Malignant skin neoplasms refer to cancerous growths of the skin that originate in the epidermis. Excluding malignant melanoma, skin cancers include basal cell carcinoma, squamous cell carcinoma, Paget's disease, and Kaposi's sarcoma.

Skin cancer is the most common type of cancer, relatively easy to detect, and the most curable type of cancer when found early and treated promptly. Skin cancer, like other cancers, originates in cells. When cells grow and divide abnormally, they create a mass of excess tissue. This results in abnormal growths or tumors that can invade and destroy surrounding tissues. The main cause of skin cancer is overexposure to ultraviolet sunlight (UVL), especially when it results in sunburn and blistering. Other factors that may contribute to skin cancer include: exposure to radiation; scarring from disease or burns; occupational exposure; exposure to chemical compounds; chronic inflammation; long-standing sores; and family history. Immune deficiencies, certain types of moles or birthmarks, age, and certain geographic locations can also be predisposing factors that cause skin cancers.

Basal cell carcinoma is the most common skin cancer, occurring in sun-exposed, fair-skinned people, and is very rare in dark-skinned people. Squamous cell carcinoma is the next most common skin cancer, and usually develops on the most sun-exposed areas on the body, but may occur anywhere on the skin. Paget's disease is a rare cancer that arises in the apocrine glands, and is found on the nipple, groin, or perianal area. Kaposi's sarcoma is caused by the human herpesvirus type 8 (HHV-8).

Basal cell carcinoma is the most common form of skin cancer. It is a relatively slow-growing cancer that arises in the lowest layer of the epidermis. Basal cell carcinoma varies in appearance. Descriptions of the lesions may include: small, shiny, fleshy bumps; firm and translucent nodules; ulcerated papules; growths with an elevated border and central indentation; scar-like areas, or flat, indurated plaques resembling psoriasis (see Diagnostic Code: 7816 Psoriasis).

The edges of the lesion may appear pearly white, and the lesions may bleed, itch, or become ulcerated. Basal cell carcinoma rarely metastasizes, but it can extend below the skin down to the bone, causing serious local tissue damage. Lesions may often recur at the site of a treatment scar, the edge of a skin graft, or within a suture line. The most common sites are the face, ears, hands, arms, legs, and body trunk (shoulders, back and chest).

Squamous cell carcinoma is the second most common skin cancer arising in the middle layer of the epidermis. Squamous cell carcinoma often develops on the most sun-exposed areas of the skin, but may occur anywhere on the skin. Lesions may appear as slightly oval or round elevated nodules, or as red, scaly, crusted, keratinous, or wart-like patches that can ulcerate. Bowen's disease, a form of squamous cell carcinoma, appears on the skin as red-brown and scaly, or as flat, crusted lesions. These lesions may look like patches of a chronic skin condition, such as psoriasis, dermatitis, or a fungal infection. Untreated squamous cell lesions may grow into large masses, and may spread into underlying tissues. Squamous cell carcinoma can metastasize to lymph glands, lungs, bone, and the brain. Common places of occurrence include the tongue, lining of the mouth, neck, face, bald scalp, hands, shoulders, arms, and back. The rim of the ear and lower lip are especially vulnerable to this type of cancer.

Paget's disease displays redness, oozing and crusting that resembles dermatitis. Kaposi's sarcoma manifests nodular or plaque-like lesions. In AIDS-related conditions (see Diagnostic Code: 6351 HIV–Related illness), papules that are pink, purple, or brown appear first on the upper body or mucosa.

A skin biopsy is essential. If the lesion is doubtful, then the biopsy should include the full depth of the dermis and a wide excision.

Early diagnosis and early treatment are the keys to successful treatment. Procedures for skin cancers, such as electrodesiccation, surgical excision, cryosurgery, and x-ray therapy are used as possible treatments. For recurring cancers and those with vague borders, the Mohs' surgery (microscopically controlled excision of tissue) is used. When lymph nodes are involved, lymph node dissection is performed. Mastectomy is performed as the treatment for Paget's disease. AIDS-related Kaposi's sarcoma may be treated with chemotherapy.

Regular skin cancer screening for early detection and prevention is recommended. Additional preventive treatments may include avoiding sun exposure, wearing protective clothing, and use of sunscreen on exposed areas of the skin when sun exposure is unavoidable.

Cancer can metastasize when malignant cells break away from a tumor and enter the bloodstream or lymphatic system. Basal cell carcinoma rarely metastasizes. Squamous cell cancers are usually curable if diagnosed and treated early. Kaposi's sarcoma does not shorten life in AIDS-related disease; rather the disease itself dominates the prognosis. Varying degrees and depth of scarring may result depending on the type and extent of skin cancer.

• To properly rate a melanoma skin growth that has spread (metastasize) to another body part or system, rate it under the other system affected.

• To properly rate a growth that has successfully been removed surgically, rate as a scar.

• Consider service connection on a presumptive basis as a condition associated with ionizing radiation exposure (38 CFR §3.307; §3.309(d); §3.311). 

• If the Veteran has a diagnosis of dermatofibrosarcoma protuberans, consider service connection on a presumptive basis as a condition associated with herbicide exposure (38 CFR §3.307(a)(6); §3.307(d); §3.309(e)). 

• If a skin malignancy requires therapy that is comparable to that used for systemic malignancies, i.e., systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision, a 100-percent evaluation will be assigned from the date of onset of treatment, and will continue, with a mandatory VA examination six months following the completion of such antineoplastic treatment, and any change in evaluation based upon that or any subsequent examination will be subject to the provisions of 38 CFR 3.105(e). If there has been no local recurrence or metastasis, evaluation will then be made on residuals. If treatment is confined to the skin, the provisions for a 100-percent evaluation do not apply.