Skin Cancer

Melanoma

Melanoma is the most deadly of the skin cancers. About 50% develop from a preexisting mole and 50% develop on normal appearing skin. This tumor develops at the most productive time in a person’s life (20-50 years). If undetected or if there is a delay in seeking medical attention, the tumor can invade deeply and eventually metastasize to other organs, with death resulting. Melanoma can appear as multicolored or brown-black papules, patches, or nodules, with irregular borders. They can crust over and bleed. They occur commonly on sun exposed parts of the body, but may develop anywhere on the body. Warning signs to look for are ABCDE: Asymmetry, Border irregularity, Color variation, Diameter (bigger than a pencil eraser), and Evolving or changing.

Melanoma is usually seen in fair skin individuals, blond or red heads, freckled skin and people exposed to excessive ultraviolet radiation. Dark skinned individuals can also develop melanoma. When this happens, it is usually found on the palms and soles.

Ultraviolet radiation comes from the sun, tanning beds, sun lamps, and tanning booths. People with fair skin that freckles and burns easily, and light colored eyes are more at risk for sun burns. People who live in areas closer to the equator (Texas and Florida) are more exposed to ultraviolet light and are at increased risk for skin cancer, compared to the northern states like Minnesota. It is important to keep in mind higher altitudes and people who ski can burn at these altitudes and are also at increased risk for skin cancer.

Other risk factors include an increased number of common moles, the presence of large moles, a family history of melanoma, history of previous dysplastic moles removed, and the presence of a giant congenital melanocytic nevus at birth.

The diagnosis of melanoma is made after your dermatologist takes a sample of your skin and sends it for pathological examination.

The best protection against developing a melanoma is to photo protect. Avoid exposure between 10am and 4pm, when the sun’s cancer causing rays are the most intense. Apply a broad-spectrum sunscreen of at least SPF 15 to sun exposed parts of the body 30 minutes before going outdoors. UV radiation can be direct, or reflected from sand, snow, water, and ice. It can affect you on a rainy, windy, and cloudy day. It can go through clothing, windshields, and windows. Photo protective clothing can also offer benefit. Look for specific fabrics that have a UPF50 designation. Reapply sunscreens every 2 hours when outdoors, and if you are in and out of the water or are sweating excessively. Avoid tanning beds, booths, and using sun lamps. Tanning beds increase your chance for melanoma four times.

Melanoma can be cured if detected early. Survival rate is about 99% if detected early. Survival falls to 15% for those patients with advanced disease. Early surgical excision with an appropriate margin is the mainstay of treatment. Patients with advanced disease or deeper tumors may benefit from surgical excision, along with radiation, chemotherapy, and immunotherapy.

Basal Cell Carcinoma

Basal Cell Carcinoma is the most common skin cancer occurring in the USA, and other countries with a large population of white, fair skinned individuals. The tumor occurs on sun exposed parts of the body namely the face, ears, scalp, chest, and back. The tumor can have multiple forms appearing as a pink, translucent papule or nodule with a rolled border, central depression or ulceration. The surface is often associated with superficial telangiectasia and crust. They can also appear as open sores, sclerotic patches, and shiny patches. Though rare, the tumor can metastasize.

Risk factors for developing Basal cell carcinoma include prolonged exposure to ultraviolet radiation, fair skin, blond or red headed individuals, multiple blistering sun burns or intermittent sunburns in the past, family history of basal cell cancer, immunosuppression from disease or medication, radiation therapy, or tanning bed exposure.

Ultraviolet radiation comes from the sun, tanning beds, sun lamps and tanning booths. People with fair skin that freckles and burns easily, light colored eyes are more at risk for sun burns. Dark skinned individuals can also get skin cancer, but are much less likely. People who live in areas closer to the equator (Texas and Florida) are more exposed to ultraviolet light and are at increased risk for skin cancer, compared to the northern states like Minnesota. It is important to keep in mind higher altitudes and people who ski can burn at these altitudes and are also at increased risk for skin cancer. Ultraviolet radiation is present in cold climates, on rainy days, and snowy days. It is important to wear sun protection daily, to sun exposed skin, when going outdoors in daylight hours. Photo protection can also be obtained by wearing photo protective clothing such as hats, tops and pants. You can look for specific fabrics that have a UPF 50 designation on it which means there is an adequate amount of protection in the clothing.The diagnosis of Basal cell carcinoma is made after your dermatologist takes a sample of your skin and sends it for pathological examination.

Treatment of skin cancer can be done using many modalities. Factors that influence the method of removal include the location of the tumor, the size of the tumor, the depth of penetration of the tumor, and the general health of the patient. Surgery is the usual mode of removal. This can be done with a simple elliptical excision. Cure rates are generally above 95%. A repeat excision may be necessary if the tissue removed is returned with tumor present at the margin of resection. Mohs micrographic surgery offers the highest cure rate of 99%. This method is indicated if the tumor is located on the central face, have indistinct borders, is a recurrent tumor, is a large tumor in a cosmetically important area or are in critical areas around the eyes, ears, nose and lips. Curettage and electrodessication has the same cure rate as elliptical excisional surgery and is usually reserved for smaller lesions. Other treatment methods include oral or topical chemotherapy, or radiation therapy.

Squamous Cell Carcinoma

This is the second most common skin cancer. It is usually seen in fair skinned individuals, blond or red heads, freckled skin and people exposed to excessive ultraviolet radiation. The tumor occurs on sun exposed areas of the body such as the face, scalp, ears, dorsal hands and neck. Squamous cell carcinoma can occur in places of the body that have not been exposed to the sun. This tumor sometimes spread to lymph nodes and other organs. When this happens they can become deadly. Other risk factors include scarring processes such as lupus, lichen planus, chronic ulcerations, human papilloma viral infection, X-radiation exposure, systemic PUVA therapy, and immunosuppression from disease or medication. Squamous cell carcinoma is estimated to metastasize in 20-30% when it develops in areas of scarring.

Squamous cell carcinoma can appear as a wart like growth, an open sore that bleeds, a scaly patch that does not resolve or an elevated growth, which bleeds when there is an attempt to remove the crust. It is usually on sun damaged skin with evidence of hyperpigmentation, extreme wrinkling and loss of elasticity.

The diagnosis of Squamous cell carcinoma is made after your dermatologist takes a sample of your skin and sends it for pathological examination.

Treatment of skin cancer can be done using many modalities. Factors that influence the method of removal include the location of the tumor, the size of the tumor, the depth of penetration of the tumor, and the general health of the patient. Surgery is the usual mode of removal. This can be done with a simple elliptical excision. Cure rates are generally above 95%. A repeat excision may be necessary if the tissue removed is returned with tumor present at the margin of resection. Mohs micrographic surgery offers the highest cure rate of 99%. This method is indicated if the tumor is located on the central face, have indistinct borders, is a recurrent tumor, is a large tumor in a cosmetically important area or are in critical areas around the eyes, ears, nose and lips. Curettage and electrodessication has the same cure rate as elliptical excisional surgery and is usually reserved for smaller lesions. Other treatment methods include oral and topical chemotherapy, or radiation therapy.