does skin cancer hurt to the touch?
Here are 5 skin conditions that often mimic skin cancer, which include psoriasis, sebaceous hyperplasia, seborrheic keratosis, nevus, and cherry angioma.

The skin may have negative effects due to various reasons, such as exposure to sunlight, dust, and pollutants, extremes of weather, lack of sleep, improper or poor diet, and hormonal changes. These unfavorable factors along with genetic predispositions may cause changes in the skin cells that may lead to cancer.

Any changes in the skin should always be noted. Skin cancer is best treated when it is detected early.

All skin changes, however, do not mean cancer.

5 skin conditions that mimic skin cancer

  1. Psoriasis
    • Psoriasis is a skin condition that is thought to be caused by an immune system issue that leads T-cells to mistakenly assault healthy skin cells.
    • This increases the formation and life cycle of skin cells, causing cells to accumulate on the skin's surface in a manner that is frequently misinterpreted for skin cancer.
    • Psoriasis symptoms include red areas of the skin covered with silvery scales, soreness, itching, and dry cracked skin.
  2. Sebaceous hyperplasia
    • Sebaceous glands are tiny glands that occur near hair follicles and provide an oily, waxy substance that lubricates and protects the skin and hair.
    • When this gland swells, it might produce tiny yellow or flesh-colored papules or bumps that mimic basal cell carcinomas (a type of skin cancer).
    • These growths, for the most part, are not hazardous and are solely removed for cosmetic reasons.
  3. Seborrheic keratosis (benign tumor)
    • One of the most frequent benign (noncancerous) skin tumors is seborrheic keratoses.
    • While there are several ideas, the actual origin is unknown. However, it frequently resembles skin cancer and manifests as scaly, dark, and oily growths on the skin.
    • Treatment of this growth is usually not required. However, it might be done if it is itchy, irritates, or is inflamed.
    • If the dermatologist is unclear if the tumor is benign, they may request a lab examination to evaluate it.
  4. Nevus (a mole)
    • Moles, also called nevi, are one of the most prevalent types of skin growth. 
    • These are some of the most frequent growths that are mistaken for melanomas. They appear predominantly in early adulthood.
    • Melanomas are distinguished by their asymmetry, irregular border, uneven coloration, and size of more than 6 mm.
    • These symptoms, however, can appear in atypical moles, which might be benign.
    • As a result, it is critical to consult a dermatologist for an accurate diagnosis of any new unusual mole.
  5. Cherry angioma
    • Cherry angiomas are benign vascular growths that appear as vivid cherry red lumps on the skin, usually on the body's trunk.
    • They are more common in adults older than 40 years and are caused by an increase in blood vessel formation.
    • While they may resemble moles or even skin cancer, they are harmless and are solely removed for cosmetic reasons or symptoms, such as bleeding.

What is skin cancer?

Skin cancer is defined as the uncontrolled growth (proliferation) of dysfunctional cells in the skin. It occurs when the DNA of a skin cell undergoes an abnormal change called a mutation. These mutations cause skin cells to grow quickly and uncontrollably, resulting in the formation of malignant tumors.

Skin cancer may result from mutations caused when the skin is exposed to ultraviolet (UV) rays in the sunlight. So, to prevent the skin from developing cancer, a person must avoid direct sun exposure and the use of UV tanning beds. It is recommended to use a sunscreen lotion to protect the skin from UV rays.

Skin cancer is defined by the cells that are involved and are mainly categorized into two types.

  1. Keratinocyte carcinoma: Cancer develops from squamous cells and develops into the basal cell and squamous cell carcinoma. They are the most common types of skin cancers.
  2. Melanoma: This type of cancer develops from melanocytes, the cells that provide pigment to the skin.

4 main types of skin cancers

The 4 main types of skin cancer include:

  1. Basal cell carcinoma (BCC)
    • Basal cell carcinoma (BCC) is the most prevalent kind of skin cancer, accounting for about 3.6 million cases diagnosed each year in the United States.
    • Basal cell carcinoma (BCC) is uncontrolled, abnormal growth of the basal cells in the skin's outermost layer (epidermis).
      • These malignancies most commonly occur on sun-exposed skin, particularly the face, ears, neck, scalp, shoulders, and back.
      • The majority of BCC is produced by a combination of intermittent, severe sun exposure and cumulative, long-term sun exposure.
      • If not diagnosed and treated early, BCC can be devastating.
      • These malignancies can metastasize (spread) and can even be lethal.
  2. Squamous cell carcinoma (SCC)
    • Squamous cell carcinoma (SCC) is the second most frequent kind of skin cancer. Each year, an estimated 1.8 million cases are diagnosed in the United States.
    • Squamous cell carcinoma (SCC) is an uncontrolled proliferation of abnormal cells that arise from squamous cells in the skin's outer layer (epidermis).
      • SCC is widespread in sun-exposed parts of the skin, such as the ears, face, head, neck, and hands, where the skin commonly shows evidence of solar damage, such as wrinkles and age spots.
    • Most SCCs are caused by cumulative, long-term exposure to ultraviolet (UV) radiation from the sun and tanning beds.
      • SCCs can develop quickly and metastasize if they are not diagnosed and treated early.
      • In the United States, invasive SCC of the skin claims the lives of up to 15,000 people each year.
  3. Melanoma
    • More than 207,390 new cases of melanoma were projected in the United States in 2021, with about 106,110 of these becoming invasive.
    • Melanoma is a kind of cancer that arises from melanocytes, which are skin cells that generate the pigment melanin that gives the skin its color. 
      • Melanomas frequently mimic moles and may develop from them.
      • They can be found on any part of the body, even in locations that are not often exposed to sunlight.
    • Melanoma is frequently initiated by the same type of severe, intermittent sun exposure that causes sunburn.
      • The usage of tanning beds raises the risk of melanoma.
      • Melanoma is the deadliest of the three most frequent types of skin cancer.
      • Melanomas are treatable if detected and treated early; however, they are expected to kill 7,180 people in 2021.
  4. Merkel cell carcinoma (MCC)
    • Each year, about 3,000 new cases of MCC and 700 fatalities are reported in the United States, and this number is increasing.
    • Merkel cell carcinoma (MCC) is a rare and deadly kind of skin cancer. This tumor often manifests as hard, painless lumps or nodules on a sun-exposed skin region (about half of the time on the head and neck and frequently on the eyelids).
    • MCCs, which are usually linked with a virus called the Merkel cell polyomavirus, most commonly appear on sun-exposed regions in fair-skinned people older than 50 years. MCCs are highly probable to reoccur and spread throughout the body, thus early identification and treatment are critical.

SLIDESHOW

Skin Cancer Symptoms, Types, Images See Slideshow

How is skin cancer diagnosed?

People are advised to consult a dermatologist if they observe any changes or abnormal growth of skin cells. The dermatologist may recommend various tests to determine the presence of skin cancer.

  • Physical examination
    • The dermatologist checks the skin to identify any spots that look different from others and notes the structural differences or presence of itch and bleeding.
    • A lesion that is cancerous looks like this:
      • A mole that is different from the others
      • The growth is protruded out like a dome
      • The patch looks scaly
      • Sore that does not heal or heals and returns
      • Brown or black discolored stripe under a nail
  • Biopsy
    • A biopsy is a process where some tissue is removed and examined under a microscope. To detect skin cancer various biopsies are done.
  • Skin biopsy
    • If the dermatologist suspects cancer, a small part of the skin is removed from the spot and sent to the lab to analyze under a microscope to determine the presence of cancer cells.
    • A local anesthetic (numbing drug) is administered into the region using a very tiny needle to do skin biopsies.
    • A person may feel a slight prick and stinging while the medication is injected, but they should not experience any discomfort throughout the biopsy.
  • Shave (tangential) biopsy
    • A shave biopsy can be used to diagnose various forms of skin disorders and to sample moles.
    • The doctor uses a thin surgical blade to shave off the top layers of skin for a shave biopsy.
    • The bleeding from the biopsy site is then halted by using an ointment or a medication that stops bleeding or by cauterizing the lesion with a mild electrical current.
  • Punch biopsy
    • A punch biopsy is performed by removing a deeper sample of the skin with an instrument that resembles a small round cookie cutter.
    • The punch biopsy instrument is rotated on the skin by the doctor until it slices through all of the layers of skin.
    • The biopsy sample is removed, and the biopsy site is frequently sewn together.
  • Excisional and incisional biopsies
    • An excisional or an incisional biopsy is used to investigate a tumor that has progressed into deeper layers of the skin.
      • Excisional biopsy: The whole tumor is removed during an excisional biopsy.
      • Incisional biopsy: Only a part of the tumor is removed during an incisional biopsy.
    • A surgical knife is used to cut through the whole thickness of the skin for these sorts of biopsies. A wedge or sliver of the skin is taken for inspection, and the borders of the incision are generally sewn together.
  • Fine needle aspiration (FNA) biopsy
    • A syringe with a thin, hollow needle extracts extremely minute pieces of the lymph node. Sometimes a local anesthetic is administered to numb the region initially.
    • This examination is rarely painful and does not leave a scar. Although FNA biopsies are less painful than other types of biopsies, they may not always give a big enough sample to detect cancer cells.
  • Surgical (excisional) lymph node biopsy
    • If an FNA does not reveal cancer in a lymph node but the clinician believes cancer has spread there, the lymph node may be surgically removed and analyzed.
    • If the lymph node is close to the skin, it is typically possible to remove it under local anesthetic at a doctor's office or outpatient surgery center. This will result in a minor scar.

Imaging tests

  • Chest X-ray
    • This test may be used to assess if cancer has progressed to the lungs although a computed tomography scan of the chest (see below) is usually performed instead.
  • Ultrasound
    • With the use of ultrasound sound waves, pictures of the inside of the body are produced on a computer screen. It examines the lymph nodes surrounding the tumor, especially if a physical exam does not reveal if they are swollen.
    • The doctor may use ultrasound to guide a needle to perform a biopsy, and it is called an ultrasound-guided biopsy.
  • Computed tomography (CT) scan
    • The CT scan makes comprehensive, cross-sectional pictures of the body using X-rays.
      • CT scans, unlike traditional X-rays, may reveal detailed soft tissues, such as internal organs.
      • This test can detect whether any lymph nodes are swollen or if organs, such as the lungs or liver, have abnormal patches that could be caused by cancer spread.
    • CT scan guided-biopsy is done where the needle is guided to the suspicious area and tissue is extracted for examination.
  • Magnetic resonance imaging (MRI) scan
    • MRI scans generate comprehensive pictures of the body using radio waves and powerful magnets. MRI scans may be quite useful in examining the brain and spinal cord.
  • Positron emission tomography (PET) scan
    • A PET scan can determine whether cancer has progressed to the lymph nodes or other regions of the body, such as the brain. It is particularly effective in adults with advanced melanoma.
    • A person is injected with a slightly radioactive kind of sugar that gathers mostly in cancer cells for this test. A specialized camera is then used to make an image of radioactive regions in the body.

What is the staging of skin cancer?

The stage of cancer defines the tumor size and how far it has spread from its origin. The malignant cells' appearance is described by the grade.

There are different types of cancer staging, each is used for particular cancer.

Skin cancer staging includes the following:

  1. Stage 0: Signifies that the cancer is still in the same place it originated (in situ) and has not spread.
  2. Stage I: Cancer is tiny and has not spread to nearby tissues.
  3. Stage II: Cancer has spread to the deeper skin layers but has not spread to the lymph nodes or beyond the skin.
  4. Stage III: Cancer has grown in size and may have spread to neighboring tissues and lymph nodes (part of the lymphatic system).
  5. Stage IV: The disease has migrated from its original site to at least one additional organ, which is sometimes called secondary or metastatic cancer.

The appearance of the cells under a microscope determines the grade of malignancy. In general, a lower grade denotes slow-growing cancer, whereas a higher grade denotes fast-growing cancer.

The most common grading system is:

  1. Grade I: Cancer cells that seem like normal cells and do not develop quickly.
  2. Grade II: Cancer cells that do not resemble regular cells and develop at a quicker rate than normal cells.
  3. Grade III: Cancer cells that appear abnormal and have the potential to develop or spread more aggressively.

7 treatment options for skin cancer

Treatment for skin cancer may include one or more of the following techniques:

  1. Skin cancer surgery: Excision entails removing the lesion and some surrounding tissue before suturing the wound with or without the use of a skin graft.
  2. Curettage and desiccation: A surgical instrument is used to remove the lesion, then an electrical current is used to destroy any residual malignant cells.
  3. Cryosurgery: Liquid nitrogen is used to freeze and kill cancer cells.
  4. Prescription topical medications: These medicines activate the body's immune system, which aids in the elimination of slow-growing cancer.
  5. Mohs micrographic surgery: Mohs surgery may be a viable option for lesions at the nose tip or those that have previously been treated but have recurred.
  6. Chemotherapy: Medications may be administered orally or injected into a vein to kill cancer cells.
  7. Radiation therapy: This treatment may be indicated if the lesion is advanced or if surgical removal is difficult.

A combination of these treatment options is generally used.

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Medically Reviewed on 12/23/2021
References
Image Source: iStock Images

Hill K. 5 Things Sometimes Mistaken for Skin Cancer. Health Union. https://skincancer.net/life-with-skin-cancer/commonly-mistaken

American Academy of Dermatology. Types of skin cancer. https://www.aad.org/public/diseases/skin-cancer/types/common

National Cancer Institute. Skin Cancer Treatment (PDQ®)–Patient Version. https://www.cancer.gov/types/skin/patient/skin-treatment-pdq

National Cancer Institute. Skin Cancer (Including Melanoma)-Patient Version. https://www.cancer.gov/types/skin