Skin Cancer - An Undeclared Epidemic


Skin cancer is the most prevalent of all cancers. Estimates vary on its occurrence but it is estimated that approximately 700,000 Americans develop skin cancer every year.

Sun avoidance is the best defense against skin cancer.

The principal cause of skin cancer is almost universally accepted by medical experts to be overexposure to sunlight, especially when it results in sunburn and blistering. Other less important factors would include: repeated medical and industrial x-ray exposure; scarring from diseases or burns; occupational exposure to such compounds as coal and arsenic, and family history.

Prevention is a matter of guarding the skin against the known causes. Since the sun and its ultraviolet rays would seem to be the main culprit, the most effective preventive method is sun avoidance. Limit the exposure of the skin to harmful rays by covering up and using sunscreens with at least a 15 SPF rating.

Early detection is the surest way to a cure.

It is a simple routine to inspect your body for any skin changes. Actinic keratosis and each of the skin cancers depicted in the following pages can be readily detected. If any growth, moles, sore or discoloration appears suddenly or begins to change, see your dermatologist.

Precancerous skin conditions

Be alert for a precancerous lesion called actinic keratosis. These small scaly spots are most commonly found on the face and back of the hands in fair-skinned individuals who have had significant sun exposure. If they are not treated, some of them may become skin cancer, requiring more extensive treatment. If they are diagnosed in the early stages, actinic keratosis can be removed By applying a topical form of chemotherapy or by other outpatient procedures.

There are three forms of skin cancer:

Basal cell carcinoma

This tumor of the skin usually appears as a small, fleshy bump or nodule on the head, neck and hands. Occasionally these nodules may appear on the trunk of the body, usually as flat growths. Basal cell carcinomas seldom occur in dark-skinned persons; they are the most common skin cancers found in Caucasians. It has been found that people who have this cancer frequently have light hair, eyes and complexions, and they don't tan easily. These tumors don't spread quickly. It may take many months or years for one to reach a diameter of one half inch. Untreated, the cancer will begin to bleed, crust over, then repeat the cycle.

Although this type of cancer rarely metastasizes (spread to other parts of the body), it can extend below the skin to the bone and cause considerable local damage.

Squamous cell carcinoma

These tumors may appear as nodules or as red, scaly patches. Squamous cell carcinoma is the second most common skin cancer found in Caucasians. It typically is found on the rim of the ear, the face, the lips and mouth. It is rarely found on dark-skinned persons. This cancer will develop into large masses. Unlike basal cell carcinoma, it can metastasize. It is estimated that there are 2,300 deaths from non-melanoma skin cancers every year.

Malignant melanoma

It is projected that this most virulent of all skin cancers develops on the skin of 32,000 Americans annually. And every year an estimated 6,800 Americans will die from melanoma. It is important to note that the death rate is at last declining, because patients are seeking help earlier. Melanoma, like its less aggressive cousins, basal cell and squamous cell carcinomas, is almost always curable in its early stages.

Melanoma has its beginnings in melanocytes, the skin cells that produce the dark protective pigment called melanin. It is melanin that is responsible for suntanned skin, acting as partial protection against sun. Melanoma cells usually continue to produce melanin, which accounts for the cancers appearing in mixed shades of tan, brown and black. Melanoma has a tendency to spread, making it essential to treat.

Melanoma may suddenly appear without warning but it may also begin in or near a mole or other dark spot in the skin. For that reason it is important that we know the location and appearance of the moles on our bodies so any change will be noticed.

Excessive exposure to the sun, as with the other skin cancers, is accepted as a cause of melanoma, especially among light-skinned people. Heredity may play a part, and also atypical moles, which may run in families, can serve as markers, identifying the person as being at higher risk for developing melanoma there or elsewhere in the skin.

Dark brown or black skin is not a Guarantee against melanoma. Black people can develop this cancer, especially on the palms of the hands, soles of the feet, under nails, or in the mouth.

Other warning signs include: changes in the surface of a mole; scaliness, oozing, bleeding or the appearance of a bump or nodule; spread of pigment from the border into surrounding skin; and change in sensation including itchiness, tenderness, or pain.

How skin cancer is treated

If a laboratory test reveals that an area of the skin is cancerous, the dermatologist has an array of procedures to choose from, dependent on the needs of the individual patient. In the treatment of any of the skin cancers, early detection and removal is the best defense.

Fortunately, skin cancers are relatively easy to detect and most can be cured. Even malignant melanoma, if caught in its early stages, can be treated successfully.

Dermatologists recommend that one helpful way to guard against melanoma/skin cancer is to do periodic self-examinations. Get familiar with your skin and your own pattern of moles, freckles and "beauty marks." Be alert to changes in the number, size, and shape and color of pigmented areas.

© 1994 American Academy of Dermatology
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Skin Cancer and Mohs Chemosurgery
Micrographic Surgery and Cutaneous Oncology


Skin Cancer and Mohs Micrographic Surgery

Cancer is the growth of abnormal cells. As cancer cells grow, they destroy the surrounding normal tissue.

The most common types of skin cancer are:

  • Basal cell carcinoma (300,000 to 400,000 new cases are diagnosed per year)
  • Squamous cell carcinoma (80,000 to 100,000 new cases per year)
  • Malignant melanoma (25,000 cases each year: one person out of every 150 will develop one of these malignant moles sometime in life)

These cancers all originate in the skin, and if left untreated will invade adjacent tissue or spread widely (metastasize). Untreated melanoma often spreads early and can be rapidly fatal. Squamous cell carcinoma can metastasize, but not commonly. Basal cells are the most common cancer, but rarely metastasize, although they too will slowly grow (invade) into surrounding areas and can destroy bones, muscles and nerves.

Unlike other forms of cancer in internal body organs, skin cancer can be seen without the aid of sophisticated medical equipment. Patients notice the lesions early and can seek treatment in the early stages, while their cancers are still small and can be easily cured.

The Signs of Skin Cancer

Skin cancer occurs in a number of ways. If you notice any of the following signs or symptoms, see your doctor as soon as possible.

  • A new growth on the skin of an adult that does not disappear in four weeks.
  • An open sore or wound that refuses to heal, persists for more than four weeks, or heals and later reopens.
  • Any skin spot or growth that continues for four weeks to itch, hurt, crust over, form a scab, erode or bleed.
  • A skin lesion that grows larger and turns brown, black or multicolored.
  • A mole, birthmark, or beauty mark that changes in size, color or texture or becomes irregular in shape. Change in color or contour is dangerous in a mole.

Prevention

Skin cancers are usually the result of damage to the skin cells by years of sun exposure. Sun damage is cumulative. We never escape the effect of any sunshine we are exposed to at any time of our lives. It all keeps adding up. Premature aging of the skin is also caused by too much sun. Common sense precautions can prevent further damage.

  • Avoid outdoor activities during peak sunlight hours-10:00 AM to 3:00 PM.
  • When in the sun, wear a hat and cover up as much as possible.
  • Use a sunscreen with a Sun Protection Factor (SPF) of at least 15 on all exposed skin. Reapply often, particularly if swimming or perspiring. Don't be fooled by cloudy or overcast days-damaging radiation can still get through. People with light complexions who do not tan easily or those with family history of skin cancer should be especially careful about excessive sun exposure.
  • Beware of light reflecting surfaces such as sand, snow and water, which magnify the potential harm to skin. Use special caution at high altitudes and near the equator, where the effect of the sun is stronger.
  • Avoid tanning booths and sun lamps. The ultraviolet (UV) light they emit is just as injurious to the skin as is the sun.

The Importance of Biopsy

There are many benign skin growths or lesions that resemble skin cancer but are found not to be cancerous when seen under a microscope. Often a biopsy is the only way to distinguish between a cancer and a sun damage spot (actinic keratosis), innocent mole or wart.

Treatment

Time-honored techniques for the treatment of skin cancer include:

  • Electrodesiccation
  • Surgical Removal
  • Irradiation Removal
  • Cryotherapy Removal
  • Mohs Micrographic Surgery-99% cure rate in lesions not treated previously A painstaking and technically demanding technique for removing cancerous tissue. More precise than standard surgery; faster and less costly than irradiation.

Each of the techniques meets a different need. Your doctor will discuss with you and choose for you the treatment guaranteeing the best result for your skin cancer. No one technique is the best for all.

When is Mohs Surgery Appropriate?

The concept of Mohs micrographic surgery was developed in 1936, but relatively few surgeons were trained in its use until recently

Only in the last few years has Mohs surgery become widely available throughout the country.

Mohs micrographic surgery is now universally recognized as the most precise method for treating skin cancers. It is especially effective for cancers of the face and other cosmetically sensitive areas, as it can remove all the cancer cells while causing minimal damage to the surrounding normal skin. It does not control spread after the cancer has reached the lymph nodes; it is designed to control cancer before it spreads.

Mohs micrographic surgery is also the best choice for the removal of recurrent skin cancers (tumors that reappear after treatment). Individual cancer cells left behind can be microscopically small, yet they will cause the tumor to reappear. The Mohs technique removes these areas with extreme accuracy, even in hard to predict situations.

What is the Mohs Technique?

Mohs micrographic surgery is named for Dr. Frederick Mohs of the University of Wisconsin, who developed the basic technique in 1936. It is called by several names: Mohs surgery, chemosurgery, microscopically controlled surgery or histographic surgery-it's all the same. In the years since the conception, many technical improvements and refinements have made micrographic surgery a swift, safe and highly effective means of treating skin cancer.

The major difference between Mohs surgery and other methods of removing skin lesions is the microscopic accuracy. In Mohs surgery, thin, horizontal sheets of the cancer are removed. This tissue is mapped on a grid pattern, with each grid line carefully identified and color stained by the surgeon so that its exact location can be pinpointed on the wound.

Each layer of tissue removed is inspected under the microscope for the presence of cancer cells. The surgeon continues to remove tissue and examine it layer by layer until no cancer cells are seen. The microscope allows the surgeon to be reasonably certain no tumor nests or scattered cells remain. In this process, very little healthy tissue is removed. From the patient's viewpoint, saving normal skin is especially important on easily visible and hard-to-replace areas such as the nose, lips and eyelids.

Before and After Surgery

Mohs surgery is usually performed on an outpatient basis using a local anesthetic. Surgery begins in the morning and is finished the same day unless the tumor is extensive. This includes the delicate laboratory preparation and microscopic examination, which is done immediately after surgical removal of each layer of tissue. One benefit of this approach is that the anesthesia rarely has a chance to wear off and doesn't need to be readministered.

If more than one layer is needed to remove all signs of tumor, a dressing is applied and you are asked to wait about 60 minutes for each layer. During this time you may leave for comfort stops, rest, or to have lunch.

Once the area is declared cancer-free, your surgeon will discuss with you how to dress the wound and what you can expect in the healing of your wound. Reconstructive surgery is not often needed unless the wound is quite large.

Follow-up visits are recommended at periodic intervals for one to five years. This is necessary to detect possible cancer recurrence. If the area is left to heal, primarily a scar will form. This scar will soften in time but requires care to follow-up to be sure.

One out of five patients with one skin cancer will develop a second skin cancer within five years. New skin cancers will be referred back to your regular doctor for his decision as to the best form of therapy.

Advantages of Mohs Surgery
Better .. Faster .. Cheaper

Cure rates for previously untreated skin cancer after treatment using Mohs surgery are as high as 99%. Larger, neglected lesions, or recurrent lesions will have a slightly poorer cure rate.

An additional benefit is that the technique produces the smallest possible wound, allowing for faster healing and a better cosmetic result, which is particularly important on the face and especially on the nose.

Many tumors can be totally removed in one treatment session, due to the rapidity of frozen microscopic sections, Occasionally, paraffin-treated microscopic sections are needed for cancers affecting deeper tissues, for which the faster frozen section technique cannot yield reliable results. Paraffins require slow overnight preparation in the lab, and sometimes next-day surgery, but are invaluable for their precision and microscopic accuracy.

Costs for Mohs surgery are kept low because the surgery can usually be performed in the doctor's office.

The Mohs Specialist

The exacting nature of the Mohs procedure has in the past limited the practice of Mohs surgery in this country. Dr. Greco completed his undergraduate study, M.D. degree and performed two years of internal medicine residency at the University of Toronto. He completed his dermatology training at McGill University in Montreal, Quebec. Dr. Greco is board certified by the American Board of Dermatology and the Royal College of Physicians and Surgeons of Canada. He is also a Fellow in the American Society for Moh's Surgery.

Patients beyond a comfortable driving distance from Mount Pleasant can usually be finished the same day.

Moh's surgery is covered by all major private insurers, Medicare and Medicaid.

For appointments, please call (903) 577-8878. Or click here to make your appointment online.

© 2000 Dermatology Center of Northeast Texas