What is skin cancer?

To understand skin cancer, it’s first important to understand what cancer is: basically, the production of abnormal cells.

The body is programmed to routinely replenish cells in different organs. As normal cells age or get damaged, they die off. New cells take their place. This is what’s supposed to happen.

Abnormal cell growth refers to a buildup of extra cells. This happens when:

• New cells form even though the body doesn’t need them
• Old, damaged cells don’t die off

These extra cells slowly accumulate to form a tissue mass, lump or growth called a tumor. These abnormal cells can destroy normal body tissue and spread through the bloodstream and lymphatic system.

The first thing to understand is that a growth can be either benign or malignant. You’ve probably heard these terms. Here’s exactly what they mean:

• Benign means not cancerous. A benign tumor can grow larger but does not spread to other tissues or organs. Benign tumors:
  • Can be removed
  • Usually don’t grow back
  • Are rarely fatal
  • Don’t spread to other tissues or body parts
• Malignant means cancerous. The cells of a malignant tumor can spread and invade nearby tissues and organs. They are destructive. Malignant tumors:
  • Can often be removed
  • Sometimes grow back
  • Can invade and damage other tissues and organs
  • Can spread to other body parts
  • Can be fatal

Skin cancer is very common; in fact, it’s the No. 1 cause of cancer in the United States. According to the American Society of Clinical Oncology (ASCO®), approximately 5.4 million cases of basal cell carcinoma and squamous cell carcinoma are diagnosed each year.

ASCO estimates that nearly 100,000 adults in the United States will be diagnosed with melanoma this year. Melanoma is the fifth most common cancer among men.

While a risk factor doesn’t mean you’ll develop skin cancer, it can increase your risk. The following factors can increase your risk of skin cancer:

Non-melanoma skin cancer risk factors include:

• Exposure to ultraviolet (UV) radiation: Exposure to UV rays from the sun and tanning beds increases the risk of melanoma.
• Fair complexion: Having fair skin, red or blond hair, freckles and blue eyes can increase your risk of melanoma.
• Moles: Having many moles or unusual moles is associated with a higher risk of melanoma.
• Family history: One in 10 people with melanoma has a family history of the condition. If your parent, sibling or child has been diagnosed with melanoma, your risk is two to three times higher than the average risk.
• Familial melanoma: Rare gene mutations can increase your risk of melanoma, including CDKN2A, P53, CDK4 and MITF.
• History of sunburns: If you’ve frequently experienced sunburns, burns or injuries on your skin, you’re at higher risk for skin cancer.
• Age: The average age of melanoma diagnosis is 65, though melanoma occurs more often in young people than many other types of cancer.
• Sex: Men are more likely to have Merkel cell cancer. Additionally, skin cancer cases have increased in older white men and younger white women.
• Suppressed or weakened immune system: Having a suppressed immune system or using medications that weaken the immune system can increase your risk of skin cancer.
• Previous skin cancer diagnosis: If you’ve previously been diagnosed with melanoma, squamous cell carcinoma or basal cell carcinoma, you’re at higher risk for a new melanoma diagnosis.
• Precancerous skin conditions: Actinic keratoses can increase the risk of squamous cell carcinoma.
• Inherited conditions: Certain genetic conditions can raise your risk of melanoma, including retinoblastoma, Li-Fraumeni syndrome, xeroderma pigmentosum, Werner syndrome and certain hereditary breast and ovarian cancer syndromes. Nevoid basal cell carcinoma syndrome, Rombo, Baze-Dupré-Christol and epidermolysis bullosa simplex syndromes are associated with a higher risk of basal cell carcinoma. Xeroderma pigmentosum, epidermolysis bullosa simplex, albinism, multiple self-healing squamous epithelioma and dyskeratosis congenita are associated with a higher risk of squamous cell carcinoma.
• Previous radiation therapy: Receiving radiation therapy for cancer treatment can increase your risk of basal cell carcinoma.
• Medications: Certain medications that increase your risk of skin sensitivity and sunburns can increase your risk of skin cancer.
• Human papillomavirus (HPV): HPV infection can increase your risk of squamous cell carcinoma, especially if you have a suppressed immune system.
• Ethnicity and race: All races and ethnicities can develop melanoma, but it’s 20 times more common in white people than in Black people. White people are also more likely to develop Merkel cell cancer, though people of Polynesian descent and Black people are also at risk.
• Merkel cell polyomavirus (MCV): Studies have found a connection between this virus and Merkel cell cancer. More research is needed to understand the link.
• Arsenic exposure: Exposure to arsenic may increase your risk of Merkel cell cancer.

 Talk to your physician if you have any of these risk factors.

You can reduce your risk of skin cancer by:

• Avoiding or limiting sun exposure when the sun’s rays are strongest (between 10 a.m. and 4 p.m.)
• Wearing UPF-labeled clothing, a wide-brimmed hat and UV-protective sunglasses.
• Applying broad-spectrum sunscreen year-round. Reapply every two hours or after swimming or sweating.
• Not using tanning beds.
• Checking your skin regularly. Examine your skin often and note any changing or unusual spots. Ask your primary care provider or dermatologist how often you need professional skin cancer screenings.
• Asking your doctor if you should take nicotinamide, a form of vitamin B3. Some research has found that taking 500mg as a twice-daily tablet may reduce non-melanoma skin cancers. Always check with your physician before taking new supplements.

There are three main ways that cancer spreads in the body. It can spread through:

• Tissue. Cancer invades nearby normal tissue.
• The lymph system. Cancer invades the lymph system and travels through the lymph vessels to other parts of the body.
• Blood. Cancer invades veins and capillaries and travels through the bloodstream to other parts of the body.

The original tumor is called the primary tumor. When cancer cells break away from it and travel to other places in the body, a secondary tumor can form. The name for this spreading process is metastasis.

The secondary tumor is the same kind of cancer as the primary tumor. For instance, if melanoma cancer cells travel to the brain, it is considered metastatic melanoma. It is not brain cancer.

As you and your doctor explore the treatment options, make sure you find out the answers to the following:

• What are my treatment choices? Which do you recommend for me and why?
• Will I have more than one kind of treatment?
• What are the expected benefits of each type of treatment?
• What are the risks and possible side effects of each treatment? What can we do to control the side effects?
• What can I do to prepare for treatment?
• Will I need to stay in the hospital? If so, for how long? 

You may want to ask these questions before the doctor takes a sample of tissue:

• Which procedure do you recommend?
• How will the tissue be removed?
• Will I have to stay in the hospital? If so, for how long?
• Will I have to do anything to prepare for it?
• How long will it take?
• Will I be awake?
• Are there any risks?
• How long will it take me to recover?
• How soon will I know the results? Who will explain them to me?
• What is the treatment likely to cost? Will my insurance cover the cost?
• How will treatment affect my normal activities?
• Would a clinical trial be right for me?
• How often should I have checkups after treatment?
• What are the chances my cancer will come back after this treatment?
• What will we do if the cancer comes back or the treatment doesn’t work?
• Will I lose my hair?
• Will you have to remove lymph nodes?
• Will it be painful?
• Will there be scars?
• What are the long-term and short-term side effects of treatment and how can I manage them?

Your immune system plays a big part in your fight against cancer. It is essential to stay as healthy as possible while undergoing cancer treatment. Here are some tips:

• Practice food safety.
• Wash your hands often, and ask your family, healthcare providers and visitors to do the same.
• Bathe every day with warm water and gentle soap.
• Ask your doctor if you should get a flu vaccine or the COVID-19 vaccine.
• Wear a mask when in public and around other people.
• Brush your teeth after meals with a soft toothbrush.
• Do your best to avoid cuts. Wear gloves when cleaning or gardening.
• If you get a small cut, wash it with soap and water, apply antibiotic cream, and put a bandage over it.
• Contact your doctor immediately if you suspect you have an infection, particularly if you have a fever.
• Be physically active.
• Maintain a healthy weight.
• Don’t use tobacco products.
• Protect your skin from the sun with sunscreen, sun-protective clothing and a wide-brimmed hat.
• Eat plenty of vegetables and fruit.
• Limit or avoid drinking alcohol.

Do your best to evaluate your financial situation as soon as possible. You will not want to deal with financial stress in the middle of treatment when you may not feel well. A social worker can help with this process. If you don’t currently have a social worker, ask your doctor or nurse for a recommendation.

It’s important to plan ahead as much as possible when beginning cancer treatment. Ask your nurse navigator or social worker if they can recommend resources to help with the logistics of treatment.

With Your Healthcare Team

When going through cancer treatment, your healthcare team is very important. Your healthcare team may include your oncologists, surgeon, nurse navigator, dietitian, social worker or other medical professionals. Every member plays an important role. Use the tips below for talking with your healthcare team:

• Establish your main point of contact.
  • Your main point of contact will probably be a nurse navigator, but it may be another member of your healthcare team. Find out who you should contact first with questions.
• Don’t be afraid to ask questions.
  • Be open and honest with your healthcare team about your physical and emotional well-being.
  • Cancer is usually not a medical emergency. There is time to ask your healthcare team any questions you may have and consider your treatment options.
  • Write down your questions before your appointments. Take a pen and paper to write down the answers.
  • If you develop any new problems or symptoms during treatment, tell your healthcare team immediately. You are not complaining. This is valuable information for your doctors.
  • Do not change your diet, start an exercise program or take any new medications, including vitamins and supplements, during treatment without talking to your healthcare team first.

With Your Caregiver

Your primary caregiver may be with you when you receive your diagnosis. Your primary caregiver may be your spouse, partner, adult child, parent or friend. This person may come with you to appointments, take care of you after surgery or treatment and support you throughout your cancer journey. Here are some tips for communicating with your caregiver:

• Everyone reacts to the news of cancer differently. You may feel upset, shocked or angry. It may take you some time to process the information. Your caregiver may react the same way you do or your caregiver may not. Even if they don’t react the same way you do, it doesn’t mean that they don’t care deeply.
• Establish your role and your caregiver’s roles early. For example, will your caregiver be the one scheduling most of your appointments or do you prefer to take an active role? Find what works best for you and your caregiver.
• Be open with each other about how you both feel. Overly positive attitudes may hinder honest communication. It’s okay to be upset.
• Encourage your caregiver to take time to care for their own physical and emotional well-being. Being a caregiver comes with its own hardships.
• If your primary caregiver is your spouse or partner, your intimate and physical relationship may change. Cancer treatment and side effects can potentially affect your libido and sexual function. If you have questions or concerns about sexuality and intimacy during and after cancer treatment, talk to your nurse, doctor or social worker.

With Your Children

Children are very perceptive, no matter their age. While you may wish to protect your children by not telling them about your cancer diagnosis, even young children may be able to tell that something is wrong. Not knowing what is wrong may cause them more stress and anxiety.

Here are some tips to talk to your children and teens about your cancer diagnosis:

• Wait until your emotions are under control and decide what to say ahead of time.
• Tell the truth and answer questions honestly. Depending on your children’s ages, it may not be appropriate to give them all the details, but do be truthful.
• Let them know what to expect. For example, tell them that after surgery, you will need a lot of rest and may need to stay in the hospital. If your chemotherapy may cause you to lose your hair, let them know. Keep your children in the loop as much as possible.
• Explain to your children, especially younger children, that they cannot “catch” cancer.
• Let your children know that it is okay to cry or be upset. This may be especially important for your teens to hear.
• Tell teachers, babysitters and others with responsibilities with and around your kids about your diagnosis in case they see behavior changes you may need to know about.
• Maintain normal schedules as much as possible.
• Let your kids help. Allow them to help with chores and let them know that their help is important. Teens may want to take an active caregiver role. Let them do so, at appropriate levels.
• Look for support groups in your area. Many places offer support groups for children and teens whose parents have a cancer diagnosis.
• Know when to seek professional help. If your child begins to demonstrate unusual behavior such as angry outbursts, nightmares or poor grades in school, ask your healthcare team for a recommendation for a counselor.

With Family and Friends

You may choose to keep your cancer journey private or you may choose to share your story with others. The choice is yours. Remember, when family, friends, coworkers or other acquaintances ask about your diagnosis, they are genuinely concerned about your well-being. You can share with them as much or as little information as you like. These suggestions may help you talk about your diagnosis:

• Decide how much information you want to share before you start telling people about your diagnosis.
• If you chose to keep your journey private, let people know that you appreciate their concern, but you hope they respect your privacy.
• Choose someone close to you, like your caregiver, to spread the word about updates and treatment progress. After a long day of treatment, you may not feel like calling and texting people, but your friends and family will probably want to know how you are.
• If you want to share your story, consider starting an email chain or a Facebook group. This way, you can update everyone with one message instead of answering a lot of emails and phone calls.
• You can also create your own private website at MyLifeLine.
• When people offer to help, let them. Your family and friends could cook dinner, drive you to an appointment, help clean your home, run errands or babysit.
• If you lose your hair due to treatment or have visible surgical scars, strangers may ask about your diagnosis. Have a response prepared. Again, you may share as little or as much as you like.