Skin Cancer Basics

By M Jason Hancey MD

Skin cancer is the most common type of cancer in the United States. More than 2 million people were diagnosed with skin cancer in 2010. This number is larger than all other cancers combined, and the incidence is increasing rapidly.​

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​One in every five Americans will be diagnosed with skin cancer during their lifetime. The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma. In general, melanoma is a high-risk cancer, while basal and squamous cell carcinomas are of lower risk.

Basal Cell Carcinoma

This very common malignancy accounts for approximately 80 percent of all skin cancers. Although they rarely metastasize, basal cell carcinomas may cause significant local tissue destruction resulting in deformity, disfigurement, pain or ulceration. Basal cell carcinoma can appear as an ulceration, red growth, shiny bump or scar. It is most common on skin with frequent sun exposure such as the face, neck, scalp, shoulders or back, but may appear anywhere.

Squamous Cell Carcinoma

Approximately 700,000 people are diagnosed with squamous cell carcinoma each year in the United States, making it the second most common form of skin cancer. It is also closely linked to ultraviolet exposure from the sun and commonly appears on the face, neck, scalp, arms and legs. If treated early, nearly all cases are curable; however, a small percentage will develop metastatic spread to distant tissues or organs, which can be fatal.

Melanoma

Melanoma is the most dangerous form of skin cancer, and approximately 75,000 new cases will occur in the United States this year. Current estimates show that 1 in every 50 white Americans will develop melanoma during their lifetime. In 2008, Utah had the second highest incidence of melanoma among all states. High altitude, fair skin, significant sun exposure, tanning beds and genetics may all play a part in melanoma formation. Melanoma may resemble a mole or may arise from an existing mole. The majority are dark brown or black in color, but may also appear white, pink, blue, purple or flesh colored.

Treatment

Treatment of skin cancer begins with proper diagnosis. If you have a skin lesion that is changing, new, bleeding, painful, non-healing, unusual or concerning, bring it to the attention of your physician. Pathologic examination of a sample of the lesion (obtained via biopsy) can be used to correctly confirm the diagnosis. Treatment is based on the specific type of skin cancer.

The mainstay of skin cancer treatment is surgery, with the following goals:

1) Remove the cancer
2) Restore your normal appearance with minimal visible scarring.

Certain physicians perform skin cancer removal including primary care physicians, dermatologists, general surgeons, otolaryngologists and plastic surgeons. In some instances, radiation, cryotherapy, photodynamic therapy, laser or topical medication may be advised. Most skin cancers can be removed during an office-based procedure using only local anesthesia. Talk to your surgeon about precautions before surgery, length of your procedure, expected scarring, recurrence rates and post-operative instructions/restrictions. For some skin cancers that are high risk or in a cosmetically sensitive area (such as the face), Mohs surgery or frozen section margin evaluation may be necessary.

Removing the skin cancer will leave a defect, but most of those defects can be closed into a simple linear scar. Some defects that are large or are in a cosmetically sensitive area may require a reconstructive flap or graft to close. A flap involves rearranging tissue located near the defect to close the wound. A skin graft is performed by completely detaching a piece of skin from a donor site, then placing the piece of skin into the cancer defect to close the wound. More complex  reconstructions can be performed for defects involving part or all of the nose, ear, eyelid, lip, etc. You may be referred to a plastic and reconstructive surgeon. Skin cancer surgery can also be performed using sedation or general anesthesia for patients who will not tolerate a procedure while awake.

Melanoma surgery will most often be performed in an operating room to remove the tumor along with a carefully measured margin of normal tissue surrounding the tumor. Lymph node sampling is indicated for certain melanomas and would be performed at the same time as the tumor resection. Patients with advanced or metastatic skin cancer may be candidates for a clinical trial, chemotherapy or radiation therapy. To aid their treatment, these patients may be presented at a Multidisciplinary Tumor Board where experts in surgery, dermatology, oncology, radiation oncology and pathology discuss the patient’s specific needs and develop an indiviualized cohesive treatment plan.

To find a physician who specializes in skin cancer, we invite you to visit the index at the back of this publication or IntermountainMedicalGroup.org