Benign and Malignant Skin Tumors

OK, we're going to keep it simple here. The truth of the matter is the only way we know for certain a skin growth is benign is to remove it and have it looked at under the microscope by the pathologist. I can look at some lesions and know, just by looking, that there isn't any present significant concern. Others I know are trouble from the first look but……….for the most part, they need examined by the pathologist. His job is to tell me what it was and if we removed all of it. If we didn't get it all, depending on the diagnosis, sometimes we can watch it and other times we need to take out a little more.

 

Skin cancer is the most common form of cancer in the United States. About 80% are on the head and neck. The primary culprit is ultraviolet radiation from the sun but ultraviolet radiation from artificial sources, like the sun tanning beds, is a problem also. I'm seeing younger and younger patients with skin cancers from our quest for the perfect tan. Everyone should use a sun screen of at least SPF 15. Don't let your children get sun burned.

You're at greater risk if:

• You're fair, freckled, light skinned and have light hair

• You have a lot of moles and a family history of skin cancer

• You have a history of blistering sun burns and you spend a lot of time working or playing in the sun

Basal cell carcinoma is the most common and the least dangerous. It grows slow and rarely spreads beyond the original site; however, it's not unusual to have different sites. It's not what you think of as life threatening but, if you ignore a spot, the bigger it gets the more difficult excision and reconstruction of the defect is. This is particularly true on the face, where we don't have a lot of extra tissue to spare. The best advice I can give you is to let me take a look at lesions when they are small because……….a little spot makes a little scar.

                                         
                                                                                        

The next most common and second most serious type of skin cancer is squamous cell carcinoma. This usually appears on the lips, face and ears. It does have the potential to spread to other parts of the body and internal organs usually through the lymph nodes. This type of cancer is more aggressive has the potential to be life threatening. My role in your treatment involves excision of the lesion and any necessary local reconstruction. The incisions and resulting scars are usually just big enough to get the growth out and usually they're quite acceptable. Your primary care physician will advise if any other treatment such as chemo therapy and/or radiation might be indicated. Not all patients require any further treatment aside from the surgical excision and routine followup.

                                   

This is the least common but the most dangerous and the most aggressive. I'm seeing more and more of it and in younger patients. If discovered and treated early enough, it can be completely cured. It usually starts from an existing mole but it can be a new growth on normal skin. It can be aggressive and spread quickly throughout the body. It is often deadly. Since this type of cancer spreads easily, a much bigger specimen is usually removed and it may require a skin graft or other type of reconstruction. The scar can be more unsightly. A lot of it just depends on where it's at.

                                

Moles

Most of us have a few moles here and there and that's not a big problem. They're usually benign. Some moles do change into cancer; however, so if you notice a change in a mole it should be looked at. What we watch for would be a change in the shape, color, size, border or if it would change characteristic and start itching, bleeding, etc. Some moles are what diagnosed as what they call junctional meaning it is benign, at the present time, but it has a higher potential of becoming malignant at some stage. So, once again, even though it was benign it's best to be rid of it in view of the malignant potential.

Actinic keratosis are sort of one step before a squamous cell carcinoma. All of the right ingredients are there for it to move into a cancerous stage….. it just hasn't dropped over the edge yet. So, yes, it's benign but pre-cancerous and, once again, you're just as well to be rid of it since it was probably going to cause you some grief at some point.

                          

When a patient, like the gentleman above, has multiple actinic keratosis, sometimes surgery isn't practical and we have to treat conservatively and repeatedly with a topical medication. This is a cream that is applied a couple of times a day. It makes the keratotic areas very red and angry. In fact, it just looks horrible for awhile. Then it scabs up and peels off and there is fresh new skin underneath.

Here's the confusing part…………..it's very difficult to tell you just what to watch for. There's no recipe. Basal cell carcinoma and squamous cell carcinoma can vary widely in appearance. The lesion can be a small white or pink nodule or bump that can be smooth, shiny, waxy or depressed. The edges can be rolled. It can also appear as a spot that's red, rough, scaly or crusty that bleeds or doesn't heal. A white patch, particularly on the lips or in the mouth, can also be the sign of cancer.

The best thing you can do is know your skin and examine it regularly. If you notice a change, have your family doctor, or me, look at it. If you have moles, take dated, close up photographs at the same time every year (like your birthday) and put them in the family album. You look at these things everyday. Sometimes it's difficult to remember what they looked like a year ago. Sometimes they're on the back or somewhere where it's difficult to see.

What is my role as your plastic surgeon?

My job is basically to remove the lesion and do whatever reconstruction, large or small, surgically necessary. Most of the cancer surgeries I do are done as an outpatient under local anesthesia and they usually won't do much to slow you down any more than any laceration would. I am not an expert in any additional treatment such as chemo, radiation, etc. Many times no more than the surgical excision and routine followup is necessary. Your family doctor will guide you with regard to this and a determine a course of followup. Patients are often times evaluated and/or treated by an oncologist who is a specialist is cancer treatment.