Clinical Dermatology
At Alaska Dermatology and Laser Center
Skin Cancer
Precancerous Tumors
The most common type is an actinic or solar keratosis - which occur on sun exposed areas on light complexioned people. The lesion has a rough or scaly surface and irregular border. They are brown to tan usually on the face, neck, hands, forearms and/or any sun exposed area. Treatment varies from topical chemo-therapy to liquid nitrogen and an occasional shave or curettage. Actinic keratosis, if untreated, may progress to a squamous cell carcinoma. A specialized form of actinic keratosis is the cutaneous horn which also may have cancer at the base.
Skin Cancer
Our goals:
- Prevention
- Detection
- Treatment
There are several different types of skin cancers but the vast majority of cases include Basal Cell Carcinoma (BCC), which is the most common type of skin cancer, Squanamous Cell Carcinoma (SCC), and Malignant Melanoma (MM); listed in descending order of frequency and ascending order aggressiveness.
With any type of cancer, an early diagnosis and treatment will offer a much higher rate of a cure than going undetected; even for malignant melanoma. Sunlight and hereditary predisposition are key factors in most skin cancers.
Basal Cell Carcinoma (BCC)
BCC is the most common type of skin cancer and is almost always curable. The type of skin cancer is usually caused by over exposure to sunlight and ultraviolet radiation over the first 20 years of life, particularly childhood. Basal cells are almost always in sun exposed areas—with superficial BCC or nodular-ulcerative BCC—most common. They appear differently from a red patch with superficial scaling to a single nodular lesion to ulcerated lesions with pearly borders. They can vary in color from red to whitish, brown or black and a pearly or waxy border.
Basal cells are most dangerous when they are close to facial features, where early detection can help prevent much of the bad cosmetic aftermath. A rare, but important BCC is a sclerosing BCC that requires specialized surgery and pathological confirmation of clear borders at the time of surgery.
Squamous Cell Carcinoma (SCC)
SCC is the second most common type of skin cancer. This type of skin cancer is caused mainly by heredity or over exposure to sunlight. Squamous cells can appear in areas of sun damaged skin and precancerous lesions such as actinic keratosis. Squamous cells can be normal skin color, red or brown. They can appear as red or brown scaling patches with crust and even occasional bleeding.
Malignant Melanoma (MM)
Again, heredity and sunlight are predisposing agents. Melanoma can arise individually from normal skin or from existing moles. People with more than 50 moles have more of a tendency for malignant melanoma. Approximately 50% of malignant melanoma occur de novo or starting spontaneously and not from an existing mole. A high percentage of malignant melanoma in women occur during pregnancy. Melanomas must be detected early and treated.
Melanoma can be raised; black, brown, red, tan and flesh colored (amelonotic malignant melanoma). Melanomas certainly contain combinations of the above colors. If they are left undetected, they may mature and metastasize (spread) and can result in death.
The “A, B, C, D, E” of Melanoma Detection
Things to watch for:
A Asymmetry - each half appearing to be different.
B Borders - uneven
C Color - multiple colors in the same lesion
D Diameter - is the size greater than 6mm or bigger than a pencil eraser
E Evolving- changing
Treatment of Pre-Cancerous and Cancerous Lesions
Precancerous
Most precancerous lesions can be treated with topical chemotherapy that usually leaves no marks. Occasionally, liquid nitrogen is required.
Cancerous
The treatment of basal cell and squamous cell skin cancers depends on the pathology and location. This is decided with each individual case and there are several approaches.
The extent of the treatment of malignant melanoma depends on progression of the individual lesion and whether or not this has been confined or has already spread. This is decided after biopsy and physical exam and is very individualized.
