Skin Cancer

with David Mai, M.D., dermatologist with Advanced Healthcare

Last Updated: Aug. 1, 2003

With our sun-worshipping culture adding to the risk for skin cancer, it is estimated that half of all Americans living to age 65 will develop skin cancer at least once. Fortunately, of the three basic types of skin cancer, the two most common – basal cell carcinoma and squamous cell carcinoma – usually remain localized and respond well to treatment.

Even the most malignant skin cancer, melanoma, is nearly always curable when diagnosed early. However, since it is difficult to have an exact diagnosis without a biopsy, any person who suspects skin cancer should consult a physician as soon as possible.

David Mai, M.D., dermatologist with Advanced Healthcare "In the 1800s if you had a tan, it was undesirable. Then it meant you were a farm worker or a laborer. The wealthy stayed indoors. Now it’s considered healthy and a sign of wealth to be playing in the sun at the beach or the golf course. In reality that prestige can be a big mistake in that it can lead to cancer."

Lowering your risk
You cannot change your genetic makeup. If you are fair skinned, you are at greater risk (people with dark skin also get skin cancer, though not as frequently). If your family has a history of skin cancer, your risk rises. But everyone can limit the amount of sun they and their children are exposed to.

It is estimated that 80% of sun exposure occurs in people before they reach age 18. In addition, some scientists believe that more of the dangerous radiation is reaching the surface of the earth today, further increasing the rate of skin cancer and lowering the age at which it appears.

According to Dr. David Mai, a dermatologist with Advanced Healthcare, skin cancer is one of the most dangerous forms of cancer in young adults. “I had a patient who was 28 and had melanoma. I see people in their early forties and fifties with melanoma. I suggest everyone wear good sun blocks, especially those with titanium dioxide, which reflects the sun.

“An easy thing to remember is that when your shadow is shorter than you are tall, the cancer-causing rays are getting through the atmosphere. In my family, we make swimming an evening event and keep the kids out of the sun during the middle of the day,” Dr. Mai said.

Getting a skin exam
Because dermatologists are specialists, they often see referrals or patients coming with a specific concern. “During the first appointment, I ask questions about sun exposure, genetic background and family history and then I do a full skin exam. Depending on my schedule, I am sometimes able to do a biopsy that same day so that the patient has the news as quickly as possible,” said Dr. Mai.

He added that some doctors also examine moles with a special high intensity light attached to a magnifying glass. This new process, called epiluminesence, allows a physician to get a detailed look at the suspicious tissue to determine if it is likely to be cancerous.

If the mole is very small and in a spot that requires no special consideration, such as on the arm, for example, Dr. Mai will often shave off the mole or excise it completely during that first exam, closing the wound with stitches. The entire growth will then be sent off for a biopsy.

Treatment
Treatment of skin cancer depends greatly on the type of cancer, where it is located and how advanced it is.

With basal and squamous cell carcinomas, which are the most common and most easily treated forms of skin cancer, removal of the cancerous tissue may be all that is needed.

If a basal cell growth is on a place where scarring would be an issue, a specialist may be called in to do Mohs surgery. This method involves taking off a thin layer of the mole, freezing it and examining it for cancerous cells. If cancer is found, another thin layer is removed and examined. Layers will continue to be removed until all the cancerous tissue is taken.

Treatment of skin cancer depends greatly on the type of cancer, where it is located and how advanced it is.

“This procedure is ideal for the face, especially near the eye; those sensitive areas where you need to preserve tissue,” Dr. Mai said.

A promising new development in the arsenal against skin cancer is a drug called Aldara. This drug, originally created to treat genital warts, appears able to treat early stages of basal cell carcinoma.

Melanoma
“This is the type of cancer most on the increase. Five years ago it was estimated that one in eighty people would develop a melanoma in their lifetime. The figure has dropped to one in sixty-five. It’s still the least common of the three types of skin cancer but it’s the most life threatening,” Dr. Mai said.

Melanoma must be caught early to ensure survival. Once this cancer is diagnosed, a physician must determine how deeply it has descended into the healthy tissue. After the dermatologist removes the lesion, it is evaluated by a pathologist. Melanomas determined to be .75-1.0 mm in depth (less than one tenth of an inch) are unlikely to have spread.

If the cancer is deeper than 1.0 mm, the patient is usually referred to specialists. The first will likely be a surgeon who does sentinel node biopsies. The surgeon examines the lymph glands to determine if the cancer has spread to them.

If it has, further tests such as CT scans and X-rays will be taken to determine further spread of the cancer. If the cancer has only spread as far as the lymph nodes, it may still be treatable.

Once it spreads throughout the body, however, the cancer becomes extremely aggressive and treatments are limited. The arsenal currently includes an experimental vaccine for melanoma and interferon.

It also is important to understand that you can get skin cancer anywhere on the body, not just in places that have been exposed to the sun.

However, though interferon will extend life in some people, it also gives the patient flu-like symptoms, often serious. And even with treatments, survival rates usually fall to less than two years. “I’ve seen many patients die within six months,” Dr. Mai said. This is why seeing a physician as soon as a problem is discovered is vitally important.

It also is important to understand that you can get skin cancer anywhere on the body, not just in places that have been exposed to the sun. This includes under the hair on the scalp, in the genital area, even inside the nose or eyelid.

Any sore that is bleeding or will not heal, should be checked by a physician. “And if you catch it early, the outcome is very good – a five-year survival rate of ninety-five percent,” Dr. Mai said.

We Have Answers Do you have medical questions or need help finding a doctor? The experts at Columbia St. Mary's and Advanced Healthcare can help. Click here.