The subject of skin cancer is a serious topic, particularly for Southern Californians who have more sun exposure because of our exceptional weather. Current medical theory directly relates skin cancer to ultraviolet radiation. A patient should know that the words Cancer, Carcinoma, Tumor and Lesion often refer to the same thing.
There are three basic types of skin cancer:
Basal cell carcinoma
Squamous cell carcinoma
Basal Cell Carcinoma
Basal Cell Carcinoma is by far the most common of all cancers in the United States, and at the same time the least serious of skin tumors.
It is thought to develop decades after the damaging sun radiation. In most cases the lesion begins as a small area of irritated skin, is slow growing and is mostly asymptomatic except for flaking, occasional bleeding or itching. It is important to understand that the basal cell layer of the skin (the epidermis} is superficial and the tumor does not extend below that level unless seriously neglected. It is also important to know that Basal Cell Carcinoma does not normally spread to other areas of the body as do the other types of skin tumors.
It is not always easy to distinguish or identify a basal cell cancer, without confirmation by biopsy. Depending on the size and location, treatment under local anesthesia can be as simple as a shave of the lesion followed by cautery to destroy any tissue remaining at the base, or a small excision. Other treatments may be effective such as anti-cancer cream for very superficial lesions, radiation, and cryosurgery (freezing).
NOTE: Recently, there has been an epidemic of Mohs Technique being used to over-treat simple basal cell tumors. This is like using a sledge hammer to swat a fly. This treatment should be reserved for lesions in areas otherwise difficult to treat, or that are large and have been neglected. The resulting deformities are an unnecessary result. Consider seeking a second opinion, if you are advised to have Mohs technique for a basal cell tumor.
Squamous Cell Carcinoma
The second most common skin cancer is Squamous Cell Carcinoma. Again it is related to sun exposure, history of severe sunburn early in life, significant radiation from x-rays, and some chemical exposure. The lesion presents as a growing bump often one inch in diameter, with a rough scaly surface, or may arise as a change in a wart or mole. A biopsy is necessary to confirm the diagnosis. This type of tumor can extend into deeper layers of the skin and beyond, and spread to other areas of the body. More aggressive treatment is indicated. If caught early prognosis for cure is good. If neglected the cancer can invade internal organs and be lethal.
Melanoma is the most serious type of skin cancer and fortunately is the least common. It is the result of changes in pigmented cells called melanocytes. Melanoma can lead to death if untreated, as it spreads rapidly. The ABCDE system can help identify and differentiate Melanoma from other skin cancers:
Yearly exams by a doctor, and monthly self exams leading to early aggressive surgical treatment can lead to a cure. There is promising research that includes a vaccine that may be available in the future.
Asymmetry: a portion of a skin lesion is different from the rest.
Borders: irregular edges
Color: changes within the lesion from brown to black or any mixture.
Diameter: the lesion is usually larger than 1/2 inch.
Evolution: rapid growth and changes in appearance.