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
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.
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.
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.
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
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
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.
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.