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Skin Cancers

Educational Video Playlist Regarding the Types of NMSC in English and French

Webinar: Melanoma and non-Melanoma Skin Cancers with Dermatologist Dr. Tom Salopek

The two most commonly diagnosed types of NMSC are Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). Merkel Cell Carcinoma (MCC) is a rare form of NMSC.

Learn more about each skin cancer type below .

Basal Cell Carcinoma (BCC)

Basal Cell Carcinoma represents approximately 80% of all cases of non-melanoma skin cancer (NMSC), and predominantly affects the Caucasian and older population. BCC originates in the basal layer of the epidermis, with studies so far suggesting origins primarily being from stem cells (Peterson SC, et al. Cell stem cell 16.4 (2015): 400-412). Basal cell carcinoma (BCC) is the most common form of skin cancer in Canada and generally arises from cumulative lifetime ultraviolet (UV) exposure and damage to the skin, and as such is often found on areas of the skin most exposed to sunlight.

BCC can develop anywhere, though it is most commonly found in sun-exposed areas. It is possible to have more than one BCC. It is rare, but possible, for BCC to spread, or metastasize – it is estimated that ~1% of BCCs can be classified as advanced BCC (Mohan SV & Chang ALS. Curr Derm Rep 2014;3:40–5).

 

 

 



Appearance

Many BCCs are small, elevated bumps or skin sores, red, pink, or pearly white in color. Some may crust, itch, or bleed and are often mistaken for “pimples” that have been present for several weeks and aren’t healing.

BCCs may appear as:

  • An open sore that bleeds, oozes, or crusts and remains open for several weeks

  • A red, raised patch or irritated area that may crust or itch but generally doesn’t hurt

  • A shiny pink, red, pearly white, or translucent bump

  • A pink growth with a raised border and crusted central indentation.

  • A scar-like, white, yellow, or waxy area, often with a poorly defined edge

  • A darker-colored (pigmented), pearly, translucent skin growth (more common in skin of color than in light skin)

  • An ulcerated lesion, which means a portion of the skin that covers the growth is not healing

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The top layer of skin, the epidermis, is predominantly composed of basal cells, squamous cells, and melanocytes. Basal cells are small and round and have a critical role in maintaining the skin tissue; they are located at the bottom portion of the epidermis and are often referred to as “basement cells” for their foundational position and function. Basal cells are constantly replicating to produce new skin cells which push to the skin’s surface to renew the skin layer as dying cells shed off. This process is essential for skin maintenance, damage repair and wound healing. When basal cells grow out of control and become cancerous, they develop into BCC. This type of skin cancer generally grows relatively slowly and is usually very treatable when addressed early on. Prompt diagnosis and removal can prevent expansion as well as skin disfigurement. Although it is rare for BCC to spread outside of the skin, it is possible and thus prompt attention is always warranted.

Sources: AIM at Skin Cancer, "Basal Cell Carcinoma." [link: https://aimatskincancer.org/basal-cell-carcinoma/]

AIM at Skin Cancer, "BCC Images." [link: https://aimatskincancer.org/basal-cell-carcinoma/basal-cell-carcinoma-images/]

Mohan SV, Chang AL. Advanced Basal Cell Carcinoma: Epidemiology and Therapeutic Innovations. Curr Dermatol Rep. 2014 Feb 9;3(1):40-45. doi: 10.1007/s13671-014-0069-y. PMID: 24587976; PMCID: PMC3931971.

Peterson SC, Eberl M, Vagnozzi AN, Belkadi A, Veniaminova NA, Verhaegen ME, Bichakjian CK, Ward NL, Dlugosz AA, Wong SY. Basal cell carcinoma preferentially arises from stem cells within hair follicle and mechanosensory niches. Cell Stem Cell. 2015 Apr 2;16(4):400-12. doi: 10.1016/j.stem.2015.02.006. PMID: 25842978; PMCID: PMC4387376.

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Immunotherapy

Immunotherapy is a drug treatment that uses the immune system to fight cancer. It may be administered to patients intravenously in the Chemotherapy Unit of the hospital, but it is not the same as chemotherapy.

A number of cancer immunotherapies have been developed using different strategies to help boost immune response. Some immunotherapies help your immune system attack the cancer directly and some help to enhance your body’s immune response to fight the cancer. For example, some cancers trick the immune system by switching off certain pathways so that cancer cells are no longer recognized, allowing them to continue to grow. One type of immunotherapy helps fight cancer by switching on the pathways that the cancer cells have switched off, so that the immune system begins to recognize and attack the cancer. This is only one approach to cancer immunotherapy.

There are different immunotherapies available in Canada to treat skin melanoma. In general, all treatment options can cause serious side effects, sometimes even fatal. That’s why it is always important to carefully weigh the benefits of any cancer treatment against the possible risks. You should discuss possible side effects with your doctor before starting treatment.

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Helen's Story

Basal cell carcinoma, in general, is the most common form of skin cancer in the world,” says Dr. Vanessa Bernstein, BC Cancer Agency. “One in eight Canadians will develop it during their lifetime. But the majority of the cases of basal cell cancer won’t be locally advanced or metastatic. These 99 per cent of basal cell cancers will be treated with local options like surgery or radiation, and they’ll be cured most of the time by that. Helen’s is an unusual case because her advanced basal cell cancer is quite a rare form of what’s usually a slow-growing, common skin cancer. It came back after radiation and it kept recurring after treatment, which is when we knew we were in trouble.”

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Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma (SCC), which begins in the keratinocyte cells, is the second most common skin cancer. This type of skin cancer generally grows slowly and occurs most often burn or wound sites, or on sun-exposed skin, such as the back of the hands, ears, and scalp. It often looks like a sore that is not healing or an enlarging red, scaly patch of skin. Many SCSCs appear as wounds that never heal. They usually grow relatively slowly and may look red, scaly, crater-like, ulcerated, or bumpy. Some are crusty or itchy and may bleed.

The top layer of skin, the epidermis, is predominantly composed of basal cells, squamous cells, and melanocytes. Squamous cells are thin, flat skin cells found in the upper section of the epidermis and appear at the skin’s surface. As part of normal skin maintenance, squamous cells are constantly shed as new cells replace older ones.

SCC is capable of spreading from the surface to deeper layers of skin, lymph nodes or organs. The annual incidence of metastasis of CSCC is approximately 4%. (Burton et al. Am J Clin Dermatol. 2016;17:491-508.)

There are two subtypes of SCC, Adenoid SCC and Desmoplastic SCC, which may have a higher chance of recurrence. Both subtypes often occur on the head or neck, and Adenoid SCC appears as a nude, brown, pink or red nodule.

You might be familiar with the term cutaneous squamous cell carcinoma; this is another way of describing squamous cell skin cancer.

Sources: Canadian Cancer Society, “Squamous Cell Carcinoma.“ [link: http://www.cancer.ca/en/cancer-information/cancer-type/skin-non-melanoma/non-melanoma-skin-cancer/types-of-non-melanoma/?region=on]

AIM at Skin Cancer. "Squamous Cell Skin Cancer." [link: https://aimatskincancer.org/squamous-cell-skin-cancer/]

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Gary's Journey

Last year, Garry Hanwell was saying goodbye to his family in preparation for a medically-assisted death, the last resort in his relentless battle with cutaneous squamous cell carcinoma (cSCC), an aggressive and common form of skin cancer. Today, he’s planting a new garden and celebrating 70 years of marriage.

Merkel Cell Carcinoma (MCC)

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Merkel Cell Carcinoma (MCC) is a rare non-melanoma skin cancer. It can develop in the merkel cells, which are found in the deepest areas of the epidermis and hair follicles. Merkel cells are related to nerve function and production of hormones. MCC generally spreads quickly, and develops in areas often exposed to the sun (head, neck, arms, and legs), but can occur anywhere on the body. Once the cancer starts to metastasize, or spread, to other parts of the body, it becomes metastatic MCC. MCC is sometimes referred to as neuroendocrine skin cancer or trabecular carcinoma.

MCC generally manifests in a non-painful, firm, raised bump on the skin, which may be red or purple in colour. As MCC spreads more bumps may appear nearby, and swelling may occur in the lymph nodes.

Source: Canadian Cancer Society, “Merkel Cell Carcinoma

Watch our informative video about merkel cell carcinoma:

PRECANCEROUS CONDITIONS: ACTINIC KERATOSIS AND BOWEN’S DISEASE

Precancerous conditions of the skin have the potential to develop into non-melanoma skin cancer. The most common precancerous conditions of the skin are Actinic Keratosis and  Bowen’s disease.

Actinic Keratosis

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Actinic keratosis is also called solar keratosis, and is often found on sun-exposed areas of the skin in people middle-aged or older. A person with one actinic keratosis will often develop more. The number of actinic keratoses often increases with age. The presence of an actinic keratosis indicates that a person’s skin has suffered sun damage.

Actinic keratoses are considered slow growing. They often go away on their own, but may return. Approximately 1% of actinic keratoses develop into squamous cell carcinoma (SCC) if left untreated. Treatment is required because it is difficult to tell which keratoses will develop into cancer.

Bowen’s Disease

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Bowen’s disease is an early form of squamous cell carcinoma (SCC). It may be called squamous cell carcinoma in situ. Bowen’s disease involves cancer cells in the epidermis or outermost layer of the skin. Although it can’t spread to the lymph nodes, Bowen’s disease can spread into the deeper layers of the skin if left untreated. When it spreads, it becomes an invasive SCC that then has the potential to spread into the lymph system.

Contributing Factors
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The following may contribute to the development of melanoma and non-melanoma skin cancers:

  • Unprotected and/or excessive exposure to ultraviolet (UV) radiation

  • A fair complexion

  • The tendency to freckle

  • Occupational exposures to coal tar, pitch, creosote, arsenic compounds, or radium

  • Some medications, such as immunosuppressants

  • Family history of skin cancers

  • Multiple or atypical moles

  • Severe sunburns, especially as a child

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Early detection is key.

​You should examine your skin at least once a month. Make sure you check the back of your body, in your hair, and between your toes. Use a mirror or have someone check for you. Look for changes in moles, any new growths, sores that do not heal, and abnormal areas of skin.

If you have any concerns about your skin and possible skin cancer, contact your physician immediately. More information about the diagnosis process can be found here.

 Steps of a Skin Cancer Self-Exam

  1. Using a mirror in a well lit room, check the front of your body -face, neck, shoulders, arms, chest, abdomen, thighs and lower legs.

  2. Turn sideways, raise your arms and look carefully at the right and left sides of your body, including the underarm area.

  3. With a hand-held mirror, check your upper back, neck and scalp. Next, examine your lower back, buttocks, backs of thighs and calves.

  4. Examine your forearms, palms, back of the hands, fingernails and in between each finger.

  5. Finally, check your feet – the tops, soles, toenails, toes and spaces in between.

When checking your own skin or that of your loved ones, keep in mind the “ABCDE’s of skin checks.”

A – Asymmetry. The shape of one half does not match the other half.

B – Border that is irregular. The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.

C – Colour that is uneven. Shades of black, brown, and tan may be present. Areas of white, grey, red, pink, or blue may also be seen.

D – Diameter. There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than 6 mm wide (about 1/4″ wide).

E – Evolving. The mole has changed over the past few weeks or months.

F – Firm. Is the mole harder than the surrounding skin?

G – Growing. Is the mole gradually getting larger? 

Contact your doctor right away if you notice any abnormalities. Your doctor may also recommend that you examine your lymph nodes every month.For full instructions on conducting skin self-exams, please CLICK HERE.

NOTE: The information on the Save Your Skin website is not intended to replace the medical advice of a doctor or healthcare provider. While we make every effort to ensure that the information on our site is as current as possible, please note that information and statistics are subject to change as new research and studies are published. 

100% of Donations go to Patients

Making awareness and education available is crucial. Since 2006, the Foundation has worked to raise awareness of melanoma and non-melanoma skin cancers focusing on education, prevention and the need for improved patient care.

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