Treating Skin Cancer

Skin cancer is the product of the uncontrollable growth of skin cells and combined they make up over half of all cancers affecting humans. Roughly one in three Americans now will develop at least one skin cancer in their lifetime but fortunately, most skin cancers are highly curable if they are caught early. The majority of skin cancers in humans are one of three types: basal cell carcinoma, squamous cell carcinoma, and melanoma.

What are the treatments for skin cancer?

• Electrodessication and curettage (ED&C)

  A sterile circular knife (curette) is used to scrape out the tumor followed by the application of electric current (electrodessication).

• Surgical excision

  The clinical tumor and several millimeters of surrounding normal appearing skin are removed into subcutaneous fat, and the defect is then closed with sutures.

• Prescription creams

  A few options exist for treating superficial BCCs with creams, avoiding surgery. They selectively kill rapidly growing cells (cancerous cells) or stimulate the immune system to kill them. In appropriately chosen cancers, this can be a good option, but lesions should always be followed closely for recurrence.

• Mohs micrographic surgery

  Mohs surgery is a tissue-preserving surgical technique for the removal of large skin cancers, aggressive cancers, or cancers involving critical structures, such as the eyelids, ears, nose, and lips. Mohs surgery involves removing cancers with a narrow margin of surrounding skin with near-immediate review of microscopic margins to ensure that the whole cancer has been removed. Although Dr. Saucier does not perform Mohs surgery in her office, she has relationships with excellent surgeons for whom she can refer her patients.

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What are the types of skin cancer?

Basal cell carcinoma

Basal cell carcinomas (BCCs) are the most common form of skin cancer. They are mostly caused by cumulative DNA damage from the sun. Because of their relation to sun, most BCCs occur on exposed skin, like the face, scalp, and ears (combined making up 70-80%), as well as the chest, upper back, hands and arms.

BCCs are usually pearly white to pink bumps with tiny blood vessels inside them. They tend to bleed and present as sores that do not heal. A skin biopsy is necessary to confirm the diagnosis of BCC and rule out less common and more dangerous forms of skin cancer, like melanoma.

Squamous cell carcinoma

Squamous cell carcinomas (SCCs) are the second most common form of skin cancer. Similar to BCCs, SCCs are mostly caused by sun driven DNA damage, and they are therefore more common on exposed skin, like face, scalp, ears, lips, hands and forearms. However, human papilloma viruses have been implicated in SCC formation as well, and these viruses increase the risk of SCC in the mouth and on genital skin. SCCs sometimes arise from a precursor lesion called actinic keratosis (pleural actinic keratoses, AKs). It is estimated that 1 in 1000 AKs become SCC each year. AKs are pink to red scaly bumps on sun exposed skin. The rationale for treating AKs is mostly to reduce the risk that they will subsequently become a SCC.

Similar to BCCs, SCCs should be confirmed with biopsy before they are treated. After confirmation they can be treated with various techniques including: ED&C, surgical excision, prescription creams, and Mohs micrographic surgery, and the details of each method are below.

Melanoma

Of the three most common forms of skin cancer, melanoma is thankfully the least common, because it is the most dangerous. Melanomas are collective cancers made from melanocytes, the cells that usually exist in the skin to create pigment to protect the skin from sun-generated DNA damage. Similar to BCCs and SCCs, sun driven DNA damage is the main contributor to melanoma formation, and so sun protection is always recommended to prevent melanomas. However, melanomas also have a strong genetic component to them, and they can accordingly occur anywhere on the skin, including sun-protected areas, like armpits, soles of the feet and between toes, genital skin and buttocks.

The prognosis of melanoma skin cancer is very much related to how early (or late) it is caught. If left untreated, melanoma is capable of spreading to local lymph nodes and then to internal organs. Caught early, melanoma is often cured by surgical excision alone. More advanced cases are often treated with additional radiation or chemotherapy.

Regular skin cancer screenings have been shown to decrease melanoma mortality on a population level. In order to assist dermatologists in finding melanomas as early as possible, it is recommended that all people regularly evaluate their own skin for concerning lesions.

• What are the signs of melanoma skin cancer?

  The ABCDE mnemonic can be used to identify melanomas (ideally look for moles that exhibit 2 of these features):

  • Asymmetry

    Half of a mole does not match the other half in size, shape or color.

  • Border

    The edges of a mole are irregular, scalloped, or poorly defined.

  • Color variability

    A mole has more than one color in it.

  • Diameter

    A mole that is greater than 6 millimeters, or the size of a pencil eraser.

  • Evolving

    Any rapid change in shape, size, texture, or color of a mole is concerning.

An additional useful sign for finding melanomas as soon as possible is the "ugly duckling" sign. Some melanomas can be detected early simply because they look different from surrounding moles, even when they otherwise would not be detected by using the ABCDE mnemonic.

Request an appointment right away if you have a mole or skin lesion that you are worried about. A biopsy may be performed to confirm the diagnosis.

What can help prevent skin cancer?

Most of the attributable risk for skin cancer is ultraviolet radiation from the sun. Skin cancer prevention is achieved with these tips:

• Cover all skin possible with clothing, hats, and sunglasses.
• Seek shade when possible.
• Avoid sun during hours of peak ultraviolet rays (10 AM - 4 PM).
• Use sunscreens on all exposed skin daily using SPF 30 sunscreen that is broad-spectrum. Of all active ingredients, zinc oxide is the most broad-spectrum and effective agent in sunscreens.
• Treat AKs. The main rationale for treating AKs is to reduce the risk that they will subsequently become a SCC.

For more information about skin cancer, visit the Skin Cancer Foundation website at: http://www.skincancer.org