More About Skin Cancer
More than a million new cases of skin cancer are diagnosed every year in the United States, making it the most common of all cancers. It can be an even greater concern for those with light skin or eye color and an active outdoor lifestyle. Prevention and early detection are the best defenses against skin cancers and routine screening is important.
To detect skin cancer early, you should regularly examine your skin to identify suspicious areas and monitor them for changes in size, shape, color, or diameter. Protecting your skin from the sun is also important as 90% of all basal and squamous cell carcinomas are thought to be caused by overexposure to ultraviolet light.
There are three basic forms of skin cancer. The two most common are basal cell and squamous cell carcinomas, which account for 90% of all cases. The third kind, and the most dangerous, is malignant melanoma, which can spread throughout the body. When detected early and treated properly, the recovery rate for all three types can be very high.
One in five Americans will develop skin cancer at some point in their lives. They are generally curable if caught early. However, people who have had skin cancer are at a higher risk of getting it again, which is why regular self-examination and doctor visits are imperative.
Basal Cell Carcinoma
This is the most common form of skin cancer. Basal cells reside in the deepest layer of the epidermis, along with hair follicles and sweat ducts. When a person is overexposed to UVB radiation, it damages the body’s natural repair system, which causes basal cell carcinomas to grow. These tend to be slow-growing tumors and rarely metastasize (spread). Basal cell carcinomas can present in several different ways such as:
- A raised pink or pearly white bump with a pearly edge and small, visible blood vessels.
- Pigmented bumps that look like moles with a pearly edge.
- A sore that continuously heals and re-opens.
- A flat, scaly scar with a waxy appearance and blurred edges.
Despite the different appearances, they all tend to bleed with little or no cause. Eighty-five percent of basal cell carcinomas occur on the face and neck since these are the areas most exposed to the sun.
Risk factors for basal cell carcinoma include having fair skin, sun exposure, age (most skin cancers occur after age 50), exposure to ultraviolet radiation (as in tanning beds), and therapeutic radiation given to treat an unrelated health issue.
Diagnosing basal cell carcinoma requires a biopsy — either excisional, where the entire tumor is removed along with some of the surrounding tissue, or incisional, where only a part of the tumor is removed (used primarily for large lesions).
Treatments for basal cell carcinoma include:
- Mohs Micrographic Surgery — The preferred method for the treatment and management of complex tumors including those on the head and neck, large tumors, or tumors previously treated by other methods where recurrence of the cancer has detected. Mohs combines removal of cancerous tissue and microscopic review while the surgery takes place. By mapping the diseased tissue layer by layer, less healthy skin is damaged when removing the tumor.
- Cryosurgery — Some basal cell carcinomas respond to cryosurgery, where liquid nitrogen is used to freeze off the tumor.
- Curettage and Desiccation — The preferred method of dermatologists, this treatment involves using a small metal instrument (called a curette) to scrape out the tumor along with an application of an electric current into the tissue to kill off any remaining cancer cells.
- Prescription Medicated Creams — These creams can be applied at home. They stimulate the body’s natural immune system over the course of weeks.
- Radiation Therapy – This is used for difficult-to-treat tumors, either because of their location, severity, or persistence.
- Surgical Excision — In this treatment, the tumor is surgically removed and stitched up.
Squamous Cell Carcinoma
Squamous cells are found in the upper layer (the surface) of the epidermis. They look like fish scales under a microscope and appear as a crusted or scaly patch of skin with an inflamed, red base. They are often tender to the touch. It is estimated that 250,000 new cases of squamous cell carcinoma are diagnosed annually, and that 2,500 of them result in death.
Squamous cell carcinoma can develop anywhere, including inside the mouth and on the genitalia. It most frequently appears on the scalp, face, ears, and back of hands. Squamous cell carcinoma tends to develop among fair-skinned, middle-aged, and elderly people who have a history of sun exposure. In some cases, it evolves from actinic keratoses, dry scaly lesions that can be flesh-colored, reddish-brown or yellow-black, and which appear on skin that is rough or leathery. Actinic keratoses spots are considered precancerous.
Like basal cell carcinoma, squamous cell carcinoma is diagnosed with a biopsy — either excisional, where the entire tumor is removed along with some of the surrounding tissue, or incisional, where only a part of the tumor is removed (used primarily for large lesions).
Treatments for squamous cell carcinoma include:
- Mohs Micrographic Surgery — Because squamous cell carcinomas can be more aggressive than basal cell carcinomas, Mohs surgery is often the best choice for treatment because it is able to give the best cure rate. It combines removal of cancerous tissue with microscopic review while the surgery takes place. By mapping the diseased tissue layer by layer, less healthy skin is damaged when removing the tumor.
- Surgical Excision — In this treatment the tumor is surgically removed and stitched up. The tissue is sent in a jar to a pathologist who sections the tissue and makes slides, then reads the slides to determine if the representative margins appear clear. It takes approximately five business days to determine if the margins are clear or if further surgery is warranted.
- Radiation Therapy — This is used for difficult-to-treat tumors, either because of their location, severity, or persistence.
Melanoma
Melanoma is the least common form of skin cancer and the most likely to spread.
Melanocytes are cells found in the bottom layer of the epidermis. These cells produce melanin, the substance responsible for skin pigmentation. That’s why melanomas often appear as dark brown or black spots on the skin. Melanomas spread rapidly to internal organs and the lymph system, making them quite dangerous. Early detection is critical for curing this type of skin cancer.
Melanomas look like moles and often do grow inside existing moles. That’s why it is important for people to conduct regular self-examinations of their skin in order to detect any potential skin cancer early, when it is treatable. Most melanomas are caused by overexposure to the sun beginning in childhood. This cancer also runs in families.
Melanoma is diagnosed with a biopsy. Treatments include surgical removal, radiation therapy, or chemotherapy.
What to Look For
The key to detecting skin cancers is to notice changes in your skin. Look for:
- Large brown spots with darker speckles located anywhere on the body.
- Dark lesions on the palms of the hands and soles of the feet, fingertips, toes, mouth, nose or genitalia.
- Translucent pearly and dome-shaped growths.
- Existing moles that begin to grow, itch, or bleed.
- Brown or black streaks under the nails.
- A sore that repeatedly heals and re-opens.
- Clusters of slow-growing scaly lesions that are pink or red.
The American Academy of Dermatology has developed the following ABCDE guide for assessing whether a mole or other lesion may be becoming cancerous.
- Asymmetry: Half the mole does not match the other half in size, shape, or color.
- Border: The edges of the mole are irregular or blurred.
- Color: The mole is not the same color throughout.
- Diameter: The mole is larger than one-quarter inch in size.
- Elevation: The mole becomes elevated or raised from the skin.
If any of these conditions occur, please make an appointment to see one of our dermatologists right away. The doctor may do a biopsy of the mole to determine if it is or isn’t cancerous.
Prevention
Roughly 90% of nonmelanoma cancers are attributable to ultraviolet radiation from the sun. That’s why prevention involves:
- Staying out of the sun during peak hours (between 10 a.m. and 4 p.m.).
- Covering up the arms and legs with protective clothing.
- Wearing a wide-brimmed hat and sunglasses.
- Using sunscreens year-round with a SPF of 15 or greater and sun blockers that work on both UVA and UVB rays. Look for products that use the term “broad spectrum.”
- Checking your skin monthly and contacting your dermatologist if you notice any changes.
Getting regular skin examinations. It is advised that adults over 40 get an annual exam with a dermatologist.