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What is skin cancer?

    
Skin cancer is a malignant tumor that grows from the skin cells. It occurs when cells in your skin grow abnormally and out of control. The cancer cells can occasionally spread to other parts of your body. There are three main types of skin cancer:

  • Basal cell carcinoma—Accounts for approximately 80 percent of all skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin, mainly those areas exposed to the sun, such as the head, neck, arms, hands and face. 
  • Squamous cell carcinoma—Although more aggressive than basal cell carcinoma, squamous cell carcinoma is highly treatable. It accounts for about 20 percent of all skin cancers. It may appear as nodules or red, scaly patches of skin, and may be found on sun-exposed areas such as the face, ears, lips and mouth. If left untreated, squamous cell carcinoma can spread to other parts of the body. 
  • Malignant melanoma—Accounts for a small percentage of all skin cancers, but accounts for most deaths from skin cancer. It starts in the melanocytes—cells that produce pigment in the skin. Malignant melanomas sometimes begin as an abnormal mole that then turns cancerous. This cancer may spread quickly. 

Our approach

At Northwell Health Cancer Institute, your treatment is individualized to meet your needs. We integrate with palliative care physicians and social workers to quickly address pain and emotional needs. Your diagnosis and treatment will be vetted by your medical oncologist, nurse and nurse practitioner, who closely interact with surgical oncologists, radiation oncologists, dermatologists and dermatopathologists at multidisciplinary tumor board meetings. We follow national established guidelines but also think outside the box for the best possible results.

Highlights of our skin cancer treatments and services include:

  • Collaboration with local and regional dermatology practices for seamless care
  • Sophisticated surgical and reconstructive techniques, such as Mohs skin cancer surgery
  • Cutting-edge approaches to delivering immunotherapy and chemotherapy
  • Precision radiation techniques, such as stereotactic radiation therapy and intensity modulated radiation therapy (IMRT), that protect healthy tissue while targeting diseased areas

Research at Northwell

As part of your skin cancer treatment plan, you also may have opportunities to participate in clinical trials. These trials study new chemotherapy or immunotherapy drugs, radiation technologies and surgical approaches. While not every patient is a candidate for clinical trials, your care team will work with you to determine eligibility. Learn more about clinical trials at Northwell Health.

Symptoms

Changes in the skin are the main warning sign for skin cancer. Each type of skin cancer can appear differently, so it is important to talk with your doctor when you notice a change in your skin. 

For basal cell carcinoma, two or more of the following features may be present:

  • An open sore that bleeds, oozes, or crusts and remains open for several weeks
  • A reddish, raised patch or irritated area that may crust or itch, but rarely hurts
  • A shiny pink, red, pearly white, or translucent bump
  • A pink growth with an elevated border and crusted central indentation
  • A scar-like, white, yellow, or waxy area, often with a poorly defined border

Squamous cell carcinoma can often crust, bleed, and appear as:

  • A wart-like growth
  • A persistent, scaly red patch with irregular borders that may bleed easily
  • An open sore that persists for weeks
  • A raised growth with a rough surface and a central depression

Some types of skin cancer spread along the nerves. If this happens, it can cause itching, pain, numbness, tingling or a feeling like there is ants crawling under the skin. Other signs may include lumps or bumps under the skin in areas such as the neck, armpit or groin.

When to see a doctor

You can perform a quick self-exam for skin cancer at home, but everyone should receive regular full skin exams from a doctor. If you notice a new growth or spot during a self-exam, you should make an appointment with your dermatologist immediately.

Risk factors

Risk factors include:

  • Being fair-skinned, especially those with blond or red hair and light-colored eyes
  • Family history of melanoma
  • Personal history of skin cancer
  • Sun exposure (the amount of time spent unprotected in the sun directly affects the risk of skin cancer)
  • Early childhood sunburns (research has shown that sunburns early in life increase a person's risk for skin cancer later in life)
  • Many freckles
  • Large or many ordinary moles
  • Dysplastic nevi
  • Being male
  • An immunosuppressive disorder or weakened immune system (such as in people who have had organ transplants)
  • Exposure to certain chemicals, like arsenic
  • Radiation exposure
  • Smoking
  • HPV (human papillomavirus)
  • Certain rare inherited conditions, such as basal cell nevus syndrome (Gorlin syndrome) or xeroderma pigmentosum (XP)

While some people are more at risk than others, anyone can develop skin cancer–-so regardless of your history, it’s important to regularly check your skin for unusual spots or bumps.

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Diagnosis

Skin cancer may first appear as a new mole, a change in a growth or mole, a sore that doesn't heal or an irritation of the skin. Northwell Health is your critical partner in cancer treatments and services. You will be seen quickly for a diagnosis and your physician will work with you to help select the right treatment to fit your lifestyle. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This may include when you first noticed the skin feature, how long it has been there and any other symptoms you may be experiencing, in addition to your personal and family history. If skin cancer is suspected, other tests will be done to make a diagnosis.

Treatment types

Mohs micrographic surgery

Mohs micrographic surgery is a highly specialized surgical procedure for the removal of skin cancers. Of all the treatments for skin cancer, Mohs micrographic surgery offers the highest cure rate (up to 99 percent) and the lowest chance for regrowth. It removes minimal skin, minimizes the potential for scarring and is the most exact and precise method currently available for removing skin cancer. Mohs surgery is typically used to treat the two most common forms of skin cancer, basal cell carcinoma and squamous cell carcinoma, but has been used successfully for certain types of melanoma and other types of skin cancer. Mohs surgery is very useful for skin cancers in cosmetically sensitive areas of the face where preservation of healthy skin is of utmost concern, such as the ears, lips, nose or near the eye. It is also recommended for tumors that are large or have aggressive root systems and for tumors that have indistinct clinical margins.

Surgery for advanced head and neck skin cancer

The common non-melanoma skin cancers (basal cell and squamous cell), when diagnosed early, can be managed by a dermatologist skilled in the technique of Mohs surgery. More advanced non-melanoma skin cancers often require the expertise of head and neck surgeons and a reconstructive surgery team.

Other treatment types include:

  • Chemotherapy—The way chemotherapy is given depends on the condition being treated. Drugs or topical creams or lotions are the treatment forms. At times, oral or intravenous chemotherapies are administered to help improve cure rates of resected skin cancers, or to treat metastatic disease.
  • Photodynamic therapy—This treatment uses a drug and light from a laser to kill cancer cells while leaving limited damage to healthy tissue.
  • Targeted therapy—Uses substances or drugs called signal transduction inhibitor which block molecular signals and may kill cancer cells. This type of therapy generally results in less damage to healthy cells than radiation or standard chemotherapy.
  • Immunotherapy—Medication is administered intravenously to allow the patient’s own immune system to better fight the cancer. This treatment has been a paradigm shift in the treatment of malignant melanoma, squamous cell cancers, and Merkel Cell cancer. 
  • Radiation therapy—Depending on the treatment plan and the type of cancer being treated, there are two types: external radiation using high-energy X-rays is used or internal radiation using radioactive substances utilizing different delivery mechanisms.

Living with skin cancer

  • Wear a wide-brimmed hat and long sleeves and pants if you are going to be outdoors for a long time.
  • Avoid the sun between 10 a.m. and 4 p.m., which is the peak time for UV rays.
  • Wear sunscreen on exposed skin. Make sure to use a broad-spectrum sunscreen that has a sun protection factor (SPF) of 30 or higher. Use it every day, even when it is cloudy.
  • Do not use tanning booths or sunlamps.
  • Use lip balm or cream that has sun protection factor (SPF) to protect your lips from getting sunburned.
  • Wear sunglasses that block UV rays.
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