Skin Cancers
Skin cancer is the most common form of cancer. It is estimated that over 1 million new cases occur annually. The annual rates of all forms of skin cancer are increasing each year, representing a growing public concern. It also has been estimated that nearly half of all Americans who live to age 65 develop skin cancer at least once during their lifetimes.
A skin cancer can be often overlooked for some time. Any new lesion which increases in size or bleeds warrants evaluation by a physician. Some lesions may spontaneously appear to go away or heal, only to return. Only a biopsy to remove part of the lesion and examine it under a microscope can definitively tell what the lesion is.
The term “skin cancer” includes three general types of cutaneous malignancies: basal cell carcinomas, squamous cell carcinomas, and melanomas. The first two, namely basal and squamous cell carcinomas, are the most common and also are referred to as non-melanotic skin cancer.
Basal Cell Carcinomas
Basal cell carcinomas represent approximately seventy-five percent of all skin cancers. A basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by small, superficial blood vessels called telangiectases. The texture of such a spot is often shiny and translucent, sometimes referred to as “pearly.” It is often hard to tell a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Some basal cell carcinomas contain the pigment melanin, making them look dark rather than shiny.
Risk factors for the formation of a basal cell carcinoma include excess sun exposure. Ultraviolet (UV) radiation from the sun has been identified as the main cause of non-melanotic skin cancer development. People with a fair complexion and light colored hair are more prone to the development of these skin malignancies. Also, people who use tanning booths have been shown to develop these skin malignancies at a higher rate due to the exposure of UV light. Age also is a risk factor. Most basal cell carcinomas develop after the age of 50. Nevertheless, excess sun exposure earlier in life is the main contributing factor and preventative measures such as wearing sun screens with an SPF of 30 or greater, avoiding sun exposure during the peak times of day (the hours around noon), and wearing protective clothing such as broad-brimmed hats are encouraged.
Treatment of basal cell carcinomas vary depending on the patient’s age and health history, as well as size and location of the lesion. At Lincoln Aesthetic Surgical Institute, we specialize in treating skin malignancies throughout the body with special emphasis of facial lesions. For most basal cell carcinomas, wide local excision of the lesion results in an over 95 percent cure rate. Basal cell carcinomas have a low rate of spread from the primary site to other areas of the body such as lymph nodes. As such, removing the lesion along with a rim of normal skin is adequate treatment. This may be done in the office with local anesthetic or in the operating room. Depending on the location and size of the defect following excision, a local skin flap or skin graft may be needed to address the resulting wound. If there is uncertainty regarding the margins of the lesion, Dr. Mitchell sometimes employs the use of the pathologist who at the time of the resection, assesses the margins of the specimen to ensure that it is completely removed.
As with all skin cancers, long-term follow up is essential to ensure that the removed lesion does not recur. In addition, screening is needed to watch for the development of new skin malignancies. Any new suspicious lesion should be biopsied.
Squamous Cell Carcinomas
Squamous cell carcinomas comprise approximately 20 percent of all skin cancers. As with basal cell carcinomas, excess exposure to UV light from the sun is the main cause. These lesions also are more common in patients with fair complexions and lighter colored hair. Although most squamous cell carcinomas are localized to the site that they arise, unlike basal cell carcinomas, squamous cell carcinomas show an increased likelihood of spreading to regional lymph node basins.
Treatment for squamous cell carcinomas is similar to basal cell carcinomas. If the lesion appears localized and there is no evidence of spread to the lymph nodes, a wide local excision can be curative. For patients with evidence of lymph node involvement, removal of the draining lymph node basis to the area of skin involved with the tumor is warranted. Coverage of the resulting wound following excision of the primary tumor may require either a local flap or skin graft. Often times, Dr. Mitchell performs these resections in the operating room with the assistance of the pathologist to ensure that the surgical margins of the specimen are free of residual cancer cells.
Melanomas
Although comprising approximately 5 percent of all skin cancers, melanomas deserve special consideration. Melanomas, of all skin malignancies, possess the highest rate of spread to both lymph nodes and other parts of the body. Unfortunately, treatment options for those with more advanced disease are still lacking and survivability decreases sharply if the tumor has spread from the area it originated.
Melanomas can occur anywhere on the skin, including under the nailbeds within our fingers and toes as well as upon the palms of our hands and soles of our feet. Most appear as a dark, irregularly shaped mole or nevus that grows rapidly. Guidelines for identifying a suspicious melanoma include the ABCDs:
Asymmetrical and Irregular Borders
Color Variation within the lesion
Diameter of the lesion greater than six mm.
Any lesion that becomes darker or lighter, increases in size, becomes raised, itches, or bleeds should prompt immediate evaluation.
The diagnosis of a melanoma is only confirmed by performing a full thickness biopsy of the lesion. There are several criteria used to evaluate the melanoma, including the presence of ulceration within the lesion, however, the tumor depth is most important. In general, the thicker the melanoma, the higher the risk of metastasizing to other areas of the body.
Treatment of melanomas varies. In general, a wide local excision of the lesion is performed. The thicker the lesion, the wider the resection margins are made around the tumor. In addition, depending upon its initial depth, sampling of the regional lymph nodes may be needed. For more advanced tumors, additional diagnostic tests may be needed including PET/CT scans, MRIs, chest X-rays, and lab work. Evaluation by a medical oncologist may be necessary except in the earliest stages of the disease.