Skin cancer is the most common tumor in North America. Most people know someone who has had a skin cancer. Skin cancers typically appear in middle age or older adults.
What are the different types of skin cancer?
There are several types of skin cancer. The most common skin cancers are:
Fortunately, especially if caught early, most skin cancers can be successfully treated and cured.
Basal Cell Carcinoma
Basal Cell Carcinoma (BCC) is the most common skin cancer and typically occurs in sun-exposed skin areas. Growth is typically slow, over months to years, and can range in appearance from a non-healing sore, to a pearly bump, to a scaly patch to a whitish area that looks like a scar.
Fortunately BCC has a very low risk of spreading to other areas. BCC does grow over time both outwardly (like an oil slick) and deeply (like the roots of a tree). This growth can impact other areas, especially facial areas such as the nose, eyelid or ear.
Untreated, BCC or BCC recurring after treatment, can eventually invade deeply, making a cure increasingly difficult.
What is the treatment for basal cell carcinoma?
Treatment for basal cell carcinoma includes:
- Creams (e.g. imiquimod)
- Surgery (including scraping of the spot, surgical excision)
- Mohs surgery
- Radiation treatment
- Chemotherapy (for difficult cases)
To determine the appropriate treatment, we assess the expected cure and results. In many cases, surgery may produce the highest cure rate. This is especially true for facial areas where Mohs surgery is commonly recommended to try and obtain the highest cure rate with precise removal of the affected skin and sparing of normal skin.
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is the second most common skin cancer. SCC can sometimes show up as a slow-growing scaly patch or sore on sun exposed skin. SCC can be painful or occur without symptoms.
Unlike BCC, SCC can be fairly fast growing and arise as an enlarged “pimple” in just a few weeks. SCC can be cured by complete removal of the cancer. Sometimes SCC can grow more aggressively with a higher risk of regrowth after removal or even metastasis (spread away from the skin).
What is the treatment for SCC?
Treatment of SCC can include:
- Surgery - Surgical excision is the primary treatment. Some smaller tumors can be treated with scraping procedures. Mohs surgery is commonly recommended to treat SCC on the face, scalp, hands or shins to try and obtain the highest cure rate with precise removal of the affected skin and sparing of normal skin.
- Radiation - Radiation can be used as a first-line treatment but is most commonly used in difficult cases as a treatment following surgery.
- Chemotherapy - Chemotherapy can be used in some advanced SCC. SCC can arise out of a preexisting actinic keratosis – the clue is often tenderness or rapid growth.
A very common skin lesion that sometimes turns into SCC is called an Actinic Keratosis (AK). AK is much more common in people as they age. Usually AK appears as scaly spots on the skin and or with some redness. The spots do not feel deep and tend to grow slowly.
Patients may have several or even numerous AKs on the sun exposed skin (e.g. hands, face, scalp). Some of these spots will become squamous cell carcinomas with time and benefit from treatment options such as liquid nitrogen (freezing) or creams to remove or reduce.
Spots that grow quickly or return after treatment should be assessed to ensure that it is not turning into skin cancer.
Melanoma is the third most common skin cancer. Most commonly, melanoma appears as an irregular mole but can sometimes appear as a rapidly growing bump. One type of melanoma presents as a patchy discoloration on the face or scalp that enlarges very slowly.
ABCDEs of Melanoma
Asymmetry. If you drew a line down the center, the spot looks different in shape or color on either side of the line.
Irregular Border. The edges of the spot are irregular or jagged rather than smooth.
Color. The spot has a combination of more than one color – browns, blacks, white, blue, red.
Diameter. Most (but certainly not all) melanomas are larger than 6mm (the size of a pencil eraser).
Enlarging. A clue to melanoma versus a normal mole is that the spot is changing – typically getting larger.
It is important to determine how deep the melanoma is as early as possible to prevent spreading of the cancer. If caught early, melanoma can be cured by simple surgical removal of a small margin of skin. This procedure can often be completed under local anesthetic without additional testing or surgical follow-up needed outside of care with your dermatologist.
However, for deeper melanomas, further testing or treatment may be recommended, including sampling of the lymph nodes and additional medical treatment.
Early detection leads to higher cure rates; any suspicious or changing “mole” should be examined.