Skin Cancer Excisions
Skin neoplasms
(also known as “skin cancer”) are skin growths with differing causes and varying degrees of malignancy. The three most common malignant skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma, each of which is named after the type of skin cell from which it arises. Skin cancer generally develops in the epidermis (the outermost layer of skin), so can usually be seen. This means that it is often possible to detect skin cancers at an early stage. Unlike many other cancers, including those originating in the other parts of the body only a small minority of those affected will actually die of the disease, though it can be disfiguring. Melanoma survival rates are poorer than for non-melanoma skin cancer, although when melanoma is diagnosed at an early stage, treatment is easier and more people survive.
Skin cancer is the most commonly diagnosed type of cancer. Melanoma and non-melanoma skin cancers combined are more common than lung, breast, colorectal and prostate cancer. Melanoma is less common than both basal cell carcinoma and squamous cell carcinoma, but it is the most serious. Most cases are caused by over-exposure to UV rays from the sun or tanning beds. Non-melanoma skin cancers are the most common skin cancers. The majority of these are basal cell carcinomas. These are usually localized growths caused by excessive cumulative exposure to the sun and do not tend to spread.
Causes
Ultraviolet radiation from sun exposure is the primary cause of skin cancer. Other factors that play a role include smoking tobacco, human papilloma virus infections, some genetic syndromes, chronic non-healing wounds, radiation, environmental carcinogens, artificial UV radiation (e.g. tanning beds), aging, and light skin color.
Epidemiology
A study of the incidence of non-melanoma skin cancer from 1992 to 2006 in the United States. The results of their research showed that cases of non-melanoma skin cancer rose an average of 4.2% a year.
More than 3.5 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in the country. According to the Skin Cancer Foundation, one in five Americans will develop skin cancer at some point of their lives. The first most common form of skin cancer is basal cell carcinoma, followed by the squamous cell carcinoma. Although the incidence of many cancers in the United States is falling, the incidence of melanoma keeps growing, with approximately 68,729 melanomas diagnosed in 2004 according to reports of the National Cancer Institute.
The survival rate for patients with melanoma depends upon when they start treatment. The cure rate is very high when melanoma is detected in early stages, when it can easily be removed surgically. The prognosis is less favorable if the melanoma has spread to other parts of the body. Australia and New Zealand exhibit one of the highest rates of skin cancer incidence in the world, almost four times the rates registered in the United States, the UK and Canada.
Prevention
Sunscreen is effective and thus recommended to prevent melanoma and squamous cell carcinoma. Other advice to reduce rates of skin cancer includes: avoiding sunburning, wearing protective clothing, sunglasses and hats, attempting to avoid periods of peak sun exposure, and avoiding the use of tobacco products. At Southeastern Skin Cancer & Dermatology we place an emphasis on preventative care so that we can minimize invasive surgeries and related complications in your future.
Prognosis
The mortality rate of basal cell and squamous cell carcinoma are around 0.3% causing 2000 deaths per year in the US. In comparison the mortality rate of melanoma is 15-20% and it causes 6500 deaths per year. Even though it is much less common, malignant melanoma is responsible for 75% of all skin cancer-related deaths.
Management
Treatment is dependent on type of cancer, location of the cancer, age of the patient, and whether the cancer is primary or a recurrence. Treatment is also determined by the specific type of cancer. Options could include Mohs Micrographic Surgery, surgical excision, radiation therapy, topical or systemic chemotherapy, photodynamic therapy (PDT / “blue light” or laser treatments), cryotherapy (freezing), or electrodesiccation and curettage (scrape and burn).
As fellowship-trained surgical dermatologists, we are well-versed in all aspects of scar prevention, reconstructive surgery, layered closures, cosmetic units and other factors that result in an excellent surgical outcome for our patients. No medical provider can guarantee a “scarless” surgery but there are ways to minimize the visibility and best position you for wondeful cosmesis – we utilize and consider all of those factors. Most often it is not necessary to undergo your procedure in a hospital/surgery center or even require sedation, local anesthesia is often quite sufficient and offers you a cost savings.
Mohs’ micrographic surgery is a technique used to remove the cancer while sparing the most normal, unaffected tissue. It provides the greatest cure rates while also leading to the most cosmetically favorable results. The full periphery and base are checked immediately with a microscope by your dermatologist to see if tumor remains or completely removed. This is especially important for areas where excess skin is limited, such as the face.
Resources
https://www.skincancer.org/
