Basal Cell Carcinoma
Basal cell carcinoma is the most common form of cancer worldwide. It is becoming more common with people spending more time outdoors and in the sun. It is believed a decrease in the ozone layer is allowing more ultraviolet radiation from the sun to reach the earth’s surface. Basal cell cancer does not typically spread to other areas of the body but it can be locally destructive to surrounding tissue. Therefore, basal cell cancer should be examined and treated promptly by your dermatologist.
Basal cell cancer most often appears in several different forms on sun-exposed areas such as the face, scalp, ears, chest, back, and legs. The most common appearance are white pearly nodules or pimple-like growths. These lesions may become tender, bleed, crust and even heal, only to come back again and again. A less common form called morpheaform, looks like a smooth white or yellowish waxy scar. A very common sign of basal cell cancer is a sore that bleeds and heals up continuously.
Squamous Cell Carcinoma
Squamous cell carcinoma is the second most common cancer of the skin. Middle-aged and elderly people, especially those with fair complexions and frequent sun exposure, are most likely to be affected. It is possible for squamous cell carcinoma to spread to other areas of the body; therefore, early treatment is important.
Squamous cell carcinomas usually appear as crusted or scaly patches on the skin. They are generally found in sun-exposed areas like the face, neck, arms, scalp, backs of the hands, and ears. The cancer also can occur on the lips, inside the mouth, on the genitalia, or anywhere on the body.
Treatment Options for Basal Cell Carcinoma and Squamous Cell Carcinoma are:
- Electrodessication and Curettage
- Simple Excision
- Mohs Surgery
These products which contain tretinoin (Retin-A, Renova, Differin, Tazorac), can improve shallow defects over a period of time. They also help to control the formation of new acne lesions. Additionally, AHAs (glycolic acid, lactic acid) contribute to overall improvement in skin texture. Over-the-counter “cosmeceuticals” ( Skinsiderations ) also aid in this chemical rejuvenation process.
Chemical peels can be utilized for superficial and deeper resurfacing. A variety of chemical peeling agents can be used and vary according to the depth at which they penetrate the skin.
A procedure called subcision can greatly reduce certain types of acne scarring. Subcision is a unique form of incisionless local undermining. This method of cutting under a depressed scar using a hypodermic needle, attempts to raise the base of the defect to the level of the surrounding skin surface. The effectiveness of this procedure depends on three distinct phenomena: (1) the act of surgically releasing the skin from its attachment to deeper tissues results in skin elevation. (2) the introduction of a controlled trauma initiates wound healing with formation of connective tissue which augments the depressed site. (3) a pressure dressing helps to flatten the defect. The disadvantage of subscision is bruising. The advantages are long-lasting scar correction with little down time and cost. It also can be repeated if needed.
Laser Surfacing is the most aggressive treatment for acne scars. This is done with an Erbium or CO2 laser and produces a controlled burn that penetrates the second layer of skin. The drawback to this type of treatment is greater “down-time”. It takes two weeks for crusting and oozing to resolve and redness may persist for several months.
Each year, over 1.2 million cases of skin cancer are diagnosed. Many of these are adequately treated by simple surgical excision or electrodessication and curettage. Surgery is effective for most types of skin cancer, but is most used to treat basal and squamous cell carcinomas, tumors that have recurred after previous surgery or tumors in cosmetically important areas. Mohs surgery has been proven effective in treating skin cancer by combining the surgical removal of cancer with the immediate microscopic examination of the tumor and underlying diseased tissue. This allows the Mohs surgeon to see beyond the visible disease and precisely identify and remove the complete tumor and a conservative amount of surrounding tissue.
The method requires both sequential excision of tissue and preparation of special frozen sections for microscopic examination under local anesthesia in the following steps:
- The area is anesthetized using a long-acting local anesthetic.
- A thin layer of tissue-surrounding and including the tumor is excised.
- A dressing is applied to the area and the patient will be able to rest while the next step of the process takes place. This will take 45-60 minutes.
- A map is drawn that corresponds exactly to the patient’s tumor.
- The excised tissue is sectioned and each section given a number which is indicated on the map, already drawn.
- Each section is frozen and stained with chemicals which highlight cancer cells.
- Each section is examined under the microscope by your doctor. If the tumor is still present on any section, it is marked on its corresponding section of the map.
- Since the map corresponds exactly to the patient’s tumor, the physician can go back and locate the exact area where the skin cancer was found on the section microscopically. If necessary, another thin layer is removed from the appropriate location.
The entire procedure is repeated until all areas are free of cancer. Once the removed tissue shows no signs of cancer, the above process stops, preserving healthy, normal tissue and closure of the defect takes place. Mohs surgery ensures that all and only the diseased tissue is removed, therefore minimizing the scar from the cancer removal.
A – Asymmetry
One half doesn’t match the other half.
B – Border
The edges are ragged, blotched, or blurred.
C – Color
The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance.
D – Diameter
The width is greater than six millimeters (about the size of a pencil eraser). Any growth of a mole should be of concern.
E – Elevation/Evolution
A mole that is of different elevations/contours or ANY mole that has changed (evolution) should be checked by a qualified dermatologist as soon as the change is detected.
Skin Phototypes I and II (red hair, blue eyed), blistering sunburns, a personal history of melanoma, and a family history of melanoma in first degree relatives are risk factors of melanoma. Be sure to schedule a yearly skin check with your dermatologist.