Skin Cancer

Skin cancer is a type of cancer that starts in the cells of the skin. It can spread to and damage nearby tissue. Over time, it can spread to other parts of the body. Skin cancer is very rare in children.

Exposure to sunlight is a major risk factor for skin cancer. Skin cancer is more common in people with light skin, light-colored eyes, and blond or red hair. Other risk factors include:

• Family history of skin cancer.
• Exposure to ultraviolet (UV) rays.
• Time spent in the sun.
• Exposure to tanning beds or lamps.
• History of sunburns.
• Having many freckles.
• Having many moles.
• Having atypical moles (dysplastic nevi). These large, oddly shaped moles run in families.
• Radiation therapy to treat cancer in the past.
• Taking a medicine that suppresses the immune system.
• Having moles present at birth (congenital melanocytic nevi).
• Certain rare, inherited conditions such as basal cell nevus syndrome (Gorlin syndrome) or xeroderma pigmentosum (XP).
• HPV infection.
• Squamous cell carcinoma in situ (Bowen disease) is a very early form of squamous cell skin cancer. It appears as rough or scaly red or brown patches on the skin.
• Actinic keratosis (AK) are rough scaly patches of skin caused by sun exposure. There is a small chance of AKs changing into squamous cell skin cancer.

There are three main types of skin cancer:

• Basal cell carcinoma. his is the most common type of skin cancer in adults. This is a very treatable cancer. It starts in the basal cell layer of the skin (epidermis) and grows very slowly. The cancer often appears as a small, shiny bump or nodule on the skin. It occurs mainly on areas exposed to the sun, such as the head, neck, arms, hands and face.
• Squamous cell carcinoma. This cancer is less common and occurs mostly in adults. It grows faster than basal cell carcinoma but is also very treatable. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and may be found on the face, ears, lips and mouth. In rare cases, it can spread to other parts of the body.
• Melanoma. Skin cancer in children is almost always this type. It's the most dangerous kind of skin cancer. It starts in the melanocyte cells that make pigment (color) in the skin. It may start as a mole that turns into cancer. Melanoma may spread quickly.

Basal cell carcinoma

Basal cell carcinomas most often start in skin that's exposed to the sun, such as the head, face, neck, arms, and hands. Symptoms can include:

• A small, raised bump that is shiny or pearly, and it may have small blood vessels or brown, blue, or black areas.
• Firm, flat yellow or pale areas that look a lot like a scar.
• A small, flat spot that is scaly, irregularly shaped, and pale, pink, or red.
• A spot that bleeds easily, then heals and appears to go away, then bleeds again in a few weeks.
• Patches of raised, red skin that might itch.
• A pink growth with raised edges, a lower area in the center, and blood vessels spreading out from it.

Squamous cell carcinoma

Squamous cell carcinoma tends to start in skin exposed to the sun, such as the head, face, neck, ears, lips, and hands. They can also appear on other parts of the body, like skin in the genital area. Symptoms can include:

• A rough or scaly bump that may bleed or crust over.
• Wart-like growths.
• A raised growth that's lower in the center.
• Open sores that don't heal or heal and then come back.

Melanoma

Sometimes moles are present at birth. But most appear during childhood or in young adults. Symptoms of melanoma include a change in a mole, or a new mole that has ABCDE traits such as:

• Asymmetry. One half of the mole does not match the other half.
• Border. The edges of the mole are ragged, notched or blurred.
• Color. The mole has different colors in it. It may be tan, brown, black, red or other colors. Or it may have areas that appear to have lost color.
• Diameter. The mole is bigger than six millimeters across, about the size of a pencil eraser. But some melanomas can be smaller.
• Evolving. A mole changes in size, shape or color.

Other symptoms of melanoma can include a mole that:

• Itches or hurts.
• Oozes, bleeds or becomes crusty.
• Turns red or swells.
• Looks different from your child's other moles.

The doctor will examine your child's skin. Tell the doctor:

• When you first noticed the skin problem.
• If it oozes fluid or bleeds, or gets crusty.
• If it’s changed in size, color or shape.
• If your child has pain or itching.

Tell the doctor if your child has had skin cancer in the past, and if other family members have had skin cancer.

Your child's doctor will likely take a small piece of tissue (biopsy) from a mole or other skin mark that may look like cancer. The tissue is sent to a lab. A doctor called a pathologist looks at the tissue under a microscope. They may do other tests to see if cancer cells are in the sample. The biopsy results will likely be ready in a few days or a week. Your child's doctor will tell you the results. They will talk with you about other tests that may be needed if cancer is found.

Types of treatment for basal cell and squamous cell cancers

• Curettage and electrodesiccation. This procedure removes tissue and burns (cauterizes) the area. Your child is given a local anesthetic to numb the area. The doctor then uses a sharp, spoon-shaped tool called a curette to remove the cancer. This is called curettage. After curettage, the doctor passes an electric needle over the surface of the scraped area to stop bleeding and destroy any other cancer cells. After it heals, a flat white scar may remain.
• Simple excision. This is done to cut the cancer from the skin, along with some of the healthy tissue around it. Your child is given a local anesthetic. Then, the doctor uses a scalpel to remove the tumor from the skin. The doctor may also remove some of the normal skin around the tumor. This is called a margin. Stitches or a bandage strip may be used to close the wound. The tissue that was removed is sent to a lab for testing. If the report shows that not all the cancer was removed, your child will likely need another procedure to remove the rest of the cancer.
• Shave excision. This method is used for cancer that is only in the top layers of the skin. Your child is given a local anesthetic. Then, the doctor uses a small blade to shave off the tumor. The goal is to remove the tumor at its base.
• Mohs surgery. This procedure removes the cancer and a small amount of normal tissue. It’s done on sensitive areas, such as the face. During Mohs surgery, your child is given a local anesthetic to numb the area being treated. The cancer is removed from the skin one layer at a time. Each layer is checked under a microscope for cancer. If cancer cells are seen, another layer of skin is removed. Layers are removed until the doctor doesn’t see any more cancer. The procedure may take several hours, depending on how many layers need to be removed. After this surgery, the cancer is fully removed and the wound can be repaired.
• Cryosurgery. This method uses cold to destroy the cancer cells. This method is best for very small cancers near the skin’s surface. The doctor uses a device that sprays a very cold liquid onto the tumor, commonly liquid nitrogen. This freezes the cells and destroys them. The dead skin then falls off. Your child may have some swelling and blistering in the area after treatment. A white scar is usually left behind. The procedure may need to be repeated.
• Topical chemotherapy. This is medicine applied as a cream or ointment onto the skin. It’s also called topical chemotherapy. This kind of medicine is only used if the cancer is just in the top layers of the skin. The medicine is applied several times a week for a few weeks.
• Radiation therapy. This is treatment with high-energy X-rays. Electron beam radiation is often used for skin cancer. This type of radiation doesn’t go deeper than the skin. This helps limit side effects. The radiation damages the cancer cells and stops them from growing. Radiation therapy is a local therapy. This means that it affects the cancer cells only in the treated area.

Types of treatment for melanoma

• Surgery. The goal of surgery is to remove the melanoma, while leaving as much of the nearby skin as intact as possible. The type of surgery depends on the number of lesions, size, and location of the cancer. Lymph nodes may be removed if the cancer has spread.
• Chemotherapy. The goal of chemotherapy is to destroy cancer cells directly to shrink tumors that can’t be removed by surgery. Or it may be used to kill cells that have spread to other areas of the body (metastatic melanoma). Chemotherapy doesn't work as well as immunotherapies and targeted therapies. Chemotherapy may be used if your melanoma doesn't respond to these treatments.
• Immunotherapy. The goal of immunotherapy is to shrink advanced melanoma tumors. This type of therapy is done with medicines that affect the immune system. The medicine uses the body’s immune defense to attack the cancer cells. These may also be given along with chemotherapy. A type of immunotherapy used to treat melanoma is called checkpoint inhibitors.
• Targeted therapy. The goal of targeted therapy is to shrink advanced melanoma tumors. This type of therapy is done with medicines that target specific parts of melanoma cells. For example, medicines called BRAF inhibitors target cells with a change in the BRAF gene. This gene is found in about half of all melanomas.

Possible complications depend on the type and stage of skin cancer. Melanoma is more likely to cause complications. And the more advanced the cancer, the more likely there will be complications.

Complications may result from treatment, such as:

• Loss of large areas of skin and underlying tissue.
• Scarring.
• Problems with the area healing.
• Infection in the area.
• Damage to nerves.
• Return of the skin cancer after treatment.

Melanoma may spread to organs throughout the body and cause death.

The American Academy of Dermatology (AAD) and the Skin Cancer Foundation advise you to:

• Limit how much direct sun your child gets between the hours of 10 a.m. and 4 p.m.
• Use broad-spectrum sunscreen with an SPF 30 or higher that protects against both UVA and UVB rays. Put it on the skin of children older than 6 months of age who are exposed to the sun.
• Reapply sunscreen every 2 hours, even on cloudy days. Reapply after swimming, sweating, or drying off with a towel.
• Use extra caution near water, snow, and sand. They reflect the damaging rays of the sun. This can increase the chance of sunburn.
• Make sure your child wears clothing that covers the body and shades the face. Hats should provide shade for both the face, ears, and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eye and protect the lids of the eyes, as well as the lens. Clothing with UV protection factor (UPF) gives additional protection.
• Don’t let your child use or be around sunlamps or tanning beds.

The American Academy of Pediatrics approves the use of sunscreen on babies younger than 6 months old if adequate clothing and shade are not available. You should still try to keep your baby out of the sun. Dress the baby in lightweight clothing that covers most surface areas of skin. But you also may use a small amount of sunscreen on the baby’s face and back of the hands.

If your child has skin cancer, you can help them during treatment in these ways:

• Your child may have trouble eating. A dietitian or nutritionist may be able to help.
• Your child may be very tired. They'll need to learn to balance rest and activity.
• Get emotional support for your child. Counselors and support groups can help.
• Keep all follow-up appointments.
• Keep your child out of the sun.

After treatment, check your child's skin every month or as often as advised.

Contact your child's doctor if you see any unusual changes in your child's skin.