The most common type of skin cancer, basal cell carcinoma, is one of the main reasons people come to my office. They frequently say there is a bump that bleeds or will not heal. For men, it gets irritated when they shave. Women usually say they have a pimple that won’t heal.
Basal cells usually occur in areas of the skin exposed to the sun, including the nose, ears, and forehead. They look waxy and they often have raised borders or partially eroded surfaces. The color of a basal cell typically is beige or pink, but in some instances they can be brown or bluish. Blood vessels coursing over the surface of the lesions are common.
Treating basal cell carcinomas depends on the sub type (based on the pathology report), the location, and the size of the cancer. Left untreated, they continue to grow and expand like a rust spot on the skin. However, most do not go to other parts of the body. Superficial basal cells may be treated with topical creams such as Aldara or Efudex. Following treatment, close follow up and/or biopsies are recommended.
Surgery is the common treatment for most basal cells. The procedure for these cancers has evolved over the past few decades and most are easily treated in an office with local anesthesia.
Using a technique known as Mohs Micrographic surgery, dermatologic surgeons are able to evaluate the margins of a skin cancer before reconstructing the defect created. Mohs is usually reserved for cancers on the face, hands, or neck, but is also indicated for certain invasive types of pathology, lesions greater than 2 cm, or cancers that recur.
Despite the skill of a dermatologic surgeon or plastic surgeon, patients who have large skin cancers removed or who have cancers in certain parts of the face are going to have a scar. Patients frequently ask me about radiation for skin cancers and I think that it is appropriate for some types. However, I am not thrilled with this as a modality because radiation has its own complications (burns, scars, etc.). Having a clear surgical margin gives patients the least chance of having a recurrence.
There are many different reasons, aside from sun exposure, that people will get basal cell carcinomas. For some, growing up exposed to arsenic in well water will be a factor. For others, genetic defects will push them to get these skin cancers. And there are many other unknown factors.
As with most types of skin cancer, avoidance and early detection are critical. This means we must minimize the ultraviolet exposure that our skin receives. The most aggressive sun avoidance should be when we are young, and I believe that most damage occurs before age 21. Moderation (avoiding sun burns and excessive exposure) is important for the duration of one’s life.
To detect skin cancer early, see a board certified dermatologist annually (more frequently if you have blue eyes and fair skin). If you suspect something on your skin is changing, make an appointment, and if there is any doubt, have the spot biopsied. Although a biopsy will leave a scar, it is a critical part of determining what is going on with a spot that has changed.
Part of an optimal outcome requires that you take an active role in your care. Make an appointment for a skin cancer screening with your dermatologist. Although insurance (or Medicare) may not pay for it, it is a worthwhile investment.
To learn more about Dr. Beer, visit www.idealskin.com and www.palmbeachcosmetic.com.
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