Skin Cancers and Moles (Nevus) Removal
Moles (Nevus) Removal
Facial moles can be cosmetically unappealing and worse, can be precursor to a dreadful skin cancer: Melanoma. Regular “moles checks” should be performed by either your General Practitioner, a dermatologist and/or a surgeon trained in skin cancers (Head and Neck/Facial Plastic and Reconstructive Surgeon; Plastic Surgeon). Any “suspicious” lesions or moles should be either excised or biopsied.
Skin Cancers:
Each year about 2 million Americans are diagnosed with skin cancer. There are 3 types of skin cancer: BCCA (Basal Cell carcinoma), SCCA (Squamous cell carcinoma), and Melanoma.
BCCA and SCCA share several features. They have a predilection for sun-exposed sites and are common in light-skinned individuals. They are seen more in individuals with chronic sun exposure.
Basal Cell Carcinoma
BCCA is the most common cancer in the US and its incidence is increasing. One estimation is that 1 out 7 white Caucasians will develop a BCC at some point in their lives. Caucasians are the most at risks especially those originating from northern Europe. Individuals with a propensity to burn and a history of sunburns (especially during teenage years) or inability to tan are at high risks of developing a BCCA. Recently I have been seeing younger and younger patients with BCCA (less than 30 yo).
BCCA can occur anywhere on the body but the majority (85%) are on the head and neck. Classically it presents as a pearly, translucent, pink-white, dome-shaped papule, with small vessels in it and it is often ulcerated (non-healing sore). Generally any new lesions, which are growing slowly but steadily, should be checked.
Several surgical options are available to remove these tumors. Cryosurgery consists of freezing the tissue with liquid nitrogen. This technique is appropriate for small, superficial lesions. One of the drawbacks is that it could leave a discolored scar and that margins (margins are the surrounding of the lesions, the limits between cancerous skin and normal skin; positive margins means that the cancer is present, negative means that normal skin is present) are not evaluated for positive disease.
Radiation therapy is usually reserved for well-defined tumors in people who cannot tolerate surgery.
Surgical excision is the well-accepted method of treatment. One method is “en-block” excision and the other one is Mohs micrographic surgery. Dermatologists usually perform the latter. The benefits are clear margins and low risks of recurrence.
Squamous Cell Carcinoma
Although it represents a minority of nonmelanoma skin cancers, it is responsible for up to 59% of deaths from such cancers. As with BCCA, light-skinned Caucasians with history of sun exposure are at high risks for developing SCC. Other risks factors include: immune status (especially recipients of organ transplant), chronic dermatoses (from sun exposure but also from chronic exposure to chemical carcinogens), and some genetic abnormalities.
SCC can arise de novo (on “normal” skin), from chronic skin diseases or from precursor lesions (AK: actinic keratosis). They are most common on the head and neck but unlike BCCA they can develop on mucous membranes (inside the mouth, nose, sinus..)
They often appear as hard nodules on an indurated base but they can appear in a scar (especially from old burn), in a chronic ulcer, or from AK (one study showed that 60% of SCCA arose from preexisting AK). Unlike BCCA, squamous cell carcinomas have a tendency to create metastasis.
Due the potential deadly nature of these lesions a total surgical excision with margins is the rule. As with BCCA Mohs surgery can provide clear margins with a very low recurrence rate.
Melanoma
Melanoma is the most deadly of the three types of skin cancer. If diagnosed early the survival rate could be as high as 98% thus the importance of checking frequently any suspicious lesions.
Both men and women can develop melanoma. All skin types are at risk for melanoma. Melanoma can also arise from any mucosa (mouth, nose, sinus). Some of the risks associated with melanoma are sun exposure (more so history of severe sunburns in the first 2 decades of life than chronic exposure), and history of familial melanoma.
There are different types of melanoma but all share the same suspicious features described as the “ABCDs”. A stands for asymmetry of the lesion (the more asymmetric the more suspicious); B signifies borders being irregular; C represents variation in color; and D for diameter greater than 6mm (1/4 of inch). You need to be aware that a lesion of less than 6mm can still be melanoma. I had several patients who presented with a 2 to 3 mm lesions that were melanoma. Also a pink halo surrounding the lesion as well as sudden growth is suspicious. Patients should regularly check their moles for any changes. Considering how rapidly a lesion can grow, we do recommend having it check as soon as possible when these above changes occur. A rule of thumb is that if one mole doesn’t look like any of the other moles you have, you should have it check.
The treatment for melanoma is surgical excision with wide margins depending where the lesion is and how deep it invades the skin.