Skin Cancer

Skin Cancer is a topic covered in the 5-Minute Emergency Consult.

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  • Most common cancer in US
  • Increasing incidence
  • 1 in 6 will have skin cancer during their lifetime
  • Actinic keratosis:
    • Premalignant lesion
    • Thickened scaly growth caused by sunlight or other artificial light source
    • Found on areas of body with high sun exposure
    • 0.1–10% may transform into squamous cell carcinoma (SCC)
  • Nonmelanoma skin cancer:
    • Less commonly fatal
    • Fast growing
    • May be destructive if left untreated
    • Basal cell carcinoma (BCC):
      • Cells arise from epidermis
      • Most common skin cancer
      • Account for 75% of all nonmelanoma skin cancers
      • Male > female, 3:2.
      • Locally invasive without risk of distant metastasis
      • Most important risk factor is sun exposure
      • More common in fair-skinned patients
      • Most lesions are on the head and neck
    • SCC:
      • 2nd most common skin cancer
      • 20% of cases of skin cancer
      • Most arise from precancerous actinic keratosis lesions
      • Male > female
      • Most important risk factor is sun exposure, especially sunburn
      • 70% occur on head and neck
      • More common in older, fair-skinned patients
      • Risk of regional lymph node and distant metastasis
      • SCC lesions of mucosal surfaces are more aggressive
  • Melanoma:
    • 5% of all diagnosed skin cancer in US
    • 62,000 new cases in 2008
    • 15% are fatal
    • 75% of skin cancer cause deaths
    • Arises from melanin-producing cells
    • Most important risk factor is sun exposure, especially sunburn
    • Additional risk factors:
      • Fair skin; blond/red hair
      • Multiple common melanocytic nevi
      • Atypical nevi
      • Immunosuppression
      • Positive family history
      • History of nonmelanoma skin cancer (BCC or SCC)
      • ≥5 sunburns in early life doubles the risk for malignant melanoma
    • Risk of regional lymph node and distant metastasis


  • UV irradiation:
    • Both UVA and UVB rays
    • Sun exposure
    • Tanning beds
  • SCC often associated with human papilloma virus (HPV)
  • Immunosuppression may predispose to SCC
  • Vitamin D metabolism may play a role

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