Our Approach to Skin Cancer

The skin is the body’s largest organ and has many functions: protection against heat, sunlight, injury, and infection; control of body temperature; and vitamin D production. The two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). The majority of skin cancers begin in the epidermis, which is made up of three kinds of cells: squamous cells, basal cells and melanocytes, the cells that make pigment and cause the skin to darken with ultraviolet light exposure. The most common skin cancers include:


Although less common than squamous cell or basal cell cancers, they are also more serious and are more likely to grow and spread if not diagnosed and treated early. Melanomas develop from melanocytes, the pigment-making cells of the skin. Melanocytes can also form non-cancerous moles. Melanoma can also affect the eye and eyelid.

Basal cell skin cancer

This is not only the most common type of skin cancer, but the most common type of cancer in humans. About 8 out of 10 skin cancers are basal cell carcinomas. They are usually found in skin exposed to sunlight. They rarely spread, but if left untreated, they can become locally destructive.

Squamous cell skin cancer

These cancers also 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 and can sometimes start within actinic keratosis, a pre-cancerous skin condition caused by too much exposure to the sun.

Merkel cell

Merkel cell carcinoma (MCC) is an uncommon type of skin cancer that can grow quickly and can be hard to treat if it spreads beyond the skin. Merkel cells are very close to nerve endings in the skin and are thought to be a type of neuroendocrine cell because they share some features with nerve cells and hormone-making cells.

Karposi sarcoma

This cancer develops from the cells that line lymph or blood vessels. Karposi sarcoma is caused by human herpes virus 8. It usually appears as tumors on the skin or on mucosal surfaces, such as inside the mouth, but tumors can also develop in other parts of the body. The most common type in the U.S. is AIDS-related Karposi syndrome. These cancers are treated as part of the HIV/AIDS management

Mycosis Fungoides and the Sézary Syndrome (cutaneous lymphoma)

This is a type on non-Hodgkin’s lymphoma in which malignant immune T-cells migrate to the skin causing lesions. Cutaneous lymphoma is often managed topically.

Our dedicated skin cancer specialists see thousands of skin cancer patients a year. Some skin cancer patients require treatment from several medical and surgical specialists, including dermatologists, dermatologic surgeons, medical and surgical oncologists, radiologists, radiation oncologists, ophthalmologists, otolaryngologists and plastic surgeons. Washington University Physicians at Siteman from these fields routinely meet to coordinate and discuss treatment options for patients. In these multidisciplinary meetings, careful consideration is given to determining the best approach to treatment.

Your care providers spend time with you, answering your questions and putting you in touch with resources. As a unique feature of your care, we also offer the services of a palliative care specialist who can help you fit treatment into your own special circumstances, if needed.

At Siteman, once it has been determined that your skin condition may be cancerous, a biopsy is performed. During the biopsy all or part of the skin cancer is removed for examination under a microscope. From this skin sample a diagnosis will be made, and the appropriate method for removing the tumor will be determined.

Washington University Physicians at Siteman are actively involved in clinical trials that investigate new chemotherapy regimens and other curative approaches.