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A brief look at skin cancer

October 3, 2014

Cancer begins in our cells. Normal cells grow and divide to form new cells as we need them. They may grow old, get damaged, die, and then new cells take their place. Sometimes the process goes wrong. In the case of cancer, new cells form when the body doesn’t need them and the buildup of the additional cells forms a mass of tissue referred to as a growth or tumor.

Such growths can be benign or malignant. With regards to our skin, benign growths (i.e. moles) rarely threaten life, typically can be removed and do not grow back, do not usually invade the tissues around them or spread to other parts of the body.

On the other hand, malignant growths (i.e. melanoma, basal cell cancer or squamous cell cancer) may be a threat to life, often can be removed but may grow back, and can invade and damage nearby organs and tissues and spread to other parts of the body.

Our skin protects us from heat, injury, infection and the damage caused by ultraviolet (UV) radiation to name a few. It is made up of two main layers. The epidermis is the top layer of our skin made up of flat cells on top called the squamous cells, and below these round cells called basal cells. Scattered among the basal cells are the melanocytes which make up the deepest part of the epidermis and are the cells which make us tan as they make up the color or pigment of our skin. Beneath the epidermis is the dermis which is made up of many different types of cells and structures.

Most Common Types of Skin Cancer 

  • Melanoma: Can occur on any skin surface and forms in the melanocytes. In men, it is often found on the head, neck or between the shoulders and hips. In women, it is often found on the lower legs or between the shoulders and hips. Melanoma is more likely to spread to other parts of the body than other forms of skin cancer.
  • Basal cell skin cancer: Begins in the basal cell layer of the skin. It is often found in places that have received the most sun exposure over time such as the face, rarely spreads to other parts of the body, and is the most common form of cancer in the US.
  • Squamous cell skin cancer: Begins in the squamous cells; the flat cells that form the surface of the skin. Interestingly, for dark skinned people this is the most common type of skin cancer often found in places that have not received the most sun exposure over time such as the legs and feet. This form of skin cancer may spread to other parts of the body.

Checking Your Skin
You can play an important role in watching and checking your skin for any changes. There are several things to keep in mind when you are doing a skin self-exam:

  • Check for anything new such as a new mole, a new red or darker color flaky patch that may be slightly raised, a new flesh-colored firm bump, a change in the size, shape, color or feel of a mole, and/or a new sore that doesn’t heal.
  • Check yourself after a shower or bath, in a room with plenty of light, using both a full-length and hand-held mirror.
  • Become familiar with your birthmarks, moles, and other marks. Checking your skin regularly will help you know what is normal for you.
  • Check yourself from head to toe! Look at your face, neck, ears and scalp. Look at the front and back of your body; raise your arms to check both sides. Check your fingernails, palms and all areas of your arms. Examine all areas of your legs, your genital area and buttocks. Check your feet completely including your nails, between your toes and even the soles of your feet.

The main risk factor for skin cancer is our exposure to UV radiation. We also know that having at least one severe and blistering sunburn increases our risk, as well as our total lifetime exposure to sunlight. Personal and family history, and fair skin or skin that burns easily also play a large role.

Symptoms of Melanoma
Melanomas vary greatly in how they look. “ABCDE” can be an easy way to remember what to look for when looking for a possible melanoma, keeping in mind that a melanoma can show all or some of these features:

  • Asymmetry: The shape of one half of the existing or new mole does not match the other.
  • Border that is irregular: The edges are ragged, notched or blurred. The pigment may spread into the surrounding skin.
  • Color that is uneven: Shades of brown, black, and /or tan. Areas of white, gray, red, pink or blue may also be seen.
  • Diameter: A change in size, usually an increase. Most are larger than the size of a pea, although they can be tiny.
  • Evolving: The mole has changed over the past few weeks or months.

Symptoms of Basal Cell and Squamous Cell Skin Cancers
A change on the skin is the most common sign of skin cancer and the appearance of one varies greatly from another. Common symptoms of basal and squamous cell skin cancers may include:

  • A lump that is small, smooth, shiny, pale or waxy.
  • A lump that is firm and red.
  • A sore or lump that bleeds or develops a crust or a scab.
  • A flat red spot that is rough, dry or scaly and may become itchy or tender.
  • A red or brown patch that is rough and scaly.

Typically, suspicious moles are biopsied, and the skin sample is sent to the lab so that a pathologist can check the sample. There are 4 common types of biopsies:

  • Shave Biopsy: the doctor uses a thin, sharp blade to shave off the growth
  • Punch Biopsy: the doctor uses a sharp, hollow tool to remove a circle of tissue from the area
  • Incisional Biopsy: the doctor uses a scalpel to remove part of the growth
  • Excisional Biopsy: in this type of biopsy, the doctor (usually a dermatologist or even a plastic surgeon) uses a scalpel to remove the entire growth as well as some of the surrounding tissue. This type of biopsy is typically used for growths that appear to be melanoma.

We have discussed prevention in past issues of our monthly Health Matters and by now most of us know what to do. Use sunscreen with an SPF factor of 15 or higher, apply it often, avoid outside activities during the middle of the day when the suns rays are the strongest, wear long sleeves, pants and hats …

Please give us a call or send us a secure message if you notice an area on your skin that seems to be changing. We are more than happy to see you to check the area of concern. We are able to do three of the four mentioned biopsies in our clinic. In some cases, we may refer you to a dermatologist if you need more regular skin screenings, an excisional biopsy to remove a larger area of skin, or lab results have returned indicating a possible new skin cancer.