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By Dr. Daisy P. Ramos, M.D., F.A.A.D.
Skin cancer is the most prevalent of all types of cancers. It is estimated that more than two million Americans develop skin cancers every year. Fair skinned people who sunburn easily are at a particularly high risk for developing skin cancer.
Skin cancers do not arise from the air. Most are caused by the sun. Over 90% of all skin cancers are caused by exposure to ultraviolet (UV) rays from the sun. This exposure is cumulative. Each unprotected exposure increases one’s lifetime risk of developing skin cancer. Going to tanning parlors and UV tanning booths is another big factor. Other less important sources include repeated medical and industrial x-ray exposures, scarring from diseases or burns, occupational exposure to compounds like coal tar and arsenic.
Most skin cancers are visible and can be diagnosed early and successfully treated before they spread to other parts of the body. Many lesions can be detected and treated at a precancerous or pre-invasive stage. Precancerous growths (Actinic Keratosis) are considered the earliest stage in the development of skin cancer. They are small, dry, rough, maybe sensitive to touch and painful. This can be treated with cream, freezing, photodynamic therapy, chemical peel or laser.
The two most common skin cancers are Basal Cell Carcinoma and Squamous Cell Carcinoma. While Squamous Cell Carcinoma is caused by cumulative long term sun exposure, Basal Cell Carcinoma may be caused by both cumulative and intense intermittent sun exposure. Growths are in sun exposed areas of the body and diagnosis is confirmed by skin biopsy. Cure rates for both is close to 100% when detected and treated early. Basal Cell Carcinoma seldom spread but deeper and larger lesions can be lethal and can cause disfigurement. In general, Squamous Cell Carcinoma has greater chance of spreading and can be life threatening if untreated. About 2,500 people die annually from invasive Squamous Cell Carcinoma. Clinically, lesions appear thick, rough, wart-like or open sores with raised borders. Treatment options are excisional surgery, MOH’s micrographic surgery, laser or freezing. Erivedge is an oral drug for rare cases of metastatic Basal Cell Carcinoma or locally advanced Basal Cell that become dangerous and even life threatening.
The most serious form of skin cancer is Melanoma. It is important to have regular total skin body check and stay alert on moles with ABCDE signs of melanoma: Asymmetry, Border irregularity, Color variability, Diameter larger than a pencil eraser (6mm) but can be smaller and Evolving or changing. If in doubt, consult your Dermatologist. Treatment depends on the depth of tumor by biopsy. Thin ones, in-situ, level 1 or 2 – standard excisional biopsy as sole treatment. Thicker ones, level 3 or 4 – wider and deeper excision. Regional lymph nodes may be dissected to check spread. When cancer cells spread beyond lymph nodes, melanoma is considered advanced. The treatment at this time include radiation, chemotherapy and immunotherapies. Prognosis is usually bad.
|DAISY P. RAMOS, M.D., F.A.A.D.
SENIOR STAFF, DERMATOLOGY DEPT
WILLIAM BEAUMONT HOSPITAL, ROYAL OAK
PRIVATE PRACTICE, TROY, MICHIGAN – 47 YEARS