Skin Cancer Detection & Treatment

What is Skin Cancer?

Overview

Skin cancer is a malignant condition that begins with the uncontrolled growth of abnormal cells. Though the skin is our first line of defense from the outside environment, its location on the surface of our body makes it susceptible to damage from the sun’s radiation. Like other types of cancer, skin cancer often starts with DNA damage. Ultraviolet (UV) radiation from the sun causes the most damage. The damage is usually repaired by the body’s built-in repair mechanisms but long-term sun exposure can lead to severe DNA damage that may not be repaired. If the damage occurs in genes that are responsible for controlling the division of skin cells, these cells may begin to divide uncontrollably, which can result in skin cancer.

Skin Cancers and Pre-Cancers

The three most common skin cancers are Melanoma, Basal Cell Carcinoma (BCC), and Squamous Cell Carcinoma (SCC). There are also pre-cancers, known as Actinic Keratoses (AK) that can turn into SCC if left untreated.

  • Melanomais the most deadly of all skin cancers (Melanoma causes more than 75% of skin cancer deaths), but when CAUGHT EARLY is almost always curable. But if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths. In 2016, an estimated 76,380 of these will be invasive melanomas, with about 46,870 in males and 29,510 in women.

     Basal Cell Carcinoma BCC almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening. It shouldn’t be taken lightly, though: it can be disfiguring if not treated promptly.

More than 4 million cases of basal cell carcinoma are diagnosed in the U.S. each year. In fact, BCC is the most frequently occurring form of all cancers. More than one out of every three new cancers is a skin cancer, and the vast majority are BCCs.

 

Squamous Cell Carcinoma (SCC) is the second most frequently occurring skin cancer. More than 1 million cases of squamous cell carcinoma are diagnosed each year in the U.S., and (depending on different estimates) as many as 8,800 people die from the disease. Incidence of the disease has increased up to 200 percent in the past three decades in the U.S. 

Estimated 65% of them arise in lesions previously diagnosed as AKs. Most are easily treated, but if not removed, some can metastasize, spreading to nearly lymph nodes, which drain the area where the cancer is located: from the lymph nodes, the cancerous cells can spread to distant tissues and organs, becoming life threatening.

SCC is mainly caused by cumulative ultraviolet (UV) exposure over the course of a lifetime; daily year-round exposure to the sun’s UV light, intense exposure in the summer months, and the UV produced by tanning beds all add to the damage that can lead to SCC. Patients that are immunocompromised due to organ transplant medications or medical conditions are at much higher risk to develop squamous cell carcinomas that are more aggressive and require very  prompt attention

SCCs may occur on all areas of the body including the mucous membranes and genitals, but are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, balding scalp, neck, hands, arms and legs. Often the skin in these areas reveals telltale signs of sun damage, including wrinkles, pigment changes, freckles, “age spots,” loss of elasticity, and broken blood vessels.

Actinic Keratoses (AK), pre-cancers, are often an early stage in development of skin cancer. They affected 58 million Americans . AK is an abnormal growth of keratinocytes, the skin cells that make up the top layer of the skin (epidermis). People with a fair complexion, blond or red hair, and blue, green or grey eyes (Identify Your Skin Type) have a high likelihood of developing AKs if they spend time in the sun and live long enough. Location makes a difference: The closer to the equator you live, the more likely you are to have actinic keratoses. The incidence is slightly higher in men, because they tend to spend more time in the sun and use less sun protection than women do. African-Americans, Hispanics, Asians and others with darker skin are not as susceptible as Caucasians (Skin Cancer and Skin of Color), but anyone can develop skin cancer.

 

Signs and Symptoms

Each type of skin cancer has particular individual signs and symptoms:

  • An actinic keratosis is a small (usually grow from 1/8″-1/4″) crusty or scaly patch, often red, or a combination of colors. It sometimes itches, is inflamed and occasionally bleeds.
  • A basal cell carcinoma tends to be pearly looking, sometimes with rolled borders. The signs to look for are also an open sore, a shiny bump, a reddish or irritated patch or a white, yellow or waxy scar-like area.
  • A squamous cell carcinoma is often pink and scaly, a wart-like growth/open sore with irregular borders, that crusts and occasionally bleeds, persisting for weeks.
  • A melanoma is typically a dark mole. Check for changes in the number, size, shape and color of pigmented areas.In light skin individuals though, there is a greater chance of developing amelanotic melanoma- without a pigment as a reddish patch

The patient does not generally feel any symptoms of skin cancer but may notice a new or changing spot or a sore that will not heal. However, advanced stages of melanoma or squamous cell carcinoma that has spread into the bloodstream may cause associated symptoms, such as pain in an area close to the spot.

 

Diagnosis and Treatment

Skin cancers are diagnosed by a combination of clinical examination and biopsy of the lesion. Once the results are back, removal of the cancer depends on the type.

  • Actinic Keratoses Treatments– Pre-cancers can be treated within one of twelve convenient locations with liquid nitrogen, chemicals, levulonic acid/ photodynamic therapy. In addition to our in-office procedures, multiple effective prescription topical creams can be also used at home under the direction of your health care provider.
  • Mohs Micrographic Surgery for Basal and Squamous cell carcinoma – is  highly specialized treatment for the removal of skin cancer that requires detailed knowledge of skin anatomy, skin cancer, pathology as well as advanced surgical skills.
    Mohs consists of removing thin layers of cancer-bearing skin and microscopically examining the area until it is tumor-free. Your Mohs surgeon  – can pinpoint areas involved with cancer that are otherwise invisible to the naked eye, therefore, even the smallest microscopic roots of cancer can be removed. It offers skin cancer patients the most minimal recurrence rate, in addition to optimal preservation of uninvolved tissue and, therefore, minimal scarring. In fact, Mohs surgery has been shown to have a 99 percent, or better, cure rate for basal cell carcinoma, the most common type of skin cancer.
    This procedure does not require general anesthesia, which permits its use on many patients who are poor candidates for conventional surgery.
  • Surgical excision / desiccation and curettage for Basal and Squamous cell carcinomas –  are outpatient procedures with high cure rates, and your doctor would decide which one would be best suited for you. Cure rates are high, and recurrence rates are low for cancers that are caught early, while they are smaller  and treated as well. Early detection of skin cancer is key.
  • Topical medications – for certain thinner types of Squamous or Basal cell carcinomas
  • Radiation therapy– for poor surgical candidates, and as add on for very aggressive cancers. Carries a risk for secondary malignancies down the line,  as well as late scarring , so patients have to be chosen carefully for this modality

More Information

*Facts provided by the Skin Cancer Foundation and American Academy of Dermatology.

DISCLAIMER: The information provided by this site is intended solely for educational purposes. This information is not to be used for medical diagnostic purposes and is not intended to serve as a recommendation for treatment and/or management of any medical/surgical condition. Most of all, this information should not be used in place of a physician or other qualified health provider. If you believe you have a medical condition, please contact your physician immediately.