Actinic keratoses are precancerous growths which are small dry, rough areas that develop slowly on sun exposed areas of the body, typically the ears, face, backs of hands, neck, legs, lips, and bald scalp. Early on you may feel the area before it is visible. It may feel like a sharp needle, rough sandpaper, or a cut.
Actinic keratoses form because of ultraviolet radiation damage. While some may remain dormant, 10 – 12% develop into a squamous cell carcinoma. As it is impossible to predict which actinic keratosis will become cancerous, it is advised to treat them all.
Basal Cell Carcinomas (BCCs) usually develop on areas of the body that have had the most sun exposure- nose, ears, other parts of the face, scalp, arms, upper chest, and back.
This is a slow-growing cancer, taking years to get large, and virtually never metastasizes (spreads through the body).
How to spot a Basal Cell Carcinoma
The typical characteristics of a Basal Cell Carcinoma include:
- An open bleeding sore that won’t heal.
- A shiny painless bump with a translucent, pearly appearance, which some people mistake as a pimple or sore.
- A flat, reddish patch which might crust or flake. It can itch or hurt, or have no special sensation at all.
- A shiny area that looks like a flat or sunken scar.
- A pink growth with a raised border and sunken center, often with fine blood vessels on the surface.
Treatment of Basal Cell Carcinoma
Surgery is the most common treatment, although radiation and select topical are other options. Ongoing follow up after the cancer is treated is required to detect possible recurrence, or the development of a new skin cancer.
How to spot a Squamous Cell Carcinoma
A Squamous Cell Carcinoma (SCC) typically is a rough, thick, crusted growth. It might look like a wart gone bad. Sometimes it will grow rapidly, over a few weeks, developing a red tender bump with a crusty core. SCCs might bleed and scab over. They occur on sun-exposed areas of the body, but can grow inside the mouth and elsewhere. Squamous Cell Carcinomas arise from Actinic Keratosis, precancerous growths which are rough, scaly and sore. Because Squamous Cell Carcinomas can metastasize, early treatment is vital. Basal Cell Carcinoma and Squamous Cell Carcinoma are both more common in people who have spent years in the sun.
Treatment of Squamous Cell Carcinoma
Treatment of Squamous Cell Carcinoma is similar to that of Basal Cell Carcinomas, and includes Surgery, Radiation, Topical Anti Cancer medications, and Mohs Surgery which is used for Squamous Cell Carcinomas occurring in sensitive areas on the ears, nose, around the eyes, mouth, lips, or genitalia. Regular follow-up is advised to detect recurrence or new cancers.
Malignant Melanoma is the most serious form of skin cancer and can be fatal. Melanocytes, the cells of the skin that give skin its color, can mutate into cancer cells and spread rapidly through the lymph system to distant organs.
Brief intense sun exposure, (think the Weekend Warrior—Triathlete type) tanning beds, and heredity all contribute to the formation of a melanoma. Fair-skinned, blue-eyed people with red or blonde hair are at more risk of melanoma because they burn more easily in the sun.
In the past twenty years, people have had more leisure time, allowing more time spent in outdoor activities. This has led to over three times the number of melanomas. (1) A previous skin cancer, family history of skin cancer, or many large, irregularly shaped moles can also increase the risk of developing melanoma.
How to spot a Malignant Melanoma
Characteristics of Malignant Melanoma include
A. Asymmetry one half differs from the other half.
B. Border irregularity—hazy, scalloped, notched or squiggly borders
C. Color variation on one growth
D. Diameter/Dark—Diameter greater than a pencil eraser (6 mm) may indicate a growth is a melanoma. Benign growths can also be larger than 6 mm and melanomas may also be smaller than 6 mm. Remember, melanoma can’t read! A melanoma may be much darker than other moles on the body.
E. Evolving—any change, or evolution, including itching, bleeding, a different shape, size, or just a new growth.
KEEP IN MIND: The “ugly duckling” sign, meaning a pigmented or non-pigmented growth that looks different from the rest of the skin, may also be used to help detect a worrisome growth that does not meet the ABCDE guidelines. (2)
Treatment for Malignant Melanoma
Treatment of localized melanoma is surgical excision, with the size of the excision and width of the margins based upon the thickness of the melanoma. Sentinal Lymph Node Dissection, SLNB, may be performed at the time of excision and is helpful to detect micrometastasis in the lymph node closest to the melanoma. A work-up including lab tests, and X rays, may be indicated based upon the recommendations of the dermatopathologist. If there is concern about an aggressive tumor or metastatic spread of melanoma, a treatment approach combining the input of a Surgical Oncologist, Medical Oncologist, and Radiation Oncologist along with the dermatologist may be required. Follow-up will be for life, including a minimum of an annual skin exam, and monthly self-exam, with lab and x-ray as appropriate.
For more information on skin cancers and their treatment visit: http://www.skincarephysicians.com/skincancernet/index.html, http://emedicine.medscape.com/article/1100753-overview
1 Robinson JK. Sun Exposure, Sun Protection, and Vitamin D. JAMA 2005; 294: 1541-43.
2 A Guide to Skin Cancers and Precancers Skin Cancer Foundation 2002, revised 2005,2006,2007 3 Grob JJ, Bonerandi JJ. The ‘ugly duckling’ sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol. Jan 1998;134(1):103-4.