The three major kinds of skin cancer are:
- Basal cell cancer
- Squamous cell cancer
- Melanoma
Basal cell carcinoma with plan of excision. Note the margin around the cancer to assure complete removal. The elliptical excision results in less distortion of the skin, often imperceptible, especially when put in natural skin lines.
Basal cell cancers (BCC) are most often found anywhere on the face, but especially on the upper lip, cheeks, and forehead. They can be found anywhere with excess sun exposure, however.
When there is an isolated lesion and it is early, meaning that it is small and of recent occurrence, it can often be treated with a cream such as Efudex, Carac (a once a day form of Efudex) or even Aldara, which increases our immunity to help reject the lesion. Often a punch biopsy (very minor procedure) is necessary to determine the diagnosis, extent or depth of the lesion. If it is too advanced for the cream treatment, it should be excised, meaning cut out and sutured closed. When the scar is placed in a natural skin line, the scars are usually imperceptible, according to the location and size of the cancer.
And extensive lesion may require a reconstructive procedure such as a flap of tissue from an adjacent area or a graft from another area. These can be minor or complicated and will be explained by your surgeon. Still excellent results can be achieved when properly done, again according to the location and size of the cancer.
I often see patients with multiple pre-malignant areas on their faces that are treated with excisions, burning them or freezing them off, all of which leave scars. These patients should be given a round of Efudex, which in most cases would eliminate all or most of the lesions without surgery, burning or freezing. I feel the least aggressive treatment for skin cancer, if still effective, is the best. Efudex or Carac must be tried to determine if they are effective, however. If not, the excision can still be implemented.
This leaves me to discuss Mohs surgery or Mohs chemosurgery. This is a very aggressive type of surgery originally developed for critical areas around the nose or eyelids, where very little extra skin exists for reconstruction. It now seems that the tendency is for Mohs chemosurgeons to use it on the chest, legs, or anywhere, where there is plenty of extra skin for reconstruction. Unfortunately, I have seen too many cases where it is abused because of the price that can be charged. In addition, instead of having a simple excision be a plastic surgeon, which would take an hour or less, the Mohs surgeon will take 5-6 hours and leave a hole that a plastic surgeon must close at a later date for yet more discomfort and an additional fee. I have seen too many deformities from Mohs chemosurgery to be an advocate. Recurrences of the cancer in my practice with simple excisions have been less than one percent. It is much less expensive, usually takes one procedure (rather than two or more), usually leaves no deformity, and there is much less discomfort. At Finger and Associates and New Youth Medical Spa, the patient’s welfare and post-treatment appearance is always our goal.
Squamous cell carcinoma. Note the undefined borders and the large amount of skin it will take to remove it. This will require a graft for closure after it is excised and the free borders are verified by a pathologist.
Squamous Cell cancers (SCC) are treated much the same as the BCC’s. Very early ones are called actinic keratoses and can often be treated successfully with Efudex or Carac. If more extensive, they should be excised and the specimen examined by a Board Certified Pathologist. (Mohs chemosurgeons examine their own specimens and are not Board Certified Pathologist). Squamous cell carcinomas are more commonly found on the lower lip, arms and legs, although they can be found anywhere. Those on the lower lip may become more aggressive and even metastasize, so they should be treated early and thoroughly. Often when caught early, a very minor procedure is adequate. SCC’s are more aggressive than BCC’s.
Virtually all BCC and SCC lesions can be removed in a few minutes to an hour in a minor surgery room under local anesthesia. The extra expense and risk of a general anesthesia is not necessary, and we do not recommend it. If needed a sedative can be given.
Melanomas are the most deadly of the common skin cancers. Melanoma is a malignant tumor of the melanocytes, which is the cell that produces melanin, the pigment that gives us our darker color. It is most often found in our skin, but can occur anywhere from our eye to bowel. Any mole or pigmented spot that has changed in any way should be examined by your physician, especially if it has changed in color, size or has started itching, is multicolored or irregular in shape. Melanomas are staged according to their depth and size and whether they involve lymph nodes or have metastasized to other areas. If they are isolated and not too deep or large, a wide excision is required, often followed by a skin graft, according to the location. Melanomas are more individualized and your plastic surgeon will help you with determining the proper treatment. In many cases an oncologist should be consulted as well.
It is believed that one severe sunburn increases the risk of melanomas, but any excess exposure to UV rays from the sun to tanning lamps or beds increases our risk of melanoma. There appears to be an epidemic of melanomas. They are being diagnosed at more than twice the rate they were in 1986, increasing faster than any other cancer.
If you or any one you know has a dark lesion or mole that is changing in any way, they should make an appointment to see their doctor at once. This is not a cancer that can be ignored.
We at Finger and Associates and New Youth Medical Spa treat a large volume of skin cancers, and we welcome the opportunity to see you if you have a lesion you are unsure of or to do a skin check to rule out any possible skin cancers.
