Written By: Robert Ripley, MD, FACS, General Surgeon
Nonmelanoma skin cancer includes basal and squamous cell carcinoma. BCC (basal cell carcinoma) arises from the basal keratinocytes of the epidermis (skin) and it is the most common cancer in humans. SCC (squamous cell carcinoma) arises from the keratinizing epidermal cells and is the second most common type of skin cancer.
The principal cause of BCC and SCC are frequent sun exposure (ultraviolet radiation), fair skin complexion, and immunosuppression. The incidence of these cancers is increasing and it is estimated that one in five Americans will develop skin cancer in the lifetime.
SCC of the skin is usually found on the head, neck or arms, and has raised edges with central ulcerations. BCC occur on sun-exposed areas of the head and neck, and usually presents as a non-healing sore that bleeds easily. Other lesions can be itchy or asymptomatic.
The increasing incidence of skin cancer is in part related to the destruction of the ozone layer. As this layer decreases the amount of UVR (ultraviolet radiation) reaching the earth’s surface increases. It has been shown that using sunscreen decreases the incidence of premalignant skin lesions, and it is recommended that sunscreen and protective clothing (hats) be used on a daily basis to decrease exposure to the sun.
The treatment of BCC and SCC is usually surgical excision done under local anesthesia. The pathologist will examine the tissue at its margins and if there is any microscopic cancer there then additional skin will be excised. Other options for treatment include cryotherapy and electrocautery which destroy the cancer leaving a sore that will heal over the next two weeks. Since no tissue is removed margins cannot be checked.
Melanoma is a cancer of the pigment producing cells of the skin called melanocytes. The incidence of melanoma is increasing faster than any other malignancy, and it is estimated that the life time risk for a white person is 1:75. In particular fair skinned individuals with freckles, blonde or red hair, and light colored eyes are at higher risk than whites with darker skin, and it is more uncommon in Asians or Blacks (but it does occur in these populations). In the United States, melanoma has an approximate mortality rate of 25%.
Men have a slightly higher incidence of melanoma than women. In men it usually occurs on the trunk, head or neck while in women it is more common on the legs. The usual presentation is a pigmented lesion that has recently changed by enlarging and raising up. The edges are irregular, and the color can range from pink to blue to black. As the lesion advances it can bleed and itch.
The first step to treating melanoma is to do a full thickness biopsy of any suspicious skin lesion. If melanoma is found then a wide excision of the lesion is performed and a sentinel node biopsy maybe done depending on the thickness of the melanoma. A sentinel node biopsy is a way to check the lymph nodes that drain the area of the melanoma, for spread of the disease.
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Contact Dr. Robert Ripley: 928-668-5506