If you are coming to our practice, chances are you either live in Florida or spend a significant amount of time here. Skin cancer is not uncommon in our state. In fact, Colorado is number 2 in skin cancer incidence out of all states (right behind Hawaii). It’s a combination of our plentiful sunshine, outdoor lifestyle, and altitude that puts us in this position. Skin cancer is unfortunately common. In fact, current statistics show that 1-out-of-5 Americans will develop skin cancer in their lifetime.
Common subcategories of skin cancers
Basal Cell Carcinoma (BCC) is the most common kind of cancer (out of all cancers). Luckily, it is also the most slow-growing and easily-treated. Typical presentations range from a shiny (pearly), clear, or pink bump; to an open sore; or an irritated patch. These lesions don’t heal (present for at least 6 weeks) and typically grow slowly over time. Sometimes a BCC will bleed. These growths originate in the basal layer of skin cells (cells that line the base of the epidermis in the skin). Commonly, a BCC will appear on chronic sun exposure areas, such as the face, hands, and chest. The overwhelming majority of basal cell carcinomas do not metastasize (I’ve only seen 2 in twenty years). It is, however, important to have them treated, as the larger they grow, the more difficult (and disfiguring) they can be to treat.
Squamous Cell Carcinoma (SCC) is the second most common skin cancer (16%). These cancers originate from squamous cells (keratinocytes) in the most superficial skin layer (epidermis). Like the basal cell, squamous cell cancers tend to occur in chronically sun-exposed areas. Actinic keratoses can be precursors of SCC. Although most SCCs are easily treated and curable, they can be aggressive; a minority of lesions can metastasize (spread) to other areas of the body and impact your long-term health. Patients that are chronically immunosuppressed (organ transplant patients, for instance) tend to be particularly susceptible to developing SCCs. These tumors may occur as a scaly red area that bleeds, a tender or ulcerated nodule, or a thickened crust. Because of their potentially aggressive nature, we typically treat these more aggressively and don’t want you to postpone treatment (within a month of diagnosis).
Melanoma is the most dangerous of the common forms of skin cancer. It comprises just 4% of all diagnosed skin malignancies. Melanoma arises from melanocytes, which are the cells in our skin responsible for melanin (pigment) production. These tumors are often related to intense and intermittent sun exposure, such as tanning beds, or severe burns during a tropical winter vacation. Melanoma is responsible for almost 10,000 U.S. deaths yearly; this is tragic, as it is preventable. If a melanoma is identified and removed early, it has a high chance of being cured. If treatment is delayed, it may spread to lymph nodes and vital organs, and at this point, the disease becomes life-threatening.
Melanomas may originate from an existing mole that is changing or may occur as a completely new lesion. Patients often wonder what signs to look for. Typically, skin experts recommend the following guidelines: The A, B, C, D, and E’s of Melanoma.
A: Stands for Asymmetry, as in one side of the mole doesn’t look like the other. The two sides are not uniform.
B: Border irregularity. Instead of a uniform smooth border, an atypical or cancerous mole will often have a smudged or jagged border.
C: Color Variegation. The color is not uniform throughout the mole. Dark brown, light brown, red, pink, black, and even white areas may be present in a worrisome lesion.
D: Diameter. A diameter of 6 millimeters or greater generally catches our attention. 6mm is the size of a pencil eraser head, for easy reference.
E: The most important component to evaluating your moles …EVOLUTION, or change in a mole. If you notice any of your moles changing, you should get in right away to be seen.
Merkel Cell Carcinoma is a rare but aggressive skin cancer that has a high rate of recurrence and metastasis (spread). It is associated with polyomavirus infection. Merkel cells are located at the base of the epidermis, and the malignancies occur in sun-exposed areas (usually on the head neck, and eyelids). Patients likely to have Merkel cell carcinoma are fair-skinned and over the age of 50. When tumors appear, they are usually painless, red, skin-colored, or purple, and about the size of a dime. Early detection is extremely important for a cure.
