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Skin Cancer

There are a number of different types of skin cancers. The most useful system is to classify skin cancers into malignant melanoma versus non-melanoma skin cancers (NMSC).

  • Non-Melanoma Skin Cancers (NMSC): This group of skin cancers includes mainly basal cell carcinomas (most common) and squamous cell carcinomas. Together, these two types of cancer account for about 95 percent of NMSC. The other 5 percent of NMSCs includes cancers that are often not from the outer surface layer of the skin but from cells that support the skin.Because squamous cell cancers and basal cell cancers of the skin are not all reported to national cancer registries (as a matter of policy), it can be difficult to know the exact number of new cases every year. However, according to the American Cancer Society, NMSC were diagnosed in 3.5 million people in the U.S., and 2.2 million people were treated for the disease in 2006, with some patients having multiple diagnoses. Most, but not all, of these forms of skin cancer are highly curable because they are often very small when found. Actually, despite millions of new cases of NMSC diagnoses each year, there are fewer than 1,000 deaths related to NMSC. An example of an NMSC that arises from a skin support cell is Merkel Cell Carcinoma. This rare cancer arises from nerve-like cells under the skin surface and is most common in whites, the elderly and sometimes immunocompromised people. It is most commonly found in the head and neck region, though it can arise in the skin of any part of the body.
  • Malignant Melanoma of the Skin: This is increasingly common in the U.S. Interestingly, of all the skin in the body, that small area of skin in the head and neck skin is involved in about 25 percent of all melanomas. Usually, melanoma is much more serious than NMSCs (because of a higher risk of spread to other parts of the body), and you should see a doctor that regularly treats this type of cancer. According to the American Cancer Society, melanoma incidence rates have been increasing for at least 30 years. In fact, since 2004, incidence rates have been increasing by almost 3 percent per year in both men and women.
References

1 Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United State: Incidence. J Am Academy of Dermatology. 1994;30:774.

2 American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society; 2012.

3 Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol. 2010:37:20-27.

4 LeBoit PE, Burg G, Weedon D, Sarasain A. (Eds.): World Health Organization. Classification of Tumours. Pathology and Genetics of Skin Tumours. IARC Press: Lyon 2006.

5 Rubin AI, Chen EH, Ratner D. Basal Cell Carcinoma. N Engl J Med. 2005;353:2262-2269.

6 Walling HW, Fosko SW, Geraminejad PA, Whitaker DC, Arpey CJ. Aggressive basal cell carcinoma: Presentation, pathogenesis, and management. Cancer and Metastasis Reviews. 2004;23(3-4):389-402.

7 Hollestein LM, de Vries E, Nijsten T. Trends of cutaneous squamous cell carcinoma in the Netherlands: Increased incidence rates, but stable relative survival and mortality 1989-2008. European Journal of Cancer. 2012;48(13):2046-2053.

8 Lardar T, Shea SM, Sharfman W, Liegeois N, Sober AJ. Improvements in the Staging of Cutaneous Squamous-Cell Carcinoma in the 7th Edition of the AJCC Cancer Staging Manual. Annals of Surgical Oncology. 2010;17(8):1979-1980.

9 Cockburn M, Peng D, Key C. Chapter 12: Melanoma. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

10 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. Chapter 31: Melanoma of the Skin. P329.

11 Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD.

12 Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003;49:832-41.

13 Engels EA, Frisch M, Goedert JJ, Biggar RJ, Miller RW. Merkel cell carcinoma and HIV infection. The Lancet. 2002;359(9305):497-498.

14 Buell JF, Trofe J, Hanaway MJ, et al. Immunosuppresion and Merkel cell cancer. Transplant Proc. 2002;34(5):1780-1.

15 Penn I, First MR. Merkel cell carcinoma in organ recipients: report of 41 cases. Transplantation. 1999;68(11):1717-21.

16 Young JL, Ward, KC, Ries LAG. Chapter 30: Cancers of Rare Sites. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.

17 Albores-Saavedra J, Batich K, Chable-Montero F, Sagy N, Schwartz AM, Henson DE. Merkel cell carcinoma demographics, morphology, and survival based on 3870 cases: a population based study. J Cutan Pathol. 2010:37:20.

18 Wang TS, Byrne PJ, Jacobs LK, Taube JM. Merkel Cell Carcinoma: Update and Review. 2011 Seminars in Cutaneous Medicine and Surgery: 30(1):48-56.

19 Robinson JK. Follow-up and prevention (basal cell carcinoma). In: Miller SJ, Maloney ME, eds. Cutaneous Oncology Pathophysiology, diagnosis, and management. Malden, MA: Blackwell Science; 1998:695-698.

20 Shin DM, Maloney ME, Lippman SM. Follow-up and prevention (squamous cell carcinoma). In: Miller SJ, Maloney ME, eds. Cutaneous Oncology Pathophysiology, diagnosis, and management. Malden, MA: Blackwell Science; 1998.

21 Romano E, Scordo M, Dusza SW, et al. Site and timing of first relapse in stage III melanoma patients: implications for follow-up guidelines. J Clin Oncol 2010;28:3042-3047.

22 Dicker TJ. Kavanagh GM, Herd RM, et al. A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group. Br J Dermatol 1999;140:249-254.

23 Johnson TM,Bradford CR,Gruber SB,Sondak VK,Schwartz JL. Staging workup, sentinel node biopsy, and follow‐up tests for melanoma: update of current concepts. Arch Dermatol. 2004; 140: 107–113.

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