Monday, November 3, 2008

Skin Cancer

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Skin cancer is a condition of uncontrolled growth of cells in one or more layers of the skin. It is the most common form of cancer in the United States. They are so common that almost everyone will have some form of skin cancer sometime during the course of their life. The younger the age at which the first one is identified the greater the risk that you will have multiple skin cancers over the course of your life. The primary cause is prolonged and/or intermittent overexposure to ultraviolet radiation from the sun. Therefore most of these skin cancers appear on parts of the body unprotected from/exposed to the sun such as the face or nose. Infrequently the cause is exposure to x-rays or chemicals like arsenic which is found in pesticides. The best way to avoid these conditions is to minimize sun exposure by the use of sunscreen and appropriate clothing.

The most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and malignant melanoma. The other types are much less common. Basal cell carcinoma is by far the most common. It is very slow growing and if left untreated can become quite large, develop an ulcerated surface that bleeds easily when rubbed and invade adjacent tissue like cartilage or bone. However, it does not spread or metastasize to other areas of the body the way other cancers do yet it is the most common cancer in Europe, the USA and Australia. Once you have had a basal cell carcinoma you are at significant risk of getting another and many patients have multiple basal cell carcinomas. Malignant melanoma is the most serious type of skin cancer with the greatest tendency to spread or metastasize to other areas of the body. The treatment for all types is early surgical removal before they have a chance to invade locally or metastasize to distant areas of the body.

The ABCDrule is used for early detection.
Border or edge irregularity
Color variability - multiple colors present
Diameter more the 6mm
are all signs that something on the skin may be a skin cancer. If accompanied by growth spurts in the area or the appearance of an ulcerated/raw surface makes the area in question highly suspicious. The definitive diagnosis though requires a biopsy where a small piece of tissue is cut out and sent to the pathologist. After examination of this tissue under a microscope the pathologist makes the definitive diagnosis.

Once you have that diagnosis removal of the entire involved area is justified. The plastic surgeon becomes involved in the removal and then closure of the resulting wound. In some cases the physician who did the biopsy does the removal and then sends the patient to a plastic surgeon for the closure of the resulting wound. The plastic surgeon's goals for wound closure are a tension free approximation of tissue, incision lines for mobilizing skin hidden in natural skin folds, coverage with similar skin in terms of color, thinness etc, the best quality least visible scars after closure, maintenance of natural skin surface contours or topography, little or no distortion of adjacent structures like the nostrils, and maintenance of normal range of motion of adjacent structures like the eyelids.

30% of patients with their first diagnosed basal cell carcinoma will develop another within 5 years. 14% will develop another within a year. These patients should have once a year full-body skin examinations for at least 3 years after their first BCC diagnosis.

Addendum October 8, 2012:
It is well-known that tanning beds have been linked to melanoma, the deadliest type of skin cancer. A just published study now related tanning beds to other forms of skin cancer and reports that they are responsible for more than 170,000 cases of basal and squamous cell skin cancer. When the researchers analyzed more than 9,000 cases of non-melanoma skin cancer, they found that tanning beds were associated with a 67 percent higher risk of squamous cell carcinoma and a 29 percent higher risk of basal cell carcinoma. Now we know why a recently passed law restricts tanning beds to those over 18 years of age and applies a new tax to their use.

Basal Cell Carcinoma of the Nose
Suntanning and Sunscreens
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