National Cancer Institute

What You Need 

To Know About TM

Melanoma

and Other

Skin Cancers

U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES

National Institutes of Health
National Cancer Institute Services

This is only one of many free booklets for

people with cancer.

You may want more information for yourself,

your family, and your doctor.

NCI offers comprehensive research-based

information for patients and their families, health

professionals, cancer researchers, advocates, and

the public.

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1–800–4–CANCER (1–800–422–6237)

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http://www.cancer.gov/espanol

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messaging service, at http://www.cancer.gov/

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U.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICES

National Institutes of Health

National Cancer Institute

Contents

About This Booklet 1

The Skin 3

Cancer Cells 5

Types of Skin Cancer 6

Risk Factors 7

Symptoms 12

Diagnosis 16

Staging 17

Treatment 21

Second Opinion 32

Taking Part in Cancer Research 34

Follow-up Care 35

Prevention 36

How To Check Your Skin 37

Sources of Support 38

Dictionary 40

National Cancer Institute Publications 53
About This Booklet

This National Cancer Institute (NCI) booklet is for

people diagnosed with the most common types of skin

cancer:*

• Melanoma 

• Basal cell skin cancer 

• Squamous cell skin cancer

Skin cancer is the most common type of cancer in

the United States. Each year, more than 68,000

Americans are diagnosed with melanoma, and another

48,000 are diagnosed with an early form of the disease

that involves only the top layer of skin. Also, more

than 2 million people are treated for basal cell or

squamous cell skin cancer each year. Basal cell skin

cancer is several times more common than squamous

cell skin cancer.

Learning about medical care for skin cancer can

help you take an active part in making choices about

your care. This booklet tells about: 

• Diagnosis and staging 

• Treatment

• Follow-up care

• How to prevent another skin cancer from forming 

• How to do a skin self-exam

This booklet has lists of questions that you may

want to ask your doctor. Many people find it helpful to

take a list of questions to a doctor visit. To help

remember what your doctor says, you can take notes.

1

*Words in italics are in the Dictionary on page 40. The Dictionary

explains these terms. It also shows how to pronounce them.
You may also want to have a family member or friend

go with you when you talk with the doctor—to take

notes, ask questions, or just listen.

For the latest information about skin cancer, please

visit our Web site at http://www.cancer.gov/

cancertopics/types/skin. For information about

melanoma, go to http://www.cancer.gov/

cancertopics/types/melanoma.

Also, NCI’s Cancer Information Service can answer

your questions about skin cancer. We can also send you 

NCI booklets and fact sheets. Call 1–800–4–CANCER

(1–800–422–6237) or chat with us online using

LiveHelp, NCI’s instant messaging service at

http://www.cancer.gov/livehelp.

This booklet does not describe rare types of skin

cancer, such as Merkel cell carcinoma. Also, this

booklet does not discuss melanoma that begins in the

eye, the digestive tract, or other areas of the body.

NCI’s Cancer Information Service can provide

information about rare skin cancers and melanoma that

begins in areas other than the skin.

2
The Skin

Your skin protects your body from heat, injury, and

infection. It also protects your body from damage

caused by ultraviolet (UV) radiation (such as from the

sun or sunlamps).

Your skin stores water and fat. It helps control body

heat. Also, your skin makes vitamin D.

The picture on the next page shows the two main

layers of the skin:

• Epidermis: The epidermis is the top layer of your

skin. It’s mostly made of flat cells called squamous

cells.

Below the squamous cells deeper in the epidermis

are round cells called basal cells.

Cells called melanocytes are scattered among the

basal cells. They are in the deepest part of the

epidermis. Melanocytes make the pigment (color)

found in skin. When skin is exposed to UV

radiation, melanocytes make more pigment, causing

the skin to darken, or tan.

• Dermis: The dermis is the layer under the epidermis.

The dermis contains many types of cells and

structures, such as blood vessels, lymph vessels, and

glands. Some of these glands make sweat, which

helps cool your body. Other glands make sebum.

Sebum is an oily substance that helps keep your skin

from drying out. Sweat and sebum reach the surface

of your skin through tiny openings called pores.

3
4

Hair shaft

Oil gland

Epidermis

Dermis

Lymph vessel

Sweat gland

Fatty tissue

This picture shows the layers of the skin—the

epidermis and dermis. At the top, the close-up shows

a squamous cell, basal cell, and melanocyte.

Basal cell

Melanocyte

Squamous

cells

Epidermis

Dermis

Blood vessels

© 2010 Terese WinslowU.S. Govt. has certain rights
Cancer Cells

Cancer begins in cells, the building blocks that make

up tissues. Tissues make up the skin and other organs

of the body.

Normal cells grow and divide to form new cells as

the body needs them. When normal cells grow old or

get damaged, they usually die, and new cells take their

place.

But sometimes this process goes wrong. New cells

form when the body doesn’t need them, and old or

damaged cells don’t die as they should. The buildup of

extra cells often forms a mass of tissue called a growth

or tumor.

Growths on the skin can be benign (not cancer) or

malignant (cancer). Benign growths are not as harmful

as malignant growths.

• Benign growths (such as moles):

—Are rarely a threat to life

—Generally can be removed and usually don’t grow

back

—Don’t invade the tissues around them

—Don’t spread to other parts of the body

• Malignant growths (such as melanoma, basal cell

cancer, or squamous cell cancer):

—May be a threat to life

—Often can be removed but sometimes grow back

—May invade and damage nearby organs and

tissues

—May spread to other parts of the body

5
Types of Skin Cancer

Skin cancers are named for the type of cells that

become malignant (cancer). The three most common

types are:

• Melanoma: Melanoma begins in melanocytes

(pigment cells). Most melanocytes are in the skin.

See the picture on page 4 of a melanocyte and other

skin cells.

Melanoma can occur on any skin surface. In men,

it’s often found on the skin on the head, on the neck,

or between the shoulders and the hips. In women,

it’s often found on the skin on the lower legs or

between the shoulders and the hips.

Melanoma is rare in people with dark skin. When it

does develop in people with dark skin, it’s usually

found under the fingernails, under the toenails, on

the palms of the hands, or on the soles of the feet.

• Basal cell skin cancer: Basal cell skin cancer

begins in the basal cell layer of the skin. It usually

occurs in places that have been in the sun. For

example, the face is the most common place to find

basal cell skin cancer.

In people with fair skin, basal cell skin cancer is the

most common type of skin cancer.

• Squamous cell skin cancer: Squamous cell skin

cancer begins in squamous cells. In people with

dark skin, squamous cell skin cancer is the most

common type of skin cancer, and it’s usually found

in places that are not in the sun, such as the legs or

feet. 

However, in people with fair skin, squamous cell

skin cancer usually occurs on parts of the skin that

have been in the sun, such as the head, face, ears,

and neck.

6
Unlike moles, skin cancer can invade the normal

tissue nearby. Also, skin cancer can spread throughout

the body. Melanoma is more likely than other skin

cancers to spread to other parts of the body. Squamous

cell skin cancer sometimes spreads to other parts of the

body, but basal cell skin cancer rarely does.

When skin cancer cells do spread, they break away

from the original growth and enter blood vessels or

lymph vessels. The cancer cells may be found in

nearby lymph nodes. The cancer cells can also spread

to other tissues and attach there to form new tumors

that may damage those tissues.

The spread of cancer is called metastasis. See the

Staging section on page 17 for information about skin

cancer that has spread.

Risk Factors

When you’re told that you have skin cancer, it’s

natural to wonder what may have caused the disease.

The main risk factor for skin cancer is exposure to

sunlight (UV radiation), but there are also other risk

factors. A risk factor is something that may increase the

chance of getting a disease.

People with certain risk factors are more likely than

others to develop skin cancer. Some risk factors vary

for the different types of skin cancer.

7
Risks for Any Type of Skin Cancer

Studies have shown that the following are risk

factors for the three most common types of skin

cancer:

• Sunlight: Sunlight is a source of UV radiation. It’s

the most important risk factor for any type of skin

cancer. The sun’s rays cause skin damage that can

lead to cancer.

—Severe, blistering sunburns: People who have

had at least one severe, blistering sunburn are at

increased risk of skin cancer. Although people

who burn easily are more likely to have had

sunburns as a child, sunburns during adulthood

also increase the risk of skin cancer.

—Lifetime sun exposure: The total amount of sun

exposure over a lifetime is a risk factor for skin

cancer.

—Tanning: Although a tan slightly lowers the risk

of sunburn, even people who tan well without

sunburning have a higher risk of skin cancer

because of more lifetime sun exposure.

Sunlight can be reflected by sand, water, snow, ice,

and pavement. The sun’s rays can get through

clouds, windshields, windows, and light clothing. 

In the United States, skin cancer is more common

where the sun is strong. For example, more people

in Texas than Minnesota get skin cancer. Also, the

sun is stronger at higher elevations, such as in the

mountains.

Doctors encourage people to limit their exposure to

sunlight. See the Prevention section on page 36 for

ways to protect your skin from the sun.

8
• Sunlamps and tanning booths: Artificial sources

of UV radiation, such as sunlamps and tanning

booths, can cause skin damage and skin cancer.

Health care providers strongly encourage people,

especially young people, to avoid using sunlamps

and tanning booths. The risk of skin cancer is

greatly increased by using sunlamps and tanning

booths before age 30.

• Personal history: People who have had melanoma

have an increased risk of developing other

melanomas. Also, people who have had basal cell or

squamous cell skin cancer have an increased risk of

developing another skin cancer of any type.

• Family history: Melanoma sometimes runs in

families. Having two or more close relatives

(mother, father, sister, brother, or child) who have

had this disease is a risk factor for developing

melanoma. Other types of skin cancer also

sometimes run in families. Rarely, members of a

family will have an inherited disorder, such as

xeroderma pigmentosum or nevoid basal cell

carcinoma syndrome, that makes the skin more

sensitive to the sun and increases the risk of skin

cancer.

• Skin that burns easily: Having fair (pale) skin that

burns in the sun easily, blue or gray eyes, red or

blond hair, or many freckles increases the risk of

skin cancer.

• Certain medical conditions or medicines: Medical

conditions or medicines (such as some antibiotics,

hormones, or antidepressants) that make your skin

more sensitive to the sun increase the risk of skin

cancer. Also, medical conditions or medicines that

suppress the immune system increase the risk of skin

cancer.

9
Other Risk Factors for Melanoma

The following risk factors increase the risk of

melanoma:

• Dysplastic nevus: A dysplastic nevus is a type of

mole that looks different from a common mole. A

dysplastic nevus may be bigger than a common

mole, and its color, surface, and border may be

different. It’s usually wider than a pea and may be

longer than a peanut. A dysplastic nevus can have a

mixture of several colors, from pink to dark brown.

Usually, it’s flat with a smooth, slightly scaly or

pebbly surface, and it has an irregular edge that may

fade into the surrounding skin.

A dysplastic nevus is more likely than a common

mole to turn into cancer. However, most do not

change into melanoma. A doctor will remove a

dysplastic nevus if it looks like it might have

changed into melanoma.

• More than 50 common moles: Usually, a common

mole is smaller than a pea, has an even color (pink,

tan, or brown), and is round or oval with a smooth

surface. Having many common moles increases the

risk of developing melanoma.

10
Other Risk Factors for Both Basal Cell and

Squamous Cell Skin Cancers

The following risk factors increase the risk of basal

cell and squamous cell skin cancers:

• Old scars, burns, ulcers, or areas of inflammation

on the skin

• Exposure to arsenic at work

• Radiation therapy

Other Risk Factors for Squamous Cell Cancer

The risk of squamous cell skin cancer is increased

by the following:

• Actinic keratosis: Actinic keratosis is a type of flat,

scaly growth on the skin. It is most often found on

areas exposed to the sun, especially the face and the

backs of the hands. The growth may appear as a

rough red or brown patch on the skin. It may also

appear as cracking or peeling of the lower lip that

does not heal. Without treatment, this scaly growth

may turn into squamous cell skin cancer.

• HPV (human papillomavirus): Certain types of

HPV can infect the skin and may increase the risk of

squamous cell skin cancer. These HPVs are different

from the HPV types that cause cervical cancer and

other cancers in the female and male genital areas.

11
Symptoms

Symptoms of Melanoma

Often the first sign of melanoma is a change in the

shape, color, size, or feel of an existing mole.

Melanoma may also appear as a new mole. Thinking

of “ABCDE” can help you remember what to look for:

• Asymmetry: The shape of one half does not match

the other half. 

• Border that is irregular: The edges are often

ragged, notched, or blurred in outline. The pigment

may spread into the surrounding skin. 

• Color that is uneven: Shades of black, brown, and

tan may be present. Areas of white, gray, red, pink,

or blue may also be seen. 

• Diameter: There is a change in size, usually an

increase. Melanomas can be tiny, but most are larger

than the size of a pea (larger than 6 millimeters or

about 1/4 inch). 

• Evolving: The mole has changed over the past few

weeks or months.

Melanomas can vary greatly in how they look.

Many show all of the ABCDE features. However,

some may show changes or abnormal areas in only one

or two of the ABCDE features.

In more advanced melanoma, the texture of the

mole may change. The skin on the surface may break

down and look scraped. It may become hard or lumpy.

The surface may ooze or bleed. Sometimes the

melanoma is itchy, tender, or painful.

12
13

This photo shows a dysplastic nevus

with an arrow pointing to a new black

bump that was not there 18 months

earlier. The black bump is a melanoma

that is about 3 millimeters.

This photo shows an asymmetric

melanoma with irregular and scalloped

borders. The color varies from gray to

brown to black. The melanoma is about

1.2 centimeters.
14

• A lump that is small, smooth, shiny, pale, or waxy

• A lump that is firm and red

Symptoms of Basal Cell and Squamous Cell

Skin Cancers

A change on the skin is the most common sign of

skin cancer. This may be a new growth, a sore that

doesn’t heal, or a change in an old growth. Not all skin

cancers look the same. Usually, skin cancer is not

painful.

Common symptoms of basal cell or squamous cell

skin cancer include:
15

• A flat red spot that is rough, dry, or scaly and may

become itchy or tender

• A red or brown patch that is rough and scaly

• A sore or lump that bleeds or develops a crust or a

scab
16

Diagnosis

If you have a change on your skin, your doctor must

find out whether or not the problem is from cancer.

You may need to see a dermatologist, a doctor who has

special training in the diagnosis and treatment of skin

problems.

Your doctor will check the skin all over your body

to see if other unusual growths are present.

If your doctor suspects that a spot on the skin is

cancer, you may need a biopsy. For a biopsy, your

doctor may remove all or part of the skin that does not

look normal. The sample goes to a lab. A pathologist

checks the sample under a microscope. Sometimes it’s

helpful for more than one pathologist to check the

tissue for cancer cells.

You may have the biopsy in a doctor’s office or as

an outpatient in a clinic or hospital. You’ll probably

have local anesthesia.

There are four common types of skin biopsies:

• Shave biopsy: The doctor uses a thin, sharp blade to

shave off the abnormal growth.

• Punch biopsy: The doctor uses a sharp, hollow tool

to remove a circle of tissue from the abnormal area.

• Incisional biopsy: The doctor uses a scalpel to

remove part of the growth.

• Excisional biopsy: The doctor uses a scalpel to

remove the entire growth and some tissue around it.

This type of biopsy is most commonly used for

growths that appear to be melanoma.
17

You may want to ask your doctor these

questions before having a biopsy:

• Which type of biopsy do you suggest for me?

• How will the biopsy be done?

• Will I have to go to the hospital?

• How long will it take? Will I be awake? Will it

hurt?

• Will the entire growth be removed?

• Are there any risks? What are the chances of

infection or bleeding after the biopsy?

• Will there be a scar? If so, what will it look

like?

• How soon will I know the results?

• If I do have cancer, who will talk with me

about treatment?

Staging

If the biopsy shows that you have skin cancer, your

doctor needs to learn the stage (extent) of the disease to

help you choose the best treatment.

The stage is based on:

• The size (width) of the growth 

• How deeply it has grown beneath the top layer of

skin

• Whether cancer cells have spread to nearby lymph

nodes or to other parts of the body 
18

When skin cancer spreads from its original place to

another part of the body, the new tumor has the same

kind of abnormal cells and the same name as the

primary (original) tumor. For example, if skin cancer

spreads to the lung, the cancer cells in the lung are

actually skin cancer cells. The disease is metastatic

skin cancer, not lung cancer. For that reason, it’s

treated as skin cancer, not as lung cancer. Doctors

sometimes call the new tumor “distant” disease.

Blood tests and an imaging test such as a chest

x-ray, a CT scan, an MRI, or a PET scan may be used

to check for the spread of skin cancer. For example, if

a melanoma growth is thick, your doctor may order

blood tests and an imaging test.

For squamous cell skin cancer or melanoma, the

doctor will also check the lymph nodes near the cancer

on the skin. If one or more lymph nodes near the skin

cancer are enlarged (or if the lymph node looks

enlarged on an imaging test), your doctor may use a

thin needle to remove a sample of cells from the lymph

node (fine-needle aspiration biopsy). A pathologist will

check the sample for cancer cells.

Even if the nearby lymph nodes are not enlarged,

the nodes may contain cancer cells. The stage is

sometimes not known until after surgery to remove the

growth and one or more nearby lymph nodes. For thick

melanoma, surgeons may use a method called sentinel

lymph node biopsy to remove the lymph node most

likely to have cancer cells. Cancer cells may appear

first in the sentinel node before spreading to other

lymph nodes and other places in the body. 
19

Stages of Melanoma

These are the stages of melanoma:

• Stage 0: The melanoma involves only the top layer

of skin. It is called melanoma in situ. 

• Stage I: The tumor is no more than 1 millimeter

thick (about the width of the tip of a sharpened

pencil.) The surface may appear broken down. Or,

the tumor is between 1 and 2 millimeters thick, and

the surface is not broken down.

• Stage II: The tumor is between 1 and 2 millimeters

thick, and the surface appears broken down. Or, the

thickness of the tumor is more than 2 millimeters,

and the surface may appear broken down.

• Stage III: The melanoma cells have spread to at

least one nearby lymph node. Or, the melanoma

cells have spread from the original tumor to tissues

nearby.

• Stage IV: Cancer cells have spread to the lung or

other organs, skin areas, or lymph nodes far away

from the original growth. Melanoma commonly

spreads to other parts of the skin, tissue under the

skin, lymph nodes, and lungs. It can also spread to

the liver, brain, bones, and other organs.
20

Stages of Other Skin Cancers

These are the stages of basal cell and squamous cell

skin cancers:

• Stage 0: The cancer involves only the top layer of

skin. It is called carcinoma in situ. 

Bowen disease is an early form of squamous cell

skin cancer. It usually looks like a reddish, scaly or

thickened patch on the skin. If not treated, the

cancer may grow deeper into the skin.

• Stage I: The growth is as large as 2 centimeters

wide (more than three-quarters of an inch or about

the size of a peanut).

• Stage II: The growth is larger than 2 centimeters

wide.

• Stage III: The cancer has invaded below the skin to

cartilage, muscle, or bone. Or, cancer cells have

spread to nearby lymph nodes. Cancer cells have not

spread to other places in the body.

• Stage IV: The cancer has spread to other places in

the body. Basal cell cancer rarely spreads to other

parts of the body, but squamous cell cancer

sometimes spreads to lymph nodes and other organs. 
21

Treatment

Treatment for skin cancer depends on the type and

stage of the disease, the size and place of the tumor,

and your general health and medical history. In most

cases, the goal of treatment is to remove or destroy the

cancer completely. Most skin cancers can be cured if

found and treated early. 

Sometimes all of the skin cancer is removed during

the biopsy. In such cases, no more treatment is needed.

If you do need more treatment, your doctor can

describe your treatment choices and what to expect.

You and your doctor can work together to develop a

treatment plan that meets your needs. 
22

Surgery is the usual treatment for people with skin

cancer. In some cases, the doctor may suggest

chemotherapy, photodynamic therapy, or radiation

therapy. People with melanoma may also have

biological therapy.

You may have a team of specialists to help plan

your treatment. Your doctor may refer you to a

specialist, or you may ask for a referral. Specialists

who treat skin cancer include dermatologists and

surgeons. Some people may also need a reconstructive

or plastic surgeon.

People with advanced skin cancer may be referred

to a medical oncologist or radiation oncologist. Your

health care team may also include an oncology nurse, a

social worker, and a registered dietitian.

Because skin cancer treatment may damage healthy

cells and tissues, unwanted side effects sometimes

occur. Side effects depend mainly on the type and

extent of the treatment. Side effects may not be the

same for each person. Before treatment starts, your

health care team will tell you about possible side

effects and suggest ways to help you manage them. 

Many skin cancers can be removed quickly and

easily. But some people may need supportive care to

control pain and other symptoms, to relieve the side

effects of treatment, and to help them cope with the

feelings that a diagnosis of cancer can bring.

Information about such care is available on NCI’s Web

site at http://www.cancer.gov/cancertopics/coping

and from NCI’s Cancer Information Service at

1–800–4–CANCER (1–800–422–6237) or at

LiveHelp.

You may want to talk with your doctor about taking

part in a clinical trial, a research study of new

treatment methods. See the Taking Part in Cancer

Research section on page 34.
23

You may want to ask your doctor these

questions before you begin treatment:

• What is the stage of the disease? Has the

cancer spread? Do any lymph nodes or other

organs show signs of cancer?

• What are my treatment choices? Which do you

suggest for me? Why?

• What are the expected benefits of each kind of

treatment?

• What can I do to prepare for treatment?

• Will I need to stay in the hospital? If so, for

how long?

• What are the risks and possible side effects of

each treatment? How can side effects be

managed?

• Will there be a scar? Will I need a skin graft or

plastic surgery? 

• What is the treatment likely to cost? Will my

insurance cover it?

• How will treatment affect my normal

activities? 

• Would a research study (clinical trial) be a

good choice for me? 

• How often should I have checkups?
24

Surgery

In general, the surgeon will remove the cancerous

growth and some normal tissue around it. This reduces

the chance that cancer cells will be left in the area.

There are several methods of surgery for skin

cancer. The method your doctor uses depends mainly

on the type of skin cancer, the size of the cancer, and

where it was found on your body. 

Your doctor can further describe these methods of

surgery: 

• Excisional skin surgery: This is a common

treatment to remove any type of skin cancer. After

numbing the area of skin, the surgeon removes the

growth (tumor) with a scalpel. The surgeon also

removes a border (a margin) of normal skin around

the growth. The margin of skin is examined under a

microscope to be certain that all the cancer cells

have been removed. The thickness of the margin

depends on the size of the tumor. 

• Mohs surgery (also called Mohs micrographic

surgery): This method is often used for basal cell

and squamous cell skin cancers. After numbing the

area of skin, a specially trained surgeon shaves away

thin layers of the tumor. Each layer is examined

under a microscope. The surgeon continues to shave

away tissue until no cancer cells can be seen under

the microscope. In this way, the surgeon can remove

all the cancer and only a small bit of healthy tissue. 

Some people will have radiation therapy after Mohs

surgery to make sure all of the cancer cells are

destroyed.
25

• Electrodesiccation and curettage: This method is

often used to remove a small basal cell or squamous

cell skin cancer. After the doctor numbs the area to

be treated, the cancer is removed with a sharp tool

shaped like a spoon (called a curette). The doctor

then uses a needle-shaped electrode to send an

electric current into the treated area to control

bleeding and kill any cancer cells that may be left.

This method is usually fast and simple. It may be

performed up to three times to remove all of the

cancer.

• Cryosurgery: This method is an option for an earlystage or a very thin basal cell or squamous cell skin

cancer. Cryosurgery is often used for people who are

not able to have other types of surgery. The doctor

applies liquid nitrogen (which is extremely cold)

directly to the skin growth to freeze and kill the

cancer cells. This treatment may cause swelling. It

also may damage nerves, which can cause a loss of

feeling in the damaged area. The NCI fact sheet

Cryosurgery in Cancer Treatment has more

information. 

For people with cancer that has spread to the lymph

nodes, the surgeon may remove some or all of the

nearby lymph nodes. Additional treatment may be

needed after surgery. See the Staging section on page

17 for information about finding cancer in lymph

nodes.

If a large area of tissue is removed, the surgeon may

do a skin graft. The doctor uses skin from another part

of the body to replace the skin that was removed. After

numbing the area, the surgeon removes a patch of

healthy skin from another part of the body, such as the

upper thigh. The patch is then used to cover the area

where skin cancer was removed. If you have a skin

graft, you may have to take special care of the area

until it heals.
26

You may want to ask your doctor these

questions before having surgery:

• What kind of surgery do you recommend for

me? Why?

• Will you remove lymph nodes? Why?

• Will I need a skin graft?

• What will the scar look like? Can anything be

done to help reduce the scar? Will I need

plastic surgery or reconstructive surgery? 

• How will I feel after surgery?

• If I have pain, how will you control it?

• Will I need to stay in the hospital? If so, for

how long? 

• Am I likely to have infection, swelling,

blistering, or bleeding, or to get a scab where

the cancer was removed? 

• Will I have any long-term side effects?

The time it takes to heal after surgery is different for

each person. You may have pain for the first few days.

Medicine can help control your pain. Before surgery,

you should discuss the plan for pain relief with your

doctor or nurse. After surgery, your doctor can adjust

the plan if you need more pain relief.

Surgery nearly always leaves some type of scar. The

size and color of the scar depend on the size of the

cancer, the type of surgery, the color of your skin, and

how your skin heals.

For any type of surgery, including skin grafts or

reconstructive surgery, follow your doctor’s advice on

bathing, shaving, exercise, or other activities.
27

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Drugs

for skin cancer can be given in many ways.

Put directly on the skin

A cream or lotion form of chemotherapy may be

used to treat very thin, early-stage basal cell or

squamous cell skin cancer (Bowen disease). It may

also be used if there are several small skin cancers. The

doctor will show you how to apply the cream or lotion

to the skin one or two times a day for several weeks.

The cream or lotion contains a drug that kills cancer

cells only in the top layer of the skin:

• Fluorouracil (another name is 5-FU): This drug is

used to treat early-stage basal cell and squamous

cell cancers.

• Imiquimod: This drug is used to treat early-stage

basal cell cancer.

These drugs may cause your skin to turn red or

swell. Your skin also may itch, ooze, or develop a rash.

Your skin may be sore or sensitive to the sun after

treatment. These skin changes usually go away after

treatment is over.

A cream or lotion form of chemotherapy usually

does not leave a scar. If healthy skin becomes too red

or raw when the skin cancer is treated, your doctor

may stop treatment. 

Swallowed or injected 

People with melanoma may receive chemotherapy

by mouth or through a vein (intravenous). You may

receive one or more drugs. The drugs enter the

bloodstream and travel throughout the body.
28

If you have melanoma on an arm or leg, you may

receive drugs directly into the bloodstream of that

limb. The flow of blood to and from the limb is

stopped for a while. This allows a high dose of drugs

in the area with the melanoma. Most of the

chemotherapy remains in that limb.

You may receive chemotherapy in an outpatient part

of the hospital, at the doctor’s office, or at home. Some

people need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are

given and how much. Chemotherapy kills fast-growing

cancer cells, but the drugs can also harm normal cells

that divide rapidly: 

• Blood cells: When drugs lower the levels of healthy

blood cells, you’re more likely to get infections,

bruise or bleed easily, and feel very weak and tired.

Your health care team will check for low levels of

blood cells. If your levels are low, your health care

team may stop the chemotherapy for a while or

reduce the dose of the drug. There are also

medicines that can help your body make new blood

cells.

• Cells in hair roots: Chemotherapy may cause hair

loss. If you lose your hair, it will grow back after

treatment, but the color and texture may be changed.

• Cells that line the digestive tract: Chemotherapy

can cause a poor appetite, nausea and vomiting,

diarrhea, or mouth and lip sores. Your health care

team can give you medicines and suggest other

ways to help with these problems. They usually go

away when treatment ends.

You may want to read the NCI booklet

Chemotherapy and You.
29

Photodynamic Therapy

Photodynamic therapy (PDT) uses a drug along with

a special light source, such as a laser light, to kill

cancer cells. PDT may be used to treat very thin, earlystage basal cell or squamous cell skin cancer (Bowen

disease).

The drug is either rubbed into the skin or injected

intravenously. The drug is absorbed by cancer cells. It

stays in cancer cells longer than in normal cells.

Several hours or days later, a special light is focused on

the cancer. The drug becomes active and destroys the

cancer cells. 

The side effects of PDT are usually not serious.

PDT may cause burning or stinging pain. It also may

cause burns, swelling, or redness. It may scar healthy

tissue near the growth. If you have PDT, you will need

to avoid direct sunlight and bright indoor light for at

least 6 weeks after treatment.

The NCI fact sheet Photodynamic Therapy for

Cancer has more information.

You may want to ask your doctor these

questions about chemotherapy:

• Why do I need this treatment?

• Which drug or drugs will I have?

• How do the drugs work?

• Do I need to take special care when I put

chemotherapy on my skin? What do I need to

do? Will I be sensitive to the sun?

• When will treatment start? When will it end?

• Will I have any long-term side effects?
30

You may want to ask your doctor these

questions about PDT: 

• Will I need to stay in the hospital while the

drug is in my body? 

• Will I need to have the treatment more than

once?

Biological Therapy

Some people with advanced melanoma receive a

drug called biological therapy. Biological therapy for

melanoma is treatment that may improve the body’s

natural defense (immune system response) against

cancer.

One drug for melanoma is interferon. It’s injected

intravenously (usually at a hospital or clinic) or

injected under the skin (at home or in a doctor’s

office). Interferon can slow the growth of melanoma

cells.

Another drug used for melanoma is interleukin-2.

It’s given intravenously. It can help the body destroy

cancer cells. Interleukin-2 is usually given at the

hospital.

Other drugs may be given at the same time to

prevent side effects. The side effects differ with the

drug used, and from person to person. Biological

therapies commonly cause a rash or swelling. You may

feel very tired during treatment. These drugs may also

cause a headache, muscle aches, a fever, or weakness.

You may find it helpful to read the NCI booklet

Biological Therapy. You may also wish to read the

NCI fact sheet Biological Therapies for Cancer.
31

You may want to ask your doctor these

questions about biological therapy:

• What is the goal of treatment?

• When will treatment start? When will it end?

• Will I need to stay in the hospital for

treatment? If so, how long will I be in the

hospital?

Radiation Therapy

Radiation therapy uses high-energy rays to kill

cancer cells. The radiation comes from a large

machine outside the body. It affects cells only in the

treated area. You will go to a hospital or clinic several

times for this treatment.

Radiation therapy is not a common treatment for

skin cancer. But it may be used for skin cancer in areas

where surgery could be difficult or leave a bad scar.

For example, you may have radiation therapy if you

have a growth on your eyelid, ear, or nose. Radiation

therapy may also be used after surgery for squamous

cell carcinoma that can’t be completely removed or

that has spread to the lymph nodes. And it may be used

for melanoma that has spread to the lymph nodes,

brain, bones, or other parts of the body. 

Although radiation therapy is painless, it may cause

other side effects. The side effects depend mainly on

the dose of radiation and the part of your body that is

treated. It’s common for the skin in the treated area to

become red, dry, tender, and itchy. Your health care

team can suggest ways to relieve the side effects of

radiation therapy.

You may find it helpful to read the NCI booklet

Radiation Therapy and You.
32

You may want to ask your doctor these

questions about radiation therapy:

• How will I feel after treatment?

• Am I likely to have infection, swelling,

blistering, or bleeding after radiation therapy?

• Will I get a scar on the treated area? 

• How should I take care of the treated area?

Second Opinion

Before starting treatment, you might want a second

opinion from another doctor about your diagnosis and

treatment plan. Some people worry that their doctor

will be offended if they ask for a second opinion.

Usually the opposite is true. Most doctors welcome a

second opinion. And many health insurance companies

will pay for a second opinion if you or your doctor

requests it. Some companies require a second opinion.

If you get a second opinion, the doctor may agree

with your first doctor’s diagnosis and treatment plan.

Or the second doctor may suggest another approach.

Either way, you’ll have more information and perhaps a

greater sense of control. You may also feel more

confident about the decisions you make, knowing that

you’ve looked carefully at all of your options. 

It may take some time and effort to gather your

medical records and see another doctor. Usually it’s not

a problem if it takes you several weeks to get a second

opinion. In most cases, the delay in starting treatment

will not make treatment less effective. To make sure,
33

you should discuss this possible delay with your

doctor. Some people with skin cancer need treatment

right away.

There are many ways to find a doctor for a second

opinion. You can ask your doctor, a local or state

medical society, or a nearby hospital or a medical

school for names of specialists.

Also, you can get information about treatment

centers near you from NCI’s Cancer Information

Service at 1–800–4–CANCER (1–800–422–6237)

or at LiveHelp (http://www.cancer.gov/livehelp).

Other sources can be found in the NCI fact sheet

How To Find a Doctor or Treatment Facility If You

Have Cancer.
34

Taking Part in Cancer Research

Doctors all over the country are conducting many

types of clinical trials (research studies in which people

volunteer to take part). Clinical trials are designed to

find out whether new treatments are safe and effective.

Doctors are trying to find better ways to care for

people with skin cancer. They are studying many types

of treatment, such as surgery, chemotherapy, biological

therapy, and combinations of treatment. For example,

doctors are studying the use of a cancer treatment

vaccine after surgery for people with advanced

melanoma. For more information about cancer

vaccines, you may want to read the NCI fact sheet

Cancer Vaccines.

Even if the people in a trial do not benefit directly,

they may still make an important contribution by

helping doctors learn more about skin cancer and how

to control it. Although clinical trials may pose some

risks, doctors do all they can to protect their patients.

If you’re interested in being part of a clinical trial,

talk with your doctor. You may want to read the NCI

booklet Taking Part in Cancer Treatment Research

Studies. It describes how treatment studies are carried

out and explains their possible benefits and risks.

NCI’s Web site includes a section on clinical trials at

http://www.cancer.gov/clinicaltrials. It has general

information about clinical trials as well as detailed

information about specific ongoing studies of skin

cancer. Information specialists at 1–800–4–CANCER

(1–800–422–6237) or at LiveHelp at http://www.

cancer.gov/livehelp can answer questions and provide

information about clinical trials.
35

Follow-up Care

After treatment for skin cancer, you’ll need regular

checkups (such as every 3 to 6 months for the first year

or two). Your doctor will monitor your recovery and

check for any new skin cancers. Regular checkups help

ensure that any changes in your health are noted and

treated if needed. 

During a checkup, you’ll have a physical exam.

People with melanoma may have x-rays, blood tests,

and scans of the chest, liver, bones, and brain.

People who have had melanoma have an increased

risk of developing a new melanoma, and people with

basal or squamous cell skin cancers have a risk of

developing another skin cancer of any type. It’s a good

idea to get in a routine for checking your skin for new

growths or other changes. Keep in mind that changes

are not a sure sign of skin cancer. Still, you should tell

your doctor about any changes right away. You’ll find

a guide for checking your skin on page 37.

Follow your doctor’s advice about how to reduce

your risk of developing skin cancer again.

You may find it helpful to read the NCI booklet

Facing Forward: Life After Cancer Treatment. You

may also want to read the NCI fact sheet Follow-up

Care After Cancer Treatment.
36

Prevention 

People with skin cancer are at risk of developing

another skin cancer. Limit your time in the sun and

stay away from sunlamps and tanning booths. Keep in

mind that getting a tan may increase your risk of

developing another skin cancer.

The best way to prevent skin cancer is to protect

yourself from the sun:

• Avoid outdoor activities during the middle of the

day. The sun’s rays are the strongest between 10

a.m. and 4 p.m. When you must be outdoors, seek

shade when you can.

• Protect yourself from the sun’s rays reflected by

sand, water, snow, ice, and pavement. The sun’s rays

can go through light clothing, windshields,

windows, and clouds.

• Wear long sleeves and long pants. Tightly woven

fabrics are best.

• Wear a hat with a wide brim all around that shades

your face, neck, and ears. Keep in mind that

baseball caps and some sun visors protect only parts

of your skin.

• Wear sunglasses that absorb UV radiation to protect

the skin around your eyes.

• Use sunscreen lotions with a sun protection factor

(SPF) of at least 15. (Some doctors will suggest

using a lotion with an SPF of at least 30.) Apply the

product’s recommended amount to uncovered skin

30 minutes before going outside, and apply again

every two hours or after swimming or sweating.
37

Sunscreen lotions may help prevent some skin

cancers. It’s important to use a broad-spectrum

sunscreen lotion that filters both UVB and UVA

radiation. But you still need to avoid the sun during

the middle of the day and wear clothing to protect your

skin.

How To Check Your Skin

Your doctor or nurse may suggest that you do a

regular skin self-exam to check for the development of

a new skin cancer. 

The best time to do this exam is after a shower or

bath. Check your skin in a room with plenty of light.

Use a full-length mirror and a hand-held mirror. 

It’s best to begin by learning where your birthmarks,

moles, and other marks are and their usual look and

feel. 

Check for anything new:

• A new mole (that looks different from your other

moles) 

• A new red or darker color flaky patch that may be a

little raised 

• A new flesh-colored firm bump 

• A change in the size, shape, color, or feel of a mole 

• A sore that doesn’t heal

Check yourself from head to toe:

• Look at your face, neck, ears, and scalp. You may

want to use a comb or a blow dryer to move your

hair so that you can see better. You also may want to

have a relative or friend check through your hair. It

may be hard to check your scalp by yourself.
38

• Look at the front and back of your body in the

mirror. Then, raise your arms and look at your left

and right sides.

• Bend your elbows. Look carefully at your

fingernails, palms, forearms (including the

undersides), and upper arms.

• Examine the back, front, and sides of your legs.

Also look around your genital area and between

your buttocks.

• Sit and closely examine your feet, including your

toenails, your soles, and the spaces between your

toes.

By checking your skin regularly, you’ll learn what is

normal for you. It may be helpful to record the dates of

your skin exams and to write notes about the way your

skin looks. If your doctor has taken photos of your

skin, you can compare your skin to the photos to help

check for changes. If you find anything unusual, see

your doctor.

Sources of Support 

Learning that you have skin cancer can change your

life and the lives of those close to you. These changes

can be hard to handle. It’s normal for you, your family,

and your friends to need help coping with the feelings

that such a diagnosis can bring.

Concerns about treatments and managing side

effects, hospital stays, and medical bills are common.

You may also worry about caring for your family,

keeping your job, or continuing daily activities.
39

Here’s where you can go for support:

• Doctors, nurses, and other members of your health

care team can answer questions about treatment,

working, or other activities. 

• Social workers, counselors, or members of the

clergy can be helpful if you want to talk about your

feelings or concerns. Often, social workers can

suggest resources for financial aid, transportation,

home care, or emotional support.

• Support groups also can help. In these groups,

people with skin cancer or their family members

meet with other patients or their families to share

what they have learned about coping with the

disease and the effects of treatment. Groups may

offer support in person, over the telephone, or on the

Internet. You may want to talk with a member of

your health care team about finding a support group.

• NCI’s Cancer Information Service at

1–800–4–CANCER (1–800–422–6237) and at

LiveHelp (http://www.cancer.gov/livehelp) can

help you locate programs, services, and NCI

publications. They can send you a list of

organizations that offer services to people with

cancer.

For tips on coping, you may want to read the NCI

booklet Taking Time: Support for People With Cancer.
40

Dictionary 

Definitions of thousands of terms are on NCI’s Web

site in NCI’s Dictionary of Cancer Terms. You can

access it at http://www.cancer.gov/dictionary. 

Actinic keratosis (ak-TIH-nik KAYR-uh-TOH-sis): A

thick, scaly patch of skin that may become cancer. Also

called senile keratosis and solar keratosis.

Basal cell (BAY-sul SEL): A small, round cell found in

the lower part (or base) of the epidermis, the outer

layer of the skin.

Benign (beh-NINE): Not cancerous. Benign tumors

may grow larger but do not spread to other parts of the

body. Also called nonmalignant.

Biological therapy (BY-oh-LAH-jih-kul THAYR-uhpee): Treatment to boost or restore the ability of the

immune system to fight cancer, infections, and other

diseases. Also used to lessen certain side effects that

may be caused by some cancer treatments. Agents used

in biological therapy include monoclonal antibodies,

growth factors, and vaccines. These agents may also

have a direct antitumor effect. Also called biological

response modifier therapy, biotherapy, BRM therapy,

and immunotherapy.

Biopsy (BY-op-see): The removal of cells or tissues for

examination by a pathologist. The pathologist may

study the tissue under a microscope or perform other

tests on the cells or tissue. There are many different

types of biopsy procedures. The most common types

include: (1) incisional biopsy, in which only a sample

of tissue is removed; (2) excisional biopsy, in which an

entire lump or suspicious area is removed; and (3)

needle biopsy, in which a sample of tissue or fluid is

removed with a needle. When a wide needle is used,
41

the procedure is called a core biopsy. When a thin

needle is used, the procedure is called a fine-needle

aspiration biopsy.

Blood vessel: A tube through which the blood

circulates in the body. Blood vessels include a network

of arteries, arterioles, capillaries, venules, and veins.

Bowen disease (BOH-en dih-ZEEZ): A skin disease

marked by scaly or thickened patches on the skin and

often caused by prolonged exposure to arsenic. The

patches often occur on sun-exposed areas of the skin

and in older white men. These patches may become

malignant (cancer). Also called precancerous dermatitis

and precancerous dermatosis.

Cancer (KAN-ser): A term for diseases in which

abnormal cells divide without control and can invade

nearby tissues. Cancer cells can also spread to other

parts of the body.

Carcinoma in situ (KAR-sih-NOH-muh in SY-too): A

group of abnormal cells that remain in the place where

they first formed. They have not spread. These

abnormal cells may become cancer and spread into

nearby normal tissue. Also called stage 0 disease.

Cartilage (KAR-tih-lij): A tough, flexible tissue that

lines joints and gives structure to the nose, ears, larynx,

and other parts of the body.

Cell (sel): The individual unit that makes up the tissues

of the body. All living things are made up of one or

more cells.

Chemotherapy (KEE-moh-THAYR-uh-pee):

Treatment with drugs that kill cancer cells.

Clinical trial (KLIH-nih-kul TRY-ul): A type of

research study that tests how well new medical

approaches work in people. These studies test new

methods of screening, prevention, diagnosis, or

treatment of a disease. Also called clinical study.
42

Cryosurgery (KRY-oh-SER-juh-ree): A procedure in

which tissue is frozen to destroy abnormal cells. This is

usually done with a special instrument that contains

liquid nitrogen or liquid carbon dioxide. Also called

cryoablation and cryosurgical ablation.

CT scan: A series of detailed pictures of areas inside

the body taken from different angles. The pictures are

created by a computer linked to an x-ray machine. Also

called CAT scan, computed tomography scan,

computerized axial tomography scan, and

computerized tomography.

Curettage (kyoo-reh-TAHZH): Removal of tissue with

a curette (a spoon-shaped instrument with a sharp

edge).

Curette (kyoo-RET): A spoon-shaped instrument with

a sharp edge.

Dermatologist (der-muh-TAH-loh-jist): A doctor who

has special training to diagnose and treat skin

problems.

Dermis (DER-mis): The inner layer of the two main

layers of the skin. The dermis has connective tissue,

blood vessels, oil and sweat glands, nerves, hair

follicles, and other structures.

Dysplastic nevus (dis-PLAS-tik NEE-vus): A type of

nevus (mole) that looks different from a common mole.

A dysplastic nevus is often larger with borders that are

not easy to see. Its color is usually uneven and can

range from pink to dark brown. Parts of the mole may

be raised above the skin surface. A dysplastic nevus

may develop into melanoma (a type of skin cancer).

Electrodesiccation (ee-LEK-troh-deh-sih-KAY-shun):

The drying of tissue by a high-frequency electric

current applied with a needle-shaped electrode.

Epidermis (EH-pih-DER-mis): The outer layer of the

two main layers of the skin.
43

Excisional biopsy (ek-SIH-zhun-al BY-op-see): A

surgical procedure in which an entire lump or

suspicious area is removed for diagnosis. The tissue is

then examined under a microscope.

Excisional skin surgery (ek-SIH-zhun-al SER-juhree): A surgical procedure used to remove moles, cysts,

skin cancer, and other skin growths using local

anesthesia. To treat skin cancer, the doctor uses a

scalpel to remove the entire tumor and some of the

healthy tissue around it.

Fine-needle aspiration biopsy (AS-pih-RAY-shun

BY-op-see): The removal of tissue or fluid with a thin

needle for examination under a microscope. Also

called FNA biopsy.

Fluorouracil (floor-oh-YOOR-uh-sil): A drug used to

treat symptoms of cancer of the colon, breast, stomach,

and pancreas. It is also used in a cream to treat certain

skin conditions. Also called 5-fluorouracil and 5-FU.

Gland:An organ that makes one or more substances,

such as hormones, digestive juices, sweat, tears, saliva,

or milk.

Graft: Healthy skin, bone, or other tissue taken from

one part of the body and used to replace diseased or

injured tissue removed from another part of the body.

Human papillomavirus (HYOO-mun PA-pih-LOHmuh-VY-rus): Also called HPV. A type of virus that

can cause abnormal tissue growth (for example, warts)

and other changes to cells. Infection for a long time

with certain types of HPV can cause cervical cancer.

HPV may also play a role in some other types of

cancer, such as anal, vaginal, vulvar, penile,

oropharyngeal, and squamous cell skin cancers. 

Imiquimod (ih-MIH-kwee-mod): A drug used to treat

early basal cell skin cancer and certain other skin

conditions. It is being studied in the treatment of other

types of cancer. Also called Aldara.
44

Immune system (ih-MYOON SIS-tem): The complex

group of organs and cells that defends the body against

infections and other diseases.

Incisional biopsy (in-SIH-zhun-al BY-op-see): A

surgical procedure in which a portion of a lump or

suspicious area is removed for diagnosis. The tissue is

then examined under a microscope to check for signs

of disease.

Infection: Invasion and multiplication of germs in the

body. Infections can occur in any part of the body and

can spread throughout the body. The germs may be

bacteria, viruses, yeast, or fungi. They can cause a

fever and other problems, depending on where the

infection occurs. When the body’s natural defense

system is strong, it can often fight the germs and

prevent infection. Some cancer treatments can weaken

the natural defense system.

Inflammation (IN-fluh-MAY-shun): Redness,

swelling, pain, and/or a feeling of heat in an area of the

body. This is a protective reaction to injury, disease, or

irritation of the tissues.

Interferon (in-ter-FEER-on): A biological response

modifier (a substance that can improve the body’s

natural response to infections and other diseases).

Interferons interfere with the division of cancer cells

and can slow tumor growth. There are several types of

interferons, including interferon-alpha, -beta, and

-gamma. The body normally produces these

substances. They are also made in the laboratory to

treat cancer and other diseases.

Interleukin-2 (in-ter-LOO-kin): One of a group of

related proteins made by leukocytes (white blood cells)

and other cells in the body. Aldesleukin (interleukin-2

made in the laboratory) is being used as a biological

response modifier to boost the immune system in

cancer therapy. Also called IL-2.
45

Intravenous (IN-truh-VEE-nus): Into or within a vein.

Intravenous usually refers to a way of giving a drug or

other substance through a needle or tube inserted into a

vein. Also called IV.

Local anesthesia (LOH-kul A-nes-THEE-zhuh): A

temporary loss of feeling in one small area of the body

caused by special drugs or other substances called

anesthetics. The patient stays awake but has no feeling

in the area of the body treated with the anesthetic.

Lymph node (limf node): A rounded mass of

lymphatic tissue that is surrounded by a capsule of

connective tissue. Lymph nodes filter lymph

(lymphatic fluid), and they store lymphocytes (white

blood cells). They are located along lymphatic vessels.

Also called lymph gland.

Lymph vessel (limf): A thin tube that carries lymph

(lymphatic fluid) and white blood cells through the

lymphatic system. Also called lymphatic vessel.

Malignant (muh-LIG-nunt): Cancerous. Malignant

tumors can invade and destroy nearby tissue and

spread to other parts of the body.

Margin:The edge or border of the tissue removed in

cancer surgery. The margin is described as negative or

clean when the pathologist finds no cancer cells at the

edge of the tissue, suggesting that all of the cancer has

been removed. The margin is described as positive or

involved when the pathologist finds cancer cells at the

edge of the tissue, suggesting that all of the cancer has

not been removed.

Medical oncologist (MEH-dih-kul on-KAH-loh-jist):

A doctor who specializes in diagnosing and treating

cancer using chemotherapy, hormonal therapy,

biological therapy, and targeted therapy. A medical

oncologist often is the main health care provider for

someone who has cancer. A medical oncologist also
46

gives supportive care and may coordinate treatment

given by other specialists.

Melanocyte (mel-AN-o-site): A cell in the skin and

eyes that produces and contains the pigment called

melanin.

Melanoma (MEH-luh-NOH-muh): A form of cancer

that begins in melanocytes (cells that make the pigment

melanin). It may begin in a mole (skin melanoma), but

can also begin in other pigmented tissues, such as in

the eye or in the intestines.

Melanoma in situ (MEH-luh-NOH-muh in SY-too):

Abnormal melanocytes (cells that make melanin, the

pigment that gives skin its color) are found in the

epidermis (outer layer of the skin). These abnormal

melanocytes may become cancer and spread into

nearby normal tissue. Also called stage 0 melanoma.

Merkel cell carcinoma (MER-kel sel KAR-sih-NOHmuh): A rare type of cancer that forms on or just

beneath the skin, usually in parts of the body that have

been exposed to the sun. It is most common in older

people and in people with weakened immune systems.

Also called Merkel cell cancer, neuroendocrine

carcinoma of the skin, and trabecular cancer.

Metastasis (meh-TAS-tuh-sis): The spread of cancer

from one part of the body to another. A tumor formed

by cells that have spread is called a “metastatic tumor”

or a “metastasis.” The metastatic tumor contains cells

that are like those in the original (primary) tumor. The

plural form of metastasis is metastases (meh-TAS-tuhSEEZ).

Metastatic (meh-tuh-STA-tik): Having to do with

metastasis, which is the spread of cancer from the

primary site (place where it started) to other places in

the body.
47

Mohs surgery (MOZE SER-juh-ree): A surgical

procedure used to treat skin cancer. Individual layers of

cancer tissue are removed and examined under a

microscope one at a time until all cancer tissue has

been removed. Also called Mohs micrographic surgery.

Mole: A benign (not cancer) growth on the skin that is

formed by a cluster of melanocytes (cells that make a

substance called melanin, which gives color to skin and

eyes). A mole is usually dark and may be raised from

the skin. Also called nevus.

MRI: A procedure in which radio waves and a

powerful magnet linked to a computer are used to

create detailed pictures of areas inside the body. These

pictures can show the difference between normal and

diseased tissue. MRI makes better images of organs

and soft tissue than other scanning techniques, such as

computed tomography (CT) or x-ray. MRI is especially

useful for imaging the brain, the spine, the soft tissue

of joints, and the inside of bones. Also called magnetic

resonance imaging.

Nevoid basal cell carcinoma syndrome (NEE-voyd

BAY-sul SEL KAR-sih-NOH-muh SIN-drome): A

genetic condition that causes unusual facial features

and disorders of the skin, bones, nervous system, eyes,

and endocrine glands. People with this syndrome have

a higher risk of basal cell carcinoma. Also called basal

cell nevus syndrome and Gorlin syndrome.

Oncology nurse (on-KAH-loh-jee): A nurse who

specializes in treating and caring for people who have

cancer.

Organ: A part of the body that performs a specific

function. For example, the heart is an organ.

Pathologist (puh-THAH-loh-jist): A doctor who

identifies diseases by studying cells and tissues under a

microscope.
48

PET scan: A procedure in which a small amount of

radioactive glucose (sugar) is injected into a vein, and

a scanner is used to make detailed, computerized

pictures of areas inside the body where the glucose is

used. Because cancer cells often use more glucose than

normal cells, the pictures can be used to find cancer

cells in the body. Also called positron emission

tomography scan.

Photodynamic therapy (FOH-toh-dy-NA-mik

THAYR-uh-pee): Treatment with drugs that become

active when exposed to light. These activated drugs

may kill cancer cells.

Plastic surgeon (PLAS-tik SER-jun): A surgeon who

specializes in reducing scarring or disfigurement that

may occur as a result of accidents, birth defects, or

treatment for diseases.

Punch biopsy (BY-op-see): Removal of a small diskshaped sample of tissue using a sharp, hollow device.

The tissue is then examined under a microscope.

Radiation (RAY-dee-AY-shun): Energy released in the

form of particle or electromagnetic waves. Common

sources of radiation include radon gas, cosmic rays

from outer space, medical x-rays, and energy given off

by a radioisotope (unstable form of a chemical element

that releases radiation as it breaks down and becomes

more stable).

Radiation oncologist (RAY-dee-AY-shun on-KAHloh-jist): A doctor who specializes in using radiation to

treat cancer.

Radiation therapy (RAY-dee-AY-shun THAYR-uhpee): The use of high-energy radiation from x-rays,

gamma rays, neutrons, protons, and other sources to

kill cancer cells and shrink tumors. Radiation may

come from a machine outside the body (external-beam

radiation therapy), or it may come from radioactive
49

material placed in the body near cancer cells (internal

radiation therapy). Systemic radiation therapy uses a

radioactive substance, such as a radiolabeled

monoclonal antibody, that travels in the blood to

tissues throughout the body. Also called irradiation and

radiotherapy.

Reconstructive surgeon (REE-kun-STRUK-tiv SERjun): A doctor who can surgically reshape or rebuild

(reconstruct) a part of the body, such as a woman’s

breast after surgery for breast cancer.

Reconstructive surgery (REE-kun-STRUK-tiv SERjuh-ree): Surgery that is done to reshape or rebuild

(reconstruct) a part of the body changed by previous

surgery.

Registered dietitian (dy-eh-TIH-shun): A health

professional with special training in the use of diet and

nutrition to keep the body healthy. A registered

dietitian may help the medical team improve the

nutritional health of a patient.

Risk factor: Something that increases the chance of

developing a disease. Some examples of risk factors

for cancer are age, a family history of certain cancers,

use of tobacco products, being exposed to radiation or

certain chemicals, infection with certain viruses or

bacteria, and certain genetic changes.

Scalpel (SKAL-pul): A small, thin knife used for

surgery.

Sentinel lymph node biopsy (limf node): Removal

and examination of the sentinel node(s) (the first

lymph node(s) to which cancer cells are likely to

spread from a primary tumor). To identify the sentinel

lymph node(s), the surgeon injects a radioactive

substance, blue dye, or both near the tumor. The

surgeon then uses a probe to find the sentinel lymph

node(s) containing the radioactive substance or looks
50

for the lymph node(s) stained with dye. The surgeon

then removes the sentinel node(s) to check for the

presence of cancer cells.

Shave biopsy (BY-op-see): A procedure in which a

skin abnormality and a thin layer of surrounding skin

are removed with a small blade for examination under

a microscope. Stitches are not needed with this

procedure.

Side effect: A problem that occurs when treatment

affects healthy tissues or organs. Some common side

effects of cancer treatment are fatigue, pain, nausea,

vomiting, decreased blood cell counts, hair loss, and

mouth sores.

Social worker: A professional trained to talk with

people and their families about emotional or physical

needs, and to find them support services.

Squamous cell (SKWAY-mus sel): Flat cell that looks

like a fish scale under a microscope. These cells cover

inside and outside surfaces of the body. They are found

in the tissues that form the surface of the skin, the

lining of the hollow organs of the body (such as the

bladder, kidney, and uterus), and the passages of the

respiratory and digestive tracts.

Supportive care: Care given to improve the quality of

life of patients who have a serious or life-threatening

disease. The goal of supportive care is to prevent or

treat as early as possible the symptoms of a disease,

side effects caused by treatment of a disease, and

psychological, social, and spiritual problems related to

a disease or its treatment. Also called comfort care,

palliative care, and symptom management.

Surgeon: A doctor who removes or repairs a part of

the body by operating on the patient.
51

Surgery (SER-juh-ree): A procedure to remove or

repair a part of the body or to find out whether disease

is present. An operation.

Tissue (TISH-oo): A group or layer of cells that work

together to perform a specific function.

Tumor (TOO-mer): An abnormal mass of tissue that

results when cells divide more than they should or do

not die when they should. Tumors may be benign (not

cancer), or malignant (cancer). Also called neoplasm.

Ultraviolet radiation (UL-truh-VY-oh-let RAY-deeAY-shun): Invisible rays that are part of the energy that

comes from the sun. Ultraviolet radiation also comes

from sun lamps and tanning beds. It can damage the

skin and cause melanoma and other types of skin

cancer. Ultraviolet radiation that reaches the Earth’s

surface is made up of two types of rays, called UVA

and UVB rays. UVB rays are more likely than UVA

rays to cause sunburn, but UVA rays pass deeper into

the skin. Scientists have long thought that UVB

radiation can cause melanoma and other types of skin

cancer. They now think that UVA radiation also may

add to skin damage that can lead to skin cancer and

cause premature aging. For this reason, skin specialists

recommend that people use sunscreens that reflect,

absorb, or scatter both kinds of ultraviolet radiation.

Also called UV radiation.

UVA radiation (RAY-dee-AY-shun): A type of

ultraviolet (UV) radiation. UV rays are invisible rays

that are part of the energy that comes from the sun.

UVA radiation also comes from sun lamps and tanning

beds. Scientists think that UVA radiation may cause

skin damage that can lead to skin cancer and premature

aging. Also called ultraviolet A radiation.
52

UVB radiation (RAY-dee-AY-shun): A type of

ultraviolet (UV) radiation. UV rays are invisible rays

that are part of the energy that comes from the sun.

UVB radiation causes sunburn, and scientists have

long thought that it can cause melanoma and other

types of skin cancer. Also called ultraviolet B radiation.

Vaccine (vak-SEEN):A substance or group of

substances meant to cause the immune system to

respond to a tumor or to microorganisms, such as

bacteria or viruses. A vaccine can help the body

recognize and destroy cancer cells or microorganisms.

Vitamin D (VY-tuh-min): A nutrient that the body

needs in small amounts to function and stay healthy.

Vitamin D helps the body use calcium and phosphorus

to make strong bones and teeth. It is fat-soluble (can

dissolve in fats and oils) and is found in fatty fish, egg

yolks, and dairy products. Skin exposed to sunshine

can also make vitamin D. Not enough vitamin D can

cause a bone disease called rickets. It is being studied

in the prevention and treatment of some types of

cancer. Also called cholecalciferol.

Xeroderma pigmentosum (ZEER-oh-DER-ma pigmen-TOH-sum): A genetic condition marked by an

extreme sensitivity to ultraviolet radiation, including

sunlight. People with xeroderma pigmentosum are not

able to repair skin damage from the sun and other

sources of ultraviolet radiation, and have a very high

risk of skin cancer.

X-ray: A type of high-energy radiation. In low doses,

x-rays are used to diagnose diseases by making

pictures of the inside of the body. In high doses, x-rays

are used to treat cancer.
53

National Cancer Institute Publications

NCI provides publications about cancer, including

the booklets and fact sheets mentioned in this booklet.

Many are available in both English and Spanish.

You may read publications online and print your

own copy. Also, people in the United States and its

territories may order NCI publications:

• By telephone: People in the United States and its

territories may order these and other NCI

publications by calling the NCI’s Cancer

Information Service at 1–800–4–CANCER

(1–800–422–6237). 

• On the Internet: Many NCI publications may be

viewed, downloaded, and ordered from

http://www.cancer.gov/publications. This Web site

also explains how people outside the United States

can mail or fax their requests for NCI booklets.

Cancer Treatment and Supportive Care

• How To Find a Doctor or Treatment Facility If You

Have Cancer (also in Spanish)

• Chemotherapy and You (also in Spanish)

• Photodynamic Therapy for Cancer

• Biological Therapy

• Biological Therapies for Cancer (also in Spanish)

• Radiation Therapy and You (also in Spanish)

• Cancer Vaccines

• Pain Control (also in Spanish)

• Eating Hints (also in Spanish)

Coping with Cancer

• Taking Time: Support for People with Cancer 
54

Life After Cancer Treatment

• Facing Forward: Life After Cancer Treatment (also

in Spanish)

• Follow-up Care After Cancer Treatment

• Facing Forward: Ways You Can Make a Difference

in Cancer

Advanced or Recurrent Cancer

• Coping With Advanced Cancer

• When Cancer Returns

Complementary Medicine

• Thinking about Complementary & Alternative

Medicine

Caregivers

• When Someone You Love Is Being Treated for

Cancer: Support for Caregivers

• When Someone You Love Has Advanced Cancer:

Support for Caregivers

• Facing Forward: When Someone You Love Has

Completed Cancer Treatment

• Caring for the Caregiver: Support for Cancer

Caregivers

Research Studies

• Taking Part in Cancer Treatment Research Studies

• Providing Your Tissue for Research: What You Need

To Know

• Donating Tissue for Cancer Research: Biospecimens

and Biorepositories
The National Cancer Institute 

The National Cancer Institute (NCI), part of the

National Institutes of Health, is the Federal

Government’s principal agency for cancer research

and training. NCI conducts and supports basic and

clinical research to find better ways to prevent,

diagnose, and treat cancer. The Institute also supports

education and training for cancer research and

treatment programs. In addition, NCI is responsible

for communicating its research findings to the

medical community and the public.

Copyright permission

You must have permission to use or reproduce the

artwork in this booklet for other purposes. The

artwork was created by private sector illustrators,

designers, and/or photographers, and they retain the

copyrights to artwork they develop under contract to

NCI. In many cases, artists will grant you permission,

but they may require a credit line and/or usage fees.

To inquire about permission to reproduce NCI

artwork, please write to: 

Office of Communications and Education

National Cancer Institute

6116 Executive Boulevard, Room 3066 

MSC 8323

Rockville, MD 20892–8323

You do not need our permission to reproduce or

translate NCI written text. The written text of this

NCI booklet is in the public domain, and it is not

subject to copyright restrictions. However, we would

appreciate a credit line and a copy of your translation

of this NCI booklet.
NIH Publication No.10-7625

Revised June 2010

Printed October 2010