What is skin cancer ?

Skin cancer is abnormal growth of cells that starts in the skin. There are different types of skin cancer, with most being fairly local and slow growing, but some, such as melanoma, being more dangerous.

What are the major types of skin cancer and how are they treated?

Basal cell cancer (BCC)
BCC is the most common kind of skin cancer. It starts in the basal cell layer of the epidermis (the top layer of the skin). This typically occurs on sun exposed areas such as the face. Sun exposure is a major risk factor for this type of skin cancer. While mainly older adults are affected by BCC, younger adults and even rarely in children can get BCC.

There are various modalities for treating BCC. If the BCC is a superficial multifocal subtype, it can be treated with excision, a cream such as imiquimod or fluorouracil, or electrodessication and curettage. If it is a nodular or other subtype, it is generally treated with excision or Mohs surgery, a skin conserving surgery that is done for skin cancers that are larger, on special sites, or affecting immunocompromised individuals. If BCC is left untreated, it can cause local destruction of nearby tissue and very rarely spread to other organs in the body.

Squamous cell cancer (SCC)

SCC is the second most common kind of skin cancer. It originates in the mid portion of the epidermis (top layer of the skin). Like BCC, it is often a slow growing and local kind of skin cancer, but can be more aggressive in certain locations. It is mainly found in older adults, as it is greatest risk factor is cumulative sun damage.

Superficial subtypes can be treated with prescription creams, electrodessication and curettage, or excision. Deeper and more aggressive types require excision or sometimes Mohs surgery, a skin conserving surgery done in special situations that relate to characteristics of the skin cancer and the patient. If there is spread of the cancer beyond the skin, an oncologist and/or another specialist will need to be involved.

Melanoma

Melanoma is one of the most dangerous kinds of skin cancer. Still, when caught early, it has a very good prognosis. It originates from melanocytes, the cells that make pigment in the skin. These are also the cells that make up moles. Melanoma can occur on its own, de novo, or it can develop from an existing mole. While it is usually a darker lesion, it can be pink or red or another color. It is recommended that you check your moles and other skin lesions regularly, about monthly, to monitor them for changes or other suspicious findings. If you are concerned about a skin lesion, please see a dermatologist as soon as possible.

The treatment of melanoma usually involves excision or Mohs surgery, a skin conserving surgery done in special situations that relate to characteristics of the skin cancer and the patient. Depending on the stage of the melanoma, which mostly relates to its depth in the skin and spread to other organs, a surgical oncologist/ and or other specialist may need to be involved.

What is Mohs surgery ?

Moh’s surgery is a skin conserving surgery, generally done with local anesthetic. It allows for the affected skin to be removed in stages, to allow for minimal normal skin to be removed while eliminating the skin cancer. With each stage, the skin removed is checked in real time for any positive margins of skin cancer. If positive margins are found, then another stage is done. Specifically, the surgeon is able to go back to the particular area that has the skin cancer and just remove that, which is then also checked for margins. There are certain criteria that qualify a patient’s skin cancer to be removed this way. These relate to the location, size or aggressiveness of the skin cancer, as well as the immune status of a patient.

What are ways to prevent skin cancer?

Ultraviolet radiation from the sun is the number one and most preventable risk factor for skin cancer. Therefore, careful sun protection is important for the prevention of skin cancer, including regular use of sunscreen (daily and reapplication every 2 hours when outside), protective clothing, seeking shade, and avoiding being outdoors during the sun’s peak hours of 10Am to 2PM. Also, it is important to monitor your skin monthly, and come in to see your dermatologist should you notice any new or changing lesions. Finally, it is important to get regular in office skin checks, particularly if you have any risk factors for skin cancer, e.g. significant sun exposure, multiple moles, previous skin cancer, etc.

Additional Resources:
American Cancer Society
American Society for Dermatologic Surgery