Skin Cancer Syracuse
Skin cancer is the most common of all cancers. There are 3 common cancers, basal cell, squamous cell, and melanoma. There is also the pre-cancerous condition called actinic keratosis. There are over 4 million basal cell cancers treated in the United States each year.
Who is at risk?
Although skin cancer is associated with accumulated sun damage and fair skin, it can occur is sun-protected areas in people who are compulsive users of sun-screen. Because it takes long training to reliably identify skin cancers, you should avoid self-diagnosis. Instead, you should periodically examine your skin. Any spots or bumps that have changed should be seen by your doctor. As you approach your late 30’s and early 40’s, you should consider an annual skin exam, especially if you have a history of sun burns. If you have a history of sun burn with blisters, you are at an even higher risk of cancer, including melanoma.
Basal Cell Cancer (BCC)
The most common skin cancer, basal cell cancers can vary from a scaly patch to an open sore, or often as a pearly nodule. Except for a rare genetic syndrome, these cancers do not metastasize. Most do not grow quickly, but they can invade in to deeper tissue. Surgery is the treatment of choice for most BCC’s. Tissue removed is sent to the lab both to confirm diagnosis and to confirm all the tumor was removed. For BCC’s in sensitive areas, frozen section may be used, where the lab confirms clear margins at the time of surgery. MOHS chemosurgery is variation of confirming clear borders at the time of surgery. In rare occasions, due to technical issues of frozen section vs permanent section, there are times where the frozen section is negative, but the permanent section is positive, showing a need for more surgery of very close monitoring. MOHS usually does not include permanent section examination.
Squamous Cell Cancer (SCC)
Most commonly presenting as a scaly patch or an open ulcer, one form of squamous cell called keratoacanthoma can develop very quickly, creating a nodule in as little a 3-4 weeks. Squamous cancers can spread to local lymph nodes. Treatment is usually surgery to remove the SCC, but some very early SCC’s may respond to a topical chemotherapy cream, like Efudex, Aldara, or Picato.
Though the least common skin cancer, it is the most likely to strike fear in your heart. While melanoma can be very aggressive and fatal, the vast majority of melanomas are cured. Any pigmented spot that changes anywhere on your body should be checked, especially pigment on your feet or the palms of your hands. Assessment by Melafind (see below) may help find tumors at a very early stage. Surgery is the treatment of choice. The extent of surgery is dictated by tumor thickness. Tumors below 0.76mm thick have the best prognosis. Because the melanoma is most likely to recur near the site of the original tumor, a margin of 1cm of normal skin is removed for each millimeter in thickness of the tumor. Depending on thickness and location, some of your lymph nodes may also be evaluated.
Actinic Keratosis (AK)
This is a precancerous condition that can lead to either basal or squamous cell cancers. AK, early BCC and/or SCC can look the same. It presents as a dry scaly area that doesn’t improve with moisturizer. There is no predictable timeline for progression from this condition to cancer. In conversation with your doctor, treatment choices include monitoring alone, treatment with a chemotherapy cream, such as Efudex, Aldara, or Picato. Photodynamic therapy (PDT: see below) is also a treatment I favor, especially for patients with diffuse damage anywhere on your body.
Based on analysis of 10,000 specimens of melanoma, Melafind can assess pigmented lesions from 2mm to 24mm in size for risk of melanoma. This is especially helpful for those blessed with tons of dark spots. Melafind takes a specialized picture of your spot. A computer analysis considering 70 features is performed, and a score from -2 to 10 is given. Negative scores a benign. Positive scores are suspicious, with risk increasing with score. Spots scoring under 2 may often do not require excision, but can be monitored closely.
Photodynamic Therapy (PDT)
PDT is a practical form of therapy for wider area of pre-cancerous change. Though the face & scalp are the most common treatment areas, I have used PDT on almost any area of the body.
The medication Levulon is applied to your skin. Like yeast in bread dough, it is allowed to react with your skin for 2-3 hours. During that time the drug is concentrated in the abnormal cells. Your skin is then treated with a special light, which activates the drug. You will experience a reaction similar to a sun burn, which usually clears in a couple days.
Because this is a light activated drug, you need to avoid sunlight for the first 2 days after treatment. More than 1 treatment may be needed. Depending on your sun exposure, periodic maintenance treatments are common.