Articles - Diagnosed with Skin Cancer! Now what?

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Diagnosed with Skin Cancer!
Now what?

"...two very common and treatable skin cancers, that appear often on sun-exposed areas... "

Joseph Cvancara, MD

Every specific cell in every specific organ (such as bone, nerve, muscle and skin) in your body can mutate and become a cancer.  Each kind of cancer responds to different types of treatment, whether it is chemotherapy, radiation, surgical, or immunologic. That is why it is so difficult to find a "cure."  Unfortunately, some cancers do not respond to any treatment.

This article will focus on basal cell and squamous cell carcinoma, two very common and treatable skin cancers, that appear often on sun-exposed areas as red papules (bumps) that will not heal in 2 months timeframe.  Other forms of skin cancer are beyond the scope of this article.

What is a carcinoma?  A carcinoma is a type of cancer that develops from epithelial cells, specifically cells that line the inner and outer (epidermis) surfaces of the body.

A basal cell carcinoma (BCC) develops from the stem cells at the "basement layer" of the epidermis, with 70% of BCCs caused by UV sunlight.  BCCs will grow slowly, and may bleed and ulcerate with trauma.  While BCC has a very low risk of spreading, or metastasis, this cancer can cause significant disfigurement by invading surrounding tissues.

A squamous cell carcinoma (SCC) is another common skin cancer.  Like BCCs, SCCs usually occur in sun-exposed areas but may also occur in immunosuppressive patients, such as solid organ transplant patients.  SCCs can also involve the anus, cervix, esophagus, lungs and urinary bladder. Like BCCs, SCCs often appear on the skin as a reddish papule that slowly grows and ulcerates.  A SCC often will arise from a pre-malignant pink, scaly lesion called an actinic keratosis.  Scalp, ears, and lips have the highest rates of metastasis, often spreading to the nerves or lymph nodes, a 20-50% chance.

BCCs and SCCs are generally treated by surgical excision, Mohs surgery, electrodessication and curettage (ED&C) or radiation.  Surgical excision is cutting out the tumor with a scalpel, often taking wide enough margins to prevent leaving any cancer behind. The problem with wide excision is it often removes a lot of normal skin, but has a 92% cure rate.  ED&C is a useful treatment mainly for the superficial BCC's on the trunk.  This treatment requires scraping and burning the lesion, often leaving a scar, but has approximately a 90% cure rate.  Mohs surgery was developed to remove cancers off important areas such as the face, ears, hands and genitalia.  Mohs surgery is a "tissue sparing and margin controlled" surgery, allowing the dermatological surgeon to make the excision as small as possible, while also examining 100% of the surgical margins. This surgical technique has a 99% cure rate.  Radiation has about a 90% cure, and is reserved for inoperable or disfiguring large tumors. Ultimately, location and size of cancer will warrant the treatment option.

At Advanced Dermatology and Skin Surgery, our physicians will provide the best care for you and your loved ones.  We have three fellowship-trained Mohs dermatological surgeons on staff, as well as general and pediatric dermatologists.  Please be sun-smart!  Wear a hat and sunscreen, and enjoy the great outdoors.

By Joseph Cvancara, MD
Fellow-American College of Mohs Surgery
Fellow-American Academy of Dermatology
Advanced Dermatology Skin & Surgery Center
Spokane, WA and Coeur d'Alene, ID
(800) 247-9519 or (509) 456-7414