Definition of breast cancer: Cancer that forms in tissues of the breast, usually the ducts (tubes that carry

milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare. Estimated new cases and deaths from breast cancer in the United States in 2011: New cases: 230,480 (female); 2,140 (male) Deaths: 39,520 (female); 450 (male)

Breast cancer is a cancer that starts in the tissues of the breast. There are two main types of breast cancer: y y Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type. Lobular carcinoma starts in the parts of the breast, called lobules, that produce milk.

In rare cases, breast cancer can start in other areas of the breast. Breast cancer may be invasive or noninvasive. Invasive means it has spread from the milk duct or lobule to other tissues in the breast. Noninvasive means it has not yet invaded other breast tissue. Noninvasive breast cancer is called "in situ." y y Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is breast cancer in the lining of the milk ducts that has not yet invaded nearby tissues. It may progress to invasive cancer if untreated. Lobular carcinoma in situ (LCIS) is a marker for an increased risk of invasive cancer in the same or both breasts.

Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancers have estrogen receptors on the surface of their cells. They are called estrogen receptor-positive cancer or ER-positive cancer. Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells (including cancer cells) have too many copies of this gene, they grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk that the disease will return (recur) than women who do not have this type.

Causes
Over the course of a lifetime, 1 in 8 women will be diagnosed with breast cancer. Risk factors you cannot change include: y Age and gender -- Your risk of developing breast cancer increases as you get older. Most advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer than men.

Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20 - 30% of women with breast cancer have a family history of the disease. Genes -- Some people have genes that make them more likely to develop breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. If a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life. Menstrual cycle -- Women who got their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.

Other risk factors include: y y Alcohol use -- Drinking more than 1 - 2 glasses of alcohol a day may increase your risk for breast cancer. Childbirth -- Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer. DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s - 1960s. Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy with estrogen for several years or more.Obesity -Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer. Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a much higher risk for developing breast cancer. The younger you started such radiation and the higher the dose, the higher your risk -- especially if the radiation was given during breast development.

y y

Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and pesticides. The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer. See:www.cancer.gov/bcrisktool

Symptoms
Early breast cancer usually does not cause symptoms. This is why regular breast exams are important. As the cancer grows, symptoms may include: y y y Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange Fluid coming from the nipple -- may be bloody, clear to yellow, green, and look like pus

Men can get breast cancer, too. Symptoms include breast lump and breast pain and tenderness. Symptoms of advanced breast cancer may include: y y y y y Bone pain Breast pain or discomfort Skin ulcers Swelling of one arm (next to the breast with cancer) Weight loss

Exams and Tests

The doctor will ask you about your symptoms and risk factors. Then the doctor will perform a physical exam, which includes both breasts, armpits, and the neck and chest area. Tests used to diagnose and monitor patients with breast cancer may include: y y y y y y y Breast MRI to help better identify the breast lump or evaluate an abnormal change on a mammogram Breast ultrasound to show whether the lump is solid or fluid-filled Breast biopsy, using methods such as needle aspiration, ultrasound-guided, stereotactic, or open CT scan to see if the cancer has spread Mammography to screen for breast cancer or help identify the breast lump PET scan Sentinal lymph node biopsy to see if the cancer has spread

If your doctor learns that you do have breast cancer, more tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future. Breast cancer stages range from 0 to IV. The higher the staging number, the more advanced the cancer.

Treatment
Treatment is based on many factors, including: y y y Type and stage of the cancer Whether the cancer is sensitive to certain hormones Whether the cancer overproduces (overexpresses) a gene called HER2/neu

In general, cancer treatments may include: y y Chemotherapy medicines to kill cancer cells Radiation therapy to destroy cancerous tissue

Surgery to remove cancerous tissue -- a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures

Hormonal therapy is prescribed to women with ER-positive breast cancer to block certain hormones that fuel cancer growth. y An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogen-sensitive breast cancer benefit from this drug. Another class of hormonal therapy medicines called aromatase inhibitors, such as exemestane (Aromasin), have been shown to work just as well or even better than tamoxifen in postmenopausal women with breast cancer. Aromatase inhibitors block estrogen from being made.

Targeted therapy, also called biologic therapy, is a newer type of cancer treatment. This therapy uses special anticancer drugs that target certain changes in a cell that can lead to cancer. One such drug is trastuzumab (Herceptin). It may be used for women with HER2-positive breast cancer. Cancer treatment may be local or systemic. y y Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment. Systemic treatments affect the entire body. Chemotherapy is a type of systemic treatment.

Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning (curing). For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured. y y Stage 0 and DCIS -- Lumpectomy plus radiation or mastectomy is the standard treatment. There is some controversy on how best to treat DCIS. Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of lymph node removal is the standard treatment. Hormone therapy, chemotherapy, and biologic therapy may also be recommended following surgery. Stage III -- Treatment involves surgery, possibly followed by chemotherapy, hormone therapy, and biologic therapy. Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal therapy, or a combination of these treatments.

y y

After treatment, some women will continue to take medications such as tamoxifen for a period of time. All women will continue to have blood tests, mammograms, and other tests after treatment. Women who have had a mastectomy may have reconstructive breast surgery, either at the same time as the mastectomy or later.

Support Groups
Talking about your disease and treatment with others who share common experiences and problems can be helpful. See: Cancer support group

Outlook (Prognosis)
New, improved treatments are helping persons with breast cancer live longer than ever before. However, even with treatment, breast cancer can spread to other parts of the body. Sometimes, cancer returns even after the entire tumor is removed and nearby lymph nodes are found to be cancer-free. How well you do after being treated for breast cancer depends on many things. The more advanced your cancer, the poorer the outcome. Other factors used to determine the risk for recurrence and the likelihood of successful treatment include: y y y y y y Location of the tumor and how far it has spread Whether the tumor is hormone receptor-positive or -negative Tumor markers, such as HER2 Gene expression Tumor size and shape Rate of cell division or how quickly the tumor is growing

After considering all of the above, your doctor can discuss your risk of having a recurrence of breast cancer.

Possible Complications
You may experience side effects or complications from cancer treatment. For example, radiation therapy may cause temporary swelling of the breast (lymphedema), and aches and pains around the area. Lymphedema may start 6 to 8 weeks after surgery or after radiation treatment for cancer. It can also start very slowly after your cancer treatment is over. You may not notice symptoms until 18 to 24 months after treatment. Sometimes it can take years to develop. Ask your doctor about the side effects you may have during treatment.

When to Contact a Medical Professional

Contact your health care provider for an appointment if: y y You have a breast or armpit lump You have nipple discharge

Also call your health care provider if you develop symptoms after being treated for breast cancer, such as: y y y y y Nipple discharge Rash on the breast New lumps in the breast Swelling in the area Pain, especially chest pain, abdominal pain, or bone pain

Prevention
Tamoxifen is approved for breast cancer prevention in women aged 35 and older who are at high risk. Discuss this with your doctor. Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy. This is the surgical removal of the breasts before breast cancer is ever diagnosed. Possible candidates include: y y y Women who have already had one breast removed due to cancer Women with a strong family history of breast cancer Women with genes or genetic mutations that raise their risk of breast cancer (such as BRCA1 or BRCA2)

Your doctor may do a total mastectomy to reduce your risk of breast cancer. This may reduce, but does not eliminate the risk of breast cancer. Many risk factors, such as your genes and family history, cannot be controlled. However, eating a healthy diet and making a few lifestyle changes may reduce your overall chance of getting cancer. There is still little agreement about whether lifestyle changes can prevent breast cancer. The best advice is to eat a well-balanced diet and avoid focusing on one "cancer-fighting" food. The American Cancer Society's dietary guidelines for cancer prevention recommend that people: y y y y y Choose foods and portion sizes that promote a healthy weight Choose whole grains instead of refined grain products Eat 5 or more servings of fruits and vegetables each day Limit processed and red meat in the diet Limit alcohol consumption to one drink per day (women who are at high risk for breast cancer should consider not drinking alcohol at all)

Definition of skin cancer: Cancer that forms in the tissues of the skin. There are several types of skin cancer. Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) is called basal cell carcinoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called

neuroendocrine carcinoma of the skin. Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems. Estimated new cases and deaths from skin (nonmelanoma) cancer in the United States in 2010: New cases: more than 1,000,000 Deaths: less than 1,000

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 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 calledsquamous 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.

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.

Cancer Cells
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the skin and otherorgans 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.

y o o o o y

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):

o o o o

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

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 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. 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 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.

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 for ways to protect your skin from the sun.

y y

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 systemincrease the risk of skin cancer.

y y

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.

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:

y y y

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.

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:

y y y y y

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.

This photo shows an asymmetic melanoma with irregular and scalloped borders. The color varies from gray to brown to black. The melanoma is about 1.2

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 millimaters.

centimeters.

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 pathologistchecks 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 havelocal anesthesia. There are four common types of skin biopsies:

y y y y

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.

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:

y y y

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 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 ismetastatic 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.

Stages of Melanoma
These are the stages of melanoma:

y y y y y

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.

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.

y y y y

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.