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Skin Cancer & Pre-Cancer

Actinic Keratosis

Diagnosis

Actinic keratosis (ak-TIN-ik ker-uh-TOE-sis) is a rough, scaly patch on the skin that develops from years of exposure to the sun. Actinic Keratosis is most commonly found on the face, lips, ears, back of your hands, forearms, scalp or neck — areas of skin typically exposed to the sun. AKs can vary in:
  • Color—they can be light, dark, tan, pink, red or even the same color as your skin
  • Size—from a pinhead to larger than a quarter
  • Appearance—from flat to slightly raised
  • Texture—smooth to rough, like sandpaper
Many doctors consider an Actinic Keratosis to be precancerous because it can develop into skin cancer. Therefore, Actinic Keratoses (AKs) should be examined annually to rule out the possibility of early skin cancer. While AKs may give rise to skin cancers like squamous cell carcinomas, they do not turn into melanomas. AKs usually respond well to treatment.

Treatment

Cryotherapy

Cryotherapy (freezing) usually requires repeated treatments as liquid nitrogen only affects visible lesions. The dermatology provider applies liquid nitrogen, a very cold liquid, to the wart with a spray gun. This freezes the AKs. However, repeat treatments are often necessary.

Topicals

A topical application of 5-fluorouracil (5 FU) cream is used to activate chemical peeling of the AKs. Continued application is required even when skin has been sensitized. This is a more difficult therapy for those with sensitive skin or people with an active outdoor lifestyle. Picato is also used to activate chemical peeling within as little as 2 days. Solarize is another choice that provides results within 3 months.

Photodynamic therapy (PDT)

By using a special topical solution called Levulan that's activated by light, abnormal cells are targeted and killed. Levulan is a "smart" solution. It is only absorbed by abnormal cells and usually requires 1 to 3 in-office treatments.

Immunotherapy

AKs on the face and scalp can be treated by immunotherapy, which involves the application of a topical treatment with the active ingredient imiquimod — an immune enhancing agent that stimulates the body's immune system to destroy precancerous cells.

Basal Cell Carcinoma

Diagnosis

Basal cell carcinoma (BCC) is the most common form of skin cancer. This cancer arises in the basal cells, which line the deepest layer of the epidermis. Almost all basal cell carcinomas occur on parts of the body excessively exposed to the sun — especially the face, ears, neck, scalp, shoulders, and back. On very rare occasions, tumors develop on unexposed areas. Click here to view images of the warning signs of BCC.

Treatments

After an examination, the diagnosis of basal cell carcinoma is confirmed with a biopsy. If tumor cells are present, treatment is required. Fortunately, there are several effective treatments for basal cell carcinoma. Choice of treatment is based on the type, size, location, and depth of penetration of the tumor, the patient's age and general health, and the likely cosmetic outcome of specific treatments. Treatment is performed on an outpatient basis in the clinic.

Mohs Micrographic Surgery

Using local anesthesia, the tumor is removed with a very thin layer of tissue around it. The layer is immediately checked under a microscope. If tumor is still present in the depths or peripheries of this surrounding tissue, the procedure is repeated until the last layer examined under the microscope is tumor-free.

This technique saves the greatest amount of healthy tissue and has the highest cure rate, generally 98 percent or better. It is frequently used for tumors that have recurred, are poorly demarcated, or are in critical areas around the eyes, nose, lips, and ears. After removal of the skin cancer, the wound may be allowed to heal naturally, be sutured, or be reconstructed using cosmetic surgery methods.

Excisional Surgery

After numbing the area with local anesthesia, we remove the entire growth along with a surrounding border of normal skin as a safety margin, is removed. The skin around the surgical site is then closed with stitches, and the excised tissue is sent to the laboratory for microscopic examination to verify that all malignant cells have been removed.

The effectiveness of the technique does not match that of Mohs, but is highly effective.

Curettage And Electrodessication

Using local anesthesia, the dermatology provider scrapes off the cancerous growth with a curette (a sharp, ring-shaped instrument). The heat produced by an electrocautery needle destroys residual tumor and controls bleeding. This technique may be repeated twice or more to ensure that all cancer cells are eliminated. It can produce cure rates approaching those of surgical excision, but may not be as useful for aggressive basal cell carcinomas or those in high-risk or difficult sites.

Cryosurgery

Tumor tissue may be destroyed by freezing with liquid nitrogen, without the need for cutting or anesthesia. The procedure may be repeated at the same session to ensure total destruction of malignant cells.

The growth becomes crusted and scabbed, and usually falls off within weeks. Cryosurgery is effective for the most common tumors and is the treatment of choice for patients with bleeding disorders or an intolerance to anesthesia.

Photodynamic Therapy

This treatment uses light-activated drugs and a laser to destroy cancer cells and treat symptomatic tissues. PDT utilizes photosensitizing agents (light-activated drugs), oxygen and light, to create a photochemical reaction that selectively destroys cancer cells.

The photosensitizing agents concentrate in cancer cells and only become active when light of a certain wavelength is directed onto the area where the cancer is. The photodynamic reaction between the photosensitizing agent, light and oxygen kills the cancer cells.

Topical Medications

Imiquimod is FDA-approved only for superficial basal cell carcinomas, with cure rates generally between 80 and 90 percent. The 5% cream is rubbed gently into the tumor five times a week for up to six weeks or longer. It is the first in a new class of drugs that work by stimulating the immune system. 5-Fluorouracil (5-FU) is also FDA-approved for superficial basal cell carcinomas, with similar cure rates to imiquimod. The 5% liquid or ointment is gently rubbed into the tumor twice a day for three to six weeks.

Trials with more invasive basal cell carcinomas are under way for both imiquimod and 5-FU. Side effects are variable, and some patients do not experience any discomfort, but redness, irritation, and inflammation are predictable.

Squamous Cell Carcinoma

Diagnosis

Squamous cell carcinoma is the second most common cancer of the skin. The cancer develops in the outer layer of the skin. Some squamous cell carcinomas arise from small sandpaper-like lesions called actinic keratosis.

Squamous cell carcinomas usually appear as crusted or scaly patches on the skin with a red, inflamed base, a growing tumor, or a non-healing ulcer. 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. It is possible for squamous cell carcinoma to spread to other areas of the body so early treatment is important. Images of the warning signs of SCC can be viewed at skincancer.org

Ultraviolet light exposure (from the sun or indoor tanning devices) greatly increases the chance of developing skin cancer. Although anyone can get squamous cell carcinoma, people with light skin who sunburn easily are at the highest risk. The chance of developing skin cancer increases with age and a history of severe sunburns as a child.

These skin cancers are usually locally destructive. Untreated squamous cell carcinoma can destroy much of the tissue surrounding the tumor and may result in the loss of a nose or ear, for example. Aggressive types of squamous cell carcinomas, especially those on the lips and ears, or untreated cancers, can spread to the lymph nodes and other organs, which can become fatal. A skin biopsy for microscopic examination may be done to confirm the diagnosis.

Treatment

Mohs Micrographic Surgery

Using local anesthesia, the tumor is removed with a very thin layer of tissue around it. The layer is immediately examined under a microscope. If tumor is still present in the depths or peripheries of this surrounding tissue, the procedure is repeated until the last layer examined under the microscope is tumor-free.

This technique saves the greatest amount of healthy tissue and has the highest cure rate, generally 98 percent or better. It is frequently used for tumors that have recurred, are poorly demarcated, or are in critical areas around the eyes, nose, lips, and ears. After removal of the skin cancer, the wound may be allowed to heal naturally, be sutured, or be reconstructed using cosmetic surgery methods.

Excisional Surgery

After numbing the area with local anesthesia, the entire growth along with a surrounding border of normal skin as a safety margin. The skin around the surgical site is then closed with stitches, and the excised tissue is sent to the laboratory for microscopic examination to verify that all malignant cells have been removed.

The effectiveness of the technique does not match that of Mohs, but is highly effective.

Curettage And Electrodesiccation

Using local anesthesia, the dermatology provider scrapes off the cancerous growth with a curette (a sharp, ring-shaped instrument). The heat produced by an electrocautery needle destroys residual tumor and controls bleeding. This technique may be repeated twice or more to ensure that all cancer cells are eliminated. It can produce cure rates approaching those of surgical excision, but may not be as useful for aggressive squamous cell carcinomas or those in high-risk or difficult sites.

Melanoma

Diagnosis

Melanoma is the most serious type of skin cancer. It begins in skin cells called melanocytes, which are the cells that make melanin and give skin its color. When people spend time in the sunlight, the melanocytes make more melanin and cause the skin to tan. This also happens when skin is exposed to other forms of ultraviolet light. If the skin receives too much ultraviolet light, the melanocytes may begin to grow abnormally and become cancerous. This condition is called melanoma.

The first sign of melanoma is often a change in the size, shape, or color of a mole. But melanoma can also appear on the body as a new mole. Men most often find melanoma on the upper body, between the shoulders and hips as well as on their head and neck. Women often develop melanoma on their lower legs. Those who have darker skin will find that melanoma can appear under their fingernails or toenails, the palms of their hands, or soles of their feet. Although these are the most common places on the body for melanomas to appear, they can appear anywhere on the skin. It is important to always examine your skin to check for new moles or changes in moles.

Melanoma is a serious and sometimes life-threatening cancer. If melanoma is found and treated in its early stages, the chances of recovery are very good. If it is not found early, melanoma can grow deeper into the skin and spread to other parts of the body. This spread is called metastasis. Once melanoma has spread to other parts of the body beyond the skin, it is difficult to treat. A biopsy of the suspicious mole or growth will be done in the office to confirm the diagnosis.

Treatments

Excisional Surgery

After numbing the area with local anesthesia, the entire growth is removed along with a surrounding border of normal skin as a safety margin. The skin around the surgical site is then closed with stitches, and the excised tissue is sent to the laboratory for microscopic examination to verify that all malignant cells have been removed.