Skin cancer can have many appearances, which is why it can often be overlooked by patients. One of the most dangerous skin cancers, malignant melanoma, classically appears as a new or changing mole in adults, often demonstrating the “ABCDEs”: Asymmetry, irregular Borders, multiple Colors, Diameter larger than 5 mm, and Evolving or Enlarging. The other two most common skin cancers – Basal cell carcinoma and Squamous cell carcinoma – can present commonly as a pink bump or patch that may or may not be scaly, tender, or bleed easily.
Skin cancer can occur anywhere on the body, including on covered and sun-protected areas, and can affect all skin types, including skin of color. A regular self-skin exam at home may identify new growths that would otherwise remain undetected by the patient. Ideally, an office visit with one of our Dermatologists or Dermatology extenders would allow a skilled assessment of possible cancerous growths.
Many common and less common skin cancers have the potential to be deadly. Traditionally among the common cancers, melanoma is viewed as the worst of the bunch because it is has the highest associated risk of metastasis and death. About fifteen percent of melanomas are fast-growing nodular melanomas that are particularly dangerous if left untreated, even if only for a short time.
Fortunately, skin cancer is highly curable when detected early. A dermatologist is trained to detect cancers and their precursors and remove them to ensure that the tumors don’t spread or recur.
Once a biopsy of a lesion confirms skin cancer, it can be treated by many different methods. The most common way is by excision. When a cancer is excised, the patient undergoes the procedure in our office with the use of local anesthesia. The skin surrounding the tumor is anesthetized, followed by removal of the tumor and a margin of uninvolved skin. The excised skin is then sent to an outside laboratory where it is examined under a microscope by a skilled pathologist. In certain instances where the tumor may be large, poorly defined to the naked eye, have aggressive features under the microscope, or located in areas that are cosmetically sensitive (e.g. face) or difficult to repair (e.g. hands/feet), your provider may recommend MOHS Micrographic Surgery as the more appropriate treatment option. MOHS surgery allows the dermatologic surgeon performing the procedure to rapidly assess the tumor margins within 30 minutes of the tumor removal and prior to repair of the defect. In the setting of either a standard excision or MOHS surgery, the defect created by the removal of the tumor is then sutured together or, in some instances, allowed to heal without repair. The resulting scar is permanent, though the goal of every surgeon is to make the scar as faint as possible.
In some situations, tumors may be treated by other methods. Radiation therapy is often used in these settings with high success rates. One type of radiation therapy, called superficial radiation therapy, has been utilized safely by dermatologists in their offices for decades and offers a painless alternative to excision in the treatment of skin cancer. Other tumors may be treated rapidly with curettage or topical treatments.
Once a wound is sutured together, it may take several months for the scar to mature and blend into the surrounding skin. Wounds that heal without sutures form a scab that can take weeks to months to fully heal, depending on the specifics of the wound. Even if sutured, the scar may not approach the strength of normal skin for many months, and therefore physical activity may be limited during the healing process.
Skin cancer may develop for several reasons. Repeated exposure of the skin to sunlight and its harmful ultraviolet rays is the main cause of skin cancer, by inducing mutations in our cells that lead to the growth of tumors. Our individual genetics also play a very important role, as do certain medications that suppress the immune system.
Sadly, some types of skin cancer can be deadly and the vast majority of skin cancer deaths come from melanoma. Melanoma, squamous cell carcinoma, and some other rare types of skin cancers have the ability to spread, or metastasize, from the initial site of the lesion to the lymph nodes and other organs in the body. Because treatment of these cancers is more difficult once metastasis has occurred, early detection of skin cancer is critical and can be life-saving.