SKIN CANCER SURGERY AND RECONSTRUCTION
Skin cancer is a disease in which malignant cancer cells are found in the layers of your skin. There are several types of cancer that originate in the skin. The most common types are basal cell carcinoma and squamous cell carcinoma. These account for nearly 90% of skin cancers. Melanoma is the third common type, but accounts for only 5% of all skin cancers. There are other very rare forms of skin cancer as well.
Most skin cancers occur on sun-exposed areas of skin, with the head and neck being the most common site for most skin cancers. Significant sun exposure is seen in most patients that develop a skin cancer, and there is a lot of scientific evidence to support UV radiation as the main cause of most types of skin cancer. A positive family history is also important, particularly in melanoma. The lighter your skin type, the more susceptible you are to UV damage and to developing a skin cancer. New studies indicate that multiple sunburns as a child increase the risk of developing skin cancer during adult years.
How to lower the risk of skin cancer development?
The most important thing is to avoid direct sun exposure, which contains the UV radiation known to cause skin cancer. The sun’s rays are most powerful during 10 AM to 2 PM. You should cover as much skin as possible, and apply sunscreen with a SPF (Sun Protection Factor) of 15. If you are swimming or sweating, then you should reapply every 1-2 hours.
Basal cell carcinoma is the most common type of skin cancer, accounting for nearly 70% of all skin cancers. It typically appears as a small raised bump that has a “pearly” appearance. It is most commonly seen on areas of the skin that have received excessive sun exposure. These cancers may spread to the skin surrounding them, but rarely spread to lymph nodes or other parts of the body.
Squamous cell carcinoma is also seen on the areas of the body that have been exposed to excessive sunlight. Common sites include the face, ears, and hands. Often this cancer appears as a firm red bump or ulceration of the skin that does not heal. Squamous cell carcinomas can spread to lymph nodes in the area, and rarely can spread to other sites in the body.
Melanoma is a skin cancer that arises from a specific cell type, melanocytes, in the skin. Melanocytes are the cells that give color to our skin; therefore, these cancers typically arise as pigmented (colored) lesions. The appearance of these lesions usually have an irregular shape, irregular border, and multiple colors. It is the most aggressive of all skin cancers because it can spread to lymph nodes and to other sites in the body.
The vast majority of skin cancers can be cured if diagnosed and treated early. The early signs of skin cancer include: skin sores that do not heal, bumps or nodules in the skin that are enlarging, and changes in existing moles (size, texture, or color). If this is noticed, then a biopsy will be needed to better evaluate the lesion. A biopsy can usually be done in the doctor’s office and usually involves numbing the skin with a local anesthetic. Once the diagnosis is made, then a treatment is planned.
There are multiple treatment options available to treat skin cancers. Treatment options include surgery, radiation therapy, and chemotherapy. The treatment for a skin cancer depends on the type of cancer, and the stage of disease (mainly the size of the lesion).
Surgery is the most common form of treatment of skin cancer. It generally consists of an office or outpatient procedure to remove the lesion and check edges (known as margins) to make sure all the cancer was removed. Mohs surgery is another technique that is performed by some dermatologists for specific skin cancers, such as basal cell carcinoma. Larger squamous cell carcinomas may also require removal of local and regional lymph nodes at the time of surgical excision. Patients that are diagnosed with melanoma may require biopsies of local-regional lymph nodes, known as sentinel lymph node biopsies, and possible removal of these lymph nodes.
Radiation and chemotherapy is not often required, only being used in patients with advanced squamous cell carcinoma and melanoma. There are other newer medical treatments, such as interferon therapy, that may be indicated for advanced melanoma.
Skin surveillance, checking the skin for abnormal lesions, is very important for a patient that has been diagnosed with a skin cancer. It is also important for patients who have risk factors for developing skin cancer to check themselves regularly for any new or changing skin lesions.
Skin cancer is very common, with non-melanoma cancer (basal cell and squamous cell carcinomas) being the most common type of cancer in both women and men. If you have an abnormal skin lesion, then please see your doctor for evaluation.
Robert Wilson, MD.