Skin Cancer

What is basal cell carcinoma?

Basal cell carcinoma (BCC) is the most common type of skin cancer and the most frequently occurring of all cancers. In the United States alone, approximately 4 million cases are diagnosed annually. BCCs arises from the epidermis and grow in an erratic and uncontrolled fashion. Because BCCs grows slowly, most are curable and cause minimal skin injury when diagnosed and treated early.

What is cutaneous squamous cell carcinoma?

Cutaneous squamous cell carcinoma (SCC) is the second most common type of skin cancer. Approximately one million cases are diagnosed annually. SCC arises from the top layer of the skin and exhibits rapid, uncontrolled growth of the epidermal cells. While most SCCs can be successfully treated, if treatment is delayed, these cancers can become disfiguring, dangerous, and even life-threatening.

What is melanoma?

Melanoma is the third most common type of skin cancer. Melanomas arise from melanocytes, the pigment-forming cells of the skin. Although melanoma accounts for only 1% of skin cancer diagnoses, it is responsible for the majority of skin cancer deaths. Early detection is of utmost importance. If caught early, the 5-year survival rate for melanoma is 99%. Thicker melanomas and melanomas that have metastasized have a worse prognosis. While most brown spots on the skin are harmless, some are more worrisome. The ABCDE’s and “ugly duckling” sign can help identify moles on your body that should be shown to a physician in our office.

What are the signs of cutaneous melanoma?

ABCDE is a mnemonic that is helpful to remember the 5 warning signs of melanoma.

A is for asymmetry. Most melanomas are asymmetric. If you divide a mole into two halves, and the sides look different from each other, it may warrant evaluation in our office. Benign moles, on the other hand, are usually symmetric.

B is for Border. While benign moles usually have a round, well-circumscribed border, melanomas often have irregular, ill-defined borders. Benign moles tend to be circular in shape, which is a reassuring feature.

C is for Color. Most benign moles are uniformly brown in color, while melanomas often have different shades of brown, black or tan. As melanomas progress, they can develop shades of white, red or blue. In some cases, melanomas may be “amelanotic,” meaning they have little or no pigment and appear pink, red, or skin-colored.

D is for Diameter. Benign moles are often a 1/4 inch in diameter, or smaller. It is a warning sign for melanoma when pigmented lesions are larger than the width of a pencil eraser (about 6 mm).

E is for Evolution. Benign moles generally remain stable in appearance. Any mole that is enlarging or changing should be evaluated by a physician, as this may be a warning sign for melanoma.

Is there any other sign that a mole can be melanoma?

Yes. Any mole that stands out, or is strikingly different from surrounding moles, should be evaluated by a board-certified dermatologist. This is often referred to as the "ugly duckling" sign.

What causes skin cancer?

The majority of skin cancers are caused by ultraviolet-induced photodamage from outdoor sun exposure or artificial tanning. Individuals with a weakened or suppressed immune system due to a bone marrow/stem cell transplant, organ transplant, HIV/AIDS, certain types of leukemia/lymphoma, or immunosuppressant medications are at an increased risk of developing skin cancer, particularly squamous cell carcinoma. Other contributing factors include advanced age, history of a prior skin cancer, fair complexion, male gender, and genetic predisposition.

How are basal cell carcinoma and squamous cell carcinoma treated?

There are a variety of treatment options for basal cell carcinoma and squamous cell carcinoma including surgery, radiation, topical medications, systemic therapies, and light-based treatments. While surgery generally offers the highest cure rate, other treatment options may be preferred in select situations.

How is melanoma treated?

Surgical excision (wide local excision) is the mainstay treatment for early melanoma. For advanced melanoma, systemic therapy (immunotherapy, targeted therapy, or chemotherapy) is usually used alone or in conjunction with surgery. Radiation therapy is generally not indicated for most people with melanoma, but may be used in select circumstances.

What is Mohs micrographic surgery?

Mohs micrographic surgery, named after Dr. Frederic Mohs, is a surgical technique used for the treatment of skin cancers, including basal cell carcinoma and squamous cell carcinoma. Mohs surgery is performed under local anesthesia with the patient fully awake. During the procedure, the previously biopsied skin cancer is surgically removed from the skin, processed, and evaluated under the microscope to ensure that the margins are clear. If skin cancer is noted at an edge, then additional tissue is removed from the area where residual cancer remains. This process is repeated until the entire cancer has been removed. The wound is then sutured or allowed to heal naturally.

The advantage of Mohs micrographic surgery is that it has a cure rate of 97-99% when used to treat squamous cell carcinoma or basal cell carcinoma. In addition, in Mohs surgery, the margins are confirmed to be clear on the day of surgery. Furthermore, Mohs surgery is tissue sparing, meaning that less healthy tissue is removed during the surgery. This often results in a smaller scar than would have otherwise been possible.

Can skin cancer be prevented?

While there is no 100% effective way of preventing skin cancer, certain steps can be taken to minimize one’s risk. Most important is practicing good sun protection behaviors. These include using a daily, broad spectrum sunscreen with SPF 30 or greater, wearing a wide-brimmed hat when outdoors, and minimizing prolonged sun exposure between the hours of 10 AM to 2 PM. When prolonged sun exposure is anticipated, a sunscreen with an SPF rating of 50 or greater should be used and re-applied every 2-3 hours, or whenever getting out of the water. When outdoors, long sleeved shirts and pants are preferred over shorts and t-shirts. In addition, UPF clothing provides an added layer of protection.

Are there medications that decrease one’s risk of developing pre-cancerous or cancerous skin lesions?

There are several topical therapies, systemic medications, light-based treatments, and oral supplements that have been shown to be effective at decreasing one’s risk of developing actinic keratoses, squamous cell carcinoma and/or basal cell carcinoma. An appointment should be scheduled in our office to see if you are a candidate for any of these therapies.