The days of the Coppertone girl showing off her tan line may be a thing of the past, but the occurrence of skin cancer continues to grow. Skin cancer is the most common cancer in the United States. Twenty percent of us will develop skin cancer sometime of our lives. The incidence of basal cell carcinoma has increased 145 percent since the 1970s; squamous cell carcinoma cases have increased 263 percent. Scariest of all — the American Cancer Society estimates that one million Americans are living with untreated melanoma.
Having your skin checked annually is the key. When skin cancer is detected early, particularly with melanoma, the success rates are very high. But when you brush off the possibility of having skin cancer you roll the dice: it’s estimated that 9,500 people will die from melanoma this year.
At The Plastic Surgery Group of New York, our surgeons have extensive experience in skin cancer removal. We use a variety of options for removing skin cancers, from excision to Mohs micrographic surgery. And our cosmetic expertise ensures scarring will be kept to a minimum.
What Is Skin Cancer?
Skin cancer occurs when the sun’s ultraviolet rays alter the genetic material in skin cells, causing them to mutate into cancer cells. Your degree of inherent protection can depend on the amount of melanin in your skin. Melanin is responsible for the pigment of our skin, and it acts as a protection against sun exposure. When our skin cells receive UV radiation, the melanin turns the skin a darker tone (tanning), as a protection mechanism.
That’s why fair-skinned people are more susceptible to skin cancer — they have less melanin in their skin. It’s estimated that up to half of all fair-skinned people who live to be at least 65 years old will develop at least one skin cancer in their lives.
What Are The Different Types Of Skin Cancer?
Everyone, no matter the skin type, should check his or her skin periodically. Have a partner check your back. Here is what the different varieties will look like:
- Actinic keratoses
Actinic keratoses are not yet skin cancer. They are precancerous, but if left alone they can turn into basal or squamous cell carcinomas. These precancerous growths will be dry, scaly patches on areas that receive lots of sun exposure. Most people see their first actinic keratoses after age 40.
- Basal cell carcinoma
This is the most common type of skin cancer. Eight out of 10 skin cancers are basal cell carcinomas. They grow in the lowest layer of the epidermis, the basal cell layer. These cancers usually develop on sun-exposed areas, especially the head and neck. They tend to grow slowly and it is rare that they spread to other parts of the body. If left untreated, basal cell carcinomas can grow into nearby areas and invade bone or other tissues beneath the skin, making removal potentially disfiguring.
Basal cell carcinomas look like a flesh-colored, pearl-like bump or pinkish patch of skin.
- Squamous cell carcinoma
The second most common form of skin cancer, squamous cell carcinoma accounts for roughly one fifth of all skin cancers. These cells will look like abnormal versions of the squamous cells that are in the outer layers of the epidermis. Squamous cell cancers appear on sun-exposed areas of the body such as the face, ears, neck, lips, and backs of the hands. They are more likely to spread to other parts of the body than basal cell cancers, but this is still rare.
Squamous cell carcinomas will look like a red firm bump, scaly patch, or a sore that heals and then re-opens.
This deadliest form of skin cancer is also the most rare. But, unlike basal and squamous cell cancers, melanomas are far more likely to grow and spread if left untreated. When melanomas grow downward, they can begin to deposit cancerous cells into the bloodstream, which can then spread the cancer anywhere in the body.
A melanoma will suddenly appear as a new dark spot on the skin. They will also show as a change in the size, shape, color, or elevation of an existing mole. This is more typical in people with over 50 moles. With melanoma, you can follow the ABCDE warning signs:
- Asymmetry — If one half of the mole doesn’t match the other half, that’s a concern. Normal moles are symmetrical.
- Border — If the border or edges of your mole are ragged, blurred, or irregular, it should be checked.
- Color — Normal moles are a single shade throughout. If your mole has changed color or if it has different shades of tan, brown, black, blue, white, or red, then it should be checked.
- Diameter — If a mole is larger than the eraser of a pencil, it needs to be checked.
- Evolving — If a mole evolves by shrinking, growing larger, changing color, itching or bleeding, or other changes, it should be checked. Melanoma lesions often grow in size or gain height rapidly.
How Will I Know If I Have Skin Cancer?
The only way to know for sure is to be screened by a dermatologist for skin cancer. But you should perform self-tests on your skin at home. Obviously, you’ll need someone else to check your back. What you want to look for are suspicious-looking growths that follow the descriptions listed above. Check sun exposed areas, obviously, but also look between your toes and on your palms because melanoma can develop even in spots that don’t receive UV radiation.
Am I At Risk For Developing Skin Cancer?
The main risk factor for developing all types of skin cancer is natural and artificial ultraviolet light. Basal cell and squamous cell cancers typically result from accumulated UV exposure over time. You can think of it as a continually increasing tally over your lifetime, eventually producing cancerous growths. Melanoma also develops from accumulated exposure, but is more a result from scorching sunburns.
Here are various risk factors for skin cancer:
- One blistering sunburn during childhood or adolescence (and most of us have had a few) doubles a person’s chances for developing melanoma later in life. Five or more of these types of sunburns increases your melanoma chances by 80 percent.
- People over 65 are more at risk for all skin cancers due to accumulated exposure.
- Exposure to tanning beds increases the risks for all skin cancers
- People with more than 50 moles have a higher risk for melanoma
- People who have had melanoma have a nine-fold increased risk for developing another melanoma compared to the general public.
- From 40 to 50 percent of people with fair skin will develop at least one skin cancer in their lives.
- People with blond or red hair are more susceptible to develop all skin cancers.
How Is Skin Cancer Treated?
Small skin cancer growths can be removed with a variety of techniques. With cryosurgery, the growth is frozen with liquid nitrogen. The frozen cells crust and scab and then fall off within a couple weeks. Electrodesiccation uses an electrocautery needle to burn and destroy the cancerous cells. Excision can be done with a curette for small growths. This is an instrument with a sharp, ring-shaped tool. Surgical excision with a scalpel, taking the cancerous growth along with a surrounding border of tissue as a safety margin, can be used on larger growths.
The most effective surgical method for skin cancer removal is Mohs micrographic surgery. It has the best chance of complete removal and it creates the least scarring. During the procedure, one thin layer of tissue is removed at a time. While the layers are removed, the margins of the tissue are studied under a microscope for the presence of cancer cells. If the result of the microscopic study shows that the margins are cancer free, then the surgery ends. If there are cancer cells present in the tissue, more tissue will be removed from where the cancer cells were found. The procedure repeats itself until the margins of the tissue sample show that they are free of cancer. Mohs micrographic surgery eliminates any guesswork in the removal of skin cancer, and can produce some of the best therapeutic and cosmetic results.
Surgical Removal Of Skin Cancer
While cryotherapy and electrodesiccation are not technically surgical procedures, the short answer is you will need to have your skin cancer removed. The method used depends on the type, area, and size of your skin cancer. Leaving skin cancer untreated isn’t like leaving an innocuous mole alone. Skin cancer will continue to grow, possibly invading nearby tissues and bone, and, in the case of melanoma, can spread through the bloodstream to any part of the body.
Recovery After Skin Cancer Removal
Skin cancer recovery is a widely variable depending on where the cancer is, what type it is, and the size of the growth. For instance, curettage involves a very small blade to scrape off the growth. This can be covered with a butterfly bandage and usually won’t require any stitches. Cryotherapy will make the growth crust over and scab, but there isn’t any recovery necessary.
Larger excisions and Mohs techniques may require plastic surgery to improve the scarring in the area. Larger incisions may require avoiding certain activities as the wound heals.
Before your surgery, we will discuss the probable recovery with you.
Will My Cancer Return After Mohs Surgery?
Mohs micrographic surgery has the highest overall cure rate for skin cancer removal — from 94 to 99 percent. This is because the borders of the removed skin are checked immediately to see if all of the cancerous cells have been removed. With excisional surgery, the accepted rate for primary tumors is 92 percent, but this rate drops to 77 percent for recurrent squamous cell cancers.
Whether it is a return or not, if you have developed one skin cancer you are far more likely to develop additional growths down the road. That is why yearly skin checkups are necessary, particularly if you have been diagnosed with any type of skin cancer in the past.
How To Prevent Skin Cancer
Skin cancer is caused by exposure to the sun’s ultraviolet rays (or the UV rays of tanning beds). There’s a bit of “what’s done is done” involved with sun exposure. You can’t do anything about the sun exposure you’ve already had, and it can lead to skin cancer even if you’re very diligent about protecting your skin now. Still, wearing sunscreen of at least 30 SPF, wearing hats and other protective clothing are the best options to help prevent skin cancer. You don’t have to go live in a cave because when detected early, most skin cancer treatments are very successful. You need to get in the habit of checking your skin for suspicious-looking lesions and of having a dermatologist check your skin once a year.