Common skin cancers




12: Common skin cancers


Abstract:



Concern for skin cancer is one of the most common reasons that patients seek out a skin examination. Approximately 20% of Americans develop skin cancer in their lifetimes, making this concern understandable. This chapter will review the three most common cutaneous malignancies: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.

Key terms:


basal cell carcinoma


squamous cell carcinoma


squamous cell carcinoma in situ


Bowen disease


melanoma



Basal cell carcinoma


Aziz Khan, Jonas Adalsteinsson, and Hao Feng


Clinical features




Nodular basal cell carcinoma




Superficial basal cell carcinoma




Morpheaform basal cell carcinoma




Other variants




Work-up





Initial steps in management




Surgical treatment options


Surgical treatment options include standard surgical excision, ED&C, and MMS.




Nonsurgical treatment options


Nonsurgical treatment options include cryosurgery, topical therapies, and radiation therapy.





TABLE 12.1

























Clinical Scenario Treatment Recommendations

BCC of the trunk or extremities, with positive margins after biopsy



BCC of the trunk or extremities with negative margins after biopsy


Note: negative margins on biopsy may not reflect true clinical negative margin



BCC of the trunk or extremities, less than 20 mm diameter: positive margins after standard excision



BCC of a cosmetically or functionally critical area on the face/neck/hands/feet with positive margins



MMS


BCC of a cosmetically critical area on the face/neck with negative margins


Note: negative margins on biopsy may not reflect true clinical negative margin



Multiple BCCs



BCC, Basal cell carcinoma; ED&C, electrodessication and curettage; MMS, Mohs micrographic surgery; 5FU, 5-fluorouracil.


Warning signs/common pitfalls




Counseling


Skin cancers occur when healthy skin cells transform into abnormal cells. Basal cell carcinoma is a common type of skin cancer and the least dangerous type of skin cancer. Basal cell carcinoma can be, in most cases, entirely removed when caught early. Very rarely, it spreads to other parts of the body; however, it can spread locally if left untreated.


Skin cancer can present as a nonspecific abnormal area of skin. It can present as a pink, crusty, bleeding bump or as a wound that will not heal. You should always show your doctor any skin changes you think might be abnormal. Your doctor will examine the spots and check the skin all over your body. Further tests, including a skin biopsy, will be suggested if your doctor suspects a skin cancer.


Skin cancer is often caused by chronic sun exposure. Sun exposure is the most important and most preventable risk factor for all skin cancers, including basal cell carcinoma. Damaging effects of sun are cumulative and therefore sun protection is urged, no matter what your age is.


You can prevent skin cancers by helping protect your skin from sun damage. Apply sunscreen to all exposed areas, preferably a water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 that provides broad-spectrum protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Reapply every 2 hours, even on cloudy days, and after sweating or swimming. Sunscreens are not perfect because some ultraviolet light may still get through; do not use them to allow you to prolong your sun exposure. You should seek shade when possible and be aware that the sun’s rays are the strongest between 10 AM and 4 PM. Wear sun-protective clothing, such as pants, a wide-brimmed hat, a long-sleeved shirt, and sunglasses, when possible. Some sunlight will still get across your clothing. You can wear sunscreen underneath, or you can buy clothing that has been treated to give additional sun protection.


Protect children from sun exposure by dressing them in protective clothing, applying sunscreen after they are older than 6 months, and having them play in the shade. Use extra precaution when near water, snow, and sand. These surfaces reflect the damaging rays of the sun and can increase your chance of getting sunburnt. Get vitamin D safely through a healthy diet rather than seeking the sun for vitamin D.


Avoid tanning beds. UV rays from tanning beds can also lead to wrinkling and skin cancer. Perform a regular self-skin examination. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.


Squamous cell carcinoma


Aziz Khan, Jonas Adalsteinsson, and Hao Feng


Clinical features


Cutaneous squamous cell carcinoma (SCC) is the second most common type of skin cancer in the United States.


Jul 22, 2021 | Posted by in Dermatology | Comments Off on Common skin cancers
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