Nail & Skin Disorders

What Is Skin Cancer?

Gone are the days when we slathered baby oil on our skin and competed with each other for the darkest skin tone. However, factors other than the sun play a role in the development of skin cancer, so even those who use the highest SPF can still be at risk. Learn to recognize changes in the skin that could indicate skin cancer and educate your clients about the importance of early treatment.


skin cancer: (n) changes that are malignant in the cells of the skin

We certainly hear plenty of talk about skin cancer, protecting our skin, and blocking the sun’s rays. Many of us have a constant, though nebulous, awareness that we could develop skin cancer at any time. However, many of us won’t develop skin cancer, even though we tanned long and hard in our younger years. To complicate the issue further, many times we hear of people who have had skin cancer, who had it removed, and that was the end of it. This could lead us to conclude that skin cancer isn’t something that’s terribly dangerous. Our conclusion would be wrong.

Skin cancer, though often treatable, can cause serious and profound damage to the skin, or worse. According to the American Academy of Dermatology (AAD), certain forms of skin cancer, such as squamous cell and melanoma, can metastasize (spread) to other areas of the body such as the lymph system and internal organs. Though treatable in the early stages, once melanoma spreads, the prognosis is not good.

While there are different types of skin cancer, all are broken down into two categories: melanoma and non-melanoma. Melanoma is the most serious and accounts for about 4% of all cases. The other two common types of skin cancer are called “basal cell carcinoma” and “squamous cell carcinoma.” Both of these fall into the “non-melanoma” category. Other non-melanoma types of skin cancer exist beyond these two common types, but, according to the AAD, they account for less than 1% of all diagnosed cases.

The cause of skin cancer is most often attributed to the sun, which puts us all at risk, but is especially problematic for those with fair skin that burns easily. However, multiple factors beyond the sun can play a role in the development of cancer, says Rashid M. Rashid, M.D., a house staff dermatologist at the University of Texas MD Anderson Cancer Center and director of the nail, hair, and skin disease division of the Morzak Center. “Among the many factors studied, genetics and viruses have been shown to trigger cancers.” Dr. Rashid explains that, due to genetics, a non-Caucasian would be more likely to develop a melanoma under the nail or on the palms or soles of the feet than a Caucasian. The National Cancer Institute lists other factors, including radiation therapy, medical conditions or drugs that suppress the immune system, skin conditions, and scars or burns on the skin. “A patient with a wart under or around a nail has a chance of it becoming a cancer,” says Dr. Rashid.

With so many factors present, the likelihood of a tech seeing a client with skin cancer is quite high. “Cancers under the nail are much more common than most people think,” says Dr. Rashid. “Part of the problem is that they tend to be painless, slow-growing, and often very subtle.” Dr. Rashid says that many times changes in the skin on the hands and around the nails is spotted because a client is in the habit of having her nails examined regularly. That should make techs feel good to know that we really are on the front lines of protecting our clients.

So what should you look for? Start with the “ABCD” warning signs: the spot will be Asymmetrical (one half doesn’t mirror the other); the Border will look like it’s spreading instead of having sharp edges; there will be Color variations in the spot, possibly with a very dark, black area. Finally, evaluate the Diameter. Though the area can be smaller, when it is the size of a pea or a pencil eraser, there is a higher possibility that the spot is malignant.

The ABCD test is often referred to when trying to assess if a spot is a melanoma. Other types of skin cancer, such as the basal cell carcinoma and the squamous cell carcinoma appear on the skin differently. Look for elevated growths that don’t seem to heal, or crusty, scaly, enflamed areas on the skin.

Types of Skin Cancer

Three types of skin cancer account for nearly 100% of all diagnosed cases. Each begins in a different type of cell within the skin, and each is named for the type of cell in which it begins. Skin cancers are divided into one of two classes: non-melanoma and melanoma. Melanoma is the deadliest form of skin cancer. The three main types of skin cancer are listed. All other skin cancers combined account for less than 1% of diagnosed cases.

Basal cell carcinoma (BCC): BCC develops in more than 1 million people every year in the United States alone. About 80% of all skin cancers are BCC, a cancer that develops in the basal cells — skin cells located in the lowest layer of the epidermis. BCC can take several forms. It can appear as a shiny translucent or pearly nodule, a sore that continuously heals and then re-opens, a pink slightly elevated growth, reddish irritated patches of skin, or a waxy scar. These tumors tend to grow slowly and can take years to reach a half-inch in size. While these tumors very rarely metastasize, dermatologists encourage early diagnosis and treatment to prevent extensive damage to surrounding tissue.

Squamous cell carcinoma (SCC): This cancer begins in the squamous cells, which are found in the upper layer of the epidermis. About 200,000 cases are diagnosed every year. SCC tends to develop in fair-skinned, middle-aged and elderly people who have had long-term sun exposure. It most often appears as a crusted or scaly area of skin with a red inflamed base that resembles a growing tumor, non-healing ulcer, or crusted-over patch of skin. SCC requires early treatment to prevent metastasis.

Melanoma: Accounting for about 4% of all diagnosed skin cancers, melanoma begins in the melanocytes, cells within the epidermis that give skin its color. Melanoma has been coined “the most lethal form of skin cancer” because it can rapidly spread to the lymph system and internal organs. In the United States alone, approximately one person dies from melanoma every hour. With early detection and proper treatment, the cure rate for melanoma is about 95%. Once its spreads, the prognosis is poor. Melanoma most often develops in a pre-existing mole or looks like a new mole, which is why it is important for people to know what their moles look like and be able to detect changes to existing moles and spot new moles.

Source: American Academy of Dermatology

What’s a Tech to Do?

It’s second nature to examine your client’s hands when they come in. You see dry skin, cuts, bruises, discoloration, and many other interesting changes to the skin around (and under) the nail. Most of these can be easily recognized as everyday wear and tear to our skin based on weather, habits, or profession. Watch for changes of color. “Classically, the teaching is that black is melanoma,” says Dr. Rashid. A tech, he explains, may see a black area or a black line under the nail. However, any change in color should send an alarm. “Recently, reports show other colors, like red, can indicate cancer under the nail. Ultimately, the nail should not be changing color,” says Dr. Rashid. “If all of a sudden the skin under or around the nail starts to look different, it is time to have the area examined by a physician.”

As to any preventative or suggested treatment the tech can offer at the desk, the answer is: One does not exist. Sunscreen and sun avoidance is always a good idea, but it is no guarantee against skin cancer. “I’d hate to see someone delay a doctor’s visit because they are trying an alternative treatment,” says Dr. Rashid. So, go with your instincts. “In many cases it is the nail tech who will note something atypical in the nail. The change may occur so slowly and over so many years that the client never notices it,” he says. He suggests techs look carefully at the nails each visit with a fresh, unbiased perspective, and if you suspect something is going on, recommend a medical consultation. “Good nail health is good health care,” says Dr. Rashid, and nail techs are positioned perfectly to notice early changes to the health of the nail.


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