Diagnosis

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Health care professionals are able to evaluate many skin abnormalities. A primary care physician should be the first health care professional you see if you notice something suspicious on your skin. Then you might consult with a dermatologist, a physician with extensive training in skin care and skin disorders, particularly skin cancer.

The first step in detecting abnormalities that may be skin cancer begins with you. Examine your skin once a month for any suspicious changes. Look for changes in color, size and surface texture of a mole. Sores that won't heal may also indicate cancerous or precancerous conditions of the skin that need attention.

Actinic keratoses. This precancerous condition typically occurs in people with a long history of sun-damaged skin. Lesions appear as rough, crusty bumps on the back of the hands, lips, face, scalp or neck that may itch or feel tender on sun-exposed skin. They may be pink or white. If untreated, these bumps may develop into skin cancer. They affect more than 10 million Americans (and in sunnier climates more) and are usually more prevalent in older people. However, the AAD reports they're appearing more frequently in people between the ages of 20 and 40.

Basal cell carcinoma. Basal cell carcinoma show up as flat, firm, pale areas or as small raised pink or red pearly bumps that may bleed after minor injury. These bumps or growths may appear anywhere on the body regularly exposed to the sun, such as the head and neck. They are slow growing and rarely spread to other parts of the body. But they can extend deep into the skin, causing significant local damage. Approximately 75 percent of all skin cancer cases diagnosed annually are basal cell carcinoma. This form of skin cancer has a high cure rate—90 percent of cases don't recur following treatment. However, if left untreated, basal cell carcinoma can result in disfigurement.

Squamous cell carcinoma. The second most common non-melanoma skin cancer, squamous cell carcinoma, appears as nodules or as red, scaly patches, typically on the ear, the face, the lips and mouth. These patches eventually develop into large masses. More than 200,000 cases of this type of cancer are diagnosed each year—about 20 percent of all skin cancers. This type of skin cancer is slightly more likely than basal cell carcinoma to spread to other parts of the body. But it is also highly treatable, with a 95 percent cure rate.

Melanoma: Melanoma can develop from a pre-existing mole or on clear, smooth skin. Unlike a non-cancerous mole, melanoma is irregularly shaped or has irregular borders, and is black, brown or tan. Melanoma is rare in childhood and adolescence, but it is one of the more common cancers in younger adulthood and middle age. It is especially prevalent in late middle and older age. The leg is the most common site in women, and the trunk is the most common site in men. Early diagnosis is key to improving the prognosis in this potentially fatal disease.

It is important to remember the "ABCDs" of melanoma. The AAD has developed an easy-to-use method to evaluate your skin for melanoma. Look for:

• Asymmetry: One half of the spot is not shaped like the other half

• Border irregularity: Poorly defined, ragged, blurred, notched or "scalloped" border.

• Color: Shades of tan, brown, black, and sometimes red, white and blue, vary across the mole.

• Diameter: The spot is larger than six millimeters, about the diameter of a pencil eraser. However, in recent years, health care professionals are finding more melanomas between three and six millimeters.

A condition called dysplastic nevus syndrome can increase a person's risk for developing melanoma. A "nevus" is a mole. These particular moles are often irregularly shaped and may be larger than other moles. They can appear anywhere on the body—sun-exposed, or not. This condition tends to run in families. A person with this condition may have many moles on her body, or just a few. Researchers believe that a genetic predisposition for dysplastic nevus syndrome may exist.

Excessive sun exposure causes the majority of melanoma. A family history of the disease is also a major risk factor. Individuals with a family history of melanoma, or who have had melanoma in the past, should see a dermatologist every three to four months in addition to performing self-examinations. To learn how to effectively perform a self-examination, visit The Skin Cancer Foundation at www.skincancer.org/self_exam/spot_skin_cancer.php.

Other types of skin cancer: Less common types of skin cancer, which together make up only one percent of all cancers, include:

• Kaposi's sarcoma. This form starts in the blood vessels of the dermis and subcutaneous layers and can affect internal organs. Prior to the middle 1980s, this skin cancer was very rare. But since it often afflicts people infected with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) it has become more common.

• Sarcomas. These are cancers that form in the cells of your connective tissues but occasionally they begin in the dermis. Angiosarcoma, a blood vessel cancer, is one example.

• Cutaneous lymphomas. These skin cancers originate in the skin's lymphocytes, which are immune system cells found in the bone marrow and blood. The most common cutaneous lymphoma is cutaneous T-cell lymphoma, also called mycosis fungoides.

• Adnexal tumors. These are typically benign tumors that originate in the hair follicles and sweat glands. Occasionally they can be malignant.

• Merkel cell carcinoma. This rare cancer begins in the skin's neuroendocrine cells. It frequently returns after treatment and can spread to internal organs and lymph nodes.

Diagnostic Tests

To determine if your skin abnormalities are skin cancer, your dermatologist may perform a biopsy: taking a sample of skin to examine under a microscope. After receiving a local anesthetic, you may feel some minor discomfort—a small needle stick, burning and pressure. There are four primary types of biopsies:

• Shave biopsy. The top layers of skin, the epidermis and a part of the dermis are shaved off in a thin slice.

• Punch biopsy. A deeper, cylindrical core sample of the skin layers and part of the fat layer is taken.

• Incisional biopsy and excisional biopsy. A wider, deeper sample of all your skin layers is taken, then the skin is sutured with stitches. Incisional biopsies remove a portion of the tumor and excisional biopsies remove the entire tumor.

To determine how widespread a melanoma is, your health care professional uses a system to describe its size and pervasiveness. The most common system is called the "TNM" system in which:

• T stands for the "tumor"—noting the size and how far it has spread within the layers of the skin and nearby tissue.

• N denotes tumor that has spread to lymph nodes.

• M stands for metastasize, in which the cancer has spread to distant organs

Using this system, melanomas are grouped according to stage. The stages are:

• Stage 0. The melanoma only involves the epidermis. Also called melanoma in situ.

• Stage I. This stage tumor is between 0.75 and 1.5 mm in thickness and appears to affect only the skin and has not been found in lymph nodes or distant organs. This stage has a five-year survival rate of more than 90 to 95 percent.

• Stage II. A tumor with any thickness greater than a stage I tumor that appears to affect only the skin and has not been found in lymph nodes or distant organs. This stage has a five-year survival rate of about 45 to 78 percent.

• Stage III. A melanoma that has spread to lymph nodes near the skin where it originally began. This stage has a five-year survival rate of about 28 to 70 percent.

• Stage IV. A melanoma that has spread well beyond the originally affected skin and the nearby lymph nodes. It has metastasized to vital organs or to distant areas of the skin or distant lymph nodes. This stage has a five-year survival rate of 10 percent.