Skin cancer is the most common type of cancer in the United States and is directly linked to ultraviolet (UV) exposure. One in five Americans will develop some form of skin cancer over their lifetime. This may be from the sun or from tanning beds. Any sun burn increases your chance of developing these types of cancers. Certain people are more predisposed to this including light hair, blue eyes, and fair skin. Those who are immunosuppressed, whether from transplants or other cancer treatments are also at a higher risk. The three most common types are basal cell carcinoma, squamous cell carcinoma, and melanoma, in that order.
Concerning findings include any skin lesion that is growing, becoming itchy, or bleeds and never seems to heal. Basal cell carcinoma is the most common but least aggressive. It tends to develop around the nose and ears but it can be found anywhere on the face. It grows slowly and has almost no chance of spreading, although it can become locally destructive. Treatment options include freezing them (cryotherapy), shaving them (curettage), radiation (rarely used), topical medications, and surgery. Factors that decide what is the best treatment option include your overall health, history of skin cancers, and previous treatments you have received.
Squamous cell carcinoma is the next most common. It can develop anywhere on the face but sun exposed areas such as the ears and scalp may have more sun exposure. It can also be found in long standing scars or ulcers. This type of skin cancer grows faster than basal cell carcinoma. If not addressed in a timely manner, it does have a chance of spreading, especially as it grows larger. Treatment most commonly involves surgery but for select, early lesions, some topical creams are available.
Melanoma is the least common of the three but is the most aggressive and increasing in incidence in the United States. Even small lesions can spread early. The ABC’s of melanoma include Asymmetry or that the lesion is not circular, Borders that are uneven or irregular, multiple Colors (brown, black, and red or a combination of the above), a Diameter larger than a pencil head, and finally Evolving or changing in size, shape, or color. Treatment involves surgery but may involve other therapy depending on the stage.
There are several ways of surgically removing skin cancers, depending on the type. Mohs surgery involves a Mohs surgeon who both removes the cancer and looks at it under the microscope. This leads to the smallest defect and reported rates of cure of 99%. The reconstruction may be performed at the same time but frequently it is delayed so a reconstructive surgeon can evaluate and repair the wound. It is ideal for smaller tumors and those that are in cosmetic locations. The other manner involves removing a margin of surrounding healthy tissue and having a pathologist evaluate the edges under a microscope. Both ways leave a defect. Dr. Guy is skilled in both the cancer removal as well as the reconstructive techniques in order to give you the most aesthetically pleasing scar and get you back to your normal activity, cancer free. All of this can be discussed with Dr. Guy in consultation.