The first thing to do if you think you have skin cancer, is NOT TO PANIC. The best thing a person can do, even if they have cancer is not to lose their cool. Your attitude has a huge effect on your overall health, especially cancer.

For the record, skin cancer is the most common form of cancer in the United States. Skin cancer is linked to cumulative exposure or chronic exposure to the ultraviolet rays of the sun. While the risk of non-melanoma skin cancers increases with cumulative exposure to the sun, melanoma — the most serious type because it spreads to other organs — is linked to intermittent intense sun exposure, genetic factors, and moles.

People who have one or two severe sunburns in childhood may double their risk of developing melanoma later in life. Ultraviolet radiation from tanning booths or sunlamps is equally dangerous. Individuals must be especially vigilant about sun exposure when taking medications that promote PHOTOSENSITIVITY (heightened sensitivity to the sun). These medications include NONSTEROIDAL ANTI-INFLAMMATORY DRUGS, sulfa drugs, tetracycline, thiazide diuretics, and tricyclic antidepressants.

Fair-skinned people with red or blond hair and blue or green eyes are at an especially high risk of skin cancer. Other risk factors include a family or personal history of skin cancer; a tendency to burn or freckle easily when exposed to the sun; having many moles; having spent a lot of time outdoors; a history of sunburns; repeated exposure to X rays or other forms of radiation; and exposure to arsenic, coal, industrial tar, paraffin, and certain types of heavy oils.

To detect skin cancer, doctors recommend regular self-examination. It is important to consult a doctor upon finding any new skin growth; a change in the surface or color of a MOLE; a spot or bump that is getting larger, scaling, oozing, or bleeding; a sore that does not heal within 3 months; or itchiness or pain in a lesion. Diagnosis is made through physical examination. The doctor will examine the size, shape, color, and texture of the lesion in question; ask about the history of the growth, such as when it first appeared and how it has changed in size or appearance; check the rest of the body; inquire about any personal or family history of skin cancer; and perform a skin biopsy (take a small sample from the lesion and examine it under a microscope).

WHAT ARE THE TYPES OF SKIN CANCER

There are three main types of skin cancer: BASAL CELL CARCINOMA, SQUAMOUS CELL CARCINOMA, and malignant melanoma (see MELANOMA, MALIG-NANT). Basal cell and squamous cell carcinomas are often referred to as non-melanoma skin cancers to differentiate them from melanoma, which is by far the most serious of the three. Most skin cancers occur on areas of the skin that are frequently exposed to sunlight.

• Basal cell carcinoma Basal cell carcinoma is the most common form of skin cancer in the United States, accounting for three of every four cases of skin cancer. Basal cell carcinoma has a cure rate of more than 95 percent and rarely spreads to other parts of the body. As with other forms of cancer, early diagnosis and treatment are essential. Left untreated, basal cell tumors will continue to enlarge and can eventually extend below the skin and invade nearby nerves.

  Basal cell carcinomas most commonly develop on sun-exposed areas of the body, such as the head, neck, and chest. They first appear either as small, shiny, pink bumps or as flat, scaly, red areas. Lesions vary from light pink to flesh colored. Blood vessels may be visible in the carcinomas themselves or in surrounding skin. These tumors grow slowly, taking months or even years to expand to a diameter of half an inch. Basal cell cancers bleed easily after a minor injury and may bleed and crust over in repeated cycles.

  Most basal cell carcinomas are completely cured by fairly minor surgery. The type of procedure depends on factors such as the size, type, depth, and location of the cancer. Surgical options include simple EXCISION (cutting), CURETTAGE (scraping), electrodesiccation (burning with an electric current delivered through a probe), and MOHS SURGERY (microscopically controlled surgery removing one layer of skin at a time). Radiation may be helpful for tumors that are difficult to treat surgically and for people unable to tolerate surgery. Less frequently, CRYOSURGERY (freezing with liquid nitrogen) may be used. In most cases, surgery is performed on an outpatient basis using a local anesthetic. In the removal of large cancers, skin grafting and reconstructive surgery may be necessary.

• Squamous cell carcinoma This is a more serious type of skin cancer. Left untreated, squamous cell carcinoma may spread into lymph nodes and become incurable. However, with early treatment, this type of cancer has a high cure rate.

  Any new growth that ulcerates or bleeds can be an indication of squamous cell or another type of skin cancer. Squamous cell carcinoma usually develops from a red, scaly, precancerous skin lesion known as an ACTINIC KERATOSIS. Actinic keratoses typically occur on parts of the body that experience the most exposure to ultraviolet light, such as the face, ears, and backs of the hands. They are rough, pink, and scaly. There is a significant risk that actinic keratoses will become squamous cell carcinomas.

  Early diagnosis and treatment of both actinic keratoses and squamous cell carcinomas are critical. It is important to have a doctor examine any new skin lesion that grows or bleeds. Diagnosis of squamous cell carcinoma is usually confirmed through skin biopsy. In their early stages (BOWEN DISEASE), growths can be removed by topical chemotherapy, cryosurgery, or electrodesiccation and curettage. Most squamous cell carcinomas, however, must be removed through surgical excision or Mohs surgery. These are minor procedures that take place on an outpatient basis using a local anesthetic.

• Malignant melanoma A serious form of skin cancer, melanoma may spread to other parts of the body, often the liver and lungs, resulting in the vast majority of deaths from skin cancer. It is potentially curable with early detection and treatment. While still relatively uncommon in comparison with nonmelanoma skin cancers, the number of people who develop melanoma is growing each year. This type of cancer is most common in fair-skinned people who live where sunlight is most intense. However, unlike nonmelanoma skin cancer, it is not as rare for people with dark brown or black skin to develop melanoma. Also in contrast with nonmelanoma skin cancers, which are caused by cumulative exposure to the sun over a lifetime, melanomas appear to be more closely linked to intermittent intense sun exposure. Malignant melanoma is an aggressive cancer that originates in the melanocytes, the cells in the epidermis that contain and produce melanin (the pigment that gives skin its color). A MOLE occurs when melanocyte-derived nevus cells form a cluster. When a mole changes color or shape, medical attention must be sought at once. Moles range in color from brown to black to blue and are not necessarily located in sun-exposed areas. In fact, moles that develop into melanomas may appear on parts of the body not frequently exposed to direct sunlight, such as the buttocks or inside the mouth.

  Risk factors for melanoma include irregular moles; a large number of moles (the normal range is between 10 and 40); a personal history of melanoma; a close relative who has had melanoma; a history of one or more severe sunburns as a child; fair skin that burns or freckles easily; and living in an area with a high level of ultraviolet radiation. About one in ten people have unusual moles. Abnormal moles are more likely than normal ones to develop into malignant melanoma. Although not everyone who has an abnormal mole develops melanoma, it is important that all moles be closely monitored.

Even more than with nonmelanoma skin cancers, early diagnosis and treatment of melanoma is essential since early diagnosis provides the best chance of a cure. To detect melanoma, doctors recommend regular skin self-examination. It is essential to seek medical attention when confronted with any new skin growth or change in a mole. In whole body examinations, dermatologists periodically inspect the entire body for changes, such as a new mole or blemish or variations in the surface or color of a mole.

Lesions that could be skin cancer can be detected in these examinations and a skin biopsy performed to confirm if there are cancerous cells. If a melanoma is detected, lymph nodes in the area are also removed and examined under a microscope to see if the cancer has spread. Other tests, such as a chest X ray, can also help determine if the cancer has spread. Once the stage of melanoma has been assessed, the doctor can plan the appropriate treatment. Treatment usually involves surgical excision of the melanoma and surrounding tissue and depends on the depth and location of the melanoma. Other options include chemotherapy and immunotherapy if the melanoma has spread.

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