“WHAT IS SKIN CANCER?”
Skin Cancer is not one problem but a collection of separate diseases. There are three common forms of skin cancer:
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Malignant Melanoma
Basal Cell Carcinoma is not only the most common form of skin cancer, but it is also the most frequently occurring of all cancers of the body. The name is derived from the skin cell that is growing in an uncontrolled fashion – the basal cell. This is the cell type located at the base or bottom of the upper skin layer – the epidermis. Although basal cell carcinoma can damage the skin where it appears, it rarely spreads to other parts of the body unless its size becomes enormous. It does not spread throughout the bloodstream and almost never involves the lymph nodes (glands). One might think of a basal cell carcinoma as a colony of termites. If left untreated, it will destroy any tissue or structure in its path of growth. This is of particular concern when basal cell carcinoma is located near the eye, ear, or nose. One cannot predict how quickly basal cell carcinomas will grow. Although they are usually slow-growing tumors, basal cell carcinomas can grow rapidly and spread. Basal cell carcinomas initially may have the appearance of a small pimple, a non-healing or bleeding sore, a shiny papule, a cyst or a larger growth. Discomfort and itching can occur but are rare. The diagnosis of basal cell carcinoma cannot be confirmed without a biopsy or sample being sent to a pathology laboratory for microscopic examination.
Squamous Cell Carcinoma can be a more serious disease than basal cell carcinoma. The squamous cells are located above the basal layer in the epidermis. This tumor may spread to the nearby glands or lymph nodes or travel through the bloodstream to distant areas of the body. Squamous cell carcinoma usually appears as a rough, scaly plaque or larger growth.
Malignant Melanoma, which often looks like a brown or black patch, or an unusual mole, is potentially the most serious form of skin cancer. However, because microscopically controlled surgery is not often used as the treatment for melanoma, it will not be discussed further.
“WHY DID I GET SKIN CANCER?”
Unfortunately, we do not know most of the factors that cause skin cancer. However, skin cancer does occur more frequently in people with fair complexions (blonde hair, blue eyes), individuals of Celtic descent and those who tend to get damaging ultra-violet radiation of the sun over many years may change normal cells of the skin to cancerous cells. This is why areas of the body exposed constantly to the sun (the face, hands) tend to be more prone to skin cancer than sun-protected areas. However, this is not the entire answer. Dark-skinned individuals who hide from the sun can still develop cancer. Other factors such as heredity and environmental agents may play some role.
“HOW CAN I PROTECT MYSELF FROM FUTURE SKIN CANCER?”
The only factor you can control is exposure to the sun. Proper use of sunscreen with a Sun Protection Factor (SPF) of 30 to 45 or greater is the most important preventative measure. You can also wear broad-rimmed hats or protective clothing if desired. Avoid sun exposure between 10:00 a.m. and 2:00 p.m. and sit in the shade when possible. You do not have to change your lifestyle – only use caution.
“HOW IS SKIN CANCER TREATED?”
Skin cancer can be treated effectively by a variety of methods, including traditional surgery, desiccation and curettage (scraping and burning), freezing (cryo-surgery), X-ray (radiation therapy) and Mohs, or microscopically controlled, surgery. The treatment of skin cancer must be individualized, taking into consideration such factors as patient’s age, location of the cancer, type of cancer and whether or not the cancer has been treated previously. In some instances, more than one type of therapy may be appropriate. But in most cases, only one or two are necessary for a particular skin cancer.
“WILL THERE BE ANY AFTER EFFECTS OF MY SURGERY?”
Discomfort, if it should occur with this procedure, is usually mild and can be managed with Extra-Strength Tylenol. Do not take aspirin or aspirin-containing products (Excedrin, Anacin, etc.) unless prescribed by your primary care physician for a cardiac or stroke history as these can promote bleeding. A pressure dressing applied to the wound should be left on 1-2 days to minimize swelling and bleeding. Although some minimal bleeding is typical, brisk bleeding after surgery is infrequent. If brisk bleeding occurs, lie down, take some gauze or a dry washcloth and apply firm pressure for twenty minutes (by the clock) on the wound. Do not remove the pressure prior to this. If the bleeding persists, contact the on-call physician at the emergency contact numbers shown on your post-operative instructions.
Other problems that may occur include black and blue marks, swelling, and redness for approximately 2 months and a bumpy suture line for approximately 4 months. Rarely, if the skin cancer involves nerves of the skin, surgical removal can lead to numbness or muscle weakness in the area. Numbness usually resolves in 12-24 months, but may occasionally be permanent.
Remember, every surgical procedure produces scarring of some type. Although every attempt will be made to minimize and hide the scar, the extent of scarring depends on the size and depth of the cancer.
The main goal of Mohs surgery is to remove skin cancer as completely as possible and prevent recurrence. Although the cure rate is not 100%, it offers the highest cure rate of any available procedure. Most patients never require further treatment.
Please remember, this information provides a general guide to skin cancer and Mohs surgery. Please consult your physician if any questions arise.