Skin Cancer Management

Skin Cancer affects 1 in 5 Americans. The most common are Basal Cell carcinomas, Squamous Cell carcinomas, and Malignant melanomas. An ounce of prevention is worth a pound of cure: Use broad spectrum sunscreen and minimize sun exposure.

Basal Cell carcinomas are the most common. On the face, especially the nose, they are often a pearly translucent tumor that ulcerates. On the trunk and extremities, they often are flat and scaly patches. They are destructive tumors but rarely metastatic. Most are due to ultraviolet sun exposure.

They occasionally metastasize, especially when they are located on the lip. Most are due to excessive ultraviolet exposure; however warts (especially genital warts), nicotine, and arsenic in well water are some other implicated agents.

Malignant Melanomas are the most potentially fatal skin cancer. Long wavelength ultraviolet tanning rays ( UVA) have long been implicated as one cause. Most are noted as expanding blue or black tumors, though some may be red.

Surgery is the mainstay of skin cancer management. Basal cell and squamous cell carcinomas can often be removed with a tangential excision followed by curettage and electrodessication. Certain types of cancer have a higher cure rate with a full thickness elliptical excision; similarly the cosmetic outcome may be higher with this approach, especially on the face. Certain Basal Cell carcinomas and occasionally Squamous Cell carcinomas require Moh’ surgery for an adequate cure rate. This specialized dermatologic procedure is performed by a specially trained Dermatologist who accepts our patients on referral.

Malignant Melanomas are excised with a 0.5 to 2 cm excision depending on the depth of dermal invasion. Lymph node removal or sentinel lymph node biopsies may be necessary. Coordinated care with an oncologist and general surgeon is sometimes needed.

Thin Basal cell carcinomas and Squamous cell carcinomas can occasionally be treated with Aldara, (a biologic-response modifier medication in topical cream) or Photodynamic Therapy. A lower cure rate for skin cancer limits the usefulness of these approaches.