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Skin Cancer

Determining the Type of Skin Cancer

First, remember that not all lumps and bumps and lesions on the skin are cancer. Next, there are some lesions that are abnormal and should be removed because they can develop into cancer. Examples of pre-cancerous lesions include:

  • Actinic keratoses
  • Keratoacanthoma
  • Bowen’s Disease

If you do have skin cancer, there are two main types:

  • Melanoma (cutaneous malignant melanoma)
  • Non-melanoma skin cancer (NMSC)

Cutaneous Malignant Melanoma (CMM)

Malignant melanoma is a type of cancer that comes from melanocytes. When melanoma is on the skin, it is called cutaneous malignant melanoma. When it is on inner body surfaces (such as inside the nose or mouth), it is called mucosal malignant melanoma. Mucosal melanoma is staged and treated differently than other types of cancers.

There are a number of subtypes of cutaneous malignant melanoma. These differ based on their appearance and special features seen only under the microscope.

The World Health Organization has identified the following types of malignant melanoma of the skin:

  • Superficial spreading melanoma
  • Nodular melanoma
  • Lentigo maligna melanoma
  • Acral lentiginous melanoma
  • Desmoplastic melanoma
  • Melanoma arising from a blue nevus
  • Melanomal arising in a giant congenital nevus
  • Melanoma of childhood
  • Nevoid melanoma

Non-Melanoma Skin Cancer (NMSC)

In this group, skin cancers start from cells called keratinocytes in the outer layer of the skin. These include:

  • Basal cell carcinoma: These are cancers from the epidermis cells in the deepest layer of the epidermis. These are the most common type of NMSC, making up about 70 to 75 percent of skin cancers. These are probably also the most common cancer in the U.S. Some people can have multiple basal cell carcinomas. They are generally very slow growing, slow to invade deeply and rarely spread to lymph nodes. However, some types can be more aggressive than others. The WHO classifies basal cell carcinomas into these types:
    • Superficial basal cell carcinoma
    • Nodular (solid) basal cell carcinoma
    • Micronodular basal cell carcinoma
    • Infiltrating basal cell carcinoma
    • Fibroepithelial basal cell carcinoma
    • Basal cell carcinoma with adnexal differentiation
    • Basosquamous carcinoma
    • Keratotic basal cell carcinoma
  • Squamous cell carcinoma: This second most common type of NMSC is from cells in the epidermis as well. These can be more aggressive than basal cell carcinomas. There are also a number of subtypes of squamous cell carcinomas as classified by the World Health Organization.
    • Acantholytic squamous cell carcinoma
    • Spindle-cell squamous cell carcinoma
    • Verrucous squamous cell carcinoma
    • Pseudovascular squamous cell carcinoma
    • Adenosquamous carcinoma

About 5 percent of non-melanoma skin cancers actually come from cells in the skin that are not epithelial (not from the outer lining). These are called adnexal (next to an organ) cancers, neural cancers, soft tissue cancers and hematolymphoid cancers. A few examples of these include:

  • Merkel cell carcinoma: This is a type of cancer from Merkel cells in the epidermis. These are very rare skin cancers, but they can be quite aggressive. They can also recur or spread to lymph nodes as well as spread throughout the body.
  • Sebaceous carcinoma: This is cancer from cells that make up the oil glands in the skin. Most of these cancers are found in the skin around the eye. These are usually slow growing but should be treated by a doctor who specializes in cancer.
  • Atypical fibroxanthoma
  • Carcinoma of the sweat glands
  • Pilomatrical carcinoma
  • Proliferating trichilemmal tumor
  • Microcystic adnexal carcinoma
  • Porocarcinoma
  • Spiradenocarcinoma
  • Malignant mixed tumor
  • Hidradenocarcinoma
  • Mucinous carcinoma
  • Apocrine carcinoma
  • Ewing sarcoma
  • Primitive neuroectodermal tumor (PNET)
  • Granular cell tumor
  • Dermatofibrosarcoma protuberans
  • Cutaneous angiosarcoma

Also, because there are lymphatic tissues in the skin, lymphomas can also be found in the skin. Those should be evaluated and treated by a medical oncologist.

Finally, even more rarely, spread of cancers from other sites could show up in this area. This includes spread from lung, kidney, breast or ovarian cancer.

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.

24 Veronesi U, Cascinelli N. Narrow excision (1-cm margin). A safe procedure for thin cutaneous melanoma. Arch Surg 1991;126:438-441.

25 Balch CM, Urist MM, Karakousis CP, et al. Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial. Ann Surg 1993;218:262-267; discussion 267-269.

26 Haigh PI, DiFronzo LA, McCready DR. Optimal excision margins for primary cutaneous melanoma: a systematic review and meta-analysis. Can J Surg 2003;43:419-426.

27 Kuijpers DI, Thissen MR, Berretty PJ, et al. Surgical excision versus curettage plus cryosurgery in the treatment of basal cell carcinoma. Dermatol Surg 2007;33:579-587.

28 O’Connor WJ, Roenigk RK, Brodland DG. Merkel cell carcinoma. Comparison of Mohs micrographic surgery and wide excision in eighty-six patients. Dermatol Surg 1997;23:929-933.

29 Asgari MM, Moffet HH, Ray GT, Quesenberry CP. Trends in basal cell carcinoma incidence and identification of high-risk subgroups, 1998-2012. JAMA Dermatol 2015; 151:976-981.

30 Walther U, Kron M, Sander S, et al. Risk and protective factors for sporadic basal cell carcinoma: results of a two-centre case-control study in southern Germany. Clinic actinic elastosis may be a protective factor. Br J Dermatol 2004;151:170-178.

31 Marrazzo G, Thorpe R, Condie D, et al. Clinical and Pathologic Factors Predictive of Positive Radiologic Findings in High-Risk Cutaneous Squamous Cell Carcinoma.

32 Gupta SG, Wang LC, Penas PF, et al. Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: The Dana-Farber experience and meta-analysis of the literature. Arch Dermatol 2006;142:685-690.

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