Types of skin cancer
By far the most common type of skin cancer is basal cell carcinoma.
Fortunately, it's also the least dangerous kind--it tends to grow slowly, and
rarely spreads beyond its original site. Though basal cell carcinoma is seldom
life-threatening, if left untreated it can grow deep beneath the skin and into
the underlying tissue and bone, causing serious damage (particularly if it's
located near the eye).
Squamous cell carcinoma is the next most common kind of skin cancer, frequently
appearing on the lips, face, or ears. It sometimes spreads to distant sites,
including lymph nodes and internal organs. Squamous cell carcinoma can become
life threatening if it's not treated.
A third form of skin cancer, malignant melanoma, is the least common, but its
incidence is increasing rapidly, especially in the
Sunbelt
states. Malignant melanoma is also the most dangerous
type of skin cancer. If discovered early enough, it can be completely cured. If
it's not treated quickly, however, malignant melanoma may spread throughout the
body and is often deadly.
Other skin growths you should know about
Two other common types of skin growths are moles and keratoses.
Moles are clusters of heavily pigmented skin cells, either flat or raised above
the skin surface. While most pose no danger, some-particularly large moles
present at birth, or those with mottled colors and poorly defined borders-may
develop into malignant melanoma. Moles are frequently removed for cosmetic
reasons, or because they're constantly irritated by clothing or jewelry (which
can sometimes cause pre-cancerous changes).
Solar or actinic keratoses are rough, red or brown, scaly patches on the skin.
They are usually found on areas exposed to the sun, and sometimes develop into
squamous cell cancer.
Recognizing skin cancer
Basal and squamous cell carcinomas can vary widely in appearance. The cancer
may begin as small, white or pink nodule or bumps; it can be smooth and shiny,
waxy, or pitted on the surface. Or it might appear as a red spot that's rough,
dry, or scaly...a firm, red lump that may form a crust...a crusted group of
nodules...a sore that bleeds or doesn't heal after two to four weeks...or a
white patch that looks like scar tissue.
Malignant melanoma is usually signaled by a change in the size, shape, or color
of an existing mole, or as a new growth on normal skin. Watch for the "ABCD"
warning signs of melanoma: Asymmetry-a growth with unmatched halves; Border
irregularity-ragged or blurred edges; Color-a mottled appearance, with shades of
tan, brown, and black, sometimes mixed with red, white, or blue; and Diameter- a
growth more than 6 millimeters across (about the size of a pencil eraser), or
any unusual increase in size.
If all these variables sound confusing, the most important thing to remember is
this: Get to know your skin and examine it regularly, from the top of your head
to the soles of your feet. (Don't forget your back.) If you notice any unusual
changes on any part of your body, have a doctor check it out.
Basal cell
carcinoma
Squamous cell
carcinoma
Malignant melanoma
Choosing a doctor
If you're concerned about skin cancer, your family physician is a good place
to start. He or she should examine your skin at your annual physical, and can
refer you to a specialist if necessary.
If you notice an unusual growth yourself, consult a plastic surgeon or a
dermatologist. Both are skilled at diagnosing and treating skin cancer and other
skin growths. A plastic surgeon can surgically remove the growth in a manner
that maintains function and offers the most pleasing final appearance- a
consideration that may be especially important if the cancer is in a highly
visible area. If a treatment other than surgical excision is called for, the
plastic surgeon can refer you to the appropriate specialist.
Diagnosis and treatment
Skin cancer is diagnosed by removing all or part of the growth and examining
its cells under a microscope. It can be treated by a number of methods,
depending on the type of cancer, its stage of growth, and its location on your
body.
Small skin
cancers can often be excised
quickly and easily in the physician's office.
Most skin cancers are removed surgically, by a plastic surgeon or a
dermatologist. If the cancer is small, the procedure can be done quickly and
easily, in an outpatient facility or the physician's office, using local
anesthesia. The procedure may be a simple excision, which usually leaves a thin,
barely visible scar. Or curettage and desiccation may be performed. In this
procedure the cancer is scraped out with an electric current to control bleeding
and kill any remaining cancer cells. This leaves a slightly larger, white scar.
In either case, the risks of the surgery are low.
Simple
excision usually leaves a thin
barely visible scar.
If the cancer is large, however, or if it has spread to the lymph glands or
elsewhere in the body, major surgery may be required. Other possible treat-
ments for skin cancer include cryosurgery (freezing the cancer cells), radiation
therapy (using x-rays), topical chemotherapy (anti-cancer drugs applied to the
skin), and Mohs surgery, a special procedure in which the cancer is shaved off
one layer at a time. (Mohs surgery is performed only by specially trained
physicians and often requires a reconstructive procedure as follow-up.)
Discussing your options and concerns
All of the treatments mentioned above, when chosen carefully and
appropriately, have good cure rates for most basal cell and squamous cell
cancers -and even for malignant melanoma, if it's caught very early, before it's
had a chance to spread.
You òld discuss these choices thoroughly with your doctor before beginning
treatment. Find out which options are available to you...how effective they're
likely to be for your particular cancer...the possible risks and side
effects...who can best perform them...and the cosmetic and functional results
you can expect. If you have any doubts about the outcome, get a second opinion
from a plastic surgeon before you begin treatment.
A word about reconstruction
The different techniques used in treating skin cancers can be life saving,
but they may leave a patient with less than pleasing cosmetic or functional
results. Depending on the location and severity of the cancer, the consequences
may range from a small but unsightly scar to permanent changes in facial
structures such as your nose, ear, or lip.
In such cases, no matter who performs the initial treatment, the plastic surgeon
can be an important part of the treatment team. Reconstructive techniques-
ranging from a simple scar revision to a complex transfer of tissue flaps from
elsewhere on the body-can often repair damaged tissue, rebuild body parts, and
restore most patients to acceptable appearance and function.
A bone/soft tissue flap is used to
reconstruct the nose following skin
cancer excision.
The incision lines of the flap are
hidden within the natural creases of
the nose and face.
Preventing a recurrence
After you've been treated for skin cancer, your doctor should schedule
regular follow-up visits to make sure the cancer hasn't recurred.
Your physician, however, can't prevent a recurrence. It's up to you to reduce
your risks by changing old habits and developing new ones. (These preventive
measures apply to people who have not had skin cancer as well.)
