May is skin cancer awareness month. It is important this month (and every month) to be aware of the different types of skin cancer that can form, treatment types and prevention methods.
WHAT ARE BASAL CELL SKIN CANCERS?
Basal cell carcinomas (BCC) are the most common form of skin cancer in the United States and four times more likely than squamous cell carcinomas in fair skinned individuals. It is the most slow growing skin cancer and rarely metastasizes (spreads to another part of the body). These skin cancers typically start as a pink, shiny bump that bleeds easily when rubbed or a flat pink scaly patch that doesn’t resolve. An excision or Mohs micrographic surgery is almost always sufficient to cure this type of skin cancer and for superficial forms, creams and light therapy can even be used.
WHAT ARE SQUAMOUS CELL SKIN CANCERS?
Squamous cell carcinomas (SCC) are the second most common form of skin cancer in the United States. These are still easily cured when found early but have the ability to grow more quickly and spread to other parts of the body, particularly if they are ulcerated, larger than 1 inch or 2 cm and are on the ears and lips. Around 2,500 people die a year from SCC. This form of skin cancer is more common than BCC in skin of color (African Americans and Asian Indians) but still less common than in light skinned individuals. Squamous cell carcinomas start as a flaky or crusted patch on the face and areas of chronic sun exposure. They can also be firm, tender nodules that develop on the legs of women. Excision or Mohs Micrographic surgeries are the preferred treatment methods.
WHAT IS MELANOMA?
Melanoma is the most aggressive form of skin cancer. It typically starts as a changing dark spot on the skin but can grow deep and spread or metastasize to other parts of the body. One in 55 Americans will be diagnosed with melanoma in their lifetime and one person dies every hour from melanoma. BUT, melanoma is highly curable when found before it has grown too deep. Despite the incidence of melanoma increasing, death from melanoma is decreasing in the US because people are doing a better job of getting their skin checked. When found early, meaning the melanoma is less than 1mm in depth, an excision is all that is needed to cure the melanoma. Once it becomes a deeper lesion, further testing is recommended to see if additional surgery to remove lymph nodes or chemotherapy is warranted.
TYPES OF TREATMENTS
For most skin cancers, we do a skin excision where the tumor with about .5cm margin of normal skin is removed, sent to pathology for further review but the patient is stitched up immediately. Mohs Micrographic Surgery is a very specialized method of surgery for basal cell and squamous cell carcinomas. Here the dermatologic surgeon removes the skin cancer and typically a smaller margin of normal skin. Then while the patient waits, this piece of tissue is frozen, cut and stained and made into microscope slides. The dermatologic surgeon reviews these slides to ensure complete clearance of the tumor before the reconstruction takes place. This method is used for high-risk tumor or tumors in cosmetically important areas like face and hands. Training to perform Mohs surgery, reading pathology and the reconstruction is a fellowship that can be done after completing your dermatology residency. I completed my dermatology residency and fellowship in Mohs surgery at Columbia University Medical Center in New York City.
While the stitches are in place, the wound should be covered with ointment and a bandage. After seeing so many allergic reactions to Neosporin, Bacitracin and Aquaphor, I decided to create RESTORE Healing Balm. It is now all we use after skin surgery because it works better than anything else, the skin heals faster and I have yet to see an allergic reaction.
HOW OFTEN SHOULD YOU GET A FULL BODY SKIN EXAM AT DIFFERENT AGES?
The American Academy of Dermatology recommends annual skin exams. If you are under 40 and have no family history of skin cancer or no additional risk factors the exams can happen less frequently. But if you are a sun worshipper, used tanning beds, have more than 100 moles or a family history of skin cancer, find a dermatologist you trust and get your skin examined. The number of women under 40 diagnosed with basal cell carcinomas has more than doubled in the past 30 years. Melanoma is the most common form of cancer for adults 25-29 years old. Once you have had a BCC or SCC, we recommended skin exams twice a year. If you have had melanoma, the recommendation is skin exams every four months. This is not because the treated lesion is going to return but because once you have made one skin cancer your risk of making another one is significantly higher and we want to catch that one early!
The American Academy of Dermatology states that UV exposure is the most preventable risk factor for skin cancer. When heading outside this month, always remember to practice safe sun. In addition, be sure to schedule your annual skin exam and regularly monitor your skin for the different signs and symptoms of skin cancer.
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Meet the author: Board-certified and practicing dermatologist, Dr. Heather D. Rogers, MD, is the founder of Doctor Rogers Skin Care and Modern Dermatology in Seattle, Washington. She studied at Stanford, University of Washington School of Medicine and Columbia University Medical Center. She lectures nationally, is well published, and an active member of the American Academy of Dermatology. Highly respected among the skin care community, Dr. Rogers has been annually named “Top 1% of Most Honored Doctors in the US” by Castle Connolly.