Current Treatment Options for Patients with Cutaneous Malignancy

Years of exposure to the sun and environmental forces have been found to contribute to the development of Skin Cancer. Ionizing radiation which accompanies sunlight, has been shown to cause changes in the genetic makeup of individual cells. In some cases, the bodies' internal defenses, which usually destroy cells that have undergone such changes, may miss one or two such cells. These then may grow and divide and evolve into an uncontrolled type of cell which we later recognize as a malignancy.

Malignancies in the skin are usually described as one of three main types. Basal Cell carcinoma is a skin cancer that arises from a type of cell at the basement layer of the skin above the fat and supporting structure. Squamous Cell Carcinoma is a skin cancer that arises from the upper flattened dried cells of the skin called squamous cells. These are the cells that mature and dry and flatten to form the hardened outer surface of the skin. Melanoma is a type of skin cancer that arises from a supporting cell, which is related to the pigment carrying cells in the skin. Each of these types of malignancies may occur in different areas of the body and, depending on the size and invasiveness of the lesion, may be treated in a variety of different ways.

Treatment options for a patient with a skin lesion are quite varied. Medical treatments, destructive methods and surgical procedures may be used at different times with effectiveness. The principal goal of treatment should be the complete removal of the malignant lesion. The success of any treatment and the risk of recurrence of any cutaneous malignancy may depend on the relative success of the selected treatment method and on the tendency for certain types to spread locally, or regionally, or to metastasize to distant sites in the body.

Because we now know that the ultraviolet types of radiation are among the most damaging, sunscreens and sunblock products are designed to retard or prevent the penetration of U/V rays into the skin beneath such a product. Fair skinned people with less melanin, or dark pigment, are more likely to be affected by cutaneous malignancies. Frequent use of sunblock creams and covering clothing as well as broad brimmed hats and sunglasses to protect the retina are now widely acclaimed as the best strategy for prevention of skin cancers.

The experts recommend cautious sun exposure for everyone. Babies should be especially protected because their skin is more delicate and sunburns much more easily. Use of sunblock is strongly encouraged. Coverage and shading with umbrellas and with hats and protective clothing is also effective.

Melanoma is a type of lesion that is often discolored and will most likely require surgical excision. Squamous Cell Carcinoma in the skin should be treated with excision also. Topical treatments such as 5-Flourouracil or 5-FU may be considered for very small lesions. Laser treatment or freezing cryotherapy may also be used on such skin cancers. For surface type lesions this may be adequate therapy. For deeper or more invasive types of lesions this may be inadequate to prevent recurrence or metastasis. Although Basal Cell carcinomas are also usually excised, they are occasionally treated with cryotherapy or with topical or laser treatment and observed. Basal Cell Carcinoma usually grows very slowly and rarely spreads beyond its area of origin. In years past, we have seen large invasive basal cell lesions, which may have been ignored for many years. These lesions can be very destructive. It is now much more rare to see such cancers because the public has become more aware of skin cancer through newspaper and magazine articles and television programs on the subject of skin cancer.

Because the face is rarely covered, the skin of the face is more likely to be the origin of a cutaneous malignancy. Some individuals with very fair skin may develop large areas of superficial malignant change and may require complete facial treatment with chemical peels or with laser treatments in a manner similar to the treatment of facial wrinkles. Certain specific lesions on the nose or near the eyelid may be best treated with radiation therapy. Radiation treatments given frequently over a few weeks and focused on the skin cancer may destroy the rapidly dividing cells of the cancer while sparing the surrounding normal tissue. This treatment may spare the patient a surgery which can cause scarring and could risk infection. Radiation treatments may also cause some local destructive problems with the surrounding skin and may impair later wound healing.

In cases where surgery is recommended, the removal of the cancer is the primary purpose. Reconstruction after removal is then the next concern. Small cancers can be removed from the ears, nose , face and lips with reconstruction using local flaps to rebuild the area with a minimum of scarring. Skin grafts can be shaved from the skin of the arm or leg or by stealing some skin from the neck and shaving it very thin. These grafts can then be used to cover areas left open by the removal of the cancerous lesion.

Treatment for some types of cutaneous malignancies may assume greater urgency. While a doctor may recommend observation for a lesion that appears to be a small basal cell carcinoma which has been treated with laser or topical curettage or 5-FU, the Squamous cell carcinoma should be surgically excised soon. Melanoma and Squamous Cell Carcinomas have a greater capacity to spread regionally and to metastasize. Early treatment may be successful while delay can be costly or even fatal. If you have a suspicious lesion on your skin that fails to heal or has changed in size, shape or coloration, you should see your doctor. If you are unsure of which type of doctor to see, consider consulting a Dermatologist or skin specialist, or an Otorhinolaryngologist who specializes in Head and Neck Cancer and Facial Plastic and Reconstructive Surgery, or a Plastic Surgeon.

Dr. Rick Love is a board certified Otolaryngologist who practices in Montgomery, Alabama. He trained at the University Hospital and Clinics in Oklahoma City, Oklahoma at the University of Oklahoma Health Sciences Center. There he acquired special training in treating Head and Neck Cancer under Dr. Jesus Medina, a World authority on the treatment of melanoma. He also has additional training and expertise in Facial Plastic and Reconstructive Surgery.

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