Melanoma is the most deadly form of skin cancer. Anyone can get melanoma. When found early and treated, the cure rate is nearly 100%. Allowed to grow, melanoma can spread to other parts of the body. Melanoma can spread quickly. When melanoma spreads, it can be deadly.
The number of deaths from melanoma would be much lower if people take the time to look at the moles on your skin because this is a good way to find melanoma early. When checking your skin, you should look for the ABCDEs of melanoma.
One half is unlike the other half.
An irregular, scalloped or poorly defined border.
Is varied from one area to another; has shades of tan, brown or black, or is sometimes white, red, or blue.
Melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller.
How is melanoma treated?
The type of treatment a patient receives depends on its depth (which is determined based on the initial biopsy) and whether lymph nodes and/or other organs are involved.
Excision: In general, this is an in office surgical procedure. It involves numbing the area to be treated and cutting out any remaining tumor plus some normal-looking skin around the tumor. The specimen is examined again under microscope to ensure that the margins are clear and the entire tumor has been removed.
Lymphadenectomy (Sentinel node biopsy): This is surgery to remove lymph nodes and is performed by a surgical oncologist.
Immunotherapy/Chemotherapy: Help the patient’s immune system fight the cancer. The newer drugs such as Yervoy® and Zelboraf ® have dramatically improved the treatment of metastatic melanoma.
This depends on how deeply the melanoma has grown into the skin. If the melanoma is properly treated when it is in the top layer of skin, the cure rate is nearly 100%. If the melanoma has grown deeper into the skin or spread, the patient may die.
Basal Cell Carcinoma (BCC)
Basal cell carcinoma (BCC) is the most common form of skin cancer. More than two million cases of this skin cancer are diagnosed in the United States each year.
This skin cancer usually develops after years of sun exposure. Around 50 years of age, the risk of developing skin cancer increases significantly, although patients younger than 50 years of age also can get BCC if they have some risk factors. These include those individuals who spent a lot of time outdoors for work or leisure, have frequently used tanning beds, and have certain physical traits such as Light-colored or freckled skin, blue, green, or gray eyes, blond or red hair.
This type of skin cancer grows slowly and rarely spreads to other parts of the body. Although rare, BCC can feel painful or itch. Usually, the only sign of BCC is a growth on the skin.
This skin cancer usually develops on skin that gets sun exposure, such as on the head, neck, and back of the hands. BCC is especially common on the face, often forming on the nose. It is possible to get BCC on any part of the body, including the trunk, legs, and arms.
BCCs may look like a sore that:
Bleeds easily, won’t heal, oozes or crusts over, or appears healed but then returns again. It is also sometimes confused as a “pimple” or a sore due to eyeglasses.
Diagnosis, treatment, and outcome
A basal cell carcinoma is diagnosed after an initial skin biopsy. Once diagnosed, there are several ways to treat BCC:
Excision: This is a surgical procedure that we often can perform during an office visit. It involves numbing the area to be treated and surgically removing any remaining tumor plus some normal-looking skin around the tumor. This procedure involves sutures that are placed both deep and on the outside; depending on the area, the patient returns in 1-3 weeks to have their sutures removed.
Curettage and electrodessication: This treatment consists of two steps. First, the tumor is scraped, then an instrument that uses electricity is used to destroy and cauterize any remaining cancer cells. No sutures are used when a skin cancer is treated this way.
Mohs surgery: ( See Mohs surgery). For facial skin cancers or those greater than 2 cm on non-facial areas, Mohs surgery is the preferred method of removal as it offers the highest chance of cure (and thus lowest chance of recurrence) of the tumor.
Radiation: This treatment usually is reserved for BCCs that cannot be cut out, or when surgery may not be the best choice.
Photodynamic therapy (PDT): This treatment uses light to remove early skin cancers.
Prescription creams: Creams that contain a drug, such as Imiquimod can sometimes be used to treat early skin cancers or shrink them before their eventual removal (usually by Mohs surgery).
Nearly every basal cell cancer can be cured, especially when the cancer is found early and treated.
Squamous cell carcinoma
Squamous cell carcinoma (SCC) is the second most common type of skin cancer. About 700,000 new cases of this skin cancer are diagnosed in the United States each year.
This skin cancer tends to develop on skin that has been exposed to the sun for years. It is most frequently seen on sun-exposed areas, such as the head, neck, and back of the hands. Women frequently get SCC on their lower legs.
It is possible to get SCC on any part of the body, including the inside of the mouth, lips, and genitals.
SCC can spread to (metastasize) to other parts of the body, although this is generally rare. With early diagnosis and treatment, SCC is highly curable.
Symptoms of SCC:
- A bump or lump on the skin that can feel rough.
- As the bump or lump grows, it may become dome-shaped or crusty and can bleed.
- A sore that doesn’t heal, or heals and returns.
- Flat, reddish, scaly patch that grows slowly (Bowen’s disease).
- In rare cases, SCC begins under a nail, which can grow and destroy the nail.
SCC can begin in a pre-cancerous growth
Some SCCs begin in a pre-cancerous growth called an actinic keratosis (or AK). In adults 40 and older, it is believed that about 40 to 60 percent of SCCs begin in an AK. Signs and symptoms of an AK include:
Most SCC is caused by ultraviolet (UV) rays from the sun or tanning beds. Other causes include:
- Long-term exposure to cancer-causing chemicals, such as when a person smokes tobacco, is exposed to tar, drinks from a water supply that contains arsenic, or uses some insecticides or herbicides.
- A serious burn.
- Ulcer or sore on the skin that has been there for many months or years.
- Some types of the human papillomavirus (HPV).
Diagnosis, treatment, and outcome
As with a basal cell carcinoma, the only way to diagnose any type of skin cancer, including squamous cell carcinoma (SCC), is with a skin biopsy done as a quick and easy in-office procedure.
Excision: It involves numbing the area to be treated and cutting out any remaining tumor plus some normal-looking skin around the tumor. In our experience, the majority of SCCs are treated with a “standard” excision which can take anywhere from 15 to 30 minutes as an outpatient/in-office procedure.
Mohs surgery: This procedure is reserved for larger SCCs or those on the head and neck.
Curettage and electrodessication: First, your dermatologist scrapes away the tumor. Then electricity is used to destroy any remaining cancer cells.
Photodynamic therapy (PDT): This treatment uses light to remove some very early skin cancers.
Chemotherapy cream: Creams containing Imiquimod or a chemotherapy drug, 5-fluorouracil (5-FU), can be used to treat SCC in the earliest stage or used to shrink the tumors before their excision.
Radiation: This treatment is usually reserved for SCCs that cannot be cut out, or when cutting may not be the best choice. A patient may need 15 to 30 radiation treatments.
In our experience and those reported in the literature, a standard excision and Mohs surgery offer the highest chance of cure for this treatable malignant skin tumor.
Actinic Keratosis (AK)
An AK represents a precancerous growth that develops when the skin is badly damaged by ultraviolet (UV) rays from the sun or indoor tanning. Left untreated, AKs may turn into a squamous cell carcinoma.
The AKs can be treated before they become skin cancer. If skin cancer does develop, it can be caught early when treatment often cures skin cancer.
Actinic keratoses (AKs): AKs form on skin that soaks up lots of sun over the years. An actinic keratosis (ak-ti-nik ker-ah-TOE-sis), or AK, is a rough, dry, scaly patch or growth that forms on the skin.
Signs and symptoms
Rough-feeling patch on skin that cannot be seen, rough patch or growth that feels painful or is “sensitive” to touch, itches or burns. On the lips, they appear as dry skin patches that do NOT resolve despite use of ample moisturizers and/ or use of chapstick.
Treatment options for actinic keratosis:
Cryotherapy: Destroys visible AKs by freezing them. The treated skin often blisters and peels off within a few days to a few weeks. This is the most common treatment. When the skin heals, you may see a small white mark.
Chemical peel: This is a medical chemical peel. You cannot get this peel at a salon or from a kit sold for at-home use. This strong peel destroys the top layers of skin. The treated area will be inflamed and sore, but healthy new skin will replace it.
Curettage: Your dermatologist carefully removes a visible AK with an instrument called a curette. After curettage, your dermatologist may use electrosurgery to remove more damaged tissue. Electrosurgery cauterizes (burns) the skin. New healthier skin will appear.
Photodynamic therapy (PDT): A solution is applied to make the skin more sensitive to light. After a few hours, the treated skin is exposed to a visible light, such as blue or laser light. The light activates the solution and destroys AKs. As the skin heals, new healthy skin appears.
Prescription medications: There are a number of topical medications that you can use at home to treat AKs either as a stand-alone procedure or in complement with the in-office procedure.