Skin Cancer

There are three basic forms of skin cancer: basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Anyone can be diagnosed with cancer at any age. Doctors link these forms of cancer to overexposure to the sun. Tanning booths can also increase your risk, as can exposure to radiation or high altitude. Because each type of skin cancer has a different look, effect and treatment, it is important to alert your physician if you notice unusual changes in the size and shape of spots, the coloration of your skin or the sensitivity and comfort of your body. Time is of the essence, and when caught early, many forms of skin cancer can be successfully treated.

Basal Cell Carcinoma and Squamous Cell Carcinoma

General Information
Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the two most common forms of skin cancer. BCC is the most common type of skin cancer accounting for about 80% of all skin cancers. SCC is responsible for about 15% of all skin cancers. Both of these types of skin cancer are associated with sun exposure and a light complexion. Fortunately both types can usually be treated successfully if identified early and treated appropriately.

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What happens if BCC or SCC are not treated?
BCC is a slow growing cancer with very little ability to spread to other parts of the body. However, it can be locally invasive, growing into and destroying nearby structures such as the nose, ear, or eye. When located on the body, the cancer can grow large and invade down to muscle or bone and create an open wound. Usually this type of destruction takes several years to occur.

SCC is a more aggressive skin cancer than BCC. It usually grows more quickly and can cause greater destruction than BCC. In addition to being locally invasive, SCC can spread to lymph nodes or other parts of the body. This type of spread occurs most often in SCC’s that are present on the lips, ears, hands, and fingers and in patients whose immune systems do not work well. In the vast majority of cases SCC remains only in the skin.

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What treatments are available for BCC and SCC?
The first step in the treatment of BCC and SCC is to take a biopsy of the suspected skin cancer to be checked under the microscope to make a definite diagnosis. Once this is done a treatment for the skin cancer can be chosen.

Several treatments are available for BCC and SCC, and each treatment has its own advantages and disadvantages. Common treatments include destruction of the cancer and surgical removal of the cancer – either with Mohs surgery or traditional surgery. Less common treatments include radiation treatment and creams that can remove skin cancer. Sometimes more than one treatment is used in combination. Your dermatologist will recommend the treatment that he or she feels is most appropriate for your skin cancer. If you have questions about treatments other than the one recommended, ask your doctor for more details.

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What do I need to do now that I have a skin cancer?
The first thing that is needed is to have treatment for the skin cancer. After the treatment for the skin cancer is completed, you should see your dermatologist regularly for follow-up exams. Your dermatologist will examine the area where the skin cancer was treated to make sure that it is not growing back and will also check your skin for new skin cancers. Once you have been diagnosed with BCC or SCC you have a 50% chance of having another skin cancer within the next 5 years.

You should also examine your own skin thoroughly each month. Use a well lighted room and the combination of a full length mirror and a hand held mirror to check all of the areas that are hard to see. A spouse, parent, or friend can also help you. Notify your dermatologist of any new growths, any spots that are changing, and any spots that “look funny.” Also pay attention to any spot that bleeds for no good reason or gets a scab that won’t heal. Most skin cancers are discovered by a patient or spouse and then brought to the attention of the doctor. Carefully examining your own skin is the best defense against a future skin cancer.

It is also important to protect your skin from the sun. Regular sun protection can decrease your chances for developing future skin cancers. The following steps should be taken for sun protection.

• Do not intentionally expose your skin to natural or artificial sunlight.
• Avoid sun exposure when possible, especially in the middle part of the day when the sun is most directly overhead.
• Protect your skin from the sun with clothing. Wear a hat with a broad brim, sunglasses, a long sleeved shirt, and pants when outdoors.
• Apply sunscreen with an SPF of 15 or higher to all skin surfaces that you cannot cover with clothes.

The above steps for sun protection are listed in the order of importance. Used together these steps will reduce your chances of developing more skin cancers.

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Where can I learn more about skin cancer?
Your dermatologist can answer many of your questions about skin cancer. Other good sources of information include the following web sites.

1. The Skin Cancer Foundation www.skincancer.org
2. The American Cancer Society www.cancer.org
3. The American Academy of Dermatology www.aad.org
4. The National Cancer Institute www.nci.nih.gov

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Melanoma

General Information
Melanoma is a type of skin cancer. It comes from the cells in the skin that produce pigment called melanocytes. Melanoma is a potentially deadly skin cancer. Fortunately, it can usually be treated effectively if it is identified and treated in its early stages.

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What is the prognosis for melanoma?
The prognosis for melanoma depends on the stage of the cancer at the time of diagnosis. The stage of the cancer is based on features of the melanoma, such as its thickness, and whether or not there is any evidence of melanoma elsewhere in the body. For more detailed information on melanoma staging refer to the links at the end of this sheet.

The most important factor associated with survival in patients with melanoma is the thickness of the melanoma. Thickness is most commonly reported as a measurement of depth given in millimeters (mm). This measurement of thickness is called the Breslow’s depth. Sometimes the thickness is reported in a different way called the Clark’s level. Clark’s levels are designated with the roman numerals I through V, with I being the thinnest and V being the thickest.

In general the thicker the melanoma is, the worse the prognosis. Some melanomas are designated as melanoma in situ. “In situ” means that the melanoma is limited to the uppermost portion of the skin called the epidermis. Melanoma in situ has a Breslow’s depth of zero and a Clark’s level of I. These melanomas have a long term survival rate of nearly 100% when treated with appropriate surgery. Melanomas with a Breslow’s depth of less than 1 mm are considered thin melanomas and have a favorable long term prognosis. The long term survival rate is about 90-95% with appropriate surgical treatment. For melanomas with a Breslow’s depth of greater than 1 mm, the long term survival rate gradually decreases with increasing depth of the melanoma. For these thicker melanomas, the lymph nodes are sometimes surgically removed and checked under the microscope for the presence of melanoma. In these cases, whether or not cancer is detected in the lymph nodes becomes an important factor in predicting long term survival.

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What treatments are available for melanoma?
Surgical removal is the main treatment for melanoma. The type of surgery recommended is determined by the depth of the melanoma. For melanomas with a Breslow’s depth of less than 1 mm, surgical removal of the melanoma and a zone of surrounding skin is all of the treatment that is needed. This can usually be accomplished with an in-office surgery performed with local anesthesia. It is not usually necessary to see another surgeon or to go to a hospital operating room. For melanomas with a Breslow’s depth of greater than 1 mm, it may be beneficial to have lymph nodes surgically removed in addition to the removal of the melanoma. This surgery is usually performed in a hospital setting by a general surgeon or a cancer surgeon.

While surgery is the main treatment for melanoma and the treatment with the greatest chance of a cure, some patients with melanoma have chemotherapy in addition to surgery. Chemotherapy is usually reserved for patients whose melanoma has already spread to other parts of the body at the time of surgery or whose melanoma will likely spread in the future. Several different chemotherapy regimens are available. No single regimen has been shown to dramatically prolong survival, but clinical trials are underway to discover better medical treatments for melanoma.

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What is a sentinel lymph node biopsy?
A sentinel lymph node biopsy is a type of surgery sometimes recommended for patients with melanoma. The purpose of the surgery is to find out if melanoma has spread to the lymph nodes. A sentinel lymph node biopsy is usually performed in a hospital operating room and is done at the same time as the surgical removal of the melanoma. Before the surgery, a radioactive dye is injected into the skin at the site of the melanoma. Then sensors are used to follow the path of the dye to the lymph nodes. This process identifies which lymph nodes are most likely to have melanoma if the melanoma has spread to the lymph nodes. Then the surgeon removes the melanoma and the lymph nodes identified by the dye. The lymph nodes are checked under the microscope for the presence of melanoma.

Sentinel lymph node biopsy is not usually recommended for melanomas with a Breslow’s depth of less than 1 mm. If the Breslow’s depth of the melanoma is greater than 1 mm a sentinel lymph node biopsy may be recommended. Not all physicians agree about how important it is to have a sentinel lymph node biopsy performed. Sentinel lymph node biopsy has not been shown conclusively to increase the chances of curing melanoma, but it does provide valuable information for predicting how likely it is that the melanoma could result in death.

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What do I need to do now that I have a melanoma?
The first thing that is needed is to have treatment for the melanoma. After the treatment for the melanoma is completed, you should see your dermatologist regularly for follow-up exams. Your dermatologist will examine the area where the melanoma was treated to make sure that it is not growing back and will also check your skin for new skin cancers. Once you have been diagnosed with melanoma, you are in the highest risk group for developing a new melanoma. You should have a full skin exam by a dermatologist two to four times a year for the first five years after the melanoma has been diagnosed and then at least once a year for the rest of your life.

You should examine your own skin thoroughly each month. Use a well lighted room and the combination of a full length mirror and a hand held mirror to check all of the areas that are hard to see. A spouse, parent, or friend can also help you. Notify your dermatologist of any new growths, any spots that are changing, and any spots that “look funny.” Most melanomas are discovered by a patient or spouse and then brought to the attention of the doctor. Carefully examining your own skin is the best defense against a future melanoma.

You need to let your primary care doctor know that you have had a melanoma. Some doctors may want to do chest x-rays or extra blood tests on their patients with a history of melanoma. You also need to let your doctor know if you develop any health changes such as unintentional weight loss, severe headache, weakness, and jaundice. Other health care providers who should be notified of your history of melanoma include your dentist, your ophthalmologist, and your gynecologist (for women).

You should notify all of your first degree relatives that you have had a melanoma. First degree relatives are your parents, siblings, and children. Melanoma tends to run in families. All of your first degree relatives should have a full skin exam by a dermatologist at least once a year.

It is also important to protect your skin from the sun. Regular sun protection can decrease your chances for developing future skin cancers. The following steps should be taken for sun protection.

• Do not intentionally expose your skin to natural or artificial sunlight.
• Avoid sun exposure when possible, especially in the middle part of the day when the sun is most directly overhead.
• Protect your skin from the sun with clothing. Wear a hat with a broad brim, sunglasses, a long sleeved shirt, and pants when outdoors.
• Apply sunscreen with an SPF of 15 or higher to all skin surfaces that you cannot cover with clothes.

The above steps for sun protection are listed in the order of importance. Used together these steps will reduce your chances of developing more skin cancers.

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Where can I learn more about melanoma?
Your dermatologist can answer many of your questions about melanoma. Other good sources of information include the following web sites.

1. Arkansas Foundation for Skin Cancer www.arfsc.org
2. Aim at Melanoma www.AimAtMelanoma.org
3. The Skin Cancer Foundation www.skincancer.org
4. The American Cancer Society www.cancer.org
5. The American Academy of Dermatology www.aad.org
6. The National Cancer Institute www.nci.nih.gov
7. The Melanoma Center www.melanomacenter.org
8. The Melanoma Research Foundation www.melanoma.org
9. The Melanoma Patient Information Page www.mpip.org

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