Skin Cancer Facts With Dr. Connolly

If you’ve been layered up in heavy clothes all winter, you may not think to give your skin a good scan. Or maybe you have, and you’ve noticed a warty growth that is big, ugly and bleeds when you pick it.

Take a deep breath and relax, says Dr. Brian Connolly, MD, FAAD, who practices at Adult & Pediatric Dermatology in Portsmouth, New Hampshire. Connolly recently hosted a Facebook live presentation on skin cancer facts to help allay people’s fears and explain the signs and symptoms you should watch out for.

His advice: You definitely shouldn’t ignore an unusual mole or skin growth, but oftentimes it is a benign type of skin cancer or a seborrheic keratosis.

Should I be worried about this growth?

Most people know to keep an eye on unsightly moles that grow or change colors or shape. Often, it’s the first visible sign of skin cancer. If you’re a ginger, fair-skinned, or have freckles, you’re especially susceptible.

There are two different kinds of skin cancer. One type is slow-growing and relatively harmless and one is more dangerous. You’ve most likely heard of melanoma, but it is not nearly as common as non-melanoma skin cancers. There are many different subtypes, but the two most common are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Melanoma: The most dangerous form of skin cancer can be deadly if it goes undetected due to its ability to spread to other areas if it is not treated early.

Non-melanoma: This type of cancer, if caught early, has a good prognosis of recovery. There are many different subtypes, including Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC).

Seborrheic keratosis: Benign, warty growths that occur with advancing age.

What is melanoma?

A cancer formed from cells in the skin called melanocytes that normally give skin its color. There are several risk factors including:

• Lots of UV radiation including working outside, tanning beds, blistering sunburns
• Fair skin, blue or green eyes, naturally blonde or red hair
• Age > 50 years old
• Numerous moles and/or atypical moles
• Weakened immune systems from medications taken for organ transplants
• First degree relatives with a history of melanoma

What to look for?

• Changing mole
• Spot that looks like a new mole, freckle, or age spot, but it looks different from the others on your skin
• Spot that has a jagged border, more than one color, and is growing
• Dome-shaped growth that feels firm and may look like a sore, which may bleed
• Dark-brown or black vertical line beneath a fingernail or toenail
• Band of darker skin around a fingernail or toenail

 When it comes to identifying a cancerous mole, remember to monitor skin growths for the ABCDEs of melanoma!

A is for Asymmetry – One half of the spot is unlike the other half,

B is for Border – Spot has an irregular, scalloped, or poorly defined border.

C is for Color – Color varies from one spot to the next, such as shades of tan, black, or brown, or areas of white, red or blue.

D is for Diameter – Melanomas are usually greater than 6 millimeters, or about the size of a pencil eraser, when diagnosed, but they can be smaller.

E is for Evolving – The spot looks different than the rest or is changing or evolving.

Diagnosing melanoma

If you’re concerned about the look or shape of a mole, try not to panic. Many people worry or ruminate over worst-case scenarios before receiving a proper diagnosis.

• Rule number 1: Don’t freak out! You have time.
• Schedule an appointment with your PCP or dermatologist.
• Diagnosis requires biopsy.

A biopsy is what helps provide the proper diagnosis. Your doctor will take a small piece of tissue and send it to a pathologist for analysis.

• Done in the office
• Techniques include punch or shave biopsy
• This is NOT definitive treatment! This is just to get a diagnosis.

Treatment of melanoma 

Receiving a diagnosis can be scary, but there are several treatment options that have good results, especially if your cancer is caught early.

One question to ask is how deep is it? The therapy is dependent on the depth of melanoma, and the depth has significant prognostic implications, Connolly says.

At Stage 1, it’s often a matter of cutting out the cancerous growth. Deeper ones that go into the skin involve more extensive treatment measures, and that’s when there is the potential to spread to other organs.  

• Early-stage melanoma is usually curative with a simple excision
• >98% 5-year survival
• Thicker melanoma may require sampling of lymph nodes
• More advanced stages may require additional surgery, chemotherapy, and/or immunotherapy
• In stage 4, 5-year survival drops to less than 25%

Non-melanoma skin cancer

Some moles and skin growths are less severe but still can pose a health hazard. If they pop up on your face, they also may affect your self-esteem. One big difference is non-melanoma skin cancers are relatively common and are very slow-growing.

There are many subtypes of non-melanoma skin cancers, but the two most common include:

Basal Cell Carcinoma (BCC) 

• Most common cancer worldwide
• >2 million cases annually in the US alone
• Very slow growing
• Rarely spreads beyond original location
• Risks factors include age, UV exposure, fair complexion, immunosuppression
• Usually starts as a nonhealing spot that bleeds easily

Squamous Cell Carcinoma (SCC)

• Develops from precancerous lesions called actinic keratoses (AK)
• Usually not life-threatening
• Grows slowly
• Can grow into deeper structures like nerves and blood vessels and cause injury
• Risks factors include age, UV exposure, fair complexion, immunosuppression
• May start as a nonhealing spot or as a wart-like growth

 Things to remember: 

• BCC and SCC are the most common type of skin cancers and are collectively known as non-melanoma skin cancer (NMSC).
• They are very slow-growing, but left untreated they can grow into other adjacent structures and cause problems.
• BCC and SCC can start as nonhealing lesions, warty growths, or spots that bleed unprovoked.

What to do about non-melanoma growths? 

• Stay calm. These cancers are very slow growing!
• Talk to your PCP or dermatologist to schedule an evaluation.
• A biopsy can determine the type and severity of NMSC

Treatment of BCCs and SCCs 

Treatments for non-melanomas are different than for melanoma, especially if it’s caught early and on the outer layer of skin. The type of treatment depends on many factors, including the size of the cancer, location, and depth of growth. You have a few options, so talk to your dermatologist about which treatment would be best for you. It needs to be decided on an individual case-by-case basis.

There are many options for treatment of these cancers:

• Topical chemotherapy (eg 5-Fluorouracil cream)
• Electrodessication and Curettage (ED&C)
• Excision
• Mohs Surgery

Electrodesiccation and Curettage is a good option for smaller and more superficial skin cancers.

• The physician “scrapes” the skin cancer cells away (curettage).
• An electric current is used to destroy the tissue (electrodesiccation).
• Multiple passes may be performed, often don’t have to go very deep.
• Usually, no need for surgery or excision.

Mohs Surgery is a state-of-the-art treatment and a more intricate surgery that removes skin cancer down to its roots. The surgery involves removing the skin cancer and immediately freezes it to examine under a microscope and see if any skin cancer is left.

• If residual tumor is still present, another smaller piece is taken and processed in the same way.
• This continues until the entire tumor has been removed.
• The wound is then sutured closed.
• Used for larger, more invasive BCCs and SCCs located on delicate areas of the body.

 What else could it be?

 Another common growth is called a seborrheic keratosis. These benign warty growths typically show up as you get older.

• 90% of adults over the age of 60 years have one or more
• Known as “barnacles”
• They violate the ABCDEs and every other rule of skin cancer surveillance but do not ever turn into skin cancer
• Can be removed with relative ease using many different destructive techniques 

It’s important to stay vigilant and know what you need to look for. Contact APDerm today if you are concerned about possible skin cancer or other growths. It’s not worth losing sleep over! Our team can evaluate your skin issues and give you a proper diagnosis.