What are the signs and symptoms of skin cancer?
Most basal cell carcinomas have few if any symptoms. Squamous cell carcinomas may be painful. Both forms of skin cancer may appear as a sore that bleeds, oozes, crusts, or otherwise will not heal. They begin as a slowly growing bump on the skin that may bleed after minor trauma. Both kinds of skin cancers may have raised edges and a central ulceration.
Signs and symptoms of basal cell carcinomas include:
- Appearance of a shiny pink, red, pearly, or translucent bump
- Pink skin growths or lesions with raised borders that are crusted in the center
- Raised reddish patch of skin that may crust or itch, but is usually not painful
- A white, yellow, or waxy area with a poorly defined border that may resemble a scar
- Persistent, scaly red patches with irregular borders that may bleed easily
- Open sore that does not go away for weeks
- A raised growth with a rough surface that is indented in the middle
- A wart-like growth
Skin cancers typically arise in areas of the skin exposed to the sun repeatedly over many years such as on the face and nose, ears, back of the neck, and the bald area of the scalp. Less commonly, these tumors may appear at sites with only limited sun exposure such as the back, chest, or the extremities. However, skin cancer may occur anywhere on the skin.
Treatment of Skin Cancer
There are several effective means of treating skin cancer. The choice of therapy depends on the location and size of the tumor, the microscopic characteristics of the cancer, and the general health of the patient.
- Topical medications: In the case of superficial basal cell carcinomas, some creams, gels, and solutions can be used, including imiquimod (Aldara), which works by stimulating the body’s immune system causing it to produce interferon which attacks the cancer, and fluorouracil (5-FU), a chemotherapy drug. Some patients do not experience any side effects of these topical treatments, but others may have redness, inflammation, and irritation. A drawback of topical medications is that there is no tissue available to examine to determine if a tumor is removed completely.
- Destruction by electrodessication and curettage (EDC): The tumor area is numbed with a local anesthetic and is repeatedly scraped with a sharp instrument (curette), and the edge is then cauterized with an electric needle. The advantage of this method is that it is fast, easy, and relatively inexpensive. The disadvantages are that the scar is often somewhat unsightly, and the recurrence rate is as high as 15%.
- Surgical excision: The area around the tumor is numbed with a local anesthetic. A football-shaped portion of tissue including the tumor is then removed and then the wound edges are closed with sutures. For very big tumors, skin grafts or flaps are needed to close the defect. The advantages of this form of treatment are that there is a greater than 90% cure rate, the surgical specimen can be examined to be sure that the whole tumor is successfully removed, and the scar produced is usually more cosmetically acceptable than that of the EDC procedure. It is a more complicated procedure and is more expensive than EDC.
- Mohs micrographic surgery: The site is locally anesthetized and the surgeon removes the visible tumor with a small margin of normal tissue. The tissue is immediately evaluated under a microscope and areas that demonstrate residual microscopic tumor involvement are re-excised and the margins are re-examined. This cycle continues until no further tumor is seen. This more complicated and expensive option is the treatment of choice for tumors where normal tissue preservation is vital, where the tumor margins are poorly defined, in tumors that have been previously treated and have recurred, and in certain high-risk tumors.
- Radiation therapy: Ten to fifteen treatment sessions deliver a high dose of radiation to the tumor and a small surrounding skin area. This form of treatment is useful in those who are not candidates for any surgical procedure. The advantage of radiation therapy is that there is no cutting involved. The disadvantages of this expensive alternative are that the treated area cannot be tested to be sure the whole tumor is gone and radiation scars look worse over time. It is for this reason it is usually reserved for elderly patients.
- Other types of treatments for skin cancers include cryosurgery where tissue is destroyed by freezing, photodynamic therapy (PDT) in which medication and blue light is used to destroy the cancerous tissue, laser surgery to vaporize (ablate) the skin’s top layer and destroy lesions, and oral medications vismodegib (Erivedge) and sonidegib (Odomzo).
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