Skin cancer

Signs and Symptoms

Basal cell carcinoma:

• Shiny bump that is pearly or translucent
• Flat, flesh-colored lesion appearing anywhere on the body

Squamous cell carcinoma:

• Hard, red nodule on face, lips, ears, neck, hands, arms
• Flat lesion with scaly surface

Melanoma:

• Change in color, size, shape or texture of a mole
• Skin lesion with irregular borders
• Growth of an existing skin lesion
• Large brown spot with darker speckles
• Hard, dome-shaped bumps anywhere on your body

The only way to know for sure whether a mole or spot on your skin is cancer is to have a doctor look at it.

What Causes It?

Exposure to ultraviolet radiation from the sun is the main cause of skin cancer. Skin cancer may also be due to genetics or radiation treatments. A virus causes Kaposi sarcoma.

Who is Most at Risk?

People at risk for developing skin cancer may have the following conditions or characteristics:

• Fair skin
• Spend a lot of time outdoors in work or leisure activities
• History of sunburn
• Family history of skin cancer
• Many moles, freckles, or birthmarks
• Over age 40
• Large dark-colored birthmark, known as congenital melanocytic nevus
• Pre-cancerous skin lesions, such as actinic keratosis
• HIV-positive. A specific risk for Kaposi sarcoma.
• Excessive sun exposure during childhood

What to Expect at Your Provider's Office

Your doctor will examine your skin for new, changed, or unusual moles. Your doctor may use a dermatoscope, which is for close examination of skin growths. If your doctor suspects cancer, you will undergo a biopsy (where your doctor takes a sample of the skin). A biopsy can confirm whether or not you have skin cancer.

Treatment Options

Prevention

In most cases, you can prevent skin cancer. If you are at high risk, stay out of the sun. When you have to be in the sun, protect yourself by covering up, wearing a hat, and applying sunscreen with an SPF of at least 30 and reapply liberally. Check your skin regularly for new or changing moles. You should also have regular skin cancer screenings with your primary health care provider or dermatologist.

Treatment Plan

The primary goals of treatment are to remove the cancerous growth and stop the spread of the disease.

Drug Therapies

In cases where cancer is found only in the top layer of skin, you may receive topical creams or lotions containing chemotherapy drugs. Melanoma that is deep or has spread and AIDS-related Kaposi sarcoma may be treated with chemotherapy.

Surgical and Other Procedures

Most skin cancer can be surgically removed. Cryotherapy (freezing), topical chemotherapy, or radiation can also treat most skin cancer. If the cancer is on or close to the skin's surface, you may receive photodynamic therapy (laser).

Complementary and Alternative Therapies

Alternative treatments are aimed at preventing rather than treating skin cancer. Some CAM treatments may reduce the side effects of conventional treatments, such as chemotherapy.

You should never rely on alternative therapies alone for treating skin cancer. Make sure all of your doctors know if you plan to use any CAM therapies along with conventional cancer treatments. Some CAM therapies can interfere with conventional cancer therapies.

Eating certain foods may help protect against skin cancer. It is hard to test the role of food in preventing skin cancer, but several studies have looked at antioxidants (including vitamin C, vitamin E, beta-carotene, zinc, and vitamin A), folic acid, fats, and proteins, and a variety of whole foods. While results are not clear, antioxidants may offer some protection from skin cancer. Foods such as fish, beans, carrots, chard, pumpkin, cabbage, broccoli, and vegetables containing beta-carotene and vitamin C may also help protect skin. Studies on animals suggest that substances found in foods, such as soy and flaxseed, may help fight cancer in general, and may help prevent the spread of melanoma from one part of the body to another.

Other substances found in plants may help protect your skin from sun-related damage:

• Apigenin, a flavonoid found in vegetables and fruits, including broccoli, celery, onions, tomatoes, apples, cherries, and grapes, and in tea and wine
• Curcumin, found in the spice turmeric
• Resveratrol, found in grape skins, red wine, pistachios, and peanuts
• Quercetin, a flavonoid found in apples and onions
• Burgund mare, an extract obtained from red grape seeds

Selenium has been promoted as an antioxidant that might help prevent skin cancer. One study, however, suggests that selenium might actually increase the risk of developing squamous cell cancer. Talk to your doctor before taking a selenium supplement. Niacin (vitamin B5), too, may help prevent skin cancer. More research is needed.

If you have skin cancer, you should always talk with your doctor before taking any supplements or making dietary changes. Some supplements, or possibly even some foods, may interfere with some drugs used to treat cancer.

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, take herbs with care, under the supervision of a health care provider. Many herbs and herbal combinations are used to prevent and treat cancer in general. However, you should never use herbs alone to treat any kind of cancer. Remember that certain herbs and supplements can change the way medications, including chemotherapy, act in your body. Make sure you tell your conventional and alternative providers about all the supplements, therapies, and medications you are using. DO NOT take any herbs or supplements without first talking to your oncologist.

• Green tea (Camellia sinensis) contains polyphenols, chemicals that are potent antioxidants. Antioxidants get rid of particles in the body called free radicals, which damage DNA. Researchers think free radicals may play a role in cancer. The main polyphenol in green tea is epigallocatechin gallate (EGCG). Scientific studies suggest that EGCG and other green tea polyphenols may prevent skin tumors from starting or growing. Because green tea contains caffeine, it may interact with several medications, and may not be safe for people with certain medical conditions, and for pregnant women. Ask your doctor before taking a green tea supplement or having more than one cup of tea per day.
• Other herbs with antioxidant and skin-protecting effects include bilberry (Vaccinium myrtillus), ginkgo (Ginkgo biloba), milk thistle (Silybum marianum), ginger (Zingiber officinale), and hawthorn (Crataegus laevigata). Although there are no scientific studies on using these herbs to treat skin cancer, they have been used traditionally to protect the skin. Each of these herbs may interact with other medications, including blood-thinners, such as warfarin (Coumadin), and may not be safe for someone with another medical condition. Ask your doctor before taking any of them.
• For Kaposi sarcoma, some naturopaths recommend a paste made from lemon balm (Melissa officinalis) cream, several drops of Hoxsey-like formula, a mixture of herbs and potassium iodide, and powdered turmeric. DO NOT use this mixture without your doctor's supervision.

Many people with cancer use homeopathy as an additional therapy, along with conventional medicine. An experienced homeopath considers your individual case and recommend treatments that address both your underlying condition and any symptoms you may be having.

While acupuncture is not used as a treatment for cancer itself, evidence suggests it can help relieve symptoms, such as the nausea and vomiting that often come with chemotherapy. Some studies have indicated that acupuncture may help reduce pain and shortness of breath.

Acupuncture needles should never be used on an area of skin where there is cancer.

Acupressure, which is a treatment that uses pressing on specific points on the body rather than needling acupuncture points, has also helped control breathlessness. Acupressure is a technique that you can learn and use to treat yourself.

Some acupuncturists prefer to wait until the person has finished conventional medical cancer therapy. Others will provide acupuncture or herbal therapy during chemotherapy or radiation.

Acupuncturists treat cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.

Prognosis/Possible Complications

The outlook (prognosis) varies, depending on the type of skin cancer being treated:

• Basal cell carcinoma: generally has an excellent outlook when conventional treatment is used.
• Squamous cell carcinoma: excellent outlook when small lesions are removed early and completely.
• Malignant melanoma: 5-year survival is almost 100% for very superficial lesions removed early. However, thick lesions and melanoma that has spread to other organs have a poor outlook.
• Kaposi sarcoma: good outlook for superficial lesions of the slow-growing form in elderly people of Italian or Jewish ancestry. The course of AIDS-related Kaposi sarcoma depends on the status of the person's immune system.

Following Up

See your health care provider regularly for screenings to check for a recurrence of skin cancer.

Supporting Research

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