How do I know if I (or someone I love) has skin cancer?

CancerSkin cancerMelanomaBasal cell carcinomaSquamous cell carcinomaSkin cancer diagnosisSkin cancer treatmentSkin cancer biopsySkin cancer punch biopsy
Written By Rachel Fisher

Hello there, friend.

If you’re seeking a comprehensive overview of how skin cancer is diagnosed and treated, I'm going to assume it's because either you or someone you know is concerned. Below I've covered information about common symptoms, methods of diagnosis and treatment, and basic types of skin cancer. This is general information only. If you or someone you know has a worry about potential skin cancer, it's absolutely critical that you consult a dermatologist or dermatological oncologist (a skin doctor who specializes in skin cancer) as soon as possible.

That said, the more information you can gather, the better prepared you'll be to make decisions. Forewarned is forearmed.

So, let's dive into the information. Remember, you are not alone in this journey. There are millions of cancer patients out there, all seeking to understand and navigate the same things.

In The No Bull**** Guide to Dealing with Cancer, I talk about the "Maybe Cancer" part of the cancer journey.

By "Maybe Cancer," I mean when a doctor has recommended a test like a biopsy to rule out cancer. This may happen because something about your body is different, like a change to a mole on your skin. Or it may happen because a different test result comes back that requires a deeper look. Whatever the reason someone goes through "Maybe Cancer," when the biopsy comes back clear, it's usually called a "cancer scare." The reason it's called a scare is because it's freaking scary. It's when your brain starts thinking, "Maybe I have cancer." That's why I say even "Maybe Cancer" brings a person and their loved ones into the outer circle of the cancer community and can have stronger than expected emotional impact.

If you're cruising the internet looking for information on the symptoms of skin cancer, it’s likely that you or someone you care about has either noticed some type of change to their skin or had a test result (or other sign) from a medical provider that concerns you. Well, better safe than sorry...

It's most important that you consult medical professionals. We go over this clearly in the book when we discuss the importance of getting testing so that you can make informed decisions. If you have any concern, see your dermatologist as quickly as possible. If you can't get an appointment as soon as you'd like, be sure to tell them you have a specific concern related to skin cancer. For example, you might say, "I'd really like to get in sooner. I'm concerned about a mole that keeps bleeding a little and won't heal. I heard that is a sign of potential skin cancer." They should prioritize getting you in sooner. It's always important to be clear and honest with your doctors and their support staff.

And please remember, we are not providing medical advice here. This is basic information about skin cancer diagnosis and treatment.

What Are the Typical Symptoms of Skin Cancer? Can You Recognize Them?

Here are the most common signs or symptoms of skin cancer.

Changes in Moles: Have you noticed any changes in the size, shape, color, or texture of existing moles? Keep an eye out for irregular borders, uneven pigmentation, or moles that bleed or itch.

Many people now see a dermatologist once per year to have their skin checked. But what if you see a change in a mole before your annual checkup? Make an appointment. Your dermatologist can take a look very quickly and gather a sample for a biopsy if needed.

Skin Irregularities: Are there any new growths, bumps, or sores on your skin that don't heal within a few weeks? Pay attention to any spots that exhibit crustiness, scaly patches, or persistent redness.

In other words, pay attention to weird **** showing up on your skin. One of the positive things that happens for cancer patients that may not occur to our healthy peers is paying greater attention to one's body. It's only possible to notice a difference if you are aware of what the "normal" or "current" state of your body is, whether that's the appearance and feel of your skin, the smoothness of your digestion, the shape of your bones and muscles, the typical patterns of rest and wakefulness, etc..

When you get to know your body and listen to it, you will get better at identifying and addressing things that need your attention. But erring on the side of caution is always best. If something about your skin seems weird, or won't heal, it's time to call your dermatologist.

While these are typical symptoms, it's important to note that skin cancer can show up differently for each person. If you have any concerns, it's always best to consult a dermatologist for a thorough evaluation.

How Is Skin Cancer Diagnosed? What Are the Key Steps?

You may be wondering how doctors actually diagnose skin cancer---what steps you might expect if you are being checked for skin cancer.

Visual Examination: During a dermatologist visit, they will carefully examine your skin, paying close attention to any suspicious areas or lesions. They may use dermoscopy, a specialized tool, to examine moles and skin structures in more detail.

This does not invade your skin. No pokes or prods, just looking.

Biopsy: If a suspicious area is found, a biopsy will be conducted. This involves removing a small sample of the affected skin for laboratory analysis. A biopsy helps determine if cancer cells are present and, if so, the type and stage of skin cancer.

You may wonder if this will hurt, since the doctor will remove skin. I believe EVERY question is fair. You deserve to know and be prepared every time someone is going to poke, prod, or slice you. Typically, the skin removal will be relatively small/shallow and it’s usually performed with a little anesthetic to numb it. This will be a little needle. Then you won't feel the removal and you'll just need a Band-aid. It should heal nicely. It's more like a small kid's knee scrape than anything else, in my experience. Of course, all people and patients are different, so your experience could be a little different, but most basic skin biopsies will be similar to what I've described.

What Are the Different Types of Skin Cancer? Can You Identify Them?

Are you familiar with the various types of skin cancer? Let’s review both common and a couple of rarer types to help familiarize you.

The most common types of skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC):

Basal cell carcinoma (BCC) - This type of skin cancer develops in the basal cells, which are located in the deepest part of the epidermis, the outer layer of skin. BCCs are often found in areas of the skin that are exposed to the sun, such as the face, head, neck, and arms. BCCs are highly treatable if detected early and treated properly.

Squamous cell carcinoma (SCC) - This type of skin cancer is generally faster growing than BCCs. SCCs can develop from actinic keratoses (AKs), which are precancerous skin growths caused by too much sun exposure. AKs usually form on the head, neck, hands, and forearms, and people who get them usually have fair skin. SCCs are also highly treatable if detected early and treated properly.

Melanoma - Melanoma is the deadliest form of skin cancer and often develops in a mole or as a new dark spot on the skin.

Merkel Cell Carcinoma - This rare but aggressive skin cancer typically appears as a flesh-colored or bluish-red nodule on the face, head, or neck. It may initially be mistaken for a cyst or pimple.

Dermatofibrosarcoma Protuberans (DFSP) - DFSP is a rare type of skin cancer that usually begins as a flat, firm, flesh-colored or purplish-brown patch. It can gradually grow and develop into a raised, dome-shaped tumor.

Partially because it is the deadliest—and therefore, scariest—and partially (I believe) because it’s easiest to say, MELANOMA is the form of skin cancer most people can name. Also the idea of a mole being the culprit or any new, visible, spot on the skin, makes most logical sense to us regular folks as a form of cancer. We expect to be able to see it and point to it, like, “There! That looks like cancer!” Unfortunately, as you can see from the variety of descriptions here, skin cancer can “look” like a lot of different things, including relatively normal things like a pimple. Whenever something about your skin’s appearance or texture changes and that change doesn’t go away (is persistent) or continues to change (is progressive), it’s worth getting it checked out.

Cancer Skin Screenings - In addition to getting an appointment if you believe something about your skin needs checked out, today most adults go see a dermatologist once a year for a “skin check” in which the doctor will visually review your entire body’s skin and look for anything they find suspicious. And when I say “entire body,” it is best if they truly look over every inch of your skin, even in your very private areas. You can get skin cancer in these areas, however unpleasant that prospect may be. Remember, this person is a medical doctor so if they need to examine your, ahem, nethers… to make sure they are cancer-free, you want to let them.

Mole-Mapping - They may also keep a record or “map” of your skin’s markings, particularly if you’re in a high-risk category. For example, I am prone to developing moles and I have a direct family member who has had an early-stage melanoma. For some folks who are very high-risk, such as someone who has had a past melanoma, a more intensive skin check and mapping may be done involving actual mapping with digital images that are saved.

Remember, early detection and prompt treatment are crucial regardless of the type of skin cancer.

What Are the Treatment Options for Skin Cancer?

Surgical Excision - The most common treatment, surgical excision, involves removing the cancerous lesion along with a safety margin of healthy skin tissue. This approach ensures complete removal of cancer cells.

If you’re scratching your head thinking—“WTF does that mean, exactly?”—please do not feel stupid. Medicine loves fancy words, but don't let them confuse you when it's important you understand. Ask questions. Look terms up in the National Cancer Institute (NCI) Dictionary of Terms. Here, the word "excise" means "to cut out." And "lesion" means the area of cancerous growth (instead of healthy growth). And "safety margin of healthy skin" means they remove some healthy skin around the cancer too.

So this is actually very simple. THEY CUT OUT THE CANCER + SOME OF THE FLESH AROUND IT TO MAKE SURE THEY GET IT ALL.

Why don't they just say this? Well, it's good that your doctors are more precise in their own field. There are many small and complex details they need to understand. But for your purposes, this is what surgical excision means.

Mohs Surgery - Mohs surgery is a specialized technique for removing skin cancer, particularly for areas where preserving healthy tissue is essential. The surgeon removes the cancer layer by layer, examining each section under a microscope until no cancer cells remain.

This is basically surgical excision, but super-precise. The goal is to stop removing tissue as soon as cancer cells are no longer seen in the slices being removed and hopefully remove less. It may not be the best option in all cases. While doctors always try to recommend the interventions that will do the least harm to your body, they also want to recommend those most likely to work.

Radiation Therapy - In some cases, radiation therapy may be recommended, especially for larger tumors or when surgery is not possible. It uses high-energy rays to target and destroy cancer cells.

High-energy rays may sound like something from science-fiction, but we've been using radiation in medicine for decades--X-rays, MRIs, CAT and PET scans... In radiation treatment for cancer, doctors use destructive levels of energy to kill cancer cells. Most often, radiation is applied from outside the body, but it can also be applied from inside the body using radiation-emitting pellets that are implanted near the cancer. Okay, I guess that sounds a little science-fiction-y, but get ready for more of that! Medicine is improving at breakneck speed now, which is very encouraging for us cancer patients and survivors.

Conclusion

Now that we've reached the end, let's revisit the beginning. If you are here seeking a comprehensive overview of skin cancer diagnosis and treatment because you have a concern for yourself or a loved one, remember that you are not alone. And more importantly, take the step to see a dermatologist as soon as you can.

I know first-hand that getting something checked out when you are worried about cancer can be stressful. You may think, “I’m not sure I want to know.” Trust me, you do.

If it does turn out to be cancer, early detection, accurate diagnosis, and timely treatment are vital for successful management of the disease. If it does not turn out to be cancer, you won't be mad at yourself for being proactive and taking that worry off the table.

Even though I am not a skin cancer survivor, I am an ovarian cancer survivor. I waited too long to get checked out. I JUST got my tumor removed in the nick of time and still had to do chemo and then had a recurrence nine years later. I will never know, but if I’d gone to the doctor when I was first concerned, maybe I wouldn’t have had to do so much treatment or face a recurrence. Get tested.

Stay informed, stay proactive, and lean on the resources, both human and otherwise, around you to manage the journey.

Stay well, friend.

Sources:

Rachel Fisher
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