Quick blog, as taking out skin cancers is not the focus of my practice. But I like to keep up on it, as it is something that is good to know. I see lots of skin and have caught a few lesions when seeing patients for something else.
First, are all skin cancers created equal?
The answer is a resounding NO. I am only going to talk about the non melanoma cancers here, but basal cell cancers are much less scary than squamous cell cancers. Luckily, basal cell cancers are more common (4-5x). They tend not to spread past where they occur, unless they go untreated for a long time. If you have had a skin cancer, your risk goes up 10 times for having another skin cancer.
How do you diagnose it?
That is done by a dermatologist by either shaving it, doing a punch biopsy, or cutting it out. When doing it, you need to get the depth of the lesion, which sometimes is missed when it is shaved.
Which lesions are higher risk?
This is IMPORTANT, as high risk lesions are treated with wider skin margins and they have much higher rates of spread and recurrence.
- Any lesion more than 20mm.
- Any lesion on the face of more than 10mm
- Any lesion on the genetalia, hand, foot, and central face (nose, lip), and ear
- Rapid growth
- Poorly defined
- When biopsied, found to be poorly differentiated, has neural involvement, or a depth of more than 2mm
- Site of prior radiation
- If you are immunocompromised (on steroids, have had a transplant, etc)
Treatment?
If it is a superficial low risk lesion, these can be treated frequently by cryotherapy (freeze it off), photodynamic therapy, or excision.
If it is a higher risk lesion, frequently derm specialists in MOHS are needed. MOHS excision looks at all of the borders when cutting out the lesion to make sure it was all removed. If it has local spread, particularly for squamous cell cancers, you may need further treatments like lymph node removal, radiation, and chemo.
The key to all of this?
If you have lots of actinic keratosis (precancerous lesions with a 1-20% chance of becoming cancers), sun damage, and lesions on your skin, you need to see a dermatologist and be followed. The best chance you have is to catch it early. And read my blog on 4 tips to help reverse your sun damage. (they are easy, non doctor things which have been proven to help).