Aging Begins at 30

Cutaneous Cancer

Ian Maclean Smith, M.D.
Emeritus Professor
Department of Internal Medicine
University of Iowa Hospitals and Clinics
First Published: December 2001
Last Revised: March 2004
Peer Review Status: Internally Peer Reviewed

Ultraviolet B radiation in sunlight is the main cause but ultraviolet A contributes to the risk. These cause mutations in the DNA. Fair skinned people are at more risk as are people who live in early life closer to the equator. A history of sunburns in childhood is important. Chemical agents can also be dangerous as was shown by Dr. Percivall Pott in the days when boy chimney sweeps exposed to soot developed cancers in the scrotal area. Arsenic has a similar effect. These people are at a slightly higher risk of developing squamous cancers than are age-matched controls.

Sun spots or actinic keratosis are the predecessors of these cancers and come from sun exposure. They are red or skin-colored, flat or raised skin thickenings that can be removed by liquid nitrogen freezing. If left they may develop into squamous cancers. Scaly plaques in sun-exposed areas may be squamous cancers "in situ" that is totally localized.

Most developed squamous cancers are on the head and neck. The trunk is the next most common area involved. They may be ulcerated, and the patients say they are somewhat itchy nonhealing ulcers and may bleed when scratched. These cancers can spread either locally or to a distant site. Small cancers recur about 7% and large ones about 15%. Small ones metastasize in about 10% and large ones 30%, and some sites more than others. Tumors that are well differentiated (that are most like normal skin) recur locally in 14% but the 5-year cure rate is 95%. Those less like normal skin recur locally in 29% and 62% have a 5-year cure rate.

People as they get older should be screened yearly in a total body skin exam looking for these cancers or their predecessors. Those with a predisposition or with prior skin cancers should be screened twice yearly for the first three years after treatment, followed by yearly visits.

Most people with this kind of skin cancer do very well. About 95% survive. If the cancer has spread to the local lymph glands or further the patients do less well with a ten-year survival of 20%. So get attention early.

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See related Patient Topics Cancers, Skin Cancer or Skin, Hair and Nails.

See related Provider Topics Cancers, Skin Cancer or Skin, Hair and Nails.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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