Skin cancer is the most common form of cancer in the United States. There are more cases of skin cancer than breast, colon, and lung cancer combined. Most skin cancers are related to (UV) radiation exposure from either intense, intermittent sun exposure; multiple sunburns; long term cumulative exposure over many years or from exposure through tanning beds. While skin cancer is more common in lighter skin (those with green or blue eyes and lighter hair), it can occur in skin of every color. An important part of our job as dermatologists is early detection of skin cancer. Fortunately, with early detection, most skin cancers are treatable. We encourage our patients to perform self-examinations frequently, bring suspicious growths to our attention and come in for a full-body skin examination annually. After the diagnosis of a skin cancer, you are more likely to develop another; therefore, more frequent full-skin examinations by a dermatologist are critical to survey the skin for new or recurrent skin cancers. Additionally, continued sun protection and sunscreen use are necessary to decrease the development of new skin cancers.
Common Forms of Skin Cancer
Basal cell carcinoma (BCC) is the most common form of skin cancer. The most common sign of a BCC is a pearly, shiny, pink or red bump, a pimple that does not go away after 3-4 weeks. BCC may also appear as a red scaly patch, a scar, or a small sore that bleeds easily. Common locations for BCC are the scalp, face, ears, neck, arms, hands, and legs. Basal cell carcinoma a has a low rate of metastasis or spread but can be destructive to the area affected by the tumor, including cartilage and bone. When caught early, BCC’s respond well to treatment.
Treatment options for BCC include surgical and topical-based therapies. Surgical excision, Mohs micrographic surgery, and electrodessication and curettage are the most common forms of treatment. Photodynamic therapy and topical creams like 5-fluorouracil or imiquimod cream may be used to treat superficial basal cell carcinomas. Radiation therapy and cryotherapy are occasionally used depending on the age of the patient.
Squamous cell carcinoma (SCC) is the second most common form of skin cancer. At least 40-60% of squamous cell carcinomas can be traced back to a previously existing precancerous lesion called an actinic keratosis. SCCs usually present as red scaly spots that are growing in size or that do not respond to treatment. They can also present as a non-healing sore or a wart-like spot. They may be irritated or painful. SCCs occur on the scalp, face, ears, lips, neck, arms, hands, and legs but can also occur on mucous membranes and the genital area. Additionally, they may develop in burn scars or non-healing ulcers. SCCs have a greater risk of spread than basal cell carcinomas, with 5-10% of SCCs metastasizing to other organs. SCCs on the lips are at greatest risk of spread. According to the Skin Cancer Foundation, 2,500 deaths each year are due to squamous cell carcinoma of the skin.
Surgical excision and Mohs micrographic surgery are the most common treatments for squamous cell carcinoma. Electrodessication and curettage, also called “scrape and burn” may also be used depending on the location and specific patient. Photodynamic therapy, radiation therapy and cryotherapy are occasionally used depending on the age of the patient. Topical treatments like 5-fluorouracil or imiquimod cream may be used before, during, or after treatment of squamous cell carcinoma.
Mohs micrographic surgery is a specialized in-office surgery for skin cancers. Dermatologists who perform Mohs micrographic surgery have specialized residency, fellowship or other intensive training experience. These dermatologic surgeons have appropriate laboratory facilities and they examine the excised tissue on the same day as the excision.
Mohs is skin sparing surgical technique developed in the 1930’s that allows for 100% microscopic examination of the surgical skin margin. The main advantage of Mohs micrographic surgery is its complete examination of the tissue margin. Some skin cancers are larger than anticipated, or have “roots” that may be missed if simple surgical excision with standard margins is performed. This procedure has a 99% cure rate for non-melanoma skin cancers but is reserved for specific clinical presentations of skin cancer: those located on the face or scalp, large lesions on the body, recurrent skin cancers, and aggressive types. The Mohs surgical procedure and repair is usually performed on the same day and completed in the office under local anesthesia.
Dr. Holcomb does NOT perform Mohs surgery, but if you are diagnosed with a skin cancer, she will help you determine whether or not you need Mohs. She can also help with scar improvement once the excision is complete.