Skin Cancer

Greater than one half of all new cancers occur in your largest organ, your skin. The vast majority are non-melanoma skin cancers, basal cell carcinoma and squamous cell carcinoma. Although locally destructive and able to penetrate through deeper layers of skin they usually don’t spread to other parts of the body. They also have a high cure rate when detected and treated early. Less than 5% of skin cancers are malignant melanoma. Unlike basal and squamous cell carcinoma, malignant melanoma has a high likelihood of spreading to other organs and tissue if not detected early. Nearly 10,000 people will die of skin cancer this year, 80% of those from melanoma.

BASAL CELL CARCINOMA (BCC) is the most common form of all cancers. Approximately 800,000 new cases are diagnosed each year. Especially alarming is the fact that the number of new cases is increasing steadily each year while the average age of onset is decreasing. Younger people are getting more BCC’s!

 

BCC originates in the cells that line the base of the outer layer of your skin, the epidermis. When these cells become malignant they multiply and can make their way to deeper layers of tissue such as cartilage or bone. Fortunately they generally do not enter the blood stream and only in very rare cases do they spread throughout the body. BCC can however cause considerable damage to surrounding tissue, even the loss of an eye, ear, or nose.

BCC is usually found on sun-exposed parts of your body such as the head, neck, and upper trunk.

Predominant risk factors for BCC are a history of frequent sun exposure and skin types 1 and 2. These are people with fair skin, light hair, and blue, green, or gray eyes.

  

SQUAMOUS CELL CARCINOMA (SCCA) is the second most common type of skin cancer afflicting more than 200,000 Americans each year. It is also found predominantly on sun exposed areas such as the head and neck especially bald scalps, rims of the ear, and lower lip. Hands are also commonly affected.

SCCA usually causes local tissue destruction but a small percentage may also spread to distant tissues and organs where it may be fatal. This is more likely when the lesion originates in chronically inflamed or injured skin. (e.g. burns, scars) and on mucous membranes such as the lips.

A common precursor of SCCA is ACTINIC or SOLAR KERATOSIS, a lesion that results from chronic sun damage. These lesions usually arise in the same areas as SCCA and often appear as rough, scaly, slightly raised growths that are red to brown in color.

Risk factors for SCCA include a history of chronic sun exposure and fair skin types 1 and 2. Darker skinned individuals of African descent are far less likely to develop skin cancer, however when they do, two thirds are SCCA, usually in areas of preexisting inflammatory skin conditions or burn injuries.

MALIGNANT MELANOMA (MM) is the most serious form of skin cancer because it has a high rate of metastasis.

Although less common than BCC and SCCA, over 85,000 new cases of melanoma are expected to be reported this year. At current rates 1 in 68 Americans have a lifetime risk of developing invasive MM. In fact MM is the most common cancer among females age 25 to 29 years old if you exclude other forms of skin cancer.

Malignant Melanoma originates from melanocytes, the pigment producing cells that color skin, hair, and eyes. MM most commonly develops in moles because they have high concentration of melanocytes.

MM is found most commonly on the upper backs of males or females or on the legs of females, but can appear anywhere on the body.

If caught early 95% of melanomas are curable, but early detection is essential. There is a direct correlation between thickness of MM and survival rate. The difference between 1 millimeter and 4 millimeters can mean the difference between life and death. Fortunately, more than 80% of MM’s are diagnosed at an early localized stage before they have spread.

DIAGNOSIS of skin cancer requires careful examination of suspicious lesions, usually with magnifiers under bright light. Suspicious lesions are then biopsied, removed in part or whole by a scalpel or similar instrument. The specimen is then submitted to a laboratory where a dermatopathologist will evaluate the lesion using special stains and a microscope.

  

TREATMENT of skin cancer and their precursors may be achieved by a number of modalities utilized by dermatologists.

Cryosurgery or treatment with liquid nitrogen is very effective for the treatment of precancerous actinic keratoses. In some cases, actinic keratosis can even be treated with drugs applied to the skin such as 5-fluorouracil, diclofenac, and imiquimod. Newer agents are being developed and tested which may be effective in the treatment of very superficial skin cancers.

The mainstay of treatment for most skin cancers is excisional surgery. This procedure is performed safely and expertly in the dermatologist’s office requiring only local anesthesia at the site of the skin cancer. The procedure involves removing entire cancer along with an additional border of normal skin using a scalpel. The area is then closed with sutures utilizing surgical techniques that ensure proper healing and minimal scar formation. The specimen is then sent to the dermatopathologist who will check the margins to make sure cancer has been completely removed. Dr. Van Gurp has successfully removed thousands of skin cancers by excisional surgery.

Electrosurgery may be used in selective cases of superficial skin cancer. In this procedure, cancerous tissue is scraped from the skin using a curette and the remaining tumor is then removed with a device that delivers an electric spark to the affected area.

Mohs micrographic surgery or microscopically controlled surgery is particularly effective for tumors that recur or those that involve large areas in difficult locations such as the nose, ears, lips, and around the eyes. X-ray therapy may also be used in special cases as well.

In the case of deeper malignant melanoma, sentinel lymph node biopsy and/or removal of the affected lymph nodes may be required. Treatments involving vaccines and immunotherapy are under investigation for later stage melanoma as well.

TANNING: There is no such thing as a healthy tan. In fact, a tan is the skin’s response to injury by ultra-violet light (UVL). UVL can cause mutations in cellular DNA that can lead to skin cancer. It also decreases the effectiveness of the immune system in the skin which may also promote skin cancer. UVL also damages proteins in the skin causing an acceleration of the aging process.

You are really fooling yourself if you think a tanning bed is a safe way to tan - recent studies show the contrary.

The best way to prevent skin cancer is to minimize your exposure to UVL. This is true whether it comes from the sun or an artificial source like a tanning bed.