Skin Cancer
Reconstructive Surgery

What is Skin Cancer?

Skin cancer is the most common form of cancer in the United States. Often masquerading as an annoying, crusty patch of skin or a seemingly innocuous freckle or lump, skin cancers are frequently ignored or simply tolerated as a "normal" part of aging until they become too problematic to be disregarded. More than 500,000 new cases are reported each year, and the incidence is rising faster than any other type of cancer. Because they most commonly appear on the sun-exposed areas of the face, head, neck, and upper extremities, skin cancers can be disfiguring as well as dangerous.

Am I at risk for skin cancer?

The primary cause of skin cancer is sun exposure. However, any source of ultraviolet radiation, including artificial sources like sunlamps and tanning booths, can increase your risk. Most skin cancers take several years to reach the size at which they become bothersome or detectable. Since the majority of our sun exposure occurs before 20 years of age, and the damage done by this exposure is cumulative, you may develop skin cancer in spite of your best efforts to use sun screens and avoid exposure.

Anyone can get skin cancer -- no matter what your skin type, race or age, no matter where you live or what you do. However, your risk is greater if...

• Your skin is fair and freckles easily
• You have light-colored hair and eyes
• You have a large number of moles, or moles of unusual size or shape
• You have a family history of skin cancer or a personal history of blistering sunburn
• You spend a lot of time working or playing outdoors
• You live closer to the equator, at a higher altitude, or in any place that gets intense, year-round sunshine
• You received therapeutic radiation treatments for adolescent acne

Are skin cancers all alike?

By far the most common type of skin cancer is basal cell carcinoma. Fortunately, it is also the least dangerous kind -- it tends to grow quite slowly and rarely spreads beyond its original site. Though basal cell carcinoma is seldom life threatening, if left untreated it can grow deep beneath the skin and into the underlying tissue and bone, causing serious damage (particularly if it's located near the eye, nose, or ear).

Squamous cell carcinoma is the next most common kind of skin cancer, frequently appearing on the lips, face, or ears. It sometimes spreads (metastasizes) to distant sites, including lymph nodes and internal organs. Squamous cell carcinoma can become life threatening if it is not treated early, because of the risk of spread.

A third form of skin cancer, malignant melanoma, is the least common, but its incidence is increasing rapidly, especially in the Sunbelt states. Malignant melanoma is also the most dangerous type of skin cancer. If discovered early enough, it is completely curable. If not treated early, however, malignant melanoma may spread throughout the body and is often deadly.

Other skin growths you should know about:

Two other common types of skin growths are moles and keratoses.

Moles are clusters of heavily pigmented skin cells, either flat or raised above the skin surface. While most pose no danger, some--particularly large moles present at birth -- or those with mottled colors and poorly defined borders -- may develop into malignant melanoma. Moles are frequently removed for cosmetic reasons, or because they are constantly irritated by clothing or jewelry (which can sometimes cause pre-cancerous changes).

Solar or actinic keratoses are rough, red or brown, scaly patches on the skin. They are usually found on areas exposed to the sun, and sometimes develop into squamous cell cancer.

How do I recognize skin cancer?

Basal and squamous cell carcinomas can vary widely in appearance. The cancer may begin as small, white, or pink nodule or bump; it can be smooth and shiny, waxy, or pitted on the surface. Or it might appear as a red spot that is rough, dry, or scaly; a firm, red lump that may form a crust; a crusted group of nodules; a sore that bleeds or doesn't heal after two to four weeks; or a white patch that looks like scar tissue.

Malignant melanoma is usually signaled by a change in the size, shape, or color of an existing mole, or as a new growth on normal skin. Watch for the "ABCD" warning signs of melanoma: Asymmetry -- a growth with an unusual shape; Border irregularity -- ragged or blurred edges; Color -- a mottled appearance, with shades of tan, brown, and black, sometimes mixed with red, white, or blue; and Diameter -- a growth more than 6 millimeters across (about the size of a pencil eraser), or any unusual increase in size.

The most important factor in recognizing skin cancer is having a high index of suspicion. Frequent self-examination combined with periodic visits to your dermatologist will allow you to catch many developing skin cancers at an early stage, when the treatment can be most effective.

Diagnosis and skin treatment of skin cancer

Working closely with your dermatologist, Dr. Cambre will develop a plan to diagnose and treat your skin cancer. Diagnosis is usually made by removing all or part of the growth and examining the tissue under a microscope.

If cancer is found, Dr. Cambre will recommend the appropriate treatment, depending on the type of cancer, its stage of growth, and its location on your body. Small skin cancers can often be excised quickly and easily in our office, requiring only a few stitches. If the cancer is superficial, curettage and electrodessication may be performed. In this procedure, the cancer is scraped out, and an electric current is used to control bleeding and kill any remaining cancer cells. The skin is allowed to heal spontaneously, leaving a flat or slightly indented scar, without sutures. In either case, the risks accompanying surgery are low.

If the cancer is large, however, or if it has spread to the lymph glands or elsewhere in the body, major surgery may be required. Your dermatologist may recommend other treatments for skin cancer, including cryosurgery (freezing the cancer cells), radiation therapy (using x-rays), topical chemotherapy (anti-cancer drugs applied to the skin), and Mohs' surgery, a special procedure in which the cancer is shaved off one layer at a time. (Mohs' surgery is usually coordinated between your dermatologist, who performs the excision and tissue examination, and Dr. Cambre, who will do the necessary reconstructive closure).

Because skin cancers most commonly occur in visible areas of the face and body, it is important to initiate treatment as soon as possible, once the skin cancer has been detected. Dr. Cambre will work with you to determine the method of treatment that will result in the most cosmetically-inconspicuous scar, while making sure that the cancerous lesion is completely removed, in order to safeguard not only your health, but your well-being.

After you've been treated for skin cancer, Dr. Cambre will recommend regular follow-up visits with our office or your dermatologist for routine skin examination, not only in the area of the cancer, but for complete surveillance of your skin.

Although this will not prevent a recurrence, or delay the onset of a new skin cancer in a different location, it will allow you to actively manage any future skin cancers that might develop. It is up to you to reduce your risks by changing old habits and establishing new ones. These preventive measures apply to people who have not had skin cancer as well:

Avoid prolonged exposure to the sun, especially between 10 a.m. and 2 p.m., and during the summer months. Remember that ultraviolet rays pass through water and clouds, and reflect off sand and snow.

When you do go out for an extended period of time, wear protective clothing such as wide brimmed hats and long sleeves.

On any exposed skin, use a sunscreen with SPF (sun protection factor) of at least 15. Reapply it frequently, especially after you've been swimming or sweating.

Finally, examine your skin regularly. If you find anything suspicious, consult Dr. Cambre or a dermatologist as soon as possible.

Although we cannot change our genetic pre-disposition to developing skin cancers, you can actively manage some of the risks, both for yourself and your children, by following the guidelines listed above. Dr. Cambre and our staff will be happy to assist you in developing your program of skin cancer prevention, which will also assist you in maintaining a healthy appearance and help to minimize the signs of aging that can come with too much exposure to the sun.