Skin Cancer

• Causes of Skin Cancer
• Risks Factors
• Types of Skin Cancer
• Diagnosis of Skin Cancer
• Treatment of Skin Cancer
• Reducing Your Risk of Developing Skin Cancer

Causes of skin cancer

The primary cause of skin cancer is ultraviolet radiation from the sun. Artificial forms of ultraviolet radiation such as sun lamps and tanning booths can also cause skin cancer. Many researchers believe that our quest for the perfect tan and the increase in outdoor activities have contributed to the alarming rise in the rate of skin cancers.

Risk of developing skin cancer

Anyone can get skin cancer no matter what your skin type, race or age. Twenty percent of skin cancers occur in areas that are not sun exposed such as the chest, back, arms, legs and scalp. The face, however, remains the most common location for skin cancers. The risk of developing skin cancer is greater if:

• Your skin is fair and freckles easily.
• You have light colored hair and eyes.
• You live closer to the equator, at a higher altitude, or in a place that gets intense year-round sunshine.
• You spend a lot of time working or playing outdoors.
• You have a family history of skin cancer or personal history of blistering sunburns.
• You have a large number of moles or moles of unusual size or shape.
• You receive therapeutic radiation treatments for adolescent acne.
  

Types of skin cancer

basal cell carcinoma is the most common type of skin cancer. It is important to note that this type of skin cancer is the least dangerous kind. It tends to grow slowly and rarely spreads beyond its original site. Tough basal cell carcinoma is seldom life threatening, however, if left untreated it can grow deep beneath the skin into the underlying tissue and bone causing serious damage (particularly if it is located near the eye). Basal cell carcinoma accounts for more than 90% of all skin cancers in the United States.

Squamous cell carcinoma is the next most common type of skin cancer, which frequently appears on the lips, face, or ears. This sometimes spread to distant sites, including lymph nodes and internal organs. This type of skin cancer can become life threatening if it is not treated appropriately.

Malignant melanoma is the third form of skin cancer. It is the least common form; however, its occurrence is increasing rapidly, especially in the Sunbelt states. Malignant melanoma is the most dangerous type of skin cancer. If diagnosed early it can be completely cured. If it is not treated quickly, however, malignant melanoma may spread throughout the body and is often deadly.

Other skin growths you should be aware of:

Solar or actinic keratosis is rough, rather brown, scaly patches on the skin. They are usual found on areas exposed to the sun and sometimes develop into squamous cell carcinoma.

Moles are clusters of heavy pigmented cells either flat or raised above the skin surface. While most pose no danger, some particularly large moles present at birth or those with mottle colors and poorly defined borders may develop into malignant melanoma. Moles are also frequently removed for cosmetic reasons or because they are constantly irritated by clothing or jewelry.

Diagnosis of skin cancer

Basal cell and squamous cell carcinomas can vary widely in appearance. (Fig. 1) The cancer may begin as a small, white, or pink nodule or bump. It can be smooth, shiny, waxy or pitted on the surface. It also might appear as a red spot that is rough, dry and/or scaly. Also, a firm red lump that may crust and bleed on occasion can be characteristics of these types of skin cancers. It is often hard to tell a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Basal cell carcinomas grow slowly, taking months or even years to become sizeable, although spreading to other parts of the body (metastases) is very rare. Basal cell carcinoma can damage and disfigure the eye, ear, nose or throat if it develops nearby. The appearance of squamous cell carcinoma is very similar to basal, however, it tends to occur more often and to be less raised in its appearance. (Fig. 2)

Malignant melanoma is usually signaled by a change in the size, shape or color of an existing mole or as a new growth on normal skin. (Fig. 3) Watch for the ABCDs warning signs of melanoma.

Asymmetry - a growth with unmatched hairs.
Border - irregularity ragged or blurred edges.
Color - a mottle appearance with shades of tan, brown and black, sometimes mixed with red, white or blue.
Diameter - a growth more than 6 mm across, about the size of a pencil eraser, or any unusual increase in size.

All of these characteristics may be confusing, but it is very important to remember this: Get to know your skin and examine it regularly from the top of your head to the soles of your feet (do not forget your back). If you notice any unusual change on any part of your body have a doctor check it out.

A basal cell carcinoma is usually diagnosed by performing a biopsy. This usually involves taking a sample or all of the growth by injecting a local anesthetic and scraping a small piece of skin. This method is referred to as the shave biopsy. The scraped sample of skin is then examined under a microscope to check for cancer cells.

Treatment options of skin cancer

There are many ways to successfully treat basal cell carcinoma and squamous cell carcinoma, with a 90% or better chance of success. The main goal is to remove or destroy the cancer completely while leaving as small a scar as possible. To plan the best treatment option, the doctor considers the location and size of the cancer, the risk of scarring, the patient's age, general health and medical history.

Methods commonly used to treat basal carcinoma include:

Curettage and desiccation - The skin is scooped out to remove the affected area.
Surgical excision - the tumor is surgically removed and closed with adjacent soft tissue and skin grafts.
Radiation therapy - doctors often use radiation to treat areas of skin that are difficult to treat with surgery.
Cryosurgery - some doctors train in this technique, which achieves good results by freezing basal cell carcinoma.
Mohs micrographic surgery - the lesion is removed and monitored microscopically following excision until all basal carcinoma cells are removed.

Through our experience we have found the direct excision of the basal cell carcinoma or squamous cell carcinoma to be the best mode of treatment. We give the specimen to a certified pathologist who immediately can examine the lesion microscopically to ensure that all of the lesion has been removed. (frozen section). Our main goal is to remove the carcinoma. We feel comfortable that with this method the lesion can be totally removed. Our secondary goal is reconstruction of the site from which the lesion was removed. With this type of approach and treatment of basal cell and squamous cell carcinomas we can usually achieve a 98%-99% cure rate if these 2 carcinomas are treated in the early stages. Following this total excision we then employ plastic surgical techniques to close the defect, seeking to avoid as much scarring as possible.

Please refer to the photos below of a patient who unfortunately lost part of her nose during the process to remove the skin cancer. Following total removal of the cancer, we performed a subsequent staged reconstruction.

Pre-surgery

Post Nasal Cancer Excision

Nasal Reconstruction After Extensive Skin Cancer Removal

Treatment of a malignant melanoma, however, is much more difficult. Melanoma must first be biopsied and then graded on its thickness. Once it is graded, then the surgeon can ascertain the approximate overall depth and thickness of the lesion, the chance of exposure to regional lymph nodes and the chance of metastasis of the cancer. It is therefore extremely important to treat the malignant melanoma at its early stages, so as to prevent spread to other tissues.

The treatment of a melanoma is different from the basal cell carcinoma in that we take much deeper and wider margins around the lesion in order to ensure total removal during the operative procedure.

How is basal cell carcinoma prevented?

• Avoiding sun exposure in susceptible individuals is the best way to lower the risk of developing all types of skin cancer.
• Regular surveillance of susceptible individuals both by self-examination and regular physical examination is also a good idea for people at higher risk.
• People who have already had any form of skin cancer should have regular medical check-ups.
  

Reducing Your Risk of Developing Skin Cancer

Here is a list of recommendations to reduce your overall risk of developing skin cancer.

• Common sense preventative techniques include limiting recreational sun exposure.
• Avoiding unprotected exposure to the sun during peak radiation times.
• Wearing broad-rimmed hats and tightly woven protective clothing while outdoors in the sun.
• Regularly using a waterproof or water-resistant sunscreen with a UVA protection SPF number of 30 or higher.
• Undergoing a regular check-up to bring any suspicious looking lesion or changing lesion to the attention of your doctor.
  

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