Dermatology Center of Northwest Houston Dermatology Center of Northwest Houston - Lisa D Hitchins MD : (281) 256-2000
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Skin Cancer

Melanoma

Melanoma Skin CancerMelanoma, the most serious type of skin cancer, begins in skin cells called melanocytes. Melanocytes produce the pigment, melanin, which determines the color of skin, hair and eyes. It is the leading cause of death from skin disease. Melanoma begins on the surface of the skin and can grow down into the skin reaching the blood vessels and spread around the body. When cancer spreads it is called metastasis.  Melanoma can occur anywhere on the skin but often occurs on sun exposed areas of the body such as arms, face, back and legs.  Melanoma cancer can also occur in the eyes, mouth or the internal organs but this is much rarer than melanoma skin cancer. It is a very dangerous type of cancer, and the patient’s chances of survival often depend on early diagnosis and treatment. Skin cancer is the most common type of cancer and is seen in people of all ages.

Causes

Skin cancer is caused by intense exposure to ultraviolet radiation from sun exposure or tanning bed usage. This can start a change in melanocytes that eventually turns them into melanoma cells.

Risk factors

  • Frequent sun exposure
  • Fair, sun-sensitive skin
  • History of sunburns
  • Reduced Immunity
  • Irregularly shaped moles
  • Previous history of melanoma
  • Older age (>50 years)
  • Hereditary conditions

Signs and Symptoms

Melanoma is often painless and usually produces the following signs:

The first sign is a change in shape, size, and color of an existing mole. It may also appear as a new irregular mole. It may appear black or blue black in color. They are typically located on the back, the shoulders or on the back of the legs. They often have an irregular border and uneven colors. Skin may become reddish or swollen and may be painful.

Treatment

Your dermatologist diagnoses melanoma by visually examining the lesions. If any lesions are suspicious, a skin biopsy will be done where a part or the entire lesion will be removed and observed under a microscope for cancer cells.  If a diagnosis of melanoma is confirmed, the cancer is staged based on its severity as stage 0-IV. Treatment will depend on the stage of cancer, size and location of the tumor, and the patient’s general health. Some of the treatment options include:

  • Surgical treatment: This is the standard treatment for melanoma. Wide surgical excision is done for removal of the tumor along with the surrounding normal skin, depending on the depth of the melanoma
  • Immunotherapy: Also known as biological therapy, immunotherapy uses the body’s immune system to fight cancer or reduce side effects caused by some cancer treatments. Some forms of immune therapy are cytokines such as interferon-alpha and interleukin-2, T-cell therapy, and vaccine immunotherapy
  • Gene therapy: Another new approach in treating melanoma is gene therapy. It involves the insertion of normal genes into cells to replace the defective genes causing cancer spread
  • Chemotherapy: This is the use of drugs to kill the cancer cells. The drugs are given in cycles, where a treatment period is followed by a recovery period before beginning another treatment period. Some of the drugs used are carmustine, tamoxifen, cisplatin, or dacarbazine. Also, combination regimens are used in the management of melanoma
  • Radiation therapy: Treatment method where high- energy rays are used to kill cancer cells

Prevention

  • Avoid excessive exposure to the sun, especially the midday sun (from 10 a.m. to 4 pm)
  • Use a sunscreen every day with an SPF of 15 or higher that blocks both UVA and UVB rays
  • When outdoors, try to stay in the shade either under a tree or an umbrella
  • Clothing and sun hats can protect the skin from the harmful rays
  • Children must be protected from sunburn until age 16. This means using a good sunscreen that blocks both UVA and UVB rays when in the sun and reapplying at least every two hours and after swimming
  • Consult your doctor if you have sores that will not heal

Basal and Squamous Cell Carcinoma

Basal Cell and Squamous Cell Skin CancersCancer, also called malignant neoplasm, occurs when cells in the body divide uncontrollably.   Cancer occurs when the genetic material in the body cells is damaged and the body is unable to repair this damage. These damaged cells divide and multiply uncontrollably forming a tumor mass. Uncontrolled division of skin cells is called skin cancer. Skin cancer is one of the most common forms of cancer with over 1 million new cases reported every year in the U.S.

The most common changes observed in skin cancer include a new growth or sore that does not heal well. The two most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. They are also referred to as non-melanoma skin cancer.

Basal cell carcinoma

Basal cell carcinoma is the most common form of skin cancer. About 80% of skin cancer cases are found to be basal cell carcinoma. It can look like a small pearly nodule or pinkish patch on the skin. It can also appear as a sore that seems to heal but returns repeatedly or as yellowish waxy scar. It develops as a result of short-term exposure to harmful UV rays such as during vacations and on the sun-exposed areas such as the face, ears, scalp, neck and trunk. These cancers grow slowly and rarely spread to other parts of the body.

Squamous cell carcinoma

About 16% of skin cancers are squamous cell carcinoma. Squamous cell carcinoma develops most commonly in middle-aged and elderly people with fair complexion and long-term exposure to sun rays. It appears as a crusted or scaly area over your skin. It is most commonly seen on sun-exposed areas of the body.

Causes

Sun exposure is the most common cause of skin cancer. Exposure to the sun’s ultraviolet (UV) rays damages the DNA in the skin cells. When your body fails to repair the damaged DNA, which has occurred with chronic sun exposure, cancer develops.

Warning Signs

Sores that does not heal, or grow bigger turn into tumors. Sores or tumors in or around the body openings should be watched carefully as these can behave aggressively.

Treatment

Dermatologists diagnose skin cancer by physical observation of the shape, size, color, and texture of an affected or suspicious area. They may also order a skin biopsy where a piece of skin from the affected area is removed and observed under a microscope for the presence of cancer cells. They may also perform various tests to exclude other causes for the lesions.

Your dermatologist considers various factors before initiating treatment such as the type, location, severity or aggressiveness of the cancer, patients’ age and condition. There are several treatment options available to treat skin cancers. Treatment is either medical therapy or surgical therapy.

  • Medical Therapy
    • Topical Medicines - Topical creams containing 5-fluorouracil (Efudex®) imiquimod (Aldara®) are applied to attack the cancer cells and stimulate the immune system
    • Interferon injections - Intralesional injections of interferon
  • Surgical Therapy
    • Curettage and Desiccation - Curettage involves scooping out the cancer mass with the help of a spoon-like instrument called a curette.
      Desiccation is then done by applying an electric current to control bleeding and kill the remaining cancer cells
    • Surgical excision - Removal of the entire tumor mass
    • Radiation therapy - This treatment uses high energy radiation to damage cell’s DNA.  It is usually used to treat cancer which has spread to organs and cancer in areas that are difficult to treat surgically
    • Cryosurgery - In this technique, liquid nitrogen is applied to freeze and kill the abnormal cancer cells
    • Laser surgery - Cancer cells are destroyed and their growth is arrested using laser beams
    • Mohs micrographic surgery - Also known as "microscopically controlled excision", in this method  the surgeon removes a small piece of the tumor mass and examines it under the microscope during surgery. The procedure of removing and examining continues until the cancerous growth is removed and skin sample is free of cancer cells. It is preferred for large tumors that recur after previous treatment

Preventive Tips

Avoiding sun exposure is a good preventive measure. Some common preventive tips you should follow include:

  • Avoid unprotected exposure to the sun between 10 am to 4 pm
  • Wear broad brimmed hats and protective clothing when outdoors in the sun
  • Use a water resistant sunscreen with UVA protection and SPF 30 or higher regularly
  • Apply sunscreen liberally and apply every two to three hours, especially after swimming or physical activity that may cause sweating
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