Moon, TE, Levine, N, Cartmel, B, Bangert, JL. "Retinoids in Prevention of Skin Cancer." Cancer Lett. 203-5. Mar 19, 1997.

Shore, RE. "Overview of Radiation-Induced Skin Cancer in Humans." Int J Radiat Biol. 809-27. Apr 1990.

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