The Diagnosis and Management of Common Skin Cancers

on the annual age-adjusted skin cancer in cidence rates per 100,000 population in the United States from the Third National Can cer Survey and other recent statistics2 are given in Table 1. The actual incidence of basal cell car cinoma is probably much higher than the data appear to indicate, however. Because it is essentially innocuous, basal cell car cinoma is frequently treated as a problem of little consequence, and many cases are not reported. Yet, some basal cell carci nomas can produce considerable morbidity and, sometimes, even mortality. This is particularly true after multiple recurrences following repeated unsuccessful attempts at eradication. Other less common, but nonetheless important, cancers arising primarily from the skin include Bowen's disease (squa mous cell carcinoma in situ), and tumors of the cutaneous adnexal structures, such as sweat gland adenocarcinoma. There are also malignant tumors of the vascular sys tem (Kaposi †̃¿ s sarcoma, lymphangiosar coma); connective and muscular tissues (dermatofibrosarcoma protuberans,leio myosarcoma); reticuloendothelial system, especially mycosis fungoides (malignant lymphoma); and other rarer cutaneous can cers. The skin may also be a site for cuta neous metastases, particularly from mel anoma and cancers of the lung, large in testine, kidney, breast, and ovary.3 More cancers occur on the skin than at any other anatomic site. Because they are di rectly visible and easily accessible, these tumors offer a unique opportunity for early diagnosis, treatment, and cure. If all cu taneous cancers were accurately diagnosed and adequately treated in early stages of development, morbidity and mortality rates would be substantially reduced. Prevention of these lesions is even more important than early diagnosis and treatment. Convincingepidemiologic data suggest that overexposure to sunlight is the major cause of skin cancer. Some of these tumors can be avoided by limiting unnec essary exposure to ultraviolet radiation. It is very likely that damage by the sun can be significantly reduced by the regular use of effective sun screens.