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Skin cancer is the most common form of cancer. There are several types of skin cancer, based on the type of cell in which the cancer starts. The most common types of skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The most aggressive types are melanoma (develops in melanocytes, the cells that produce melanin) and a rare Merkel cell carcinoma (usually appears as a flesh-colored or bluish-red nodule, often on the face, head or neck).
Exposure to ultraviolet light is a common risk factor for all skin cancers. Risk can stem from exposure to the sun or artificial sources, such as tanning beds. Exposure occurs over your lifetime and is cumulative. Other risk factors include:
- Weakened immune system
- Personal history of a prior skin cancer
- Skin cancer in the family
- High mole count or “funny-looking” moles (for melanoma)
Melanoma and other skin cancers are diagnosed by a skin biopsy. Cancer cells are detected by a dermatopathologist—a pathologist who specializes in evaluating skin. An evaluation includes a microscopic examination of a portion of skin, or tissue just beneath the skin. If present, additional features of the cancer are described to determine treatment and prognosis. If there is concern for spread of cancer, a biopsy of another body part may also be necessary.
One or more of the following tools may be used in diagnosising melanoma and other skin cancer:
- Clinical examination. Looks for moles, birthmarks or other areas that look abnormal in color, size, shape or texture.
- Blood testing. Measures certain substances in the blood that may indicate cancer or organ dysfunction.
- Radiographic studies. Evaluate abnormalities with pictures of certain parts of the body. This includes technology such as computed tomography (CT) scan, positron emission tomography (PET)/CT scan, magnetic resonance imaging (MRI) scan or X-ray.
- Sentinel node biopsy locates, removes and examines the sentinel lymph node(s), the first lymph node(s) where cancer cells are likely to spread from a primary tumor.
The Indiana University Health Melvin & Bren Simon Cancer Center offers comprehensive diagnostic services, specialty consultations, treatments and clinical trials to people with any stage of melanoma or other complicated skin cancer.
Our multidisciplinary team has specialists in cutaneous oncology, including dermatologists, surgical, radiation and medical oncologists, Mohs micrographic surgeons, plastic surgeons, dermatopathologists, otolaryngologists, neurosurgeons and radiologists, as well as dietitians, speech therapists, psychologists and social workers. They meet at a weekly conference to discuss cases and develop individualized treatment plans for patients.
Treatment options for patients with melanoma and other skin cancers include one or more of the following, depending on the most current treatment recommendations, the stage of the cancer and needs of the patient:
- Surgical excision. Removes the cancer plus a border of surrounding healthy tissue. This is the most common treatment for melanoma and other advanced skin tumors. Depending upon the case, removal of lymph nodes and reconstruction may be necessary. One method of reconstruction is a skin graft, which takes skin from another part of the body and grafts it to the affected area. Another specialized surgical procedure, isolated limb perfusion, is sometimes recommended. This procedure treats an affected arm or leg with heat and chemotherapy directly into the blood vessels.
- Radiotherapy. Uses energy beams to kill cancer cells. This may be recommended to reduce the risk of recurrence at a particular site in certain cases of melanoma and advanced skin tumors. It may also be recommended in patients with advanced cancer to reduce pain or bleeding.
- Stereotactic Body Radiation Therapy (SBRT). Precisely directs a large dose of radiation to a tumor without affecting normal tissue.
- Gamma-knife radiosurgery. Uses specialized equipment aimed at a tumor from many angles in a single treatment.
- Systemic therapies. Medicines used for more advanced melanoma and skin tumors. They work in different ways to kill or control cancer cells.
- Chemotherapies. Damage various parts of the cancer cell in an effort to destroy them. Dacarbazine and temozolomide are examples of chemotherapies used to treat melanoma.
- Immunotherapies program. The immune system is used to fight the cancer. In melanoma, interferon, high-dose Interleukin-2 and ipilimumab are commonly recommended.
- Molecularly targeted therapies. Attack various pathways in cancer cells to stop their functioning. Vemurafenib, a BRAF inhibitor, is a molecularly targeted therapy that may be used in cases of advanced melanoma.
For patients with basal cell carcinoma—the most common type of skin cancer—or squamous cell carcinoma, the IU Health Simon Cancer Center offers Mohs micrographic surgery. This skin cancer treatment uses the precision of a microscope and a pathological examination of sampled tissue to remove skin cancer down to its roots. This technique ensures that all diseased tissue is removed, leaving healthy skin intact and ready for reconstructive surgery to repair the wound. A Mohs surgeon, trained in reconstructive surgery, can minimize scarring. For these types of skin cancer, Mohs micrographic surgery offers successful outcomes up to 99 percent of the time.
Patients of the melanoma program are seen in consultation during a weekly multidisciplinary clinic. The IU Health Simon Cancer Center is at the forefront of cancer care discoveries, giving our patients access to highly skilled doctors and advanced diagnostic and treatment options. Our patients also benefit from clinical trials and compassionate support through the CompleteLife Program, where staff care for their emotional, mental, social and spiritual needs.
Long-term follow-up is often necessary for melanoma and other advanced skin cancers. This care is determined on a case-by-case basis.
Dermatology and Dermatologic Surgery
Plastic and Reconstructive Surgery
Melanoma Nurse Coordinators
Lisa Freestone, RN
Melissa Koffi, RN
The IU Health Simon Cancer Center is a leader in research to improve cancer diagnosis and treatment. Read more about cancer research and learn about patients who may qualify to participate in advanced clinical trials.