Skin Cancer
Diagnosis, Treatment and Reconstruction
The facts are staggering. One in five people will develop some form of skin cancer in their lifetime, and one-half of all new cancers are skin cancers. Overexposure to sunlight, especially when it causes burning and blistering, is universally accepted by medical experts to be the leading cause of this often-deadly disease. Other contributing factors include repeated medical and industrial exposure to x-rays; scarring from diseases or burns; occupational exposure to compounds such as coal and arsenic, and family history.
Basal cell carcinoma usually appears as a small, fleshy bump or nodule on the head, neck or hands. Although this type of cancer rarely spreads to other parts of the body, it can extend below the skin and cause considerable damage. Squamous cell carcinoma appears as nodules or as red, scaly patches, usually located on the rim of the ear, the face, the lips and the mouth. Although this form of cancer can metastasize and result in death, early detection and treatment has kept the cure rate at 95 percent.
The most virulent and deadly of skin cancers is malignant melanoma. This form of cancer is more aggressive and may suddenly appear without warning. Since it often appears near a mole or other dark spot on the skin, periodic self-examination should be conducted of all moles, with special attention being paid to asymmetry, irregular borders, color variations and change in diameter.
People with the following characteristics have the highest risk for melanoma: fair complexions that burn or blister easily; blond or red hair; blue, green, or gray eyes; excessive sun exposure during childhood and teen years, as well as sunburns and blistering before age 20; a family history of melanoma; and more than 50 – 100 moles, depending on moles.
Dermatologists have a wide variety of skills and treatment options available for the management of skin cancer. The type of treatment offered depends upon the type of cancer, its location, the age of the patient, and the desired cosmetic effect. Low-grade skin cancers, such as basal cell carcinoma or squamous cell carcinoma, are often removed by simple excisional surgery performed under local anesthesia with suture closure. This kind of procedure can often be conducted in the doctor’s office, yielding complete removal of the lesion and excellent cosmetic results. MOHS surgery is a highly specialized type of surgery that allows for the removal of the skin cancer, and histologic diagnosis while the patient waits in the office. More complicated surgery might include procedures where skin flaps or grafts are used to cover a surgical area, particularly when the skin cancer is large or in an area difficult for tissue removal.
Some skin cancers are treated with laser destruction or intralesional injection of chemotherapy agents. In addition, cryosurgery – or freezing – of certain tumors is often acceptable, particularly for lesions on the nose or ears where surgical removal may be difficult to achieve without some sort of deformity. Finally, radiation therapy is sometimes necessary for management of particularly large or invasive tumors on the face and neck. As for malignant melanoma – the most serious form of skin cancer – early detection of the disease and proper surgical intervention can often cure the condition. Most early melanomas can be completely cured by simple excision of the lesion within the doctor’s office. However, the longer a melanoma goes unrecognized and the deeper the lesion grows, there is a greater risk that the disease will spread to regional lymph nodes and organs. Unfortunately, despite the availability of vaccines and new chemotherapy regimes, disseminated malignant melanoma is a life-threatening disease that has no known cure.
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