Skin cancers (skin neoplasms) are named after the type of skin cell from which they arise.

Basal cell cancer originates from the lowest layer of the epidermis and is the most common but least dangerous skin cancer.

Squamous cell cancer originates from the middle layer, and is less common but more likely to spread and, if untreated, become fatal.

Melanoma, which originates in the pigment-producing cells (melanocytes), is the least common, but most aggressive, most likely to spread and, if untreated, become fatal.

Most cases are caused by over-exposure to UV rays from the sun or sunbeds. Treatment is generally via surgical removal.

Melanoma has one of the highest survival rates among cancers, with over 75% of people surviving 10 years.

There are three main types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma.

Basal cell carcinomas are present in sun-exposed areas of the skin, especially the face. They rarely metastasize and rarely cause death. They are easily treated with surgery or radiation.

Squamous cell carcinomas (SCC) are common but much less common than basal cell cancers. They metastasize more frequently than BCCs. Even then, the metastasis rate is quite low, with the exception of SCC of the lip, ear, and in immunosuppressed patients.

Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders.

Sometimes small blood vessels can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develop. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring.

Squamous cell carcinoma is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped like keratoacanthomas.

Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous cell is the second most common skin cancer. It is dangerous but not nearly as dangerous as a melanoma.

Most melanomas consist of various colors from shades of brown to black. A small number of melanomas are pink, red or fleshy in color; these are called amelanotic melanomas which tend to be more aggressive.

Warning signs of malignant melanoma include a change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around the site, or bleeding at the site.

An often-used mnemonic is “ABCDE”, where A= asymmetrical, B= “borders” (irregular= “Coast of Maine sign”), C= “color” (variegated), D= “diameter” (larger than 6 mm—the size of a pencil eraser) and E= “evolving.”

Treatment is dependent on the type of cancer, location of the cancer, age of the patient, and whether the cancer is primary or a recurrence.

Treatment is also determined by the specific type of cancer.

For a small basal cell cancer in a young person, the treatment with the best cure rate (Mohs surgery or CCPDMA) might be indicated.

In the case of an elderly frail man with multiple complicating medical problems, a difficult to excise basal cell cancer of the nose might warrant radiation therapy (slightly lower cure rate) or no treatment at all.

Topical chemotherapy might be indicated for large superficial basal cell carcinoma for good cosmetic outcome, whereas it might be inadequate for invasive nodular basal cell carcinoma or invasive squamous cell carcinoma.

In general, melanoma is poorly responsive to radiation or chemotherapy.

For low-risk disease, radiation therapy (external beam radiotherapy or brachytherapy), topical chemotherapy (imiquimod or 5-fluorouracil) and cryotherapy (freezing the cancer off) can provide adequate control of the disease; both, however, may have lower overall cure rates than certain type of surgery.

Mohs’ micrographic surgery (Mohs surgery) is a technique used to remove cancer with the least amount of surrounding tissue and the edges are checked immediately to see if the tumor has spread.

This provides the opportunity to remove the least amount of tissue and provide the best cosmetically favorable results.

This is especially important for areas where excess skin is limited, such as the face. Cure rates are equivalent to wide excision.

Special training is required to perform this technique. An alternative method is CCPDMA and can be performed by a pathologist not familiar with Mohs surgery.

In the case of disease that has spread (metastasized), further surgical procedures or chemotherapy may be required.



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