Skin Cancer

It is estimated that one million Americans develop skin cancer every year, making it the most widespread of all cancers. Overexposure to the sun is the primary cause of this condition. Protection against the sun is the best prevention, and early detection is the key to a cure. There are three types of skin cancer (1) basal cell carcinoma, the most common skin cancer (2) squamous cell carcinoma, and (3) malignant melanoma.

BASAL CELL CARCINOMA

What are the facts about basal cell carcinoma?

Basal cell carcinoma is the most common form of skin cancer. It is estimated that it affects 800,000 Americans a year. This lesion arises from the basal cell, which is at the bottom of the epidermis (outer skin layer). Formerly the most affected group was those of older age, however, the age of onset is steadily decreasing. Chronic exposure to the sun is the overwhelming factor in the development of this lesion. Those at highest risk are those with fair skin, blonde or red hair, and blue, green or grey eyes and individuals whose work or recreation places them in the sunlight for extended periods of time on a routine basis. Basal cell carcinomas can resemble non cancerous conditions such as eczema or psoriasis. A dermatologist can determine which condition actually exists.

What are warning signs of a basal cell carcinoma?

The following conditions may signal the presence of a basal cell carcinoma:

  • A red patch often seen on the arms, legs, chest, and shoulders that may become irritated, itch or crust.
  • A pinkish growth with elevated border, a crusted indentation in the center.
  • A shiny bump that can be many colors from red, pink and white to tan, black or brown.
  • An open sore that bleeds, oozes and crusts. A non healing sore is a very common sign of a basal cell carcinoma.
  • A scar like lesion that is white, yellow or waxy appearing with poorly defined borders.

If you observe any of the above, or any other skin lesion that you are concerned about, consult with your dermatologist as soon as possible. Early detection equals good treatment results.

What is the treatment for basal cell carcinoma?

Diagnosis of basal cell carcinoma is confirmed with a biopsy of the lesion performed by your dermatologist. Treatment methods are determined by type, size, location and depth of penetration of the tumor as well as the patient's age and health. Almost all treatment is performed in the physician's office under local anesthetic. Discomfort during and after the procedure is minimal.

The following treatments are available:

  • Excision
  • Curettage (scraping of the skin)
  • Cryosurgery (freezing of the tumor)
  • Radiation

Tumors that are treated very early require simple, confined treatment creating a cosmetically acceptable result. If the tumor has become larger, the treatment may be more extensive. This cancer very rarely spreads, however, if left untreated, can damage surrounding tissues and in some cases may require a skin graft or flap to cover the defect.

What is the risk of recurrence of basal cell carcinomas?

Once a basal cell carcinoma has been detected, it is possible that others may occur in either the same area or elsewhere on the body. Regular follow up visits to a dermatologist to examine both the site of the former tumor or the existence of a new one is part of good skin health maintenance.

SQUAMOUS CELL CARCINOMA

What are the facts about squamous cell carcinoma?

Squamous cell carcinoma originates in the epidermis and can be found in any area of the body including mucous membranes, but is most common in areas exposed to the sun such as the face, neck hands, arms back, and bald scalp. The rim of the ear and the lower lip are very vulnerable to the development of this tumor. The most frequent cause of squamous cell carcinoma is chronic exposure to sunlight. Those at most risk include individuals with fair skin, blue, green, or gray eyes with light colored hair. This condition may arise at the site of preexisting inflammatory skin conditions or burn injuries.

Are there skin conditions that sometimes develop into squamous cell carcinoma?

The following non cancerous conditions may develop into squamous cell carcinoma:

  • Actinic keratosis
  • Actinic cheilitis
  • Leukoplakia - White patches on the tongue or inside of the mouth
  • Bowen's Disease - Considered to be a superficial squamous cell cancer that is contained within the epidermis. A persistent red-brown scaly patch which may resemble psoriasis or eczema.

What types of lesions might be squamous cell carcinoma?

The following lesions may be squamous cell carcinomas:

  • A red patch with irregular borders that is scaly and sometimes crusts or bleeds
  • An elevated growth with a central depression that may bleed
  • An open sore that bleeds and crusts
  • A growth that resembles a wart that crusts and bleeds
  • Cutaneous Horn

How is squamous cell carcinoma treated?

After a physician exam and biopsy to confirm the diagnosis of squamous cell carcinoma, a course of treatment will be determined based on the type, size, location and depth of penetration of the tumor as well as the patient's age and health status. The following are available treatment options:

  • Excision
  • Curettage (scraping of the skin)
  • Cryosurgery
  • Radiation

When diagnosed in its early stages, squamous cell carcinoma is almost always curable. As with other skin cancers, the earlier the treatment is administered, the smaller the area affected resulting in a cosmetically acceptable result. The larger the tumor, the more invasive the treatment. Although squamous cell carcinomas rarely spread, it should be noted that approximately 11% of these tumors found on the lip do metastasize.

Do squamous cell carcinomas recur?

Anyone who has had a squamous cell carcinomas has an increased chance of developing another. If you have had a basal cell carcinoma you are at more risk of developing a squamous cell carcinoma. Both types of skin cancer are normally caused by excessive sun exposure. Squamous cell carcinomas on the lips, ears and nose are more likely to recur.

MALIGNANT MELANOMA

What is malignant melanoma?

Melanoma is an abnormal growth of cells originating in the melanocytes or cells that color the skin. It may appear suddenly in the skin, nails, mucous membranes, genitals or scalp and may arise near a mole. It can look like a freckle or mole and can be flat or raised. Individuals with increased risk for this condition include fair skinned individuals, those with history of significant sunburns, have a family history of melanoma, or a high number of atypical moles.

In the last twenty years, the incidence of melanoma has doubled and presently is the most common form of cancer in the 25-29 age group. Early detection is critical in the successful treatment of melanoma. Any suspicious growth should be brought to the attention of a dermatologist who has extensive training and is able to visually detect signs of melanoma in its early stages.

What are the early signs of malignant melanomas?

Survival in cases of melanoma is related to the thickness of the tumor. If detected early and treated, the survival rate is very high. As the disease advances there is a higher possibility that it will spread to other areas of the body and the survival rate decreases. The following factors, known as the A B C D's*, indicate early signs of this condition:

  • Asymmetry - One half does not mirror the other half
  • Borders - Notched, irregular
  • Color - Variegated, uneven color, often brown, black or pink
  • Diameter - Greater than half an inch*

*California Dermatology Society

What is the treatment for malignant melanoma?

The treatment for malignant melanoma is surgical excision. A consistent follow up program for five years is developed, the frequency of visits being determined by the severity of the condition.

SKIN CANCER PREVENTION TIPS

Avoiding the sun is the most important thing you can do to help prevent skin cancer. Some tips for protecting your skin against the ultraviolet rays are:

  • Stay out of sunlight during peak hours.
  • Apply sunscreens with SPF of at least 15.
  • Wear protective clothing, hats, sunglasses.
  • Avoid tanning booths.
  • Develop a routine for regular visual inspection of your body for any skin changes. Simple steps to accomplish this include:
  • Stand in front of a full length mirror and examine your body, front and back. Raise your arms and look at the right side, then the left.
  • Bend your elbows and look at your forearms, the back of your arms and the palms of your hands.
  • Look at the front and back of your legs, the spaces between your toes, and the soles of your feet.
  • Inspect the back of your neck and your scalp using a hand mirror.
  • Check you back and buttocks in the same way.

Schedule an appointment with your dermatologist at least once a year for a complete skin exam. If you have had skin cancer, this should be done at least twice a year or at the direction of your dermatologist.

See Your Skin and the Sun