Pediatrics - Skin Cancer
Skin cancer is the most common form of cancer in the United States. There are many types of skin cancers. They are classified as melanomas or non-melanomas. Melanomas begin in the melanocytes, the cells in skin that produce color. Melanoma can spread quickly to other parts of the body. It is the deadliest form of skin cancer. Non-melanomas originate in skin cells other than melanocytes. Non-melanomas are less aggressive and rarely spread.
Exposure to the ultraviolet (UV) rays in the sun and a history of childhood sunburns are the main causes of most skin cancers. In some cases, skin cancer may be prevented. Skin cancer that is detected and treated early is very curable. It is important to have regular skin and mole checks by a skin specialist. Untreated skin cancer can cause disfigurement, spread to other parts of the body, and cause death.
The skin covers the body and protects it from the environment. The skin is composed of three major layers, the epidermis, dermis, and subcutaneous tissue. The epidermis is the outermost layer of the skin. It protects the inner skin layers. The epidermis is made up of protein containing cells called keratinocytes, also referred to as squamous cells. The keratinocytes form at the bottom layer of the epidermis and move upward to the outer layer. They eventually wear off and are replaced by the next layer of cells. The epidermis also contains melanocytes. This type of cell contains color pigments called melanin. The lowest layer of the epidermis is composed of basal cells.
The dermis is the second layer of skin. It is made up of connective tissue and provides structure. It is composed of collagen and various elements that give the skin strength and elasticity. The dermis contains hair cells, sweat glands, and sebaceous glands that secrete oils to hydrate the skin.
Subcutaneous tissue composes the inner most layer of skin. Subcutaneous tissue contains fat cells. The fat cells insulate the body and make the skin appear plump and full. Below the subcutaneous tissue are fat tissues, muscles, and bones.
Basal cell carcinoma and squamous cell carcinoma are common non-melanomas that result from changes in the basal cells and squamous cells, respectively, in the epidermis layer of the skin. Non-melanomas are slower growing and tend to spread less aggressively than melanomas. However, if untreated, nonmelanoma skin cancers can grow quite large and cause disfigurement.
There are many different types of skin cancers, and they have several different appearances. Skin cancer can develop on normal skin, injured skin, or moles. Melanoma can develop on the skin, in a mole, or in the iris or retina of the eye. You should look for changes in the shape, texture, size, or color of a mole or new skin growth. Skin cancer may look like a sore that does not heal. Cancerous moles or skin areas may also develop pain, swelling, itching, and bleeding.
Nonmelanoma skin cancers tend to develop on places that have been exposed to the sun, such as the scalp, nose, ears, face, and the backs of the hands. Melanoma can develop anywhere on the skin, even in places that have not been exposed to the sun. However, the backs of men and the lower legs of women are the most frequent places that melanoma develops.
The ABCD method is useful when examining your child’s skin for cancer related changes:
A- Asymmetry: One half of the abnormal area does not match the other half.
B- Border Irregularity: The growth or mole has uneven, notched, ragged, or irregular edges.
C- Color: The abnormal area or mole contains different colors instead of one solid color.
There may be different shades of tan, brown, black, red, blue, or white.
D- Diameter: The mole or abnormal growth is larger than ¼ inch across. However, some melanomas may be smaller.
Actinic keratosis is a precancerous condition that can turn into melanoma. Actinic keratosis results from overexposure to the sun. They look like small rough dry patches on the skin. They may be pink-red or skin colored. They typically appear in areas that have been exposed to the sun. Actinic keratosis are slow growing. They may go away on their own and come back. Your doctor should remove actinic keratosis.
Your doctor can diagnose skin cancer by examining the growth and performing a biopsy of the suspected area. A biopsy is a simple procedure that takes tissue for examination. There are a few types of biopsy methods.
After numbing your child’s skin, your doctor may perform a shave, punch, incisional, or excisional biopsy. A shave biopsy removes the top layers of the skin. A punch biopsy uses a round punch to cut through all of the layers of skin to remove a tissue plug. An incisional biopsy removes a part of the tumor, and an excisional biopsy removes the entire tumor. In some cases, the incisions will need to be stitched.
The tissue samples are sent to a laboratory for examination. Request to have your child’s tissue sample examined by a dermapathologist. A dermapathologist is a pathologist with special training in skin cell disorders. The dermapathologist will determine if your child’s tissue sample contains skin cancer and identify the type and extent of skin cancer.
Your doctor’s office will contact you with the results when they receive them. Skin cancer is classified based on how far it has spread. Stages are classified as 0-4, with 4 being a more serious cancer. There is more than one type of staging system, so make sure that you and your doctor are referring to the same one. Your doctor will order tests if metastasized (spreading) cancer is suspected.
Skin grafting and reconstructive surgery may be necessary after the removal of large skin cancers. Scarring after skin cancer removal is common. Cosmetic surgery techniques can improve the appearance of scars. Some people choose to cover their scars with make-up.
If your child’s cancer has spread, surgery, radiation, chemotherapy, and immunotherapy treatments may be necessary to treat the metastasized cancer or relieve symptoms. Skin cancer can return even years later. Your doctor will let you know how often you should be rechecked. The five year survival rates are the best for small superficial cancers that were detected and treated early.
Your child may be able to prevent skin cancer by limiting the amount of time that he or she is exposed to the sun. Anyone that is exposed to the sun should wear a sunblock that blocks both UV A and B sunrays. A sunscreen is a different product. Sunscreens allow your child to spend a longer amount of time in the sun without burning than your child could if he or she were not wearing sunscreen. Sunscreens may reduce your risk of getting skin cancer, but it is not a guarantee. If your child is in the sun for a long time, even with sunscreen, your child is at risk for developing skin cancer.
Am I at Risk
Is My Child at Risk?
Risk factors may increase your child’s likelihood of skin cancer, although some people that experience skin cancer may not have any risk factors. People with all of the risk factors may never develop skin cancer; however, the likelihood increases with the more risk factors your child has. You should tell your doctor about your child’s risk factors and discuss your concerns.
Risk factors for skin cancer:
_____ People with light colored skin (Caucasians), blue eyes, green eyes, gray eyes, blond hair, or red hair have an increased risk for developing skin cancer. However, people with darker complexions and dark hair may get skin cancer as well, but they have a lower risk.
_____ People that spend a lot of time in the sun, such as construction workers, farmers, fishermen, lifeguards, sunbathers, and outdoor sport enthusiasts have an increased risk for skin cancer.
_____ Receiving multiple severe sunburns in childhood or as a teenager is a big risk factor for developing skin cancer.
_____ People that have had skin cancer before are at risk for developing skin cancer again.
_____ Cigarette smoking can contribute to skin cancer. The tar in cigarettes is a known cancer causing agent.
_____ Exposure to cancer causing chemical agents, such as oils, tars, and arsenic (found in some herbicides) is associated with an increased risk for skin cancer.
_____ Chronically injured skin is a risk factor for skin cancer. Friction burns and injury can cause chronic skin injury.
_____ People with suppressed immune systems, such as organ transplant recipients or people that have AIDS, have an increased risk for skin cancer.
_____ Not wearing a sunblock for UVA and B rays while in the sun increases the risk of skin cancer.
_____ Your risk for skin cancer increases with age. Most cases develop in people that are middle aged or elderly, but it certainly can develop in younger people.
_____ People that sunburn easily are at a higher risk for developing skin cancer.
_____ People with multiple moles have a higher risk of developing skin cancer.
_____ People with dysplastic or atypical moles have an increased risk for developing melanoma.
_____ People with freckled skin have a higher risk of developing skin cancer.
_____ Artificial tanning lights used in tanning booths, beds, and lamps have harmful UV rays and increase the risk of skin cancer.
_____ Some people have a genetic predisposition to skin cancer. Skin cancer can run in families. If your child’s close relatives have skin cancer, your child has an increased risk for developing it.
_____ Overexposure to X-rays or other forms of radiation increases the risk of skin cancer.
_____ People with rare genetic disorders, such as nevoid carcinoma syndrome, basal cell nevus syndrome, xeroderma pigmentosum, or Bazex syndrome, have an increased risk for developing skin cancer.
_____ People with the human papilloma virus (HPV) carry an increased potential for developing squamous cell carcinoma.
_____ People that received X-ray treatment for acne in the 1950s have a higher risk of developing squamous cell carcinoma.
_____ Actinic keratosis is a skin condition that can develop into skin cancer. Actinic keratosis results from overexposure to the sun. It looks like rough dry patches on the skin. Your doctor should remove actinic keratosis.
Untreated squamous cell carcinoma may grow quite large and result in disfigurement, such as the loss of an ear or nose. The cancer may turn into a large open sore that is vulnerable to infection. Squamous cell carcinoma can spread to other parts of the body, including fatty tissues, lymph nodes, and internal organs, and cause death. Squamous cell carcinomas located on the lip, ears, palm of the hand, or sole of the foot have the highest risk of spreading.
Untreated basal cell carcinoma can become large and disfiguring if they are at places of concern, such as the face, nose, and ears. Untreated basal cell carcinoma can spread, in rare instances, to the muscles, nerves, bones, and brain. In rare cases, it can result in death.
Skin cancers can come back, even many years later. People that have experienced skin cancer are at risk for developing additional skin cancers in the future. Because the potential consequences are so severe, you should be vigilant about checking your child’s skin and attending all of his or her follow up appointments. It is important to do what you can to prevent future skin cancers.
Researchers have discovered a link between some types of HPV and squamous cell carcinoma. If your child has HPV, you should ask your doctor about your child’s risk and preventative screenings.
Researchers have a good understanding of how the sun’s UV rays damage certain genes and cause skin cancer. Scientists have found changes in genetic material that are both inherited and not inherited but caused by sunlight. It appears that some people can repair damage caused by the sun better than others can, and they are less likely to develop melanoma. Researchers hope to use this information to develop gene therapies to prevent and cure skin cancer.
Researchers hope to use gene therapy in several ways. Researchers anticipate replacing the damaged genes in cells with healthy genes. This has had limited success because usually there is more than one type of damaged gene in a melanoma cell.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.