Skin Cancer

It is estimated that one in five Americans will develop skin cancer in their lifetime. Approximately one million new skin cancers are diagnosed each year in the United States. Eighty percent are basal cell carcinoma, 16% are squamous cell carcinoma and only the remaining 4% are melanoma.

BASAL CELL CARCINOMA
Basal cell carcinoma is the most common type of skin cancer. Approximately 800,000 cases are diagnosed each year in the United States alone. If caught early, there is a better than a 95% cure rate. This tumor presents as a new or changing fleshy bump or nodule, usually on the sun-exposed areas of the skin. It is more common on Caucasians with fair complexions.

It is estimated that one in five Americans will develop skin cancer during their lifetime. Approximately one million new skin cancers are diagnosed each year in the United States. Eighty percent are basal cell carcinoma, 16% are squamous cell carcinoma and 4% are melanoma. (Statistics provided by the American Academy of Dermatology.)

If left untreated, basal cells grow under the skin and may cause considerable tissue destruction as well as possibly spreading to other parts of the body.
Significant risk factors for basal cell are fair skin and over exposure to the sun. Some people with a history of x-ray therapy, thermal burns or exposure to arsenic compounds are predisposed to basal cell tumors. A dermatologist or plastic surgeon treats this type of tumor by local destruction or surgical excision. The extent and type of treatment depends on the characteristics, size and location of the tumor.

Recommendations:
Sun avoidance, protection and sunscreen are the basics of good skin care. Skin rejuvenation and health is accomplished by daily maintenance and sun protection.
The three most widely used treatments for healthy skin include antioxidants, Vitamin A preparations and exfoliating agents.

Antioxidants: Antioxidants are an emerging concept in skin health and maintenance. The sun's ultraviolet radiation produces tissue damaging free radicals that are absorbed and neutralized by antioxidants. The most common antioxidants are Vitamins A, C, E and beta-carotene.

Antioxidants are most effective when applied topically. Topical Vitamin C is the most widely used. In addition to its antioxidant properties, topical Vitamin C stimulates cell replication and collagen production. The result is a thickening of the skin with a reduction in the appearance of fine lines and wrinkles.

Vitamin A: Vitamin A is available in common forms such as Retin-A® (tretinoin) or retinol. Retin-A® is prescription strength and is stronger than over-the-counter Vitamin A derivatives. Over-the-counter retinol, though less potent, is very effective in reversing sun damage. When used consistently, the milder formulations provide effective treatment while avoiding many of the side effects such as redness, irritation and peeling that is associated with the prescription products. (See retinol)

Topical Vitamin A is also essential for skin health and maintenance. The skin has receptors that specifically absorb Vitamin A, aiding in cellular growth and differentiation. The results are impressive, with a reduction of fine lines and wrinkles and a complexion that is smooth, supple and evenly pigmented.

Exfoliation: Skin exfoliation is achieved by mild acid application to the skin. The acids currently in use are alpha and beta hydroxy acids. (See hydroxy acids.) Hydroxy acids are readily absorbed into the deeper layers of the epidermis. Effects include superficial exfoliation and stimulation of both the epidermis and dermis. The result is skin thickening with more uniform pigmentation and a reduction in the appearance of fine lines and wrinkles.

What treatment regimen is right for you?
Dermatologists uniformly agree that skin health and maintenance should be addressed twice daily using one product in the morning and another in the evening. If a simplified regimen is tolerated, products can always be added and combined based on individual goals and preferences.

Remember, damaged skin is the result of many years of sun exposure. Expect improvement to occur gradually with a consistent daily program of skin care maintenance.

SQUAMOUS CELL CARCINOMA
Squamous cell carcinoma is the second most common type of skin cancer. It appears as pink-to-red scaly growths usually on sun-exposed surfaces such as the scalp, face, ears, hands, and arms.

It is estimated that one in five Americans will develop skin cancer during their lifetime. Approximately one million new skin cancers are diagnosed each year in the United States. Eighty percent are basal cell carcinoma, 16% are squamous cell carcinoma and 4% are melanoma. (Statistics provided by the American Academy of Dermatology.)

Risk factors for squamous cell carcinoma include fair skin, freckles, blue eyes and blonde hair. Environmental factors such as excessive ultraviolet light exposure from the sun or tanning booths also present a high risk.

People on immunosuppressant medications such as organ transplant patients are particularly susceptible. Other important factors increasing susceptibility to squamous cell include occupational x-ray exposure, environmental exposure to coal or chemicals such as arsenic and scarring from trauma, diseases or burns. Finally, family history plays an important role as some individuals are more susceptible to skin cancer.

Many times squamous cell carcinoma develops from a pre-existing actinic keratosis. The risk of an actinic keratosis developing into a squamous cell carcinoma ranges from less than 1% to 20% in a one-year period. If an actinic area does develop into a squamous cell carcinoma, the risk of the cancer spreading is between 2% and 6%.

Squamous cell carcinoma is characterized into several distinct types. These types are characterized as follows:

Bowen's disease: This is a superficial squamous cell carcinoma. It may occur on sun-protected or sun-damaged skin. Bowen's disease has a unique association with arsenic exposure. However, its most common presentation is on sun damaged skin.

Erythroplasia of Queyrat: This is a distinctive form of squamous cell carcinoma occurring on the penis. It is characterized as a bright red, non-healing plaque, most common in older uncircumcised men.

Bowenoid papulosis: This type of squamous cell carcinoma presents as multiple flesh-colored, red or brown growths on the genitals of both men and women. There is an association with the wart virus called human papilloma virus type 16. It is often mistaken as a wart.

Invasive squamous cell carcinoma: This type of skin cancer can occur anywhere on the body. It is characterized as a nonhealing, indistinct, red, scaling growth. This type of skin cancer typically presents on chronically sun-damaged skin. Squamous cell carcinoma is especially of concern when present on the ears, nose, lips or external genitalia. Equally problematic are lesions presenting in a site of previous injury or chronic ulceration. The potential for spreading is much greater when in these locations.

The cure rate for squamous cell carcinoma is approximately 95% when treated properly. The tumor should be treated by a dermatologist or plastic surgeon. The extent and type of treatment depends on the characteristics, size and location of the tumor.

Recommendations:
Sun avoidance, protection and sunscreen are the basics of good skin care. Skin rejuvenation and health is accomplished by daily maintenance and sun protection.
The three most widely used treatments for healthy skin include antioxidants, Vitamin A preparations and exfoliating agents.

Antioxidants: Antioxidants are an emerging concept in skin health and maintenance. The sun's ultraviolet radiation produces tissue damaging free radicals that are absorbed and neutralized by antioxidants. The most common antioxidants are Vitamins A, C, E and beta-carotene.

Antioxidants are most effective when applied topically. Topical Vitamin C is the most widely used. In addition to its antioxidant properties, topical Vitamin C stimulates cell replication and collagen production. The result is a thickening of the skin with a reduction in the appearance of fine lines and wrinkles.

Vitamin A: Vitamin A is available in common forms such as Retin-A® (tretinoin) or retinol. Retin-A® is prescription strength and is stronger than over-the-counter Vitamin A derivatives. Over-the-counter retinol, though less potent, is very effective in treating sun damage. When used consistently, the milder formulations provide effective treatment while avoiding many of the side effects such as redness, irritation and peeling that is associated with the prescription products. (See retinol)

Topical Vitamin A is also essential for skin health and maintenance. The skin has receptors that specifically absorb Vitamin A, aiding in cellular growth and differentiation. The results are impressive, with a reduction of fine lines and wrinkles and a complexion that is smooth, supple and evenly pigmented.

Exfoliation: Skin exfoliation is achieved by mild acid application to the skin. The acids currently in use are alpha and beta hydroxy acids. (See hydroxy acids.) Hydroxy acids are readily absorbed into the deeper layers of the epidermis. Effects include superficial exfoliation and stimulation of both the epidermis and dermis. The result is skin thickening with more uniform pigmentation and a reduction in the appearance of fine lines and wrinkles.

What treatment regimen is right for you?
Dermatologists uniformly agree that skin health and maintenance should be addressed twice-daily using one product in the morning and another in the evening. If a simplified regimen is tolerated, products can always be added and combined based on individual goals and preferences.

Remember, damaged skin is the result of many years of sun exposure. Expect improvement to occur gradually with a consistent daily program of skin care maintenance.

MALIGNANT MELANOMA
Melanoma derives its name from the pigment cells in the skin called melanocytes. Melanoma is a malignant skin cancer that presents as a spot with irregular borders and colors of tan, blue, black, red or white. It usually starts small and changes over a time. Approximately 95% of melanomas originate from pre-existing moles. Melanoma is one of the most serious types of skin cancer. In the United States, approximately 47,300 new cases of melanoma will be diagnosed during the year 2000. An estimated 7,700 people will die from this disease. Approximately 1 in 75 Americans have a lifetime risk of developing melanoma. (Statistics provided by the American Academy of Dermatology.)

Family history and environmental exposure to ultraviolet light are two of the most important risk factors. It appears that the predisposition for melanoma can pass from one generation to another. Moles from birth or atypical-appearing moles also have a higher risk of melanoma. Melanoma usually occurs after puberty; however, it can arise at any age.

Fair skin individuals have an increased risk of skin cancer and melanoma, especially if the excess sun exposure occurred before the age of 18. Periodic short intense exposures with sunburn or blistering increases the risk of melanoma significantly.

Most melanomas present with irregular growth of pigmented areas. The mnemonic ABCD has been established to identify concerning characteristics of skin pigmentation.
A - asymmetry
B - irregular borders
C - colors of gray, blue, black, red and white
D - diameter greater than 6 mm (the size of a pencil eraser)

If a pigmented area changes or shows irregular characteristics, it should be examined immediately by your dermatologist.

Types of Melanoma:
Superficial Spreading Melanoma: This is the most common of all melanomas. It is a flat, asymmetrical, irregularly pigmented area that usually grows without invasion. This is the most curable.

Nodular Melanoma: This type of melanoma occurs when vertical (invasive) growth is present. This is seen as a changing pigmented area with various colors. The surface appears "lumpy" and irregular.

Lentigo Maligna: This is seen on sun-exposed areas in the elderly. The skin has a mottled, irregular pigmentation with indistinct borders. This tumor is slow growing and is almost exclusive on sun-exposed areas in the elderly.

Acral Lentiginous Melanoma: This type of melanoma is rare and is most common among African-American and Asian people. This type of tumor usually presents as a dark area on the palms, soles, fingers and toes, or under fingernails and toenails. It is also seen in the mucous membranes of the mouth or genital region.

Diagnosis:
Self-examination leads to early detection and diagnosis of melanoma. The sooner a melanoma is found, the better the prognosis and likelihood successful treatment.
If a growth is suspicious, consult your dermatologist immediately. The growth should be biopsied and examined under a microscope to establish the diagnosis.
The appearance under the microscope determines the seriousness and extent of involvement with melanoma. The stages of melanoma are classified in terms of Clark level and Breslow thickness. The thicker the lesion, the greater the possibility of spread to lymph nodes and internal organs.

Management:
Sun protection, self-examination and early detection are consistent and effective methods to help protect against and prevent deaths from melanoma.

Melanomas do occur on non-sun exposed areas; however, they are more prevalent on sun exposed skin. In men, the most common area is the back; while in women, melanomas occur more frequently on the legs. Intense ultraviolet exposure, such as sunbathing and tanning, is believed to be one of the primary factors contributing to melanoma. Sun protection is essential. Avoid excessive sun exposure between the hours of 10:00 AM and 4:00 PM. If out in the sun, wear sunscreen with SPF 15 or above, with both UVA and UVB protection. A 3-inch wide-brimmed hat along with sunglasses and protective clothing should be used in the sun.

Treatment:
Surgery is the standard of care for melanoma treatment. If the melanoma is thin, the prognosis is excellent. Usually, a biopsy is performed to confirm the diagnosis and staging of melanoma. A subsequent wider surgical excision is then done, based on the initial biopsy results. If indicated, lymph node biopsies are done at the time of the wide excision to help detect further spread. Other forms of concurrent treatment involve chemotherapy, interferon, experimental vaccines or possibly radiation therapy. These treatment options should be discussed with your dermatologist and oncologist.

Remember, the best treatment is early detection and prevention. Patients at high risk should be examined annually by their dermatologist.