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Skin Cancer

Skin Cancers and Moles (Nevus)

Regular "mole/lesion checks" should be performed by a general practitioner, dermatologist, or surgeon (Head and Neck/Facial Plastic and Reconstructive Surgeon; Plastic Surgeon) trained in the diagnosis and treatment of skin cancers. Any "suspicious" moles or lesions should then be excised or biopsied. Dr. Gaboriau regularly performs full face and body mole/lesion examinations as well as any necessary excisions and/or biopsies. Both the examination and treatment(s) are covered by insurance.

Moles (Nevus):

Moles can be cosmetically unappealing and worse, can be a precursor to the most serious form of skin cancer - Melanoma. Moles should be checked regularly and any changes should be addressed immediately.

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 areas of the face and body, and are most common in light-skinned individuals especially those who have had chronic sun exposure.

Basal Cell Carcinoma

BCCA is the most common cancer in the United States and its incidence is increasing. One estimation is that 1 out of 7 Caucasians will develop a BCCA at some point in their lives. Caucasians are the most at risk, especially those whose ancestry is from northern Europe. Individuals with a propensity to burn and a history of sunburns (especially during teenage years) or an inability to tan, are at highest risk of developing a BCCA. Unfortunately, due primarily to sun exposure BCCA is becoming more and more common in young people (under 30 years of age).

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, containing small vessels, and is often ulcerated (a 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 (the area surrounding the lesions) are not evaluated for positive disease. (Positive margins indicate that cancer is present; negative margins indicate normal, non-cancerous skin.)

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 an "en-block" excision; the other is Mohs micrographic surgery. Dermatologists usually perform the latter. The benefits are clear margins and low risk of recurrence.

 

Squamous Cell Carcinoma

Although it represents a minority of non-melanoma skin cancers, squamous cell carcinoma is responsible for up to 59% of deaths from such cancers. As with BCCA, light-skinned Caucasians with a history of sun exposure are at high risk for developing SCCA. Other risk factors include: immune status (especially recipients of organ transplant), chronic dermatoses (from sun exposure or from chronic exposure to chemical carcinogens), and some genetic abnormalities.

SCCA 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, etc.)

SCCA often appear as hard nodules on an indurated base, but they can appear in a scar (especially from an old burn), in a chronic ulcer, or from AK (one study showed that 60% of SCCA arose from pre-existing AK). Unlike BCCA, squamous cell carcinomas have a tendency to create metastasis.

Due to 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 for 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 with a history of severe sunburns in the first 2 decades of life, than chronic exposure), and a 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). However, please be aware that a lesion of less than 6mm CAN still be melanoma. A pink halo surrounding the lesion, as well as sudden growth, is also suspicious. Patients should regularly check their moles for any changes. Considering how rapidly a lesion can grow, we do recommend having it checked as soon as possible when any of 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 checked.

The treatment for melanoma is surgical excision with wide margins depending upon where the lesion is and how deeply it invades the skin.      

 



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