Skin Cancer

Skin cancer risk increases with age, sun exposure, and exposure to radiation or certain chemicals like arsenic. Patients with lighter skin, a sunburn history, or those with a compromised immune system either from disease or medication have a higher incidence of skin cancers as well. These cancers can occur anywhere on the skin but are more common on sun-exposed areas like the face, ears, scalp, and neck. They can present as changes in moles or other pre-existing skin lesions or as new skin lesions that may bleed or itch. Skin cancers are often mistaken for wounds that “just won’t heal.” Skin cancers can look like ulcers or wounds, flat pigmented lesions, or raised masses. There is no one thing to look for, and even experienced physicians can have difficulty telling a cancer from a non-cancer just by looking at it. New skin lesions larger than a pencil eraser, those that are increasing in size (especially if it has a tendency to bleed), or a wound that does not seem to heel for a prolonged time despite appropriate care should raise suspicion. There are many types of skin cancer, but the three most common are Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma.

Basal Cell Carcinoma (BCC) arises from the basal cells in the deepest layer of the skin’s epidermis. BCC is the most common form of skin cancer, and more than 90% of these occur on the head and neck. BCC rarely (if ever) metastasizes (moves to other organs or lymph nodes), but if left untreated it can cause tissue destruction by growing into surrounding structures. It is rare for patients with BCC to die from this disease and these patients tend to do very well overall.

Squamous Cell Carcinoma (SCC) arises from squamous cells in the epidermis. SCC is the second most common form of skin cancer, and a significantly higher rate of occurrence in immunosuppressed patients, especially kidney transplant patients. SCC is capable of moving to nearby lymph nodes or even distant organs, especially SCC of the ear. Your examining physician will evaluate the patient’s regional lymph nodes at least with physical exam, and depending on the stage of the disease may also employ other methods to examine the lymph nodes with procedures such as fine needle aspiration or sentinel lymph node biopsy. Imaging such as CT scans or MRI may be used to obtain additional information about possible lymph node or distant organ spread.

Melanoma arises from melanocytes which produce the pigment that darkens or tans our skin. These cancers are very dangerous and must be treated aggressively, especially at moderate or advanced stages. Melanoma moves to lymph nodes and other organs at a higher rate than SCC, and evidence of this will be looked for your treating physician utilizing (depending on stage) physical exam, imaging, and in some cases fine needle aspiration or sentinel lymph node biopsy.

Treatment may include destruction with Electrodesiccation and Curettage (scraping the visible tumor away and burning the cells left behind or Cryosurgery (freezing), both are very effective for small lesions and are typically performed in a Dermatologist’s office. Occasionally medical treatment such as topical chemotherapy drugs or radiation may be appropriate for some cancers, but these options are not typically first-line choices. For most BCC’s, SCC's and melanomas surgical excision is typically standard treatment. Typically the lesion is cut out with full thickness skin and 0.5 to 3cm margins of normal tissue around the cancer, depending on the type and stage of disease. This may be accomplished with local anesthetic in the office or in the operating room with anesthesia. In select cases where a cancer is difficult to excise with adequate margins, a patient may be referred to a Mohs surgeon.