DIAGNOSIS OF “CANCER” ISN’T SOMETHING ANYONE WANTS TO HEAR!

Unfortunately though, more and more of us are getting skin cancer – especially those in their 30’s and 40’s! It is no longer a diagnosis just for the elderly. In this article we will explore the various types of the common skin cancers and how to prevent and treat them.

GENERAL INFO

The most common form of skin cancer is called Basal Cell Carcinoma or BCC. BCC are the least dangerous types of skin cancer. The second most common, and second most dangerous, skin cancer is called Squamous Cell Carcinoma or SCC. The most dangerous of the common skin cancers is called Melanoma. It is important that any of these cancers be diagnosed and treated as early as possible to avoid significant disability or even death.

PREVENTION

Fortunately, the vast majority of skin cancers can be prevented by avoiding prolonged exposure to Ultraviolet Radiation (UVR) from the sun or tanning beds. As UVR damage accumulates over a lifetime, the risk of skin cancer increases.

DIAGNOSIS

Please perform a monthly skin examination as this quick 30 second task could save your life. If any of the below are present, see a local Dermatologist for evaluation and possible treatment.

  • Any spot that is changing in size, shape, color, or symptoms. This is the most important rule to remember! If a spot has been the same for years and you start to notice any change in it, please have it evaluated.
  • Any spot that does not heal. If you have a spot that is not healing or bleeds easily, please have it checked.
  • Any spot that is not behaving correctly. For example, all of us get an acne pimple from time to time. These lesions usually last for a week or two and then go away. If a “pimple” has been there for a couple months, it is likely not a pimple. Likewise, all of us get dry, irritated skin. If we put lotion on it and it does not go away in a week or two, it is likely not just dry skin.

TREATMENT

It is important to talk about not only the treatment of skin cancers, but also the procedures that can be performed to reduce the chances that they will develop.

What is Actinic Keratosis

Actinic Keratosis (AK) is a “pre-cancerous” condition that often precedes the development of SCC – the second most common form of skin cancer. AKs have about a 10% chance of turning into a SCC over about 10 years and so it is important to treat them while they are still in the pre-cancerous state. AKs feel like little pieces of sandpaper on areas of the body that are chronically exposed to UVR like the top of the forearms, hands, head and neck.

The mainstay of AK treatment is freezing with liquid nitrogen. Freezing with liquid nitrogen is about 80% effective for getting rid of an AK. Liquid nitrogen is the “whack a mole” approach to treating the pre-cancerous lesions. When one pops up, we knock it down. However, it does nothing for the surrounding skin that is just as UV damaged and will likely produce problems in the future.

In order to help prevent other pre-cancerous and cancerous growths from forming in an area that is damaged by UVR exposure, Dermatologists will often prescribe creams or utilize a procedure called BLU Light Therapy. The creams are typically applied to the damaged area once to twice a day for 3-6 weeks. Patients usually experience redness and irritation to the areas being treated and will frequently have to take breaks in their treatment because the side effects and reactions can become too much for them to comfortably handle.

Another way of treating the UV damaged skin is with BLU Light Therapy. BLU Light Therapy is usually preferred by patients as it typically has about 20% of the reactions, down time, and side effects that occur with the creams. BLU Light Therapy is performed in the clinic with each area usually treated twice over about 6 weeks.

Basal Cell and Squamous Cell Carcinomas:

Once a BCC or an SCC has developed, treatment is necessary to prevent the cancer from destroying the surrounding tissue and to stop them from spreading internally.

If the cancer is just on the surface of the skin, creams or a simple procedure called an EDC can be performed. Both have about an 80% cure rate. Once a BCC or SCC has grown below the surface of the skin a simple excision or Mohs Surgery can be performed to remove the deeper portion of the cancer.

1). A simple excision is usually a 30 minute procedure in which the patient is awake and the area being excised is numbed with local anesthetic. The lesion is then excised and the remaining hole closed with sutures that need to be removed at a later date. Simple excisions have about a 90% cure rate.

2). Mohs Surgery is a more involved process that takes about 3 hours and is mostly used for areas of high cosmetic importance like the head and neck. The patient is awake during the surgery and the area being treated is numbed with local anesthetic. Then the surgeon takes a small piece of tissue and everyone waits for about 45 minutes while the tissue is being processed and evaluated. If all of the cancer is removed, the surgeon usually closes the hole with sutures. If more cancer is still present, the surgeon will take more tissue and everyone waits for another 45 minutes.This process continues until all of the cancer is removed. Mohs Surgery has about a 96-99% cure rate.

While surgery is the main method to remove BCC and SCC, these cancers can be treated without surgery and with very effective results! There are multiple reasons why patients might not want surgery to treat these BCC and SCC such as: patient’s don’t like/tolerate surgeries well, are on a blood thinner, have multiple areas that need treatment at the same time, have advanced age which can make skin more difficult to heal, or have health issues that make surgery more difficult. For these patients, Superficial Radiotherapy (SRT) is a reasonable choice. Patients typically come into the clinic 2-3 times a week for about 3-6 weeks of treatment. Treatment can be easily paused if patients need to take a break from treatment for whatever reason (vacation, illness, weather, etc). Most patients tolerate the procedure very well and are grateful that they have a non – surgical, non-painful option. SRT has about a 95% cure rate for select BCC and SCC.

5 steps or tips to avoid the effects of UV radiation from sunscreen to protective clothing

Melanoma:

The treatment for Melanoma skin cancer is mainly focused on surgical excision. If the Melanoma is just on the surface of the skin, then surgical excision is often curative. If the Melanoma has grown beyond the surface of the skin then other procedures, diagnostic tests, and chemotherapy might be needed.

Skin cancers are on the rise. Prevention by avoiding UVR exposure and early detection by patients performing monthly skin exams are prudent strategies to follow. However, once UV damage is done, there are a number of different treatment strategies to reverse some of the damage before skin cancers start appearing. Once skin cancers are present, especially if the cancers are BCC or SCC, there are multiple surgical and nonsurgical approaches to their treatment. Your local dermatologists have dedicated their professional lives to helping you prevent, detect, and treat any skin condition that hinders you from living life on your terms. We look forward to “Helping You Become Comfortable in Your Skin.™”

About the author

Dr. Anderson with Doctors Quarterly Magazine - Cropped
Dr. Reagan Anderson

Dr. Anderson is a Board Certified Dermatologist and Mohs Micrographic Surgeon. He serves as a Clinical Professor of Dermatology and is actively involved in patient and healthcare provider education on dermatology conditions and treatment.

Colorado Dermatology Institute
8580 Scarborough Drive / 1220 Lake Plaza Drive
Colorado Springs, Colorado