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Types of skin cells

There are 3 main types of cells in the top layer of the skin (called the epidermis):

Squamous cells: These are flat cells in the outer part of the epidermis that are constantly shed as new ones form.

Basal cells: These cells are in the lower part of the epidermis, called the basal cell layer. These cells constantly divide to form new cells to replace the squamous cells that wear off the skin's surface. As these cells move up in the epidermis, they get flatter, eventually becoming squamous cells.

Melanocytes: These cells make the brown pigment called melanin, which gives the skin its tan or brown color. Melanin acts as the body's natural sunscreen, protecting the deeper layers of the skin from some of the harmful effects of the sun. For most people, when skin is exposed to the sun, melanocytes make more of the pigment, causing the skin to tan or darken.

The epidermis is separated from the deeper layers of skin by the basement membrane. When a skin cancer becomes more advanced, it generally grows through this barrier and into the deeper layers.

Types of skin cancer

Basal cell carcinoma

This the most common type of skin cancer. About 8 out of 10 skin cancers are basal cell carcinomas (also called basal cell cancers). When seen under a microscope, the cells in these cancers look like cells in the lowest layer of the epidermis, called the basal cell layer.

These cancers usually develop on sun-exposed areas, especially the head and neck. These cancers tend to grow slowly. It's very rare for a basal cell cancer to spread to other parts of the body. But if a basal cell cancer is left untreated, it can grow into nearby areas and invade the bone or other tissues beneath the skin.

If not removed completely, basal cell carcinoma can recur (come back) in the same place on the skin. People who have had basal cell skin cancers are also more likely to get new ones in other places.

Squamous cell carcinoma

About 2 out of 10 skin cancers are squamous cell carcinomas (also called squamous cell cancers). The cells in these cancers look like abnormal versions of the squamous cells seen in the outer layers of the skin.

These cancers commonly appear on sun-exposed areas of the body such as the face, ears, neck, lips, and backs of the hands. They can also develop in scars or chronic skin sores elsewhere. They sometimes start in actinic keratoses (described below). Less often, they form in the skin of the genital area.

Squamous cell cancers are more likely to grow into deeper layers of skin and spread to other parts of the body than basal cell cancers, although this is still uncommon.

Keratoacanthomas are dome-shaped tumors that are found on sun-exposed skin. They may start out growing quickly, but their growth usually slows down. Many keratoacanthomas shrink or even go away on their own over time without any treatment. But some continue to grow, and a few may even spread to other parts of the body. Their growth is often hard to predict, so many skin cancer experts consider them a type of squamous cell skin cancer and treat them as such.

Melanoma

These cancers develop from melanocytes, the pigment-making cells of the skin. Melanocytes can also form benign (non-cancerous) growths called moles. Melanomas are much less common than basal and squamous cell cancers, but they are more likely to grow and spread if left untreated. Melanoma and moles are discussed in Melanoma Skin Cancer.

Less common types of skin cancer

Other types of skin cancer are much less common and are treated differently. These include:

Together, these types account for less than 1% of all skin cancers.

Pre-cancerous and pre-invasive skin conditions

These conditions may develop into skin cancer or may be very early stages of skin cancer.

Actinic keratosis (solar keratosis)

Actinic keratosis (AK), also known as solar keratosis, is a pre-cancerous skin condition caused by too much exposure to the sun. AKs are usually small (less than 1/4 inch across), rough or scaly spots that may be pink-red or flesh-colored. Usually they start on the face, ears, backs of the hands, and arms of middle-aged or older people with fair skin, although they can occur on other sun-exposed areas. People who have them usually develop more than one.

AKs tend to grow slowly and usually do not cause any symptoms (although some might be itchy or sore). They sometimes go away on their own, but they may come back.

Some AKs may turn into squamous cell skin cancers. Most AKs do not become cancer, but it can be hard sometimes to tell them apart from true skin cancers, so doctors often recommend treating them. If they are not treated, you and your doctor should check them regularly for changes that might be signs of skin cancer.

Squamous cell carcinoma in situ (Bowen disease)

Squamous cell carcinoma in situ, also called Bowen disease, is the earliest form of squamous cell skin cancer. "In situ" means that the cells of these cancers are still only in the epidermis (the upper layer of the skin) and have not invaded into deeper layers.

Bowen disease appears as reddish patches. Compared with AKs, Bowen disease patches tend to be larger (sometimes over ½ inch across), redder, scalier, and sometimes crusted. Like AK, Bowen disease usually doesn't cause symptoms, although it might be itchy or sore.

Like most other skin cancers (and AKs), these patches most often appear in sun-exposed areas. Bowen disease can also occur in the skin of the anal and genital areas (where it is known as erythroplasia of Queyrat or Bowenoid papulosis). This is often related to sexually transmitted infection with human papilloma viruses (HPVs), the viruses that can also cause genital warts.

Bowen disease can sometimes progress to an invasive squamous cell skin cancer, so doctors usually recommend treating it. People who have these are also at higher risk for other skin cancers, so close follow-up with a doctor is important.

Benign skin tumors

Most skin tumors are benign (not cancerous) and rarely if ever turn into cancers. There are many kinds of benign skin tumors, including:

Most types of moles (see Melanoma Skin Cancer for more about moles)

Seborrheic keratoses: tan, brown, or black raised spots with a waxy texture or occasionally a slightly rough and crumbly surface when they are on the legs (also known as stucco keratosis)

Hemangiomas: benign blood vessel growths, often called strawberry spots

Lipomas: soft tumors made up of fat cells

Warts: rough-surfaced growths caused by some types of human papilloma virus (HPV)

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What Are Basal and Squamous Cell Skin Cancers?

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There are 3 main types of cells in the top layer of the skin (called the epidermis): Squamous cells: These are flat cells in the outer part of the epidermis that are constantly shed as new ones form. Basal cells: These cells are in the lower part of the epidermis, called the basal cell layer.

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Since its inception in 1979, The Skin Cancer Foundation has always recommended using a sunscreen with an SPF 15 or higher as one important part of a complete sun protection regimen. Sunscreen alone is not enough, however. Read our full list of skin cancer prevention tips.

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Skin Cancer Prevention Behaviors among Northeast Florida College Students

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Skin Cancer Prevention Behaviors among Northeast Florida College Students

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Skin Cancer U? Students Tan on Campus at Top Colleges

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Skin Cancer U? Students Tan on Campus at Top Colleges

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America's top universities may be teaching a dangerous lesson about tanning.

Twelve percent of the nation's top colleges and universities have tanning beds on campus, and nearly half have them either on campus or in off-campus housing, according to a report published online Wednesday in JAMA Dermatology.

Students can even use "campus cash" debit cards loaded up by parents for tanning at 14 percent of the 125 top colleges and universities compiled by U.S. News & World Report. And when tanning beds were offered in off-campus housing, it was free to tenants 96 percent of the time, the study found.

Melanoma, the deadly form of skin cancer, is on the rise among young people and has become the number one cancer in young adults aged 25 to 29, said lead author Sherry Pagoto, Ph.D., associate professor of medicine at University of Massachusetts Medical School.

"It's one of those cancers that's actually sneaking up on us. People don't usually think of skin cancer of being a super prevalent cancer, one to be concerned about, but it really is sneaking up on us, particularly in young people and the reason is because of exposure to ultraviolet radiation, and that includes obviously in tanning salons," Pagoto told NBC News.

In previous research, Pagoto and others have found that young people aren't just after tan skin - in fact, tanning can even be addictive.

"Of course they say they love to be tan, but they also say it's something fun to do, to reduce their stress, to relax particularly in the winter time when it's so cold - so they're doing it to warm up, to feel good, something that they're doing kind of after class to unwind," Pagoto said.

The Indoor Tanning Association released a statement saying there was "no consensus among researchers regarding the relationship between melanoma skin cancer and UN exposure from the son or a sunbed."

Still, Pagoto hopes to see campuses treat tanning as they do tobacco - banning tanning beds on campus and blocking payment by campus cash cards that parents fill up to pay for books, food and other necessities.

As for off-campus housing? She suggests that schools only endorse apartment complexes without tanning beds, and that parents ask about the amenities made available to students.

"Even if your child isn't into tanning, if it's in their apartment and it's free and all their friends are doing it, it could be a way that they're getting hooked on it," she said.
Erika Edwards of NBC News Channel contributed to this report.

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Skin Cancer U? Students Tan on Campus at Top Colleges

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America's top universities may be teaching a dangerous lesson about tanning. Twelve percent of the nation's top colleges and universities have tanning beds on campus, and nearly half have them either on campus or in off-campus housing, according to a report published online Wednesday in JAMA Dermatology.

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Risk of skin cancer doesn't deter most college students who tan indoors, study shows

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Risk of skin cancer doesn't deter most college students who tan indoors, study shows

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White female college students in Indiana who tan indoors know they are placing themselves at risk of skin cancer and premature skin aging, but most continue to tan indoors anyway, according to a study conducted by researchers at the Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis.

The self-administered questionnaire survey of 629 female undergraduate and graduate students between the ages of 18 and 30 at Indiana University's campuses in Bloomington and Indianapolis was conducted in 2016. The survey gathered information about indoor tanning habits and attitudes toward tanning.

Keming Yang, a Ph.D. student in epidemiology, published the survey's findings in an article in the Journal of Dermatological Science. Yang is the first author of the paper; Jiali Han, professor and chair of the Department of Epidemiology, is the senior author.

Indoor tanning exposes users to ultraviolet radiation, a well-known risk factor for premature skin aging and skin cancers, and is particularly dangerous for younger and more frequent indoor tanners. Nonetheless, indoor tanning is quite prevalent in the United States, with one study finding the prevalence of indoor tanning to be highest in the Midwest, according to the paper's authors.

One statistical analysis of several separate but similar studies showed those who had ever used tanning beds had a 25 percent higher risk of melanoma, and those who first used tanning beds before the age of 35 had an 87 percent higher risk of melanoma, compared to those who had never used tanning beds.

The survey asked students to agree, disagree or say they had no opinion to a number of statements. According to the survey, of those who tan indoors currently or did so in the past:

99.4 percent agreed that tanning can cause skin problems such as premature aging and skin cancer.

78.7 percent disagreed that indoor tanning is safe or at least safer than outdoor tanning.

69.1 percent agreed they still like to get a tan even though they know tanning may be bad for their skin.

83.6 percent agreed that a tan makes them feel more attractive.

83 percent agreed that compared to how they feel before tanning, they feel more relaxed and pleasant during tanning.

The researchers said they found those more likely to use indoor tanning were women who had families or friends who used tanning devices, tanned easily, viewed a tan as attractive, believe tanning can stimulate healthy vitamin D production and still seek to get a tan despite knowing its ill effects.

Results showing a higher proportion of those who currently tan indoors or tanned indoors in the past feeling more relaxed and pleasant during tanning may be due to addictive behaviors, the paper's authors said.

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cosmetics; skin cancer; skin care; healthy aging; psoriasis; cosmetic surgery; diseases and conditions; medical education and training

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Risk of skin cancer doesn't deter most college students who tan indoors, study shows

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White female college students in Indiana who tan indoors know they are placing themselves at risk of skin cancer and premature skin aging, but most continue to tan indoors anyway, according to a study conducted by researchers at the Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis.

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When Courtney McClanahan enrolled as a freshman in college in 2006, she was impressed by her school's newly renovated, state-of-the-art recreation center with a hot tub, steam room, smoothie bar and ultraviolet (UV) tanning salon. "It had everything you wanted in one place," McClanahan recalls.

The Communications major had tried tanning beds a few times in high school before her senior prom, but in college she developed a full-fledged bronzing habit. Naturally pale-skinned, she went for twice-weekly tanning sessions with her girlfriends, using an unlimited tanning pass debited monthly to her student account. "Looking back, I see they made it easy for students to tan," says McClanahan, now 26. "If a sorority formal or dance was coming up, I wanted to be darker to look nice in a dress. I thought it made me look better. But now I look at pictures of myself from then, and I see I was bright orange or burnt."

For many young adults, using UV tanning devices is firmly rooted in college culture. Despite the well-established link between tanning beds and skin cancer, more than half of all US college students have tried these devices at least once, according to a 2014 meta-analysis published in JAMA Dermatology. ¹ Young white females ages 18-25 are among the most vulnerable: ² they are the most frequent tanners, and their skin cancer rate has been rising rapidly. In young people ages 15 to 39, melanoma incidence among females more than doubled between 1973 and 2004. ³

The Pressure to Be Pretty

When young women are living away from home for the first time, and the pressure to fit in and feel beautiful is strongest, many coeds become habitual indoor tanners. Whether it's to achieve a so-called "base tan" before spring break or maintain a glow for campus formals, the lure of tanning is constant. In a 2014 survey of sorority members at the University of North Carolina, 45% of respondents had used tanning beds. ⁴ Asked why, the young women said they did it to improve their appearance (to look thinner and more toned, and to hide skin imperfections); many also reported that it reduced stress and relaxed them. A majority of the students admitted knowing the health risks, but tanned anyway.

McClanahan was well aware of the hazards of tanning. "What's crazy is how bad I knew it was; my dad had skin cancer and so did grandpa," she says. But she felt more confident with a tan, and didn't think skin cancer could happen to her.

At 25, just three years out of college, her perspective abruptly changed, when a scab-like growth on her forehead was diagnosed as a basal cell carcinoma. Her doctors performed minimally invasive Mohs surgery to remove the tumor, leaving an inch and a half vertical scar that has since faded. Since this wake-up call, McClanahan shuns any form of tanning, has become vigilant about sun safety and sees her dermatologist for a skin check-up every six months. Today, working as an entertainer aboard a cruise ship, she packs a large stash of sunscreens, which she constantly shares with colleagues. "I'm very vocal about sun safety now. It hurts me to see people lying out in the sun. And tanning in tanning beds is not worth it! Embrace your natural color and protect yourself. Your skin will thank you 20 years from now.

Bonding in the Sunbed

As a freshman at Amherst College in Massachusetts, Kirby Williams started tanning with her girlfriends during regular trips to a salon in town for manicures, waxing and other beauty treatments. "It was a fun group activity. And during the long winters, it would give you a high, like you had been out in the sun," said Williams, who has red hair and light skin.
Her skin was so fair that tanning salon operators allowed her to tan for only three-to four-minute sessions. "My friends and I would laugh about it," she says. "I tried to get them to let me do more. It was ridiculous. I was burning my skin."

A few years out of college, Kirby noticed a mole on her leg that had suddenly increased in size and turned dark brown. She put off seeing her dermatologist for a few months, but when she did, she learned it was an early melanoma that had to be removed immediately.

While "improving appearance" remains the main reason people say they tan indoors, social factors also drive this choice. After conducting a focus group of college-aged female tanners, Jerrod Stapleton, PhD, a behavioral scientist at Rutgers Cancer Institute in New Jersey, was surprised to see how large a role peer influence played in tanning. "A lot of women talk to their friends and engage in conversations about tanning to a level I found surprising. They compare their tans to friends' and go on tanning dates." Stapleton observed some women tanning three to four times a week, beyond what they needed to maintain a bronze. "If it were only about having a tan appearance they'd go once a week, so I think there's more to it."

Identity and Addiction

For some frequent tanners it can be especially hard to quit because it's so tied up not just in their idea of beauty but in their very identity. "These women have internalized tanning as an important way they need to look and part of who they are," said Stapleton. "To hear them talk about how they monitor their looks and compare how tan they are really speaks to the power of tanning."

Influenced by images of bronzed celebrities and models, Lauren Beloff, of Hoboken, NJ, became hooked on tanning in college after she won a one-month tanning pass in a contest. With the tanning salon near her school, she and her girlfriends dropped in for quick sessions between classes or after working out. "A lot of my friends went. We didn't talk about the dangers of tanning back then," said Beloff, now 31. "College students can be insecure; everybody was trying to fit in. The more I tanned, the more compliments I got. I loved the way I looked," she said.

At one point, Beloff was visiting the salon up to three days a week. For some frequent users, whether they know it or not, the "power of tanning" may amount to both a physical and psychological dependency. Researchers have found that a segment of habitual tanners are addicted to UV light much like those addicted to drugs or alcohol. Frequent ultraviolet light exposure releases endorphins in the pleasure centers of the brain, creating feelings of relaxation and wellbeing that reinforce the behavior. ⁵ A 2010 study of 229 college tanners found that 39% met the scientific criteria for addiction to indoor tanning. ⁶

The tanning pull affected Beloff so strongly that she continued to visit tanning salons even after she was diagnosed in 2007 with a stage I melanoma on her chest. "I went tanning the day after I had a biopsy showing melanoma. I had to be tan," she said. She feared being "a pasty white girl" and prided herself on not having to wear makeup with her bronzed skinIn the end, it wasn't the potentially deadly melanoma on her body that made her give up tanning, but a far less dangerous cancer on her face, because this time the cancer was visible to others. She quit the habit in 2012, when she had a BCC removed below her lower right eye. Doctors had to scrape down to her muscle to remove the tumor, and young, single Beloff feared she would have an unattractive scar on her face for the rest of her life. "I knew at that moment I would give up tanning."

Fortunately, she was left without a major scar, and today Beloff accepts her naturally porcelain skin. She takes pride in telling people her skin cancer survivor story and realizing that her health is much more important than a bronzed hue. "It was a horrible experience to go through. I get very annoyed now when I see people walk into tanning salons. I was that girl, and it didn't work out well for me."
Published on August 18, 2015

Tanning: Before and After

Making It Too Easy

Diana Schmitz, a senior at Texas Tech University in Lubbock, Texas, has a long scar by her elbow from an early but high-risk melanoma removed earlier this year. As a freshman, she had convinced her parents to buy her a tanning pass to achieve a glow in time for a spring sorority formal. No tanning salons are available on her campus, but the nearby town has up to five salons, which she visited regularly, she said. Occasionally, she would also use the free tanning beds available at her friends' off-campus apartments. "Pretty much every apartment complex has a tanning bed," said Schmitz.

That summer, home in Dallas, she noticed a mole on her arm that looked different. Her dermatologist checked it but didn't seem concerned. He took a biopsy, just in case. A week later she received a call saying it was melanoma. "It was surreal," said Schmitz. "It was instant regret that I had used tanning beds."

Back at school, people started to ask Schmitz about her scar, and she made a point to tell them about her tanning experience. "It affected me deeply. It's so scary and traumatic to have to go through. A lot of my friends have listened and stopped using tanning beds."

She also thinks colleges need to do more to protect their students. "I look at tanning as something that is so dangerous and unnecessary. To make it that easy to have tanning beds where students live makes me really angry."

> References

Wehner MR, Chren MM, Nameth D, et al. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol 2014; 150(4):390-400.

Morbidity and Mortality Weekly Report: Use of indoor tanning devices by adults-United States 2010. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6118a2.htm Published May 11, 2012. Accessed March 5, 2015.

Purdue MP, Freeman LEB, Anderson WF, Tucker MA. Recent trends in incidence of cutaneous melanoma among US Caucasian young adults. J Invest Dermatol 2008; 128:2905-2908.doi:10.1038/jid.2008.159; published online 10 July 2008. Last checked June 4, 2014.

Noar SM, Myrick JG, Morales-Pico B, Thomas NE. Development and validation of the Comprehensive Indoor Tanning Expectations scale. JAMA Dermatol 2014; 150(5):512-521.

Hornung RL, Poorsattar S. Tanning addiction: the new form of substance abuse. The Skin Cancer Foundation Journal 2010; 28:28-29.

Mosher CE, Danoff-Burg S. Addiction to indoor tanning: relation to anxiety, depression and substance abuse. Arch Dermatol 2010; 146(4):412-417.7. Roth AJ. FDA accepts sBLA for adjuvant ipilimumab in melanoma. OncLive March 2, 2015. http://www.onclive.com/web-exclusives/FDA-Accepts-sBLA-for-Adjuvant-Ipilimumab-in-Melanoma

Published on August 18, 2015

Tanning: Before and After

Tanning: Before and After

Tanning: Before and After

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When Courtney McClanahan enrolled as a freshman in college in 2006, she was impressed by her school's newly renovated, state-of-the-art recreation center with a hot tub, steam room, smoothie bar and ultraviolet (UV) tanning salon. "It had everything you wanted in one place," McClanahan recalls.

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Half of Top US Colleges Provide Tanning Beds for Students

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Half of Top US Colleges Provide Tanning Beds for Students

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Half of Top US Colleges Provide Tanning Beds For Students - SkinCancer.org

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People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent. With tanning bed use highest among young, non-Hispanic white women, and with skin cancer rates soaring in this group, researchers warned that "the presence of indoor tanning facilities on and near college campuses may passively reinforce indoor tanning in college students, thereby facilitating behavior that will increase their risk for skin cancer both in the short-term and later in life."