Skin Cancer

Nishad Sathe; Patrick Zito

Skin Cancer

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Continuing Education Activity

Skin cancer encompasses a broad range of benign and malignant neoplasms that are common worldwide and more prevalent than many other cancer types. This condition involves the neoplastic proliferation of cells and tissues within the skin and can be associated with significant morbidity and mortality. UV radiation is a primary etiologic factor for most subtypes of skin cancer, including basal cell carcinoma, squamous cell carcinoma, and melanoma. These cancers may present with varying clinical features and often require evaluation through a skin biopsy and histopathological assessment to determine the specific type. This heterogeneous group of neoplasms may require a skin biopsy with histopathological evaluation and advanced therapies, including topical treatments, local non-topical therapies (eg, antineoplastic injections), systemic medications (eg, chemotherapy and immunotherapy), radiation therapy, and surgical or procedural interventions (eg, Mohs micrographic surgery and cryosurgery).

Risk factors, including UV exposure and genetic mutations, contribute to skin cancer development, thereby making preventive measures such as sunscreen use and minimizing UV exposure essential. In addition, early detection and tailored treatment are essential for optimal outcomes. This activity reviews the epidemiology, genetics, clinical presentation, and management of skin cancer and provides healthcare professionals with the knowledge and tools needed to improve patient care and outcomes. This activity also highlights the importance of collaboration among interprofessional healthcare providers to enhance patient care for this complex and prevalent condition.

Objectives:

Identify early signs and symptoms of various skin cancer subtypes for timely diagnosis and treatment.
Apply evidence-based guidelines for managing and treating skin cancer, including surgical and nonsurgical options.
Select the appropriate diagnostic test, such as a skin biopsy, to identify skin lesions that may be skin cancer.
Collaborate with interdisciplinary healthcare teams to ensure a comprehensive approach to the diagnosis and treatment of skin cancer.

Introduction

Skin neoplasms are one of the most common diagnoses among patient encounters.[1] Evaluating both benign and malignant neoplasms is vital, particularly due to the increasing incidence of skin cancers and complications associated with the condition.[2][3] Skin cancer has multiple etiologic factors, with UV radiation-induced DNA damage and oncogenesis being the most prominent. Preventive strategies, such as sunscreen application, are essential in reducing risk.[4] After evaluation by a trained healthcare provider, a biopsy is typically performed, and histopathological evaluation helps confirm the diagnosis and differentiate the type of skin cancer from other conditions.[5] Management of skin cancer may involve observation, topical therapies, local non-topical treatments (eg, antineoplastic medication injections), systemic regimens (eg, chemotherapy and immunotherapy), radiation therapy, and surgical or procedural interventions (eg, Mohs micrographic surgery and cryosurgery).

The skin's anatomical complexity allows skin cancer to arise from any of its cells or components. The proliferation of cells in skin cancer can be benign or malignant (see Image. Anatomy of the Human Skin). Please see StatPearls' companion resource, "Anatomy, Skin (Integument)," for more information on skin anatomy. In standard literature, malignant skin cancer is typically categorized into melanoma and nonmelanoma skin cancers, which usually refer to basal cell carcinoma or squamous cell carcinoma. However, this classification can be problematic, as skin cancer can originate from various cells and subdivisions of the skin.

Benign epidermal tumors may include epidermal nevi, pseudoepitheliomatous hyperplasia (eg, prurigo nodularis), and acanthomas (eg, seborrheic keratosis). Premalignant dysplasia, such as actinic keratosis and arsenical keratosis, may also be present. Malignant tumors of the epidermis include intraepidermal carcinoma (eg, Bowen disease), basal cell carcinoma, squamous cell carcinoma, and verrucous carcinoma. Please see StatPearls' companion resources, "Seborrheic Keratosis," "Clear Cell Acanthoma," "Cutaneous Horn," "Keratoacanthoma," "Cutaneous Melanoacanthoma," "Cutaneous Squamous Cell Carcinoma," "Intraepidermal Carcinoma," and "Basal Cell Carcinoma," for more information on common epidermal tumors.

Pigmentary lesions include those with basal melanocytic proliferation (eg, solar lentigo), junctional or dermal melanocytic lesions (eg, Spitz nevus), dysplastic lesions (eg, dysplastic nevus), and malignant lesions (eg, melanoma, clear cell sarcoma). Please see StatPearls' companion resources, "Subungual Melanoma," "Lentigo Maligna Melanoma," "Metastatic Melanoma," "Dysplastic Nevi," "Atypical Mole," "Acral Lentiginous Melanoma," and "Congenital Melanocytic Nevi," for more information on pigmentary lesions relevant to skin cancer.

Skin cancer may arise from cutaneous appendages, such as hair follicles (eg, desmoplastic trichoepithelioma), sebaceous glands (eg, sebaceous adenoma and sebaceous carcinoma), apocrine glands (eg, spiradenoma), and eccrine glands (eg, porocarcinoma). Please see StatPearls' companion resources, "Desmoplastic Trichoepithelioma," "Sebaceous Carcinoma," "Syringoma," "Spiradenoma," "Trichoblastoma and Trichoepithelioma," and "Cylindroma," for more information on tumors of cutaneous appendages.

Fibrous tissues of the skin can also proliferate, leading to skin cancer, such as dermatofibroma and its malignant counterpart, dermatofibrosarcoma protuberans. Please see StatPearls' companion resources, "Dermatofibrosarcoma Protuberans" and "Dermatofibroma," for more information on fibrous tumors.

The presence of fat, muscle, cartilage, and bone can lead to skin cancers such as liposarcoma, leiomyosarcoma, chondroma, and osteosarcoma (although osteosarcoma may be considered metastatic by some). Please see StatPearls' companion resources, "Atypical Fibroxanthoma" and "Leiomyosarcoma," for more information on fat, muscle, cartilage, and bone tumors.

Benign and malignant skin cancers can arise from neural tissue, such as Merkel cell carcinoma and schwannoma, or from vascular tissue, such as hemangioma and angiosarcoma. Please see StatPearls' companion resources, "Angiolymphoid Hyperplasia With Eosinophilia," "Angiosarcoma," "Merkel Cell Carcinoma of the Skin," "Neurothekeoma," "Hemangioma," "Cutaneous Vascular Malignancies," "Angiosarcoma," " Kaposi Sarcoma," and "Cutaneous Angiofibroma," for more information on common tumors of neural and vascular origin.

Infiltrative skin cancers can arise from various immune cells that reside in the skin, including mastocytoma, xanthoma, Langerhans cell histiocytosis, T-cell lymphoma, natural killer (NK)—cell lymphoma, and B-cell lymphoma. Please see StatPearls' companion resources "Sezary Syndrome," "Extranodal NK-Cell Lymphoma," "Peripheral T-Cell Lymphoma," "Dermatopathology Evaluation of Cysts," "Mastocytoma," "Mycosis Fungoides," and "Lymphomatoid Papulosis," for more information.

Etiology

The etiology of skin cancer varies depending on the type of cancer. UV radiation is a major etiologic factor for most nonmelanoma skin cancers, including squamous cell carcinoma and basal cell carcinoma, as well as melanoma.[6][7][8] Along with chemical carcinogens and wound-related changes, UV radiation is believed to damage DNA, which results in mutations in tumor suppressor genes (eg, p53) and genomic instability.[9][10][11] Most cutaneous squamous cell carcinomas (90%) exhibit UV-induced p53 gene mutations, leading to the uncontrolled proliferation of keratinocytes.[12] Mutations implicated in basal cell carcinoma include mutations in the PTCH gene and the p53 gene.[13] Mutations associated with melanoma include alterations in cyclin-dependent kinase inhibitor-2A (CDKN2A), melanocortin-1 receptor (MC1R), BRAF, and DNA repair enzymes, such as UV-specific endonuclease in xeroderma pigmentosum.[14]

Multiple risk factors may synergistically interact with etiologic factors to accelerate skin cancer development, including age, sex, radiation exposure, environmental carcinogens, immune suppression, comorbid conditions, organ transplant history, family history, certain infections (eg, human papillomavirus), tanning bed use, vitamin levels, and occupational exposure.[15][16][17][4] Risk levels also vary within each category. For example, patients who receive thoracic cavity solid organ transplants (eg, heart) have a higher risk of skin cancer compared to those undergoing hematopoietic stem cell transplants, renal transplants, or other solid organ transplants.[18]

Environmental carcinogens, such as arsenic and pollution, can accelerate DNA damage, increasing the risk of skin cancer.[19][20] Please see StatPearls' companion resource, "Overview of Environmental Skin Cancer Risks," for more information. Genetic predispositions also contribute to malignancies, as seen in conditions such as xeroderma pigmentosum, neurofibromatosis, and retinoblastoma.[21][22][23] Additionally, some skin cancers, such as Merkel cell carcinoma, are associated with infection, including the Merkel cell polyomavirus, which generally indicates a better prognosis in affected patients.[24] Although UV radiation is a significant factor in skin cancer development and progression, various other risk factors can accelerate this process on a case-by-case basis.

Pause and Reflect

What risk factors do many individuals regularly face in their day-to-day lives that may predispose them to skin cancer?

How might you counsel individuals to reduce their exposure to environmental risk factors related to skin cancer?

Why is it essential to know how many hours workers spend outside during their workday regarding their risk for skin cancer development?

Epidemiology

Skin cancers are more frequent than any other type of cancer worldwide and in the United States.[25][26][1] The economic burden of risk factors, such as indoor tanning, contributes to the rising incidence of skin cancer, resulting in an annual economic burden of at least 8.1 billion dollars in the United States.[27][28] The increasing number of people diagnosed with skin cancer highlights a significant health challenge, both in terms of patient well-being and healthcare expenditures.[29]

Skin cancer occurs in all races worldwide but is more common in individuals with lighter skin, likely due to the reduced photoprotective effects of epidermal melanin.[30] In individuals with lighter skin, approximately 75% to 80% of nonmelanoma skin cancers are basal cell carcinomas, whereas up to 25% are squamous cell carcinomas.[31][32] Heritable defects in DNA repair mechanisms, such as those seen in xeroderma pigmentosum and Muir-Torre syndrome, also increase the risk of cutaneous carcinomas in some patients.

Among skin cancers, melanoma has the highest disability-adjusted life year, basal cell carcinoma has the highest incidence rate, and squamous cell carcinoma has the highest prevalence.[1] The incidence of melanoma in the United States, from 1990 to 2019, increased to 17 per 100,000 individuals, and prevalence increased to 138 per 100,000 individuals. Meanwhile, nonmelanoma skin cancer had an incidence of 787 per 100,000 individuals and a prevalence of 359 per 100,000 individuals.[1] Males had a higher incidence, prevalence, and mortality rate than females from 1990 to 2019.[1] Although skin cancer occurs in all age groups, it is more common in older adults, likely due to increased cumulative UV light exposure.[33][34] Geographically, melanoma rates are higher in the northern half of the United States compared to the southern half, while nonmelanoma skin cancer incidence is highest in the southeastern, western, and northeastern regions of the country.[1]

Other malignancies, such as Merkel cell carcinoma or Kaposi sarcoma, have unique epidemiological information outside the scope of this resource. Merkel cell carcinoma is far more common in men and among individuals with lighter skin.[35] Kaposi sarcoma is more common in individuals with HIV.[36] Worldwide, skin cancer rates are highest in populations with significant UV light exposure and lighter skin tones, such as those in Europe and Australia.[37][38]

Pathophysiology

The pathophysiology of skin cancer is not fully understood, but various etiological factors, with UV light being the most prominent, interact with risk factors that likely contribute to the development and neoplastic proliferation of skin cancer.[39] These proliferations may be benign or malignant; benign proliferation typically results from dysregulation, while malignant proliferation is driven by genetic and molecular alterations associated with UV radiation.[39]

Exposure to UV light from solar radiation is the most significant modifiable risk factor for developing both nonmelanoma skin cancer and melanoma.[40] UV radiation can be categorized into UV-A, UV-B, and UV-C based on their respective wavelengths—approximately 320 to 380 nm for UV-A, 280 to 320 nm for UV-B, and 100 to 280 nm for UV-C.[37] Sunlight is primarily composed of UV-A (~90%) and UV-B (~10%) radiation,[7] while UV-C rays are absorbed mainly by the atmosphere.[41]

UV-A, with its longer wavelength, penetrates the dermis and generates free radicals.[42] UV-B, with a shorter wavelength, penetrates to the level of the stratum basale of the epidermis, leading to the formation of pyrimidine dimers, such as thymidine dimers.[43][44] Both UV-A and UV-B contribute to carcinogenesis, with UV-A significantly impacting skin aging.[45] UV radiation causes cell injury and apoptosis and impairs DNA repair mechanisms, leading to DNA mutations.[46][47] Please see StatPearls' companion resource, "Biochemistry, DNA Repair," for more information on DNA damage from UV radiation.

The development of cutaneous malignancy following DNA damage from solar radiation is multifactorial and influenced by genetic factors, Fitzpatrick skin type, and immunosuppressed status. Most (90%) cutaneous squamous cell carcinomas exhibit UV-induced p53 gene mutations, leading to uninhibited keratinocyte proliferation.[48] DNA mutations associated with basal cell carcinoma include mutations in the PTCH and p53 genes.[49] Melanoma-related DNA mutations include alterations in CDKN2A, MCR1, BRAF, and DNA repair enzymes, such as UV-specific endonuclease in xeroderma pigmentosum.[50][51] The complete list of genetic mutations and risk factors remains incomplete, but ongoing research continues to uncover new genes and targets involved in each subtype of skin cancer.[52][53][54]

Histopathology

The staging of skin cancer varies depending on the subtype and is beyond the scope of this resource. For example, histologic features of basal cell carcinoma include basophilic cells with minimal cytoplasm, and palisading or nests of cells may be observed. Necrosis and mitotic figures may also be evident (see Image. Basal Cell Carcinoma on Cheek—H&E Staining Showing Basaloid Islands). Histopathology showing intercellular bridges and pleomorphic nuclei, with or without nuclear molding, is consistent with squamous cell carcinoma. Keratin pearls may also be present but are not always observed (see Image. Squamous Cell Carcinoma). Please see StatPearls' companion resources, "Dermatopathology, Cutaneous Lymphomas" and "Melanoma Pathology," for more information on skin cancer histopathology.

History and Physical

A thorough skin examination is essential for identifying premalignant and malignant skin lesions, during which key symptoms (such as itching, bleeding, pain, and irritation) should be explored. Notably, it is essential to assess the location, texture, size, color, shape, borders, and any recent changes in suspicious lesions. Premalignant actinic keratoses often present as rough, gritty skin papules on an erythematous base.[55] Basal cell carcinomas usually appear as pink, pearly papules with telangiectasia (see Image. Basal Cell Carcinoma Presenting as Pink Papules on a Patient's Skin).[56] Squamous cell carcinomas are often pink, rough papules, patches, and plaques (see Image. Cutaneous Squamous Cell Carcinoma).[57]

Melanomas are usually brown-to-black lesions with asymmetry, irregular borders, color variegation, and diameters greater than 6 mm (see Image. Ulcerated Acral Lentiginous Melanoma on Dorsal Toe). Please see StatPearls' companion resource, "Dermatoscopic Characteristics of Melanoma Versus Benign Lesions and Nonmelanoma Cancers," for more information. Any new or changing lesion that differs from other body nevi (often referred to as the "ugly duckling sign") should be considered suspicious.[58] A thorough full-body examination should be performed as soon as possible when a patient presents with a suspicious lesion, such as one consistent with melanoma.

Basal cell and squamous cell carcinomas are commonly found on parts of the head and neck that accumulate the most UV radiation over a lifetime, such as the nose, ears, and upper lip. Melanomas can occur anywhere on the body, with the most frequent locations being the backs and shoulders of men and the lower limbs of women.[59] Studies comparing melanoma risk per unit skin area have shown that the face is the highest-risk area for melanoma.[60] However, the presentation of skin cancer can vary across different body types and skin colors, so a thorough examination with dermoscopy and further diagnostic workup may be necessary if the clinical history and examination are insufficient or equivocal.

Evaluation

Patients at risk for cutaneous malignancy are typically evaluated by a medical professional with a full-body skin examination. While most primary care providers can conduct this exam, specialists with advanced dermatology training may assist with dermoscopy, allowing for a more detailed inspection of suspicious lesions. Please see StatPearls' companion resources, "Dermatoscopic Characteristics of Melanoma Versus Benign Lesions and Nonmelanoma Cancers" and "Dermoscopy Overview and Extradiagnostic Applications," for more information on skin cancer evaluation with dermoscopy.

Most concerning lesions identified during a physical examination will undergo an office procedure called a skin biopsy, typically a shave or punch biopsy. This is performed under local anesthesia during an outpatient visit. The specimen is then sent to a trained dermatopathologist for interpretation. If the pathologist confirms a diagnosis of cutaneous malignancy, further intervention is typically required based on the pathological diagnosis and clinical context. In some cases, laboratory tests may be necessary to prognosticate or assess the extent of the disease. For example, patients with suspected Kaposi sarcoma should undergo an HIV test.

A shave or punch biopsy is typically sufficient for most nonmelanoma skin cancers, provided it reaches an adequate depth to analyze the tissue pattern and possible perineural invasion. For melanoma, however, complete excisional removal is recommended. In the case of dermatofibrosarcoma protuberans, a deep incisional biopsy is necessary. For many lymphomas, such as cutaneous T-cell lymphoma, a broad-shave biopsy is preferred over a punch biopsy. Meanwhile, for cutaneous B-cell lymphoma, a deep incisional biopsy is preferred.[5] Imaging may be required to assess bony invasion, such as with squamous cell carcinoma. Following specific tumor guidelines is important, such as those provided by the National Comprehensive Cancer Network (NCCN), as these are frequently updated to reflect the latest research.

Treatment / Management

Treatment of precancerous lesions and cutaneous malignancies should be individualized to achieve the best clinical outcome for each patient. When presented as isolated lesions, precancerous actinic keratoses can be treated with lesion-directed therapies, such as cryotherapy.[61] In cases where patients have numerous lesions or diffuse actinic damage, field-directed therapies may be more appropriate than treating each lesion individually.[61] These therapies can include topical agents, such as 5-fluorouracil and imiquimod, or photodynamic therapy, which involves sensitizing the skin with a topical agent before treatment.[62]

Initial preemptive efforts should aim to reduce the patient's risk of developing cutaneous malignancies. This includes optimizing immunosuppressant regimens in solid organ transplant patients, such as switching to sirolimus, establishing appropriate surveillance schedules for patients receiving immunomodulatory therapies, and adequately treating precancerous lesions.[63]

Many superficial basal cell and squamous cell carcinomas can be treated with topical or local therapies, depending on provider preference. However, the standard approach is surgical treatment using destructive methods such as electrodesiccation and curettage or surgical excision. Larger cancers or those in functionally or cosmetically sensitive areas (eg, head and neck) may qualify for micrographic dermatologic surgery or other forms of peripheral and deep margin assessment, such as Mohs micrographic surgery, according to the Appropriate Use Criteria.[64][65][66]

Please see StatPearls' companion resources, "Mohs Micrographic Surgery Appropriate Use Criteria (AUC) Guidelines," "Mohs Micrographic Surgery," "Mohs Micrographic Surgery Evaluation and Treatment of Microcystic Adnexal Carcinoma," "Mohs Micrographic Surgery of Uncommon Tumors (Angiosarcoma, Eccrine, Paget, and Merkel Cell)," "Mohs Micrographic Surgery Management of Melanoma and Melanoma In Situ," and "Mohs Micrographic Surgery Evaluation and Treatment of Dermatofibrosarcoma Protuberans," for more information.

Patients with aggressive or recurrent basal cell carcinoma who are not good surgical candidates may be treated with radiation therapy, systemic medications (eg, vismodegib), or novel therapies such as oncolytic viruses.[67][68][69][70][71] Please see StatPearls' companion resource, "Vismodegib," for more information. Other malignancies, such as melanoma, are typically treated with surgical excision or other unique systemic therapies. Late-stage unresponsive malignancies may require chemotherapy or immunotherapy.[72][73]

Differential Diagnosis

Skin neoplasms can be either benign or malignant, with each type of skin cancer presenting in a variety of ways. Due to this diversity, the differential diagnosis includes all lesions that may appear as macules, patches, papules, plaques, or nodules. In rare cases, they may also present as vesicles, bullae, or pustules. The differential diagnoses should consider relevant vascular, infectious, neoplastic (eg, metastases to the skin from other organs), inflammatory, traumatic, metabolic, mechanical, allergic, autoimmune, and iatrogenic lesions.

Common lesions to distinguish from true skin cancer include:

Psoriasis
Atopic dermatitis
Tinea corporis (or other body area)
Acne vulgaris
Warts
Lupus erythematosus
Actinic keratosis
Metastatic skin tumors
Sebaceous hyperplasia
Nevus
Benign melanocytic lesions
Dysplastic nevi [74][75][76][77][78]

Cysts should also be considered in the differential diagnosis of skin cancer. Please see StatPearls' companion resource, "Dermatopathology Evaluation of Cysts," for more information.

Staging

The staging of skin cancer is specific to each subtype of skin cancer and is beyond the scope of this resource. Please see StatPearls' companion resource, "Clinical Guidelines for the Staging, Diagnosis, and Management of Cutaneous Malignant Melanoma," for more information on the staging, diagnosis, and management of cutaneous malignant melanoma.

Prognosis

Most skin cancers, particularly nonmelanoma types such as basal cell and squamous cell carcinomas, have a good prognosis with curative management.[79][80][81] However, prognosis can vary widely depending on the subtype. For example, Merkel cell carcinoma has an unfavorable prognosis, with survival rates often less than 20%.[82][83][84] The prognosis generally depends on specific risk factors and treatment options for each malignancy. Detailed prognosis for each subtype is beyond the scope of this resource.

Complications

Skin cancer can lead to several complications, many of which can be prevented with early detection and management. However, the complications vary based on the subtype of skin cancer. General complications include:

Further invasion of the cancer locally, either peripherally or deeply, causing tissue damage and symptoms such as pain.[85]
Metastasis of skin cancer to other areas of the body, including the brain, lungs, lymph nodes, or skin.[86]
Infection of skin cancer, particularly in ulcerated lesions.[87]
Scarring and tissue destruction from the cancer or its surrounding skin, which could lead to temporary or permanent physical debility or disfigurement.[88]
Unpleasant patient-reported symptoms, such as pain, itching, bleeding, or discomfort in the area of the skin cancer.[89][90]
Recurrence of skin cancer, even after treatment.[91]
Psychiatric conditions associated with skin cancer, such as depression or anxiety.[92]
Psychological complications, such as distress or fear.[93]
Effects of treatments, such as adverse drug events.[94]
Impaired immune function.[95]

Early evaluation and management of skin cancer are crucial to prevent potential complications. For example, recurrence rates of skin cancer vary widely depending on the subtype. Basal cell carcinoma has a rare recurrence rate after treatment with micrographic dermatologic surgery.[96] In contrast, mucinous carcinoma of the skin, which can be either primary or metastatic from other areas (eg, colon and breast), has a local recurrence rate estimated to be between 20% and 40%. Recurrence is most commonly associated with the tumor's size.[97] The interprofessional team's coordination throughout a patient's care continuum is essential in communicating skin cancer prevention, early detection of skin cancer, tailored treatment, and early detection of complications.

Enhancing Healthcare Team Outcomes

Patients with skin cancer are at high risk for morbidity and mortality associated with the disease. Early identification and management are critical in reducing these risks. The care of skin cancer patients requires a collaborative approach among healthcare professionals to ensure patient-centered care and optimize outcomes. Dermatologists, primary care physicians, pathologists, surgeons, advanced practitioners, nurses, pharmacists, and other healthcare providers involved in patient care should have the necessary clinical skills and knowledge to accurately diagnose and manage skin cancer. This includes expertise in recognizing the varied clinical presentations and understanding the nuances of diagnostic techniques such as biopsies and histopathology.

Healthcare teams can improve early detection and, in some cases, the eradication of skin cancer through collaboration. Patient and caregiver education on risk factors, medication adherence, treatments, and prevention (eg, sun protection) is crucial to reduce morbidity associated with skin cancer.[98] Please see StatPearls' companion resource, "Skin Cancer Prevention," for more information on skin cancer prevention. A strategic approach is essential, incorporating evidence-based strategies to optimize treatment plans and minimize adverse effects. Ethical considerations should guide decision-making, ensuring informed consent and respecting patient autonomy in treatment choices.

Each healthcare professional must understand their responsibilities and contribute their unique expertise to the patient's care plan, fostering a collaborative, multidisciplinary approach. Effective interprofessional communication is crucial, facilitating seamless information exchange and collaborative decision-making among healthcare team members. Care coordination is pivotal in ensuring that the patient's journey from diagnosis to treatment and follow-up is well-managed, minimizing errors and enhancing patient safety. By embracing these principles—skill, strategy, ethics, responsibilities, interprofessional communication, and care coordination—healthcare professionals can deliver patient-centered care, ultimately improving patient outcomes and enhancing team performance in the management of skin cancer.

(Click Image to Enlarge)

Basal Cell Carcinoma Presenting as Pink Papules on a Patient's Skin.

Kelly Nelson, MD, Public Domain, via Wikimedia Commons

(Click Image to Enlarge)

Basal Cell Carcinoma on Cheek—H&E Staining Showing Basaloid Islands.

Gupta N, Kapoor R, Sharma SC. Colon carcinoma presenting with a synchronous oesophageal carcinoma and basal cell carcinoma of the skin. ISRN Oncol. 2011;2011:107970.

(Click Image to Enlarge)

Squamous Cell Carcinoma.

Contributed by D Anand, MD

(Click Image to Enlarge)

Cutaneous Squamous Cell Carcinoma. This type of carcinoma typically presents as a scaly, erythematous, or hyperpigmented papule or plaque on the skin.

DermNet New Zealand

(Click Image to Enlarge)

Anatomy of the Human Skin.

Daniel de Souza Telles, Public Domain, via Wikimedia Commons

(Click Image to Enlarge)

<p>Ulcerated Acral Lentiginous Melanoma on Dorsal Toe

Ulcerated Acral Lentiginous Melanoma on Dorsal Toe. Clinical photo showing an ulcerated acral lentiginous melanoma on the dorsal aspect of a patient's toe.

Contributed by RP Rapini, MD

Details

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