Skin Cancer Types
There are two types of skin cancer: Malignant Melanoma and Nonmelanoma. Malignant Melanoma (MM) is the deadliest form of skin cancer. Nonmelanoma skin cancers include basal cell carcinoma (BCC) and Cutaneous Squamous cell carcinoma (cSCC). Nonmelanoma skin cancers are the most commonly diagnosed tumors in America, affecting more than three million each year. One in five Americans will develop skin cancer during their lives. A hallmark of cancer is a growth or sore that won’t heal.
Who is at risk for skin cancer?
Fair complexioned men and women who have long-term exposure to UV radiation from the sun or indoor tanning and have a history of sunburns and those with impaired immunity.
What causes skin cancer?
90% of nonmelanoma skin cancers and 86% of melanomas are associated with UV radiation from the sun or indoor tanning. UV radiation damages the DNA of the skin cells and leads to uncontrolled cell growth or tumors. Skin cancer usually develops on skin that is frequently exposed to the sun including the face, ears, chest, neck, scalp, hands, shoulders and back.
What are the treatment options?
Regardless of the type of skin cancer, early diagnosis and treatment is the key to successful outcomes. Treatment options depend upon the location of the cancer, the type of skin cancer, the severity of the tumor, your age and health. Treatment options include electrosurgery, Mohs surgery, excision, radiation, photodynamic therapy, cryotherapy, laser surgery, topical medications, and in more advanced cases oral medications. Dr. Saini is fellowship-trained in Mohs surgery, the gold standard for the treatment of non-melanoma skin cancers.
How is skin cancer diagnosed?
Dr. Saini will perform a physical examination looking for signs of skin cancer, review your medical history and when a lesion is suspected, will take a biopsy to confirm your diagnosis. A biopsy is performed by removing a small part of the lesion and sending it to a pathologist.
Non-melanoma Skin Cancers
Basal Cell Carcinoma
Basal Cell Carcinoma is the most common type of skin cancer and the most common of all cancers. Basal cells form new skin cells. BCC is the uncontrolled growth of basal cells. It is slow growing and is curable when found and treated early. However, if not treated early it can invade healthy tissues nearby and cause damage. Outpatient treatment for small and early BCC is often very successful. Men are more likely to be diagnosed with BCC.
BCC looks like a sore that won’t heal, red patches, pink growths, shiny bumps and scars or growths that are raised with rolled edges and are indented in the center. They my itch, crust, bleed or ooze. In people with darker skin tones, the lesions may be pigmented.
Cutaneous Squamous Cell carcinoma
Cutaneous Squamous cell carcinoma is the second most common type of skin cancer that affects about one million Americans each year. cSCC is the result of uncontrolled growth of abnormal squamous cells, thin cells that make up the epidermis or outer most layer of skin. cSCC is fast growing, usually not life threatening but can be disfiguring and can spread to the lymph nodes and other organs if left untreated. About 15,000 Americans die from invasive cSCC each year.
SCC looks like thick, scaly, red patches, open sores found on skin that receives the most sun exposure and from indoor tanning. The skin around the tumor usually has signs of sun damage. As it grows cSCC can become a raised bump with a depression in the center that crusts and bleeds. It can also grow in a scar, mole or birthmark. In addition to UV radiation, SCC has a genetic component, and can also arise after radiation treatments for another skin condition.
Early detection is essential to successful treatment. Many treatments are office procedures. When cSCC does not respond to treatments, invades underlying tissues, spreads beyond its original location or reoccurs it is considered to be an advanced case. Advanced cases of cSCC are treated with excision, Mohs surgery, radiation and immunotherapy.
Malignant Melanoma
MM develops in the skin cells called melanocytes, that produce melanin the pigment that give our skin color. MM is dangerous, spreads quickly and can be life-threatening. It is curable if diagnosed and treated at an early stage. New cases of MM based on 2020 estimates are for about 100,000 new cases and 6800 deaths. Before age 50, more women are diagnosed with melanoma. After age 50, more men are diagnosed with melanoma. Caucasians have the highest incidence of melanoma.
The 5-year survival rate for early detected melanomas is 98%. If it has metastasized to the lymph nodes survival falls to 63%. If it spreads to other organs, the survival rate is about 20%.
These skin tumors can occur anywhere on the body including areas never exposed to the sun.
However, melanoma is commonly triggered by intense, recurrent sun exposure that causes sunburns, and tanning indoors.
Melanoma tumors often look like moles and can sometimes grow from a mole. Normal moles tend to look alike. Melanomas look different than normal moles. Melanomas come in many forms.
Early warning signs include the ABCDEs:
- the lesion is asymmetric
- the borders are uneven
- the lesion has multiple colors like red, white, blue, black and brown
- the lesion diameter is like a pencil eraser (about a quarter inch in diameter), and
- the lesion evolves meaning the size, shape, color and elevation change, and new symptoms occur such as bleeding, itching, and crusting.
Diagnosis is by biopsy. When melanoma is diagnosed your dermatologist will stage the tumor to determine the treatment that is right for your situation. Staging usually requires additional tests include imaging tests and blood tests. Treatment options include surgery, immunotherapy, targeted therapy, chemotherapy and radiation.
The best way to protect yourself from skin cancer is to wear sunscreen daily and schedule an annual skin check by a board-certified dermatologist like Dr. Ritu Saini in New York City, NY. Call us today.
Mohs
Skin cancer often has roots that are not visible to the naked eye. Mohs Micrographic Surgery is a specialized method to remove skin cancer that spares healthy tissue surrounding the tumor and provides the patient with the peace of mind in knowing that there are free of skin cancer upon leaving the office. In addition to basal cell and squamous cell cancer, Mohs surgery is used to treat many other less commonly see skin cancers such as atypical fibroxanthoma, sebaceous carcinoma, dermatofibrosarcoma protuberans, etc.
Dr. Saini takes a very thin margin around what appears clinically to be the tumor on the surface. The specimen is then processed into frozen sections in the laboratory on the premises. Within, 45 minutes to 1 hour, you will know whether or not you are cancer-free. If there is a need to remove more of the tumor, it will be precisely delineated on a map as to exactly where the tumor cells still persist in relation to the surrounding anatomy. The entire procedure in performed under local anesthesia, much like the process carried out when the initial biopsy was taken.
Conventional surgical removal of skin cancers consists of taking wider margins without knowing whether or not the margins are clear. With Mohs surgery, complete removal of skin cancer approaches 99% and has the lowest rate of recurrence as compared with other modalities used to treat skin cancer. In most cases, after the skin cancer is completely removed, the defect created from the surgery will require closure or reconstruction. Dr. Saini will design and carry out an appropriate repair that will maximize the best cosmetic outcome and minimize the scar. The vast majority of repairs are done the same day in the office following Mohs surgery. If more advanced reconstruction is required, you will be referred to one of several premier facial plastic reconstructive surgeons that our office has had a professional relationship with for decades.
Dr. Ritu Saini is specially trained in Mohs Micrographic Surgery under the direction of world-renowned Mohs surgeon Dr. Perry Robins, Professor Emeritus of New York University Department of Dermatology.
Scar Revision
Scars can result from accidents, surgery, acne, skin cancer and some skin conditions. Scars may only be skin deep, but their impact goes much deeper. Scars are permanent and can negatively affect appearance and self-confidence, and ultimately quality of life, particularly when they are on highly visible areas like the face, neck, chest and back.
Scar revision therapy is designed to improve or minimize the appearance of scars, refining their texture to make them less obvious so they blend in with surrounding tissues. Treatment options depend upon the type and degree of scarring, the location of the scars, their thickness, age of the scars and the patient’s skin type.
How is a scar formed?
Scar tissue forms as a function of the natural process of wound healing. Scar tissue is made of collagen, the protein that provides support and structure to the skin, but scar tissue is inferior to the original skin. Scar tissue does not grow hair, and it lacks elasticity. Atrophic scarring (depressed scars) is the result of too little collagen. Overproduction of collagen can create hypertrophic scars creating red, raised lumps. Stretch marks are a form of scarring that results from the rapid stretching of the skin that occurs with significant weight gain and pregnancy.
Scars must mature before revision therapies can be considered. Immature scars are reddish in color and may be raised, itchy and painful. As the scar matures it will flatten out and fade in color. It can take up to two years for a scar to mature. In some cases, such as acne, the best approach is early and effective acne treatment to prevent scarring.
