Can Skin Cancer Cause Itching? A Dermatologist’s Take

Itching can be a sign that something is happening beneath the skin’s surface. Sometimes, it occurs where you see a blemish. Other times, it arises on normal-looking skin. Indeed, it’s a complex symptom that can puzzle the untrained.

The thing is, itching can be worrying for people at higher risk of skin cancer. Various health conditions can cause it, and emotional or nerve issues can cloud its significance, leaving many with lingering questions.

Can skin cancer cause itching? Does itching occur with other symptoms of malignancy? Does intense itching mean advanced disease?

At BHSkin Dermatology, your concerns are never brushed aside. So, before you panic, let’s look at what science says about the link between these skin issues.

What Does “Itch” Mean?

Itching, called “pruritus” in medical parlance, is an uncomfortable feeling that provokes the urge to scratch. Most itching occurs when the skin is irritated, with insect bites and allergic rash as common examples.

Pain, like itching, also causes discomfort, but it elicits different behaviors. Pain triggers protective instincts like pulling away and guarding, rather than scratching, the affected site.

Some skin conditions can give rise to both itching and pain. Recognizing the difference is crucial to identifying the true cause and getting the proper treatment.

Itching episodes lasting less than 6 weeks are considered acute. Chronic itching continues for a longer duration. Persistent skin itchiness from any source can be distressing, impacting quality of life and mental wellness.

What Actually Happens When People Itch?

The itching sensation typically develops from an elaborate process that requires close interaction between skin cells, inflammatory cells, sensory nerves, the spinal cord, and the brain. It starts when a skin change, such as irritation, causes inflammatory cells to release chemicals that activate nerves close by.

The stimulated nerves send signals through the spinal cord up to the brain. There, the sensation is recognized as itchiness, which leads to the urge to scratch.

But this process applies only when itching comes from a real skin problem. Other cases of skin itch have no tangible cause but are triggered by the mind. Psychological factors like stress or anxiety can activate nerve pathways that create the feeling of itch, leading to itchy skin without any actual skin damage.

What Conditions Cause Itching?

A long list of external and internal factors can make the skin itch. Notable examples include the following:

• Skin inflammation: Eczema, insect bites, contact allergy, atopic dermatitis
• Infection: Viral rash (e.g., chickenpox; hand, foot, and mouth disease), scabies, ringworm
• Autoimmune disease: Bullous pemphigoid, lupus, psoriasis
• Blood cancer: Cutaneous T cell lymphoma, Hodgkin lymphoma 
• Genetic disorders: Darier disease, epidermolysis bullosa pruriginosa
• Chronic skin problems: Scarring, dry skin
• Conditions blocking bile flow: Gallbladder or pancreatic cancer
• Hormonal dysfunction: Uncontrolled diabetes or hyperthyroidism 
• Nervous system issues: Stroke, brain infections, brachioradial (arm and forearm) pruritus
• Mental health challenges: Anxiety, depression, obsessive-compulsive disorder
• Other systemic causes: Drug reactions (e.g., opioids, chemotherapy, anti-malarials), heavy metals, iron deficiency anemia, vitamin D deficiency

Additionally, in some conditions, itching can arise from several overlapping factors, not just the main illness. Such conditions include liver cancer, chronic kidney disease, and HIV infection. Situations where an itch should be evaluated for possible cancer include symptoms developing within the past year, age above 60, male sex, history of liver problems, and chronic smoking.

Is Persistent Itching a Skin Cancer Warning?

Now that we’ve covered how skin itch starts, we turn to whether skin tumors can be a source of this symptom. You may ask, is skin cancer itchy? The answer: It’s not a simple yes or no.

Skin malignancies can cause itchiness, though the exact mechanism remains uncertain. Some researchers suggest that skin cancer itch may stem from the tumor’s local effects, as the body reacts to toxic or allergy-causing substances released by cancer cells.

Others point to an increased number of inflammatory cells called “eosinophils” in the affected area. Eosinophils release interleukin 31, a chemical strongly linked to the sensation of itching.

But is having itchy skin a reliable indicator of malignancy? Or more importantly, its severity? Let’s take a closer look at the evidence.

Is Intense Itching Connected to Later Stages of Skin Cancer?

Research shows that skin cancer often starts without any obvious signs or discomfort. However, about 20-40% of people with basal cell carcinoma or squamous cell skin cancer experience itching in the affected area, though usually mild to moderate in intensity, as the disease advances.

One study reports that basal cell carcinoma itch is typically less severe than that seen in atopic dermatitis or acne. That means the itch is often tolerable and less disruptive to daily life compared to skin issues known to cause relentless itching.

Skin cancer severity and outlook usually relate to the depth of skin involvement. Yet for itchy skin cancer types, most notably basal and squamous cell carcinoma, researchers found no connection between lesion depth and itch severity. On the other hand, pain levels have been shown to increase as these tumors extend deeper.

As for melanoma, the chance of itching, especially severe itching, is very low. Additionally, pain levels don’t seem to be linked to how deep this type of tumor spreads.

Taken together, itching can be a skin cancer symptom, but it’s not a sure sign of malignancy. Its intensity also doesn’t consistently match how far the disease has progressed.

When Should You Consult for Skin Itchiness?

Talk to your doctor if you have a hard-to-explain skin itch that won’t go away, even with over-the-counter remedies. If you’re concerned that you may have more than just irritated skin, remember that itching is only one of several skin cancer symptoms and rarely signals malignancy by itself. Additionally, severe itching is more often linked to benign skin conditions than skin tumors.

That said, clues that an itchy lesion may be malignant include the following:

• Bleeding with minimal trauma
• Persistence or recurrence
• Appearance that differs from older lesions
• Rapid growth
• Occurrence in areas with repeated UV, trauma, or carcinogen exposure or previous high-risk wart infection

To distinguish melanoma from common moles, remember the ABCDE guide—asymmetry, border, color, diameter, and evolution. We’ve tackled this topic, along with self-skin exams, in our previous articles.

Doctors also typically consider various risk factors when assessing itchy lesions for possible skin cancer. The most important ones include the following:

• Significant sun or UV contact
• Family or personal history of skin cancer
• Exposure to carcinogens, including radiation and arsenic
• Weakened immunity
• Use of certain drugs, particularly chemotherapeutic, UV-sensitizing, and immunosuppressive medications
• History of high-risk warts
• Chronic skin injuries, such as burn scars and autoimmune skin disorders

Medical practitioners may also look for other signs that itchiness isn’t from a skin malignancy. A complete discussion of these manifestations is beyond the scope of this discussion, but common examples include the following:

• High-grade fever and a runny nose may signify an infection.
• Yellowing of the eyes and skin may indicate liver, pancreatic, or gallbladder cancer.
• High blood pressure may suggest diabetes, thyroid problems, or kidney disease.
• Lymph node swelling and chronic fatigue may point to blood cancers like cutaneous lymphoma.
• A sudden blood pressure drop, together with drowsiness and dry mouth, may hint at opioid toxicity.

To ensure early skin cancer detection, everyone is advised to perform a self-skin check at least once a year. People particularly vulnerable to this skin condition, such as those with poor immunity or a history of cancer treatment, may be advised to do it more often.

Importantly, early and accurate skin cancer diagnosis starts with consulting a board-certified dermatologist. Only a true specialist can ensure comprehensive cancer care and manage the condition effectively.

Not All That Itches Is Cancer

In summary, itching results from a multifaceted process involving skin cells, inflammatory cells, and the nervous system. Many different conditions can cause this symptom. Some produce a visible rash, while others don’t.

In cases without skin lesions, itching may have a psychological origin. Figuring out the source of this skin issue may be tough due to the variety of potential triggers.

In the context of skin cancer, studies show that itching isn’t a reliable indicator of the presence or severity of the condition. Less than half of patients with basal or squamous cell carcinoma report mild-to-moderate itch. Melanoma rarely causes itching, and when it does, it’s usually mild. However, skin itch is more likely to be serious when it occurs with sores that won’t heal and lumps that grow fast or bleed at the slightest touch.

Finally, skin issues like stubborn itching always deserve attention from a board-certified dermatologist. Only a highly trained skin specialist is uniquely qualified to diagnose and manage skin disorders skillfully.

Worried About a Nagging Itch? Get Answers From LA’s Top Skin Experts

Chronic skin itching may or may not be a sign of skin cancer. If you have tried everything but still feel stuck, it’s time to call in the true pros.

At BHSkin Dermatology, our skin cancer specialists are some of California’s best. They combine expert knowledge with a caring touch, drawing from daily experience with patients diagnosed with this condition. Visit us at our Glendale or Encino office or use our telederm portal for your initial consultation.

Take control of your skin health with trusted professionals. Book your appointment today!

References:

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Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA's leading board-certified dermatologist is the president of BHSkin Dermatology and proud father of 3 wonderful children. He treats patients in both Encino-Tarzana and Glendale. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from his practice.