Skin Cancer Detection and Prevention

Skin cancer is the most common form of cancer in this country, affecting about one million Americans each year. The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal. It is important to come in to have one of our doctors check any unexplained changes in the appearance of your skin that don’t go away within two weeks.

According to the U.S. National Institutes of Health, ultraviolet (UV) radiation from the sun is the main cause of skin cancer. Artificial sources of UV radiation, such as sunlamps and tanning booths, can also cause skin cancer. The risk of developing skin cancer is also affected by where a person lives. People who live in areas that receive high levels of UV radiation from the sun are more likely to develop skin cancer. In addition, skin cancer is related to lifetime exposure to UV radiation. Most skin cancers appear after age 50, but the sun’s damaging effects begin at an early age. Therefore, sun protection should start in childhood in order to prevent skin cancer later in life.

Two of the most common skin cancers, basal cell carcinoma and squamous cell carcinoma, are both completely curable if they are brought to a doctor’s attention and treated before they have an opportunity to spread. Melanoma is generally the most serious form of skin cancer because it tends to spread (metastasize) quickly. Treatment for these kinds of skin cancer will depend on the type and location of the skin cancer and your age and health. Our goal is to choose the most effective form of treatment while also minimizing scars. Methods used include curettage and desiccation, surgical excision, cryosurgery, radiation, and Mohs micrographic surgery.

The best way to reduce your risk for all forms of skin cancer is to avoid sun exposure. Regular surveillance, both by self-examination and examination by a physician, are also advised, especially for people at higher risk. This includes people with fair skin, light eyes, people who sunburn easily and/or have a history of prior skin cancers.

Basal Cell Carcinoma

What is basal cell carcinoma?
Basal cell carcinoma, the most common form of skin cancer, accounts for more than 90 percent of all skin cancer in the U.S. Though it almost never spreads to other parts of the body, these cancerous lesions can cause damage by growing and invading surrounding tissue.

What are risk factors for developing basal cell carcinoma?
Light-colored skin and sun exposure are both important factors in the development of basal cell carcinomas. The most common location is the face, though an estimated 20 percent of these skin cancers are found in areas that are not sun-exposed, such as the chest, back, arms, legs and scalp. Individuals with a weakened immune system, from disease or regular use of medication, are at higher risk for developing basal cell carcinoma

What does basal cell carcinoma look like?
This form of skin cancer typically first appears as a small, dome-shaped bump, often covered by small, superficial blood vessels called telangiectases. This spot is often shiny and translucent, sometimes referred to as “pearly.” It can be difficult to distinguish a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Some basal cell carcinomas are dark, rather than shiny, because they contain melanin pigment.

Basal cell carcinomas grow very slowly. It is nonetheless important to treat them as soon as possible, since a basal cell carcinoma can damage and disfigure the eye, ear or nose if it grows nearby.

How is basal cell carcinoma diagnosed?
A proper diagnosis usually involves removing all or part of the growth. First the area where the procedure will be done is numbed with a local anesthetic, after which a small piece of skin is scraped away (called a “shave” biopsy). This is then sent to a pathology lab to be examined under a microscope to check for cancer cells.

How is basal cell carcinoma treated?
The main goal of treatment is to remove or destroy the cancer completely with minimal scarring. To plan the best treatment for each patient, the location and size of the cancer, risk of scarring and the person’s age, general health and medical history are taken into consideration.

Methods used to treat basal cell carcinomas include:

• Curettage and desiccation: The cancer is removed with a spoon-like instrument called a curette. Desiccation is the additional application of an energized current to control bleeding and eradicate any remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in areas such as the trunk and extremities.
• Surgical excision: The tumor is surgically removed and the area is then sutured close.
  Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions.
• Cryosurgery: This is a technique that involves freezing basal cell carcinomas, typically with liquid nitrogen applied to destroy the abnormal cells with only minimal discomfort.
• Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is also known as “microscopically controlled excision.” It involves removal of a small piece of the tumor and examining it immediately under the microscope during surgery, sequentially, so that the cancerous growth can be mapped and removed with great precision. This method removes as little of the healthy normal tissue as possible, delivering the highest cure rate — – exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. This includes the scalp, forehead, ears and the corners of the nose.

How is basal cell carcinoma prevented?
Avoiding sun exposure, especially if you are known to be susceptible because of your coloring or previous medical history, is the first and most important precaution.

Common sense preventive techniques include:

• Limiting recreational sun exposure
• Avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon)
• Wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun
• Regularly using a waterproof or water resistant sunscreen with UVA/UVB protection and SPF number of 30 or higher
• Undergoing regular total body skin exams and bringing any suspicious-looking or changing lesions to the attention of the doctor

Squamous Cell Carcinoma

What is squamous cell carcinoma?
Squamous cell carcinoma is cancer that begins in the squamous cells, which are thin, flat cells that, under a microscope, resemble fish scales. (The word “squamous” comes from the Latin squama, meaning “the scale of a fish or serpent.”) Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body and the passages of the respiratory and digestive tracts. Squamous cell carcinomas can therefore arise in any of these tissues.

Squamous cell carcinoma of the skin is far less common than basal cell carcinoma, occurring about one-quarter as often. Individuals with light-colored skin and a history of sun exposure are especially vulnerable to this kind of cancer and men are affected more often than women.

What are risk factors for developing squamous cell carcinoma?
The single most important factor in producing squamous cell carcinomas is sun exposure. Many such growths can develop from precancerous spots, called actinic or solar keratoses. These lesions appear after years of sun damage on parts of the body like the forehead and cheeks, as well as the backs of the hands. Since sun damage becomes skin cancer only after many years, it is not uncommon for people to develop the disease long after they’ve stopped sunbathing.

Also, there are other less widely known factors that may predispose people to squamous cell carcinoma. These include exposure to arsenic, hydrocarbons, heat or x-rays. Some squamous cell carcinomas arise in scar tissue. Suppression of the immune system by infection or drugs may also promote such growths.

Can squamous cell carcinoma of the skin spread (metastasize)?
Unlike basal cell carcinomas, squamous cell carcinomas can metastasize, or spread to other parts of the body. These tumors usually first appear in the form of firm, skin-colored or red nodules. Those that begin within solar keratoses or on sun damaged skin are easier to cure and metastasize less often than those that develop in traumatic or radiation scars. The lower lip can be particularly vulnerable.

How is squamous cell carcinoma diagnosed?
Usually diagnosis is made by performing a biopsy. This involves taking a sample by injecting local anesthesia and using a circular punch blade to remove a small piece of skin (a “punch” biopsy). The cells are then examined under a microscope usually by a pathologist to check for the presence of cancer.

How is squamous cell and cancer treated?
Techniques for treating squamous cell carcinoma are similar to those for basal cell carcinoma:

• Curettage and desiccation: The cancer is removed with a spoon-like instrument called a curette. Desiccation is the additional application of an energized current to control bleeding and eradicate any remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in areas such as the trunk and extremities.
• Surgical excision: The tumor is surgically removed and the area is then sutured closed.
  Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions.
• Cryosurgery: This is a technique that involves freezing basal cell carcinomas, typically with liquid nitrogen applied to destroy the abnormal cells with only minimal discomfort.
• Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is also known as “microscopically controlled excision.” It involves removal of a small piece of the tumor and examining it immediately under the microscope during surgery, sequentially, so that the cancerous growth can be mapped and removed with great precision. This method removes as little of the healthy normal tissue as possible, delivering the highest cure rate — – exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. This includes the scalp, forehead, ears and the corners of the nose.

The possibility of metastasis makes it especially important to diagnose squamous cell carcinomas early.

How is squamous cell carcinoma prevented?
Due to its increased severity as a cancer, following the key principles of prevention are even more important – minimizing sun exposure and getting total body skin examinations by your dermatologist.

Common sense preventive techniques are the same as for basal cell carcinoma and include:

• Limiting recreational sun exposure
• Avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon)
  Wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun
• Regularly using a waterproof or water resistant sunscreen with UVA/UVB protection and SPF number of 30 or higher
• Undergoing regular total body skin exams and bringing any suspicious-looking or changing lesions to the attention of a doctor