21st Century Adult Cancer Sourcebook: Nonmelanoma Skin Cancer - Squamous Cell Carcinoma and Basal Cell Carcinoma (BCC and SCC) - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - October 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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PART ONE
Chapter 1A: Nonmelanoma Skin Cancer Patient Information
Chapter 2A: Nonmelanoma Skin Cancer Health Professional Information
Chapter 3A: Nonmelanoma Skin Cancer NCI Drugs
Chapter 4A: Nonmelanoma Skin Cancer Background Information
Chapter 5A: Skin Cancer Clinical Trials
PART TWO
Chapter 1B: Levels of Evidence for Adult and Pediatric Cancer Treatment Studies (NCI)
Chapter 2B: Glossary of Clinical Trial Terms
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: Chemotherapy and You
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PART ONE
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Chapter 1A: Nonmelanoma Skin Cancer Patient Information
Patient Version
Last Modified: 05/02/2011
General Information About Skin Cancer
Key Points for This Section
* Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.
* Skin color and exposure to sunlight can affect the risk of developing nonmelanoma skin cancer and actinic keratosis.
* Nonmelanoma skin cancer and actinic keratosis often appear as a change in the skin.
* Tests or procedures that examine the skin are used to detect (find) and diagnose nonmelanoma skin cancer and actinic keratosis.
* Certain factors affect prognosis (chance of recovery) and treatment options.
Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.
The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of 3 kinds of cells:
* Squamous cells: Thin, flat cells that form the top layer of the epidermis.
* Basal cells: Round cells under the squamous cells.
* Melanocytes: Found in the lower part of the epidermis, these cells make melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment, causing the skin to darken.
Skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, neck, hands, and arms. There are several types of cancer that start in the skin. The most common types are basal cell carcinoma and squamous cell carcinoma, which are nonmelanoma skin cancers. Actinic keratosis is a skin condition that sometimes develops into squamous cell carcinoma.
This summary refers to the treatment of nonmelanoma skin cancer and actinic keratosis. Nonmelanoma skin cancers rarely spread to other parts of the body. Melanoma, the rarest form of skin cancer, is more likely to invade nearby tissues and spread to other parts of the body.
Skin color and exposure to sunlight can affect the risk of developing nonmelanoma skin cancer and actinic keratosis.
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for basal cell carcinoma and squamous cell carcinoma include the following:
* Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
* Having a fair complexion, which includes the following:
* Fair skin that freckles and burns easily, does not tan, or tans poorly.
* Blue or green or other light-colored eyes.
* Red or blond hair.
* Having actinic keratosis.
* Past treatment with radiation.
* Having a weakened immune system.
* Being male.
Risk factors for actinic keratosis include the following:
* Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
* Having a fair complexion, which includes the following:
* Fair skin that freckles and burns easily, does not tan, or tans poorly.
* Blue or green or other light-colored eyes.
* Red or blond hair.
Nonmelanoma skin cancer and actinic keratosis often appear as a change in the skin.
Not all changes in the skin are a sign of nonmelanoma skin cancer or actinic keratosis, but a doctor should be consulted if changes in the skin are seen.
Possible signs of nonmelanoma skin cancer include the following:
* A sore that does not heal.
* Areas of the skin that are:
* Small, raised, smooth, shiny, and waxy.
* Small, raised, and red or reddish-brown.
* Flat, rough, red or brown, and scaly.
* Scaly, bleeding, or crusty.
* Similar to a scar and firm.
Possible signs of actinic keratosis include the following:
* A rough, red, pink, or brown, raised, scaly patch on the skin.
* Cracking or peeling of the lower lip that is not helped by lip balm or petroleum jelly.
Tests or procedures that examine the skin are used to detect (find) and diagnose nonmelanoma skin cancer and actinic keratosis.
The following procedures may be used:
* Skin examination: A doctor or nurse checks the skin for bumps or spots that look abnormal in color, size, shape, or texture.
* Biopsy: All or part of the abnormal-looking growth is cut from the skin and viewed under a microscope by a pathologist to see if cancer cells are present. There are 3 main types of skin biopsies:
* Shave biopsy: A sterile razor blade is used to “shave-off” the abnormal-looking growth.
* Punch biopsy: A special instrument called a punch or a trephine is used to remove a circle of tissue from the abnormal-looking growth.
* Punch biopsy. A hollow, circular scalpel is used to cut into a lesion on the skin. The instrument is turned clockwise and counterclockwise to cut down about 4 millimeters (mm) to the layer of fatty tissue below the dermis. A small sample of tissue is removed to be checked under a microscope. Skin thickness is different on different parts of the body.
* Excisional biopsy: A scalpel is used to remove the entire growth.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends mostly on the stage of the cancer and the type of treatment used to remove the cancer.
Treatment options depend on the following:
* The stage of the cancer (whether it has spread deeper into the skin or to other places in the body).
* The type of cancer.
* The size and location of the tumor.
* The patient’s general health.
Glossary Terms
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
actinic keratosis (ak-TIH-nik KAYR-uh-TOH-sis)
* A thick, scaly patch of skin that may become cancer. It usually forms on areas exposed to the sun, such as the face, scalp, back of the hands, or chest. It is most common in people with fair skin. Also called senile keratosis and solar keratosis.
basal cell (BAY-sul sel)
* A small, round cell found in the lower part (or base) of the epidermis, the outer layer of the skin.
basal cell carcinoma (BAY-sul sel KAR-sih-NOH-muh)
* Cancer that begins in the lower part of the epidermis (the outer layer of the skin). It may appear as a small white or flesh-colored bump that grows slowly and may bleed. Basal cell carcinomas are usually found on areas of the body exposed to the sun. Basal cell carcinomas rarely metastasize (spread) to other parts of the body. They are the most common form of skin cancer. Also called basal cell cancer.
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
condition (kun-DIH-shun)
* In medicine, a health problem with certain characteristics or symptoms.
dermis (DER-mis)
* The inner layer of the two main layers of the skin. The dermis has connective tissue, blood vessels, oil and sweat glands, nerves, hair follicles, and other structures. It is made up of a thin upper layer called the papillary dermis, and a thick lower layer called the reticular dermis.
epidermis (EH-pih-DER-mis)
* The outer layer of the two main layers of the skin.
excisional biopsy (ek-SIH-zhuh-nul BY-op-see)
* A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.
immune system (ih-MYOON SIS-tem)
* The complex group of organs and cells that defends the body against infections and other diseases.
infection (in-FEK-shun)
* Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
melanin (MEH-luh-nin)
* A pigment that gives color to skin and eyes and helps protect it from damage by ultraviolet light.
melanocyte (meh-LAN-oh-site)
* A cell in the skin and eyes that produces and contains the pigment called melanin.
melanoma (MEH-luh-NOH-muh)
* A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or in the intestines.
microscope (MY-kroh-SKOPE)
* An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
nonmelanoma skin cancer (non-MEH-luh-NOH-muh skin KAN-ser)
* Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) or in squamous cells, but not in melanocytes (skin cells that make pigment).
nurse (nurs)
* A health professional trained to care for people who are ill or disabled.
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
pathologist (puh-THAH-loh-jist)
* A doctor who identifies diseases by studying cells and tissues under a microscope.
petroleum jelly (peh-TROH-lee-um …)
* A thick, greasy, substance with no odor or taste made from petroleum (mixture of oily liquids found in the earth). Petroleum jelly is used on the skin to prevent drying and to help heal scrapes and burns. It is also used as a base for some ointments. Also called petrolatum.
pigment (PIG-ment)
* A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair.
prognosis (prog-NO-sis)
* The likely outcome or course of a disease; the chance of recovery or recurrence.
punch biopsy (... BY-op-see)
* Removal of a small disk-shaped sample of tissue using a sharp, hollow device. The tissue is then examined under a microscope.
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)
* The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.
recover (ree-KUH-ver)
* To become well and healthy again.
risk factor (... FAK-ter)
* Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
scalpel (SKAL-pul)
* A small, thin knife used for surgery.
shave biopsy (shayv BY-op-see)
* A procedure in which a skin abnormality and a thin layer of surrounding skin are removed with a small blade for examination under a microscope. Stitches are not needed with this procedure.
skin cancer (skin KAN-ser)
* Cancer that forms in the tissues of the skin. There are several types of skin cancer. Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) is called basal cell carcinoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called neuroendocrine carcinoma of the skin. Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems.
squamous cell (SKWAY-mus sel)
* Flat cell that looks like a fish scale under a microscope. These cells cover inside and outside surfaces of the body. They are found in the tissues that form the surface of the skin, the lining of the hollow organs of the body (such as the bladder, kidney, and uterus), and the passages of the respiratory and digestive tracts.
squamous cell carcinoma (SKWAY-mus sel KAR-sih-NOH-muh)
* Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma.
stage
* The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
sterile (STAYR-il)
* Unable to produce children. Also means free from germs.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
trephine (TREE-fine)
* A surgical tool used to cut out circular pieces of bone or other tissue.
vitamin D (VY-tuh-min ...)
* A nutrient that the body needs in small amounts to function and stay healthy. Vitamin D helps the body use calcium and phosphorus to make strong bones and teeth. It is fat-soluble (can dissolve in fats and oils) and is found in fatty fish, egg yolks, and dairy products. Skin exposed to sunshine can also make vitamin D. Not enough vitamin D can cause a bone disease called rickets. It is being studied in the prevention and treatment of some types of cancer. Also called cholecalciferol.
Table of Links
1 http://www.cancer.gov/cancertopics/pdq/treatment/melanoma/Patient
2 http://www.cancer.gov/cancertopics/pdq/treatment/mycosisfungoides/Patient
3 http://www.cancer.gov/cancertopics/pdq/treatment/kaposis/Patient
4 http://www.cancer.gov/cancertopics/pdq/treatment/merkelcell/Patient
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Stages of Skin Cancer
Key Points for This Section
* After nonmelanoma skin cancer has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.
* There are three ways that cancer spreads in the body.
* Staging of nonmelanoma skin cancer depends on many factors, including whether the tumor has certain "high-risk" features.
* The following stages are used for nonmelanoma skin cancer:
* Stage 0 (Carcinoma in Situ)
* Stage I
* Stage II
* Stage III
* Stage IV
* Treatment choices are based on the type of nonmelanoma skin cancer or precancerous skin condition diagnosed:
* Basal cell carcinoma
* Squamous cell carcinoma
* Actinic keratosis
After nonmelanoma skin cancer has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.
The process used to find out if cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. A biopsy is often the only test needed to determine the stage of nonmelanoma skin cancer. Lymph nodes may be examined in cases of squamous cell carcinoma to see if cancer has spread to them.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
* Through tissue. Cancer invades the surrounding normal tissue.
* Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
* Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
Staging of nonmelanoma skin cancer depends on many factors, including whether the tumor has certain "high-risk" features.
Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.
The following are high-risk features for nonmelanoma skin cancer:
* The tumor is thicker than 2 millimeters.
* The tumor is described as Clark level IV (has spread into the lower layer of the dermis) or Clark level V (has spread into the layer of fat below the skin).
* The tumor has grown and spread along nerve pathways.
* The tumor began on an ear or on a lip that has hair on it.
* The tumor has cells that look very different from normal cells under a microscope.
The following stages are used for nonmelanoma skin cancer:
Stage 0 (Carcinoma in Situ)
Stage 0 nonmelanoma skin carcinoma in situ. Abnormal cells are shown in the epidermis (outer layer of the skin).
In stage 0, abnormal cells are found in the squamous cell or basal cell layer of the epidermis (topmost layer of the skin). These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed. The tumor is not larger than 2 centimeters at its widest point and may have one high-risk feature.
Stage II
In stage II, the tumor is either:
* larger than 2 centimeters at its widest point; or
* any size and has two or more high-risk features.
Stage III
In stage III:
* The tumor has spread to the jaw, eye socket, or side of the skull. Cancer may have spread to one lymph node on the same side of the body as the tumor. The lymph node is not larger than 3 centimeters.
or
* Cancer has spread to one lymph node on the same side of the body as the tumor. The lymph node is not larger than 3 centimeters and one of the following is true:
* the tumor is not larger than 2 centimeters at its widest point and may have one high-risk feature; or
* the tumor is larger than 2 centimeters at its widest point; or
* the tumor is any size and has two or more high-risk features.
Stage IV
In stage IV, one of the following is true:
* The tumor is any size and may have spread to the jaw, eye socket, or side of the skull. Cancer has spread to one lymph node on the same side of the body as the tumor and the affected node is larger than 3 centimeters but not larger than 6 centimeters, or cancer has spread to more than one lymph node on one or both sides of the body and the affected nodes are not larger than 6 centimeters; or
* The tumor is any size and may have spread to the jaw, eye socket, skull, spine, or ribs. Cancer has spread to one lymph node that is larger than 6 centimeters; or
* The tumor is any size and has spread to the base of the skull, spine, or ribs. Cancer may have spread to the lymph nodes; or
* Cancer has spread to distant parts of the body.
Treatment choices are based on the type of nonmelanoma skin cancer or precancerous skin condition diagnosed:
Basal cell carcinoma
Basal cell carcinoma is the most common type of skin cancer. It usually occurs on areas of the skin that have been in the sun, most often the nose. Often this cancer appears as a small raised bump that has a smooth, pearly appearance. Another type looks like a scar and is flat and firm to the touch. Basal cell carcinoma may spread to tissues around the cancer, but it usually does not spread to other parts of the body.
Squamous cell carcinoma
Squamous cell carcinoma occurs on areas of the skin that have been in the sun, such as the ears, lower lip, and the back of the hands. Squamous cell carcinoma may also appear on areas of the skin that have been burned or exposed to chemicals or radiation. Often this cancer appears as a firm red bump. Sometimes the tumor may feel scaly or bleed or develop a crust. Squamous cell tumors may spread to nearby lymph nodes.
Actinic keratosis
Actinic keratosis is a skin condition that is not cancer, but sometimes changes into squamous cell carcinoma. It usually occurs in areas that have been exposed to the sun, such as the face, the back of the hands, and the lower lip. It appears as rough, red, pink, or brown, raised, scaly patches on the skin, or cracking or peeling of the lower lip that is not helped by lip balm or petroleum jelly.
Glossary Terms
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
actinic keratosis (ak-TIH-nik KAYR-uh-TOH-sis)
* A thick, scaly patch of skin that may become cancer. It usually forms on areas exposed to the sun, such as the face, scalp, back of the hands, or chest. It is most common in people with fair skin. Also called senile keratosis and solar keratosis.
basal cell (BAY-sul sel)
* A small, round cell found in the lower part (or base) of the epidermis, the outer layer of the skin.
basal cell carcinoma (BAY-sul sel KAR-sih-NOH-muh)
* Cancer that begins in the lower part of the epidermis (the outer layer of the skin). It may appear as a small white or flesh-colored bump that grows slowly and may bleed. Basal cell carcinomas are usually found on areas of the body exposed to the sun. Basal cell carcinomas rarely metastasize (spread) to other parts of the body. They are the most common form of skin cancer. Also called basal cell cancer.
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
bone cancer (bone KAN-ser)
* Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
breast cancer (brest KAN-ser)
* Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
capillary (KA-pih-layr-ee)
* The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.
carcinoma in situ (KAR-sih-NOH-muh in SY-too)
* A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
centimeter (SEN-tih-MEE-ter)
* A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.
Clark level IV skin cancer (klark LEH-vul … skin KAN-ser)
* Skin cancer that has spread down into the reticular dermis (the thick bottom layer of the dermis).
Clark level V skin cancer (klark LEH-vul … skin KAN-ser)
* Skin cancer that has spread down into the subcutaneous tissue (tissue beneath the skin).
condition (kun-DIH-shun)
* In medicine, a health problem with certain characteristics or symptoms.
distant cancer (DIS-tunt KAN-ser)
* Refers to cancer that has spread from the original (primary) tumor to distant organs or distant lymph nodes. Also known as distant metastasis.
epidermis (EH-pih-DER-mis)
* The outer layer of the two main layers of the skin.
invasive cancer (in-VAY-siv KAN-ser)
* Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.
lymph (limf)
* The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.
lymph node (limf node)
* A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
lymph vessel (limf ...)
* A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.
lymphatic system (lim-FA-tik SIS-tem)
* The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.
metastasis (meh-TAS-tuh-sis)
* The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).
microscope (MY-kroh-SKOPE)
* An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
millimeter (MIH-luh-MEE-ter)
* A measure of length in the metric system. A millimeter is one thousandth of a meter. There are 25 millimeters in an inch.
nerve (nerv)
* A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.
nonmelanoma skin cancer (non-MEH-luh-NOH-muh skin KAN-ser)
* Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) or in squamous cells, but not in melanocytes (skin cells that make pigment).
petroleum jelly (peh-TROH-lee-um …)
* A thick, greasy, substance with no odor or taste made from petroleum (mixture of oily liquids found in the earth). Petroleum jelly is used on the skin to prevent drying and to help heal scrapes and burns. It is also used as a base for some ointments. Also called petrolatum.
primary tumor (PRY-mayr-ee TOO-mer)
* The original tumor.
radiation (RAY-dee-AY-shun)
* Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).
skin cancer (skin KAN-ser)
* Cancer that forms in the tissues of the skin. There are several types of skin cancer. Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) is called basal cell carcinoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called neuroendocrine carcinoma of the skin. Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems.
spine (spine)
* The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spine encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spinal column, and vertebral column.
squamous cell (SKWAY-mus sel)
* Flat cell that looks like a fish scale under a microscope. These cells cover inside and outside surfaces of the body. They are found in the tissues that form the surface of the skin, the lining of the hollow organs of the body (such as the bladder, kidney, and uterus), and the passages of the respiratory and digestive tracts.
squamous cell carcinoma (SKWAY-mus sel KAR-sih-NOH-muh)
* Cancer that begins in squamous cells, which are thin, flat cells that look like fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma.
stage
* The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stage 0 nonmelanoma skin carcinoma in situ (... non-MEH-luh-NOH-muh skin KAR-sih-NOH-muh in SY-too)
* Abnormal cells are found in the squamous cell or basal cell layer of the epidermis (topmost layer of the skin). These abnormal cells may become cancer and spread into nearby normal tissue. Also called nonmelanoma carcinoma in situ.
stage I nonmelanoma skin cancer (… non-MEH-luh-NOH-muh skin KAN-ser)
* The tumor is not larger than 2 centimeters at its widest point and may have one of the following high-risk features: (1) is thicker than 2 millimeters; (2) has spread into the lower layer of the dermis or into the layer of fat below the skin; (3) has grown and spread along nerve pathways; (4) began on an ear or on a lip that has hair on it; or (5) has cells that look very different from normal cells under a microscope.
stage II nonmelanoma skin cancer (… non-MEH-luh-NOH-muh skin KAN-ser)
* The tumor is larger than 2 centimeters at its widest point; or the tumor is any size and has two or more of the following high-risk features: (1) is thicker than 2 millimeters; (2) has spread into the lower layer of the dermis or into the layer of fat below the skin; (3) has grown and spread along nerve pathways; (4) began on an ear or on a lip that has hair on it; or (5) has cells that look very different from normal cells under a microscope.
stage III nonmelanoma skin cancer (… non-MEH-luh-NOH-muh skin KAN-ser)
* The tumor has spread to the jaw, eye socket, or side of the skull. Cancer may have spread to one lymph node on the same side of the body as the tumor. The lymph node is not larger than 3 centimeters; or, cancer has spread to one lymph node on the same side of the body as the tumor. The lymph node is not larger than 3 centimeters and one of the following is true: (1) the tumor is not larger than 2 centimeters at its widest point and may have one high-risk feature (is thicker than 2 millimeters, has spread into the lower layer of the dermis or the layer of fat below the skin, has grown and spread along nerve pathways, began on an ear or on a lip that has hair on it, or has cells that look very different from normal cells under a microscope); (2) the tumor is larger than 2 centimeters at its widest point; or (3) the tumor is any size and has two or more high-risk features (is thicker than 2 millimeters, has spread into the lower layer of the dermis or the layer of fat below the skin, has grown and spread along nerve pathways, began on an ear or on a lip that has hair on it, or has cells that look very different from normal cells under a microscope).
stage IV nonmelanoma skin cancer (… non-MEH-luh-NOH-muh skin KAN-ser)
* The tumor is any size and may have spread to the jaw, eye socket, or side of the skull. Cancer has spread to one lymph node on the same side of the body as the tumor and the affected node is larger than 3 centimeters but not larger than 6 centimeters, or cancer has spread to more than one lymph node on one or both sides of the body and the affected nodes are not larger than 6 centimeters; or, the tumor is any size and may have spread to the jaw, eye socket, skull, spine, or ribs. Cancer has spread to one lymph node that is larger than 6 centimeters; or, the tumor is any size and has spread to the base of the skull, spine, or ribs. Cancer may have spread to the lymph nodes; or, cancer has spread to distant parts of the body.
staging (STAY-jing)
* Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
vein (vayn)
* A blood vessel that carries blood to the heart from tissues and organs in the body.
Treatment Option Overview
Key Points for This Section
* There are different types of treatment for patients with nonmelanoma skin cancer and actinic keratosis.
* Four types of standard treatment are used:
* Surgery
* Radiation therapy
* Chemotherapy
* Photodynamic therapy
* New types of treatment are being tested in clinical trials.
* Biologic therapy
* Patients may want to think about taking part in a clinical trial.
* Patients can enter clinical trials before, during, or after starting their cancer treatment.
* Follow-up tests may be needed.
There are different types of treatment for patients with nonmelanoma skin cancer and actinic keratosis.
Different types of treatment are available for patients with nonmelanoma skin cancer and actinic keratosis. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Surgery
One or more of the following surgical procedures may be used to treat nonmelanoma skin cancer or actinic keratosis:
* Mohs micrographic surgery: The tumor is cut from the skin in thin layers. During surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove skin cancer on the face.
* Mohs surgery. A surgical procedure to remove skin cancer in several steps. First, a thin layer of cancerous tissue is removed. Then, a second thin layer of tissue is removed and viewed under a microscope to check for cancer cells. More layers are removed one at a time until the tissue viewed under a microscope shows no remaining cancer. This type of surgery is used to remove as little normal tissue as possible and is often used to remove skin cancer on the face.
* Simple excision: The tumor is cut from the skin along with some of the normal skin around it.
* Shave excision: The abnormal area is shaved off the surface of the skin with a small blade.
* Electrodesiccation and curettage: The tumor is cut from the skin with a curette (a sharp, spoon-shaped tool). A needle-shaped electrode is then used to treat the area with an electric current that stops the bleeding and destroys cancer cells that remain around the edge of the wound. The process may be repeated one to three times during the surgery to remove all of the cancer.
* Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy.
* Cryosurgery. An instrument with a nozzle is used to spray liquid nitrogen or liquid carbon dioxide to freeze and destroy abnormal tissue.
* Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
* Dermabrasion: Removal of the top layer of skin using a rotating wheel or small particles to rub away skin cells.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Chemotherapy for nonmelanoma skin cancer and actinic keratosis is usually topical (applied to the skin in a cream or lotion). The way the chemotherapy is given depends on the condition being treated.
Retinoids (drugs related to vitamin A) are sometimes used to treat or prevent nonmelanoma skin cancer. The retinoids may be taken by mouth or applied to the skin. The use of retinoids is being studied in clinical trials for treatment of squamous cell carcinoma.
Photodynamic therapy
Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. For skin cancer, laser light is shined onto the skin and the drug becomes active and kills the cancer cells. Photodynamic therapy causes little damage to healthy tissue.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site 1.
Biologic therapy
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Glossary Terms
abdomen (AB-doh-men)
* The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
actinic keratosis (ak-TIH-nik KAYR-uh-TOH-sis)
* A thick, scaly patch of skin that may become cancer. It usually forms on areas exposed to the sun, such as the face, scalp, back of the hands, or chest. It is most common in people with fair skin. Also called senile keratosis and solar keratosis.
biological therapy (BY-oh-LAH-jih-kul THAYR-uh-pee)
* Treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. Also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in biological therapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct antitumor effect. Also called biological response modifier therapy, biotherapy, BRM therapy, and immunotherapy.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
carcinoma in situ (KAR-sih-NOH-muh in SY-too)
* A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.
catheter (KA-theh-ter)
* A flexible tube used to deliver fluids into or withdraw fluids from the body.
cavity (KA-vih-tee)
* A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
cerebrospinal fluid (seh-REE-broh-SPY-nul FLOO-id)
* The fluid that flows in and around the hollow spaces of the brain and spinal cord, and between two of the meninges (the thin layers of tissue that cover and protect the brain and spinal cord). Cerebrospinal fluid is made by tissue called the choroid plexus in the ventricles (hollow spaces) in the brain. Also called CSF.
chemotherapy (KEE-moh-THAYR-uh-pee)
* Treatment with drugs that kill cancer cells.
clinical trial (KLIH-nih-kul TRY-ul)
* A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
condition (kun-DIH-shun)
* In medicine, a health problem with certain characteristics or symptoms.
cryosurgery (KRY-oh-SER-juh-ree)
* A procedure in which tissue is frozen to destroy abnormal cells. Liquid nitrogen or liquid carbon dioxide is used to freeze the tissue. Also called cryoablation and cryosurgical ablation.
curettage (kyoo-reh-TAZH)
* Removal of tissue with a curette (a spoon-shaped instrument with a sharp edge).
curette (kyoo-RET)
* A spoon-shaped instrument with a sharp edge.
dermabrasion (DER-muh-BRAY-shun)
* A type of surgery used to make the skin smooth and to improve the way deep scars, pits, and wrinkles look. After numbing the skin, a doctor removes the top layer of skin using sandpaper or a brush or burr (small file) that spins at a high speed.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
drug (drug)
* Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
electrode (ee-LEK-trode)
* In medicine, a device such as a small metal plate or needle that carries electricity from an instrument to a patient for treatment or surgery. Electrodes can also carry electrical signals from muscles, brain, heart, skin, or other body parts to recording devices to help diagnose certain conditions.
electrodesiccation (ee-LEK-troh-deh-sih-KAY-shun)
* The drying of tissue by a high-frequency electric current applied with a needle-shaped electrode.
excision (ek-SIH-zhun)
* Removal by surgery.
external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee)
* A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.
follow-up (FAH-loh-up)
* Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.
immune system (ih-MYOON SIS-tem)
* The complex group of organs and cells that defends the body against infections and other diseases.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
internal radiation therapy (in-TER-nul RAY-dee-AY-shun THAYR-uh-pee)
* A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.
laser (LAY-zer)
* A device that forms light into intense, narrow beams that may be used to cut or destroy tissue, such as cancer tissue. It may also be used to reduce lymphedema (swelling caused by a buildup of lymph fluid in tissue) after breast cancer surgery. Lasers are used in microsurgery, photodynamic therapy, and many other procedures to diagnose and treat disease.
laser surgery (LAY-zer SER-juh-ree)
* A surgical procedure that uses the cutting power of a laser beam to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
lesion (LEE-zhun)
* An area of abnormal tissue. A lesion may be benign (not cancer) or malignant (cancer).
microscope (MY-kroh-SKOPE)
* An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
Mohs surgery (moze SER-juh-ree)
* A surgical procedure used to treat skin cancer. Individual layers of cancer tissue are removed and examined under a microscope one at a time until all cancer tissue has been removed. Also called Mohs micrographic surgery.
NCI
* NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.
nonmelanoma skin cancer (non-MEH-luh-NOH-muh skin KAN-ser)
* Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) or in squamous cells, but not in melanocytes (skin cells that make pigment).
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
photodynamic therapy (FOH-toh-dy-NA-mik THAYR-uh-pee)
* Treatment with drugs that become active when exposed to light. These activated drugs may kill cancer cells.
radiation (RAY-dee-AY-shun)
* Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)
* The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.
radioactive (RAY-dee-oh-AK-tiv)
* Giving off radiation.
radioactive seed (RAY-dee-oh-AK-tiv...)
* A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.
recur
* To come back or to return.
regional chemotherapy (REE-juh-nul KEE-moh-THAYR-uh-pee)
* Treatment with anticancer drugs directed to a specific area of the body.
research study (reh-SERCH STUH-dee)
* A scientific study of nature that sometimes includes processes involved in health and disease. For example, clinical trials are research studies that involve people. These studies may be related to new ways to screen, prevent, diagnose, and treat disease. They may also study certain outcomes and certain groups of people by looking at data collected in the past or future.
retinoid (REH-tih-noyd)
* Vitamin A or a vitamin A-like compound.