Cellular heterogeneity and microenvironmental control of skin cancer

J Intern Med. 2021 May;289(5):614-628. doi: 10.1111/joim.13177. Epub 2020 Oct 20.


Healthy tissues harbour a surprisingly high number of cells that carry well-known cancer-causing mutations without impacting their physiological function. In recent years, strong evidence accumulated that the immediate environment of mutant cells profoundly impact their prospect of malignant progression. In this review, focusing on the skin, we investigate potential key mechanisms that ensure tissue homeostasis despite the presence of mutant cells, as well as critical factors that may nudge the balance from homeostasis to tumour formation. Functional in vivo studies and single-cell transcriptome analyses have revealed a tremendous cellular heterogeneity and plasticity within epidermal (stem) cells and their respective niches, revealing for example wild-type epithelial cells, fibroblasts or immune-cell subsets as critical in preventing cancer formation and malignant progression. It's the same cells, however, that can drive carcinogenesis. Therefore, understanding the abundance and molecular variation of cell types in health and disease, and how they interact and modulate the local signalling environment will thus be key for new therapeutic avenues in our battle against cancer.

Keywords: cancer; dermatology; epidermal stem cells; microenvironment; tissue heterogeneity.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Carcinogenesis
  • Carcinoma, Basal Cell / pathology
  • Carcinoma, Basal Cell / physiopathology
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / physiopathology
  • Cell Transformation, Neoplastic
  • Epidermal Cells / physiology
  • Fibroblasts / physiology
  • Humans
  • Signal Transduction
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / physiopathology
  • Skin Physiological Phenomena
  • Stem Cells / physiology
  • Tumor Microenvironment*