General Information About Childhood Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin

KEY POINTS

• Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.
• Different types of cancer start in the skin.
• Exposure to sunlight affects the risk of basal cell carcinoma and squamous cell carcinoma of the skin.
• Signs of basal cell carcinoma and squamous cell carcinoma of the skin include a raised lump and a sore that does not heal.
• Tests that examine the skin are used to diagnose basal cell carcinoma and squamous cell carcinoma of the skin.

Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.

The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:

• Squamous cells: Thin, flat cells that form the top layer of the epidermis.
• Basal cells: Round cells under the squamous cells.
• Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to darken.

Skin cancer can occur anywhere on the body, but it usually occurs in skin that is exposed to sunlight, such as the face, neck, and hands.

Different types of cancer start in the skin.

There are two main forms of skin cancer:

• Nonmelanoma: Skin cancer that forms in basal cells is called basal cell carcinoma. Skin cancer that forms in squamous cells is called squamous cell carcinoma of the skin. Basal cell carcinoma and squamous cell carcinoma of the skin are two types of nonmelanoma skin cancer.
• Melanoma: Skin cancer that forms in the melanocytes (cells that color the skin) is called melanoma. In children and adolescents, melanoma is more common than both basal cell carcinoma and squamous cell carcinoma of the skin.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk.

Risk factors for childhood basal cell carcinoma and squamous cell carcinoma of the skin include the following:

• Being exposed to natural sunlight or artificial sunlight (such as from tanning beds).
• Having a fair complexion, which includes the following:
  • Fair skin that freckles and burns easily, does not tan, or tans poorly.
  • Blue or green or other light-colored eyes.
  • Red or blond hair.
• Having actinic keratosis.
• Having Gorlin syndrome.
• Past treatment with radiation.
• Having a weakened immune system.

These and other signs and symptoms may be caused by basal cell carcinoma and squamous cell carcinoma of the skin or by other conditions.

Check with your child's doctor if your child has any of the following:

• A sore that does not heal.
• Areas of the skin that are:
  • Small, raised, smooth, shiny, and waxy.
  • Small, raised, and red or reddish-brown.
  • Flat, rough, red or brown, and scaly.
  • Scaly, bleeding, or crusty.
  • Similar to a scar and firm.

Tests that examine the skin are used to diagnose basal cell carcinoma and squamous cell carcinoma of the skin.

The following tests and procedures may be used:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Skin exam: A doctor or nurse checks the skin for bumps or spots that look abnormal in color, size, shape, or texture.
• Biopsy: All or part of a growth that doesn't look normal is cut from the skin and viewed under a microscope by a pathologist to check for signs of cancer. There are three main types of skin biopsies:
  • Shave biopsy: A sterile razor blade is used to “shave off” the growth that does not look normal.
  • Punch biopsy: A special instrument called a punch or a trephine is used to remove a circle of tissue from the growth that does not look normal.

  • Incisional biopsy: A scalpel is used to remove part of an abnormal-looking growth.
  • Excisional biopsy: A scalpel is used to remove the entire growth.

The main treatment for basal cell carcinoma and squamous cell carcinoma of the skin is surgery. Two types of surgery may be used:

• Excision: The tumor and a small amount of healthy tissue around the tumor is removed.
• Mohs micrographic surgery: The tumor is cut from the skin in thin layers. During surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove skin cancer on the face.