Skin cancer is the most common form of cancer in humans. The incidence of skin cancers increases yearly.

On this page:

• Basal Cell Carcinoma
• Squamous Cell Carcinoma
• Melanoma
• Causes of Skin Cancer
• Risk Factors
• Screening and Diagnosis
• Treatment
• Mohs Microscopic Surgery
• Clinical Trials
• Research
• Skin Cancer Care Team

Basal Cell Carcinoma

Basal cell carcinoma accounts for about 80 percent of all skin cancers. It is a slowly growing cancer, which does not tend to metastasize (spread), but can cause destruction of skin tissue locally. A basal cell cancer in these areas may invade into cartilage and bone, and can result in complete loss of these structures if left untreated. Basal cell carcinoma typically begins as a persistently pink or pearly white area, which later may break down to form an ulcer or bleed.

Squamous Cell Carcinoma

Squamous cell carcinoma is the second most common skin cancer (about 12 percent of skin cancers). It grows more quickly than basal cell cancer, and may also metastasize to lymph nodes and internal organs, sometimes causing death. Squamous cell cancers begin as raised red scaly areas which persist over months.

Melanoma

Melanoma is the least common but most deadly of all skin cancers. For more information, see the Melanoma Web page.

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Causes of Skin Cancer

A tumor is defined by the abnormal, uncontrolled growth of cells. Benign tumors tend to grow in single locations and may require removal if they interfere with a body function. Malignant tumors are termed cancers. In addition to causing local destruction of normal structures, cancers may recur in the same location after treatment, and can spread to other parts of the body — a process termed "metastasis." 

The largest factor causing skin cancer is ultraviolet radiation found in sunlight. Most skin cancers occur on the sun-exposed parts of the body; the head, neck, arms and hands. An individual's risk of skin cancer depends upon many factors, some of which are listed below. 

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Risk Factors

• Ultraviolet radiation (UV) from the sun — Outdoor occupations and long hours of outdoor recreation are also associated with a greater tendency to form skin cancer.
• Artificial sources of UV radiation — Exposure to X-rays can increase the risk of developing skin cancer.
• People who have fair-skin that burn or freckle easily are at a greater risk than those who are dark skinned and tan easily.
• Severe sunburns occurring during childhood.
• Chronic arsenic exposure, usually through pesticides.
• Chronic exposure to chemical carcinogens, such as coal tar or other tar derivatives.
• Chronic immunosuppression after organ transplantation.

Individuals who have had one skin cancer have an increased chance of discovering another skin cancer within two or three years. Therefore, those who have had one skin cancer should be examined by a dermatologist at least once a year.

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Screening and Diagnosis

Adults should examine their skin regularly and pay attention to any change in the size, color, texture or shape of a mole or other darkly pigmented area; the appearance of a new, abnormal mole; or spontaneous bleeding from a mole. Changes in other bumps or nodules in the skin are also suspect. 

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Treatment

According to the type of cancer and stage of the disease, doctors may choose among several treatment options or a combination of methods such as:

• radiation 
• chemotherapy
• immunotherapy
• surgery

Surgical removal of a non-melanoma or melanoma is the most common and still the most effective treatment. 

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Mohs Micrographic Surgery

In addition to routine excisional surgery, University of Minnesota physicians offer a unique kind of surgery for skin cancer called Mohs Surgery.

Performed in an outpatient setting, Mohs Surgery is used to treat aggressive cancer and cancer in cosmetically sensitive areas, such as the nose, eyelids, or anywhere on the face. This unique procedure involves removing skin cancer by taking special horizontal sections (routine excisional surgery removes vertical sections) and reviewing the specimen using a microscope at the time of surgery. This way, the cancer can be removed completely without any guesswork.

Mohs Surgery also requires smaller incisions, resulting in a smaller surgical defect and ultimately a smaller scar. When properly performed, Mohs Surgery gives the highest rate of cure for Basal and Squamous cell cancer while removing the least amount of normal, healthy skin. Currently, Mohs Surgery also is performed for certain types of melanomas, especially ones located on the head and neck region.

Because the technique requires highly specialized training, specialized office personnel, and a team effort, few medical centers in the country are equipped to offer this treatment. University of Minnesota dermatologic surgeon Peter Lee, M.D., Ph.D. is among a handful of Mohs College-trained surgeons in the state of Minnesota who perform Mohs Surgery.  

How the procedure works

While the patient is under a local anesthetic, the surgeon removes a section of the skin that the tumor may have invaded. This takes only a few minutes. The tissue is then immediately processed under a microscope in the lab. If the microscopic reading shows cancer, another section is taken from the tumor location. The process is repeated until the slides show no remaining cancer cells. This process allows the surgeon to see results immediately and is more accurate than other skin cancer treatments. 

Reconstructive surgery after Mohs Surgery

After patients are treated with Mohs Surgery, they often have a defect or wound that may require reconstructive surgery. Dr. Lee, an experienced dermatologic surgeon with years of facial reconstructive surgical experience, performs this type of surgery as needed. 

For more information about Mohs Surgery, read Cancer Center Story: "Research inroads against melanoma"

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Clinical Trials

Clinical trials are studies that evaluate the effectiveness of new interventions for patients. There are different types of cancer clinical trials such as prevention trials, early detection trials, and treatment trials. If you take part in a clinical trial, you may benefit from a new drug, procedure, or symptom-control method while helping scientists evaluate its effectiveness. 

The skin cancer care team is actively engaged in both national and regional clinical trials for skin cancer.

• Skin cancer trials available through Cancer Center
• All clinical trials available through the Masonic Cancer Center

If you have questions about clinical trials, or if you need help searching for a clinical trial at the University of Minnesota or other facilities locally or nationally, please contact the Masonic Cancer Center's Cancer Information Line.

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Research

Current research within the skin cancer program includes: 

• Investigating the effectiveness of photodynamic therapy in treating non-melanoma skin cancers.
• Determining the effect of laser treatment of acquired moles. 
• Comparing the effectiveness of interferon plus vaccine versus interferon alone in treating advanced melanoma.
• Using topical human response modifiers for treatment of actinic keratoses.
• Testing for a promising new cancer therapy that uses a patient's own cancer cells to create a vaccine. 

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Skin Cancer Care Team

The skin cancer care team at the University of Minnesota offers individuals with any type of skin cancer a comprehensive program in skin cancer screening, diagnosis, treatment, after-treatment support, and ongoing follow-up. Both standard-of-care and investigational treatment strategies are offered. Our team includes general dermatologists; dermatologic surgeons; dermatopathologists; oncologists; and general, plastic, and head and neck surgeons. 

For more information about skin cancer specialists at the University of Minnesota and how to schedule an appointment, visit the University of Minnesota Physicians Web site. The links below go to physician profiles on the University of Minnesota Physicians site. To return to the Cancer Center site, either bookmark this page or use your browser's back button.

General Dermatology
Dermatology Clinic, 612-626-6666 
Maria Hordinsky, M.D.
Kimberly Bohjanen, M.D.

Dermatologic Surgery
Cutaneous Surgery and Laser Center, 612-626-6999
Peter K. Lee, M.D., Ph.D.

Dermatopathology
Dermatopathology Office, 612-625-7420 
Desiree Langel, M.D.

Medical Oncology
Medical Oncology Clinic, 612-625-5411 
Arek Dudek, M.D.
Elena Chiorean, M.D.

General Surgery
Surgery Clinic, 612-626-6666 
Todd Tuttle, M.D., 612-625-1400 

Plastic and Reconstructive Surgery
Surgery Clinic, 612-626-6666 
Bruce L. Cunningham, M.D., 612-625-1188 

Head and Neck Surgery
ENT Clinic, 612-625-3200 

Oculoplastics
Andrew Harrison, M.D., Director, Ophthalmic Plastic and Reconstructive Surgery, 612-625-4400 

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* Courtesy of American Academy of Dermatology