Skin cancer is the most common form of cancer and the incidence is rising faster than any type of cancer. More than 3.500.000 cases were reported last year in the US only. Most often UV radiation triggers mutations that lead the skin cells to multiply rapidly and form malignant tumors.
Since 80% appear on the face, head and neck the Plastic Surgeon has a central role in the diagnosis and treatment in order to prevent disfigurement and dangerous insufficient treatments.
Prevention starts with getting to know your skin and examine it regularly, from the top of your head to the soles of your feet. Don't forget your back and if you notice any changes, have a plastic surgeon or dermatologist check it out.
The principal cause of skin cancer is UV radiation and anyone, regardless of age and race, can get skin cancer.
Your risk is greater if:
BASAL CELL CARCINOMA
Is the most common type of skin cancer and can vary widely in appearance. It may begin as a small white or pink bump or as a red spot that is dry, rough. Itching, bleeding or crust formation are often seen. Seldom it may present as a white patch similar to a scar.
It's the least dangerous skin cancer with slow growth and seldom life-threatening as it rarely spreads to other sites. If untreated it continues to grow deep into cartilage or bone. Particularly near to the eyes and nose this causes serious damage.
SQUAMOUS CELL CARCINOMA (SCC)
Is frequently appearing on the lips, face, arms, legs and ears and does metastasize to lymph nodes and organs. It is the second most common skin cancer and if not treated properly is life threatening . The incidence of this disease has increased 200% in the past 3three decades and 700.000 case of SCC are diagnosed each year in the US.
It might look similar to a basal cell carcinoma or warts or be more waxy or pitted on the surface. SCC might grow with a central depression covered with crust and occasionally bleed.
A sore that fails to heal, or the development of a new growth, should prompt an immediate visit to a specialist.
This is the most dangerous form of skin cancer with over 135.000 new cases a year with almost 1 death every hour (American Cancer Society). It is the most common cancer in young adults and the leading killer for women aged 25-30, taking in account all causes.
It is again UV radiation that triggers mutations leading the pigment producing melanocytes to multiply rapidly and form malignant tumors.
Melanomas resemble moles and some develop from moles. Most often melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white.
Heredity plays a major role in melanoma. Each person with a first-degree relative diagnosed with melanoma has a 50 percent greater chance of developing the disease. If this skin cancer is diagnosed, it is standard practice for physicians to recommend the relatives to be examined immediately for melanoma or atypical moles. For more information please visit American Cancer Society home page.
Surgery is the primary treatment for all skin cancer and is covered by Health Insurance. Depending on cancer type, staging and location a excision with sufficient tumor free margins is planned. The Plastic Surgeon will plan the direction of incision and the type of closure with skin flaps or grafts to get the best aesthetic outcome without compromising cancer survival.
In case of melanoma depending on the depth of skin penetration a wide excision is performed. Dr. Reuter according to international tumor protocols performs also the sentinel lymph node biopsy or the clearance of the affected lymph-nodes. Every patient's treatment is planned individually with the oncologist in tumor board meetings.
In critical areas such as the face Dr. Reuter, as a trained Mohs Surgeon, employs this technique to reduce the resected area to the minimum. After the resection of the skin cancer all margins are marked with color coded ink and sent for a special microscopic analysis.
Mohs surgery is also performed for skin cancers that have recurred following previous treatment (Laser, Cryotherapy...) sending out deep roots along blood vessels, nerves and cartilage.
Mohs surgery removes only cancerous tissue, while normal tissue is spared. The cure rate with Mohs Surgery is 99% for BCC.
Do you know your ABCDEs?
Even if you practice sun safety you should examine your skin head-to-toe once a month, take note of any new mole or existing growth that begin to change. Look for the ABCDE signs of melanoma:
Asymmetry If you draw a line through the middle of the mole and the halves do not match
Border A benign mole has even borders unlike melanomas
Color Having a variety of colors is a warning signal for melanoma
Diameter Benign moles usually have a smaller diameter
Evolving Moles look the same over the years. Any evolving change in size,shape,elevation, bleeding, itching or crusting point to danger.
Does Screening help ?
YES! An observation German study was instituted in a part of the country. 5% of biopsies in older men, and < 2% of biopsies in younger men were positive for melanoma. The mortality from melanoma within the region dropped to 50% of the previous levels and when compared to the rest of Germany. Germany now has a biannual screening program for adults over 35.