Skin Cancer
Some cancers are more common in
aging skin. The underlying cause of skin cancer in older people is often
the accumulated damage of many years of excessive exposure to the sun.
In some cases there may be a genetic predisposition to skin cancer—either
"cancer in the family" or the inheritance of a type of skin
that increases risk for skin cancer. All skin cancers can be
successfully treated if they are discovered and treated early. All are
potentially disfiguring, and potentially fatal if they metastasize
(spread) to other parts of the body.
The three most common forms of
skin cancer are:
—develops
in 300,000 to 400,000 persons every year in the United States
Squamous cell carcinoma —develops
in 80,000 to 100,000 persons per year in the United States
Melanoma —45,000
to 50,000 new cases are diagnosed every year in the United States.
Melanoma is the deadliest form of skin cancer—6 of every 7 deaths
from skin cancer in the United States are due to melanoma
Basal Cell Carcinoma
Basal cell carcinoma arises in a
layer of skin (basal layer) beneath the skin’s surface. It seldom
metastasizes, although it may do so if the cancer invades lymph or blood
vessels that can carry cancer cells to distant organs. The major
spreading mechanism of basal cell carcinoma is by local invasion of
surrounding skin tissue. If left untreated, it may become large and
disfiguring.
The major risk factors for
developing basal cell carcinoma are:
-
excessive and chronic sun
exposure over many years
-
a fair (white) skin complexion,
especially when hair is blond or red
While basal cell carcinoma has
traditionally been a cancer associated with older people, it is now seen
in more young adults than in the past.
Early detection of basal cell
carcinoma can lead to early treatment and prevention of disfigurement.
The most likely places for basal cell carcinoma to develop are areas
exposed to sun—face, scalp, ears, neck, shoulders and back. Criteria
to look for in self-examination:
-
a small, pearly nodule, which
may or may not have telangiectasia (small enlarged blood vessels) on
the surface; the nodule increases in size slowly and may form an
ulceration in its center; there may be some pigmentation
-
a solitary, flat or slightly
depressed lesion that is hard to the touch; it may be yellowish or
whitish and have indistinct borders
-
one or more reddish, scaling
plaques that slowly enlarge; these lesions may resemble dermatitis or
psoriasis
Any suspicious lesion should be
examined immediately by a dermatologist and biopsied if the
dermatologist deems it necessary to determine proper treatment.
To view photos of basal
cell carcinoma shown in various forms on various parts of the face, please
click here.
The next photo illustrates the
disfigurement that may follow late treatment of basal cell carcinoma:
(Photo used with permission of
Richard Bennett, MD)
Early, effective treatment of
basal cell carcinoma by a dermatologic surgeon has a cure rate of more
than 95%. However, new basal cell carcinomas can develop after
treatment, so continued self-examination and regular examination by a
dermatologist are important.
When basal cell carcinoma is
discovered early and the diagnosis confirmed by biopsy, treatment may be
carried out in the dermatologist’s office or an outpatient setting.
Treatment procedures include:
-
Curettage: A scalpel is used to
scrape away malignant tissue. Electrocautery may be used after
curettage to "mop up" any remaining cancer cells. Curettage
is used chiefly for superficial carcinoma not previously treated.
-
Cryosurgery: Liquid nitrogen is
applied to the lesion to destroy malignant tissue by ultra-cold
freezing.
-
Topical chemotherapy: Cancer
cells are destroyed by pharmacologic agents applied to the surface of
the skin.
-
Surgical excision: The cancer is
surgically removed and the skin closed with stitches. This technique
is used when the carcinoma is in deeper tissues.
-
MOHS microscopic surgery:
Surgical removal is performed under a microscope. In this technique,
the surgeon can perform surgery layer by layer into the skin, under
direct microscopic observation.
-
Laser surgery: Cancerous tissue
is destroyed by laser beam.
The dermatologist or dermatologic
surgeon will discuss with the patient the type of treatment that will be
most effective.
Squamous Cell Carcinoma
Squamous cell carcinoma develops
in the outer layers of the skin. It is capable of metastasizing to other
areas of the body if not treated early. It also spreads locally and may
cause significant disfigurement.
The major risk factors for
developing squamous cell carcinoma are:
-
excessive, chronic exposure to
sun, over many years
-
overexposure or chronic exposure
to x-rays
-
long-term treatment with
immunosuppressive drugs
-
white skin, especially with
blond or red hair
Criteria for self-examination:
-
commonly appears as an ulcerated
nodule or superficial erosion with poorly defined margins on the skin
or lower lip; the lesion persists and does not heal
-
a wart-like growth or plaque
-
premalignant forms of squamous
cell carcinoma include actinic keratosis, cutaneous horns
(hard, fibrous growths), and Bowen’s disease (scaling,
inflamed-looking plaques)
A suspicious lesion should be
examined immediately by a dermatologist, and biopsied if deemed
necessary by the dermatologist to determine proper treatment.
To view photos of several
forms of squamous cell carcinoma shown on various parts of the body, please
click here.
Squamous cell carcinoma can be
significantly disfiguring if not treated early, as shown in these two
photos:
(photos used with permission of
Richard Bennett, MD)
When a diagnosis of squamous cell
carcinoma is confirmed by biopsy, treatment options are similar to those
for basal cell carcinoma.
Melanoma
As with basal cell carcinoma and squamous cell carcinoma, excessive and chronic sun exposure is a
major risk factor for melanoma. There also is a tendency for
melanoma to "run in the family", and to be associated with a
familial trait of having many moles on the body. Melanoma often arises
in a pre-existing mole or pigmented lesion. Early diagnosis and
treatment of melanoma is essential. Any person with many moles or a
family history of melanoma should be examined regularly by a
dermatologist. Every adult should self-examine at regular intervals to
detect any early indications of melanoma. Self-examination is done using
the A-B-C-D criteria:
A=Asymmetry (the left side of
the lesion is unlike the right side)
B=Border Irregularity (the
lesion has a scalloped or poorly defined border)
C=Color Variation (not all parts
of the lesion are the same color;
within the lesion may be patches of
tan, brown, black, pink, white or blue)
D=Diameter (a melanoma is
usually larger than 6 millimeters in diameter,
about the size of a
pencil eraser)
It is worth noting that some melanomas do not conform to the A-B-C-D criteria, so any suspicious mole should be examined by a dermatologist.
For more and detailed information
on the causes, prevention and treatment of melanoma, please see the MelanomaNet Web site.
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