Basal and Squamous Cell Skin Cancers: Treatment including Mohs Surgery Video - Brigham and Women’s
How to Treat Skin Cancer
Skin cancer is best defined as the abnormal growth of skin cells, often due to too much sun exposure, but there are other factors to consider also.There are three main types of skin cancer, which are named based on which layer of skin is affected: basal cell carcinoma, squamous cell carcinoma and melanoma. Melanoma is the rarest form, but also the most deadly type because it's most likely to spread to other parts of the body. Checking your skin for unusual changes on a regular basis can help detect cancer in its early stages, which gives you the best chance of successful treatment.
Recognizing Skin Cancer
Focus on skin most exposed to the sun.Although skin cancer can develop anywhere on the body, it's most likely to occur on areas with the most sun exposure.It's the UV radiation in the sun that damages the DNA of skin cells and makes them mutate into cancer cells. Thus, spend more time checking parts of your body that get the most sun, such as your scalp, face (especially your nose), ears, neck, upper chest, forearms and hands. Look for unusual marks and blemishes on your skin, especially new growths (see below).
- It's obviously a good idea to not let certain areas get constant sun exposure, but some outdoor jobs make it difficult. If you can't always cover skin up, then apply a strong sunscreen that blocks out UV radiation.
- Women tend to be more susceptible to skin cancer on their legs and upper arms because they wear skirts, shorts and halter tops.
- Check your skin for unusual spots while you're naked (just prior to bathing, for example) so you can see as much of your skin as possible. Use a magnifying glass if your eyesight is poor.
Determine your risk factors.Some people are more susceptible to skin cancer than others because they have more risk factors. The main risk factors currently identified include: fair skin with freckles, red hair, over-exposure to UV radiation (from the sun or tanning beds), history of serious sunburns, having lots of moles, prior radiation treatments, weakened immunity, exposure to arsenic and a family history of skin cancer.Some of these risk factors can't be avoided (skin complexion), but some are merely behaviors that can be changed, such as being cautious while in the sun.
- Any skin color is susceptible to cancer, but lighter shades have less pigment (melanin), which is protective against the damaging effects of UV radiation. This makes people with lighter skin more at risk for skin cancer.
- Blistering sunburns as a child/teenager increases your risk of getting skin cancer as an adult.
- People who live in sunny and/or high-altitude climates get more UV exposure. That's beneficial for producing vitamin D and lowering your risk of depression, but a potential risk factor for developing skin cancer.
- Moles are not cancerous, but large irregularly shaped ones (called dysplastic nevi) can become cancerous when exposed to lots of UV radiation.
Distinguish between different cancer types.It's important to understand the differences between normal marks on the skin (such as freckles, moles, warts, pimples) and skin cancer. For examples, basal cell carcinoma often appears as pearly/waxy bumps in its early stages, and later as a flat, flesh-colored or brown scar-like lesions.In contrast, squamous cell carcinoma often appear firm, red nodules and progress to flat lesions with scaly, crusted surfaces. Finally, melanomas can appear as large brownish spots with darker speckles, or small lesions with irregular borders and colorful speckles (red, white, blue-black).
- Basal cell carcinomas almost always appear in sun-exposed areas, such as your neck or face.
- Squamous cell carcinomas also appear in sun-exposed areas and are more common in darker-skinned people.
- Melanoma tends to develop anywhere, even on skin that has no sun exposure. It has a tendency to develop on the palms, soles, fingertips or toes.
Learn the ABCDEs of melanoma acronym.A handy acronym to learn and help you identify potential melanomas on your skin is referred to as the ABCDEs of melanoma.More specifically, the characteristics are: A = asymmetry, B = border, C = color, D = diameter and E = evolving.
- Asymmetry: one half of the mole/blemish is unlike the other half.
- Border: a mole/blemish with an irregular, scalloped or poorly defined border.
- Color: the mole/blemish is varied from one area to another — has shades of tan, brown or black, or is sometimes white, red or blue.
- Diameter: melanomas are usually greater than 6 mm when diagnosed, but they can be a little smaller.
- Evolving: a mole/blemish that looks different from others or is changing in size, shape or color.
- Consult your dermatologist immediately if any of your moles or pigmented spots exhibit the above-mentioned signs or features.
Getting Professional Treatment
Make an appointment with your family doctor or dermatologist.If you find unusual looking marks or blemishes on your skin, particularly if you didn't notice them before or they've recently transformed, see your doctor right away. Your family physician can rule out most other skin conditions that can mimic cancer (such as eczema, psoriasis, ingrown hairs, carbuncles, skin tags), but you'll likely get referred to a skin specialist called a dermatologist.Remember that catching skin cancer early makes treatment much more effective.
- To better diagnose your skin condition, the doctor will likely take a skin biopsy (tissue sample) and look at it under a microscope. Different types of skin biopsies are called a shave biopsy and a punch biopsy.
- In addition to a suspicious look, skin cancer can get itchy, inflamed and tender to touch. In some cases, particularly with melanoma, the skin can bleed and form a scab.
- Most cases of skin cancer change/grow slowly. If it gets bigger quickly, it's usually a more serious variety of skin cancer.
Ask your doctor about non-surgical procedures.There are a number of non-invasive and quick procedures that are used if your skin cancer is a simple basal cell carcinoma or a thin squamous cell carcinoma — not nearly as serious or dangerous as melanomas.Examples include radiation therapy, chemotherapy, photodynamic therapy and biological therapy.
- Radiation therapy uses high-powered focal x-rays to kill skin cancer cells. It's typically used for basal cell carcinomas that can't easily be cut out. Patients often need 15-30 treatments.
- Chemotherapy involves using cancer killing drugs in ointments or creams that are applied directly to the skin lesion. This treatment is limited for cancers on the skin's surface, not deeper ones.
- Photodynamic therapy (PDT) uses laser light after chemicals are applied to the skin and absorbed. The combination destroys cancer cells because the drugs make them sensitive to the high-intensity light.
- Biological therapy (or immunotherapy) enlists your immune system to kill cancerous cells. You're given compounds (interferon, imiquimod) made by your body or in the lab that boost your natural defenses against cancer.
Ask your doctor about cryosurgery (freezing).Skin cancer treatment varies greatly and depends on the size, type, depth and location of the lesion(s). Small skin cancers on the surface are easiest to remove, either by shaving them off or by freezing them off.Getting cryosurgery is a sign your skin cancer is small and not very dangerous. Your doctor then applies liquid nitrogen to the lesion to freeze and kill the cells, and then the dead tissue eventually sloughs off when it thaws — it takes a few days.
- Cryosurgery can be very effective for small basal cell carcinomas and squamous cell carcinomas because they are closer to the surface of the skin, but it's not often used for deeper melanomas.
- Cryosurgery is also used to remove warts and skin tags. It's a quick and simple procedure that's that very painful.
Consult your doctor about excisional surgery.Excisional surgery involves cutting (or excising) out the cancerous tissue and the surrounding margin of healthy skin.Sometimes quite a bit of normal skin is removed around the lesion just to be on the safe side, which leaves a relatively large wound to heal. This type of surgery is appropriate for any type of skin cancer, even deeper melanomas.
- Excisional surgery is performed by your dermatologist during an office visit. The area around the lesion is numbed with topical anesthesia.
- The removed marginal (normal) skin is always examined under the microscope to see if it's truly free of cancer cells.
Expect Mohs surgery for more serious skin cancers.Mohs surgery involves removing successive layers of skin from a lesion and examining each layer under the microscope until no cancerous cells can be seen.It's similar to excisional surgery, but it allows cancer cells to be removed without taking lots of surrounding healthy skin (smaller wounds and quicker recovery). Mohs surgery is more appropriate for larger, recurring or difficult-to-treat skin cancers.
- Mohs surgery is often used on the nose, where it's necessary to conserve as much skin as possible.
- Mohs surgery has a reputation for offering the highest cure rate for difficult-to-treat basal cell carcinomas.
Talk with your doctor about the need for curettage or electrodesiccation.This treatment involves scraping away the surface tumor with a sharp, spoon-shaped tool called a curette and then destroying any remaining cancer cells with an electric needle (electrodessication).The electricity not only destroys cancer cells, but it also cauterizes the wound so it doesn't bleed. The procedure is often repeated up to 3 times to get all of the cancerous cells.
- Electrodesiccation is used on essentially all skin cancer types, although it's more effective and efficient on smaller lesions closer to the surface of the skin.
- This technique tends to leave a moderate wound, less than regular excisional surgery, but bigger than that left from Mohs surgery.
QuestionWhat can I do to ease the discomfort of itching around a suspected skin cancer?wikiHow ContributorCommunity AnswerWhatever you do, don't scratch until it bleeds. With some exceptions, cancer growth raises exponentially when exposed to oxygen.Thanks!
How do you treat skin cancer
How long is the operation to remove lymph nodes?
How do I treat my skin cancer?
To treat skin cancer, monitor your skin so you notice changes as soon as they appear. A helpful acronym to remember is the “ABCDE’s” of melanoma, where A stands for asymmetry, B for border, C for color, D for diameter, and E for evolving. Abnormally shaped moles that you haven’t noticed before, unexplained bumps or lesions, or any weird variation in your skin’s color or texture could merit a trip to the dermatologist. Your dermatologist will take a biopsy to check for cancerous cells, then will recommend a surgical or nonsurgical treatment.
- Other less common types of skin cancer include Kaposi sarcoma (common in people with AIDS), Merkel cell carcinoma (often found in hair follicles) and sebaceous gland carcinoma (which originates in oil glands in the skin).
- Roman numerals (I through IV) are used to indicate a cancer's stage. Stage I are least serious and localized, whereas Stage IV indicates advanced cancer that's spread to other areas.
- Most basal cell and squamous cell carcinomas are successfully treated with minor surgery.
- If your skin cancer (melanoma) has spread to nearby lymph nodes, your doctor will need to remove them.
- You need to be vigilant for returning skin cancers, as the risk is higher if you've already developed skin cancer once.
- The elderly are more likely to develop skin cancer, along with most other cancers. Check yourself and any elderly family members who you may take care of to get any skin concerns evaluated early.
Video: The 4 Stages of Melanoma: The Deadliest Form of Skin Cancer - Mayo Clinic
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