By National Cancer Institute
Skin cancer begins in the cells that make up the outer layer (epidermis) of your skin. Skin cancer — the abnormal growth of skin cells — most often develops on skin exposed to the sun. But skin cancer cells can also occur on areas of your skin not ordinarily exposed to sunlight.
3 Common Types of Skin Cancer Among Older Adults
- Basal cell skin cancer
- Squamous cell skin cancer
Melanoma is more aggressive than basal cell skin cancer or squamous cell skin cancer.
What is Melanoma?
Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin). Melanocytes are found throughout the lower part of the epidermis. They 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 tan, or darken.
The skin is the body's largest organ. It protects against heat, sunlight, injury, and infection. The skin has 2 main layers: the epidermis (upper or outer layer) and the dermis (lower or inner layer). When melanoma starts in the skin, the disease is called cutaneous melanoma.
Melanoma can occur anywhere on the body. In men, melanoma is often found on the trunk (the area from the shoulders to the hips) or the head and neck. In women, melanoma often develops on the arms and legs.
Melanoma Risk Factors
- Unusual moles.
- Exposure to natural sunlight.
- Exposure to artificial ultraviolet light (tanning booth).
- Family or personal history of melanoma.
- Being white and older than 20 years.
- Red or blond hair.
- White or light-colored skin and freckles.
- Blue eyes.
Melanoma Warning Signs
To be on the lookout for skin cancer, check moles twice a year.
- A change in the appearance, including the size, shape and color of a mole or pigmented area.
- Moles with irregular edges or borders
- More than one color in a mole
- An asymmetrical mole (if the mole is divided in half, the 2 halves are different in size or shape)
- Itches, oozes or bleeds
- Ulcerated (a hole forms in the skin when the top layer of cells breaks down and the underlying tissue shows through).
- Change in pigmented (colored) skin.
- Satellite moles (new moles that grow near an existing mole).
Screening Tests for Skin Cancer or Melanoma
There are many different tests that examine the skin are used to detect and diagnose melanoma or other skin cancer in elderly people. If a mole or pigmented area of the skin changes or looks abnormal, the following tests and procedures can help detect and diagnose melanoma and other skin cancers.
Skin examination: A doctor or nurse examines the skin to look for moles, birthmarks, or other pigmented areas that look abnormal in color, size, shape, or texture.
Biopsy: A local excision is done to remove as much of the suspicious mole or lesion as possible. A pathologist then looks at the tissue under a microscope to check for cancer cells. Because melanoma can be hard to diagnose, patients should consider having their biopsy sample checked by a second pathologist. Suspicious areas should not be shaved off or cauterized (destroyed with a hot instrument, an electrical current, or a caustic substance). Certain factors affect prognosis (chance of recovery) and treatment options.
Chance of Recovering From Skin Cancer
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of melanoma (whether cancer is found in the outer layer of skin only, or has spread to the lymph nodes, or to other places in the body.
- Whether there was bleeding or ulceration at the primary site.
- The location and size of the tumor.
- The elderly patient's general health.
Although many people are successfully treated, melanoma can recur (come back). After melanoma 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 whether 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.
Tests and procedures used in the staging process
Wide local excision: A surgical procedure to remove some of the normal tissue surrounding the area where melanoma was found, to check for cancer cells.
Lymph node mapping and sentinel lymph node biopsy: Procedures in which a radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through lymph ducts to the sentinel node or nodes (the first lymph node or nodes where cancer cells are likely to have spread). The surgeon removes only the nodes with the radioactive substance or dye. A pathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes.
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. For melanoma, pictures may be taken of the chest, abdomen, and pelvis.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Laboratory tests: Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time. The results of these tests are viewed together with the results of the tumor biopsy to determine the melanoma stage.
The Clark levels are used for thin tumors to describe how deep the cancer has spread into the skin:
- Level I. The cancer is in the epidermis only.
- Level II. The cancer has begun to spread into the papillary dermis (upper layer of the dermis).
- Level III. The cancer has spread through the papillary dermis (upper layer of the dermis) into the papillary-reticular dermal interface (the layer between the papillary dermis and the reticular dermis).
- Level IV. The cancer has spread into the reticular dermis (lower layer of the dermis).
- Level V. The cancer has spread into the subcutaneous layer (below the skin).
Treatments for Melanoma in Elderly Patients
There are different types of treatment for patients with melanoma. 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.
Surgery to remove the tumor is the primary treatment of all stages of melanoma. The doctor may remove the tumor using the following operations:
Local excision: Taking out the melanoma and some of the normal tissue around it. Wide local excision with or without removal of lymph nodes.
Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer.
Sentinel lymph node biopsy: The removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed for biopsy. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
Skin grafting (taking skin from another part of the body to replace the skin that is removed) may be done to cover the wound caused by surgery. Even if the doctor removes all the melanoma that can be seen at the time of the operation, some patients may be offered chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after surgery, to increase the chances of a cure, is called adjuvant therapy.
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 spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). In treating melanoma, anticancer drugs may be given as a hyperthermic isolated limb perfusion.
This technique sends anticancer drugs directly to the arm or leg in which the cancer is located. The flow of blood to and from the limb is temporarily stopped with a tourniquet, and a warm solution containing anticancer drugs is put directly into the blood of the limb. This allows the patient to receive a high dose of drugs in the area where the cancer occurred. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
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.
- 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.
The National Cancer Institute conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer.