Thursday, October 29, 2009

Diagnosis and Treatment of Skin Cancer

The Diagnosis and Treatment of Skin Cancer: A large part of Greenville Dermatology’s practice involves the diagnosis and treatment of skin cancer. Skin cancer can be basically divided into two types: Melanoma and Non-melanoma skin cancer.
Malignant melanoma is a serious skin cancer. It arises in the melanocytes, or pigment producing cells, in the skin. Early on, malignant melanoma is 100% curable, but it can spread, or metastasize, at any time causing serious health problems and even death. Most of the deaths in the US from skin cancer are from melanoma. A melanoma usually appears as a darkly pigmented but not perfectly round spot on the body. Many of my patients are under the false impression that melanomas are raised spots or “bumps” on the skin, but early on, they can be just flat, irregularly shaped spots. As time goes on, the spot will enlarge and at some point, if not detected or removed, will become raised. Early detection and removal is very important in surviving a malignant melanoma. People who have had a blistering sunburn before age 18 (which, is about all of us!) are at a twofold increased risk for developing a malignant melanoma. However, a much stronger risk factor is having a first-degree relative (i.e. mother, father, sister, brother) puts someone by some estimates at a 60-fold increased risk for melanoma over someone without a family history. Another little known fact is that a melanoma can occur anywhere on the body and does not necessarily have to be on sun exposed skin. In fact, melanoma can occur in the body—most notably the eye as there are melanocytes in the retina of the eye. Therefore, a full skin exam at your dermatologist should include looking at every inch of skin on the body—including the parts of the skin that are never in the sun. This can be embarrassing especially if your dermatologist is the opposite sex from you, but should not be ignored completely. These areas can be examined by the patient themselves, or spouse, or in the case of a female, her OB/GYN and if anything unusual is seen, then it should be seen and examined and possibly biopsied by a dermatologist. Once diagnosed, the primary treatment for melanoma is surgery. There is a standard of care which should be followed in removing melanomas. The amount of normal appearing skin around the melanoma is dependent upon how thick and aggressive the melanoma is. The thicker the melanoma, the more skin around it is removed. Once a melanoma reaches a critical width, then something called lymph node mapping should be considered. This is a procedure a surgeon often will do before the surgery to see what lymph nodes are draining the area of the melanoma, then these lymph nodes will be removed or at least sampled to see if the melanoma has spread to them. Thinner early melanomas don’t usually require this extra procedure. Melanomas can spread, or metastasize, to other organs and once this happens then usually chemotherapy has to be performed along with the initial surgery. This is done under the guidance of an oncologist, or cancer physician.
So, everyone should be performing self exam on their skin and look for spots that look like moles, but are A=asymmetric , B= have irregular or ill defined borders, or C= have multiple colors or a recent color change. Anything like this should be seen by a dermatologist as soon as possible.
Non-melanoma skin cancer is not as serious as melanoma, although ignoring these malignancies can result in serious consequences and even death. Basal cell carcinoma and squamous cell carcinoma fall into this category and make up about 90% of all skin cancers seen. These cancers do not have any inheritance patterns. They are completely due to over exposure to the sun or tanning beds. The more sun you are exposed to in your life, the more of these skin cancers you will be likely to get. If your father or mother had a lot of these, you may not necessarily get them if you protect yourself from the sun. These cancers usually start out as a red, scaly patch on the skin that just won’t heal, or will heal only to recur a few days or weeks later. Eventually, they will grow into a bump that can be skin colored or clear and pink, and will bleed very easily. The most common site for them is on the face, since our faces are usually not covered when we are out in the sun. However, the upper shoulders, back, and arms , and on women, legs, are areas where we see a lot of these types of skin cancers. It would be rare to see one in the genital area although nude sunbathers can get them there. The treatment of these types of skin cancers depends on how advanced and aggressive they are, the location on the body, and the desired cosmetic outcome. They are almost always, with rare exceptions, 100% curable by simply removing them and rarely do they spread, or metastasize elsewhere in the body. Skin cancers on the face we generally recommend that the patient see a “Mohs” surgeon. This is a dermatologist who has specialized further in a specialized type of surgery to remove skin cancer and are well trained in plastic surgery procedures to close the defects left behind. On the back, chest or other areas of the body, your dermatologist usually will treat these themselves by surgically removing them, or scraping them off with a special procedure called curettage and electrodessication. Some very early basal cell carcinomas can be treated by a cream called “Aldara”. Non-melanoma skin cancers make up more than all the other solid tumors combined and will be diagnosed more than 1 million times in the US each year and so represent a significant portion of a dermatologists business.
If you feel you have either of these types of skin cancer, contact us here at Greenville Dermatology or your own dermatologist as soon as possible for an exam.