Skin cancer can be largely divided into two categories: melanoma and non-melanoma skin cancers (NMSC). NMSC are the most common cancers in humans, with 2 million cases diagnosed in the United States in 2004. It is estimated that one out of five Americans will develop a skin cancer in their lifetime. The number of NMSC has been increasing at the rate of 3 to 8 percent per year in U.S., Canada, Europe and Australia.
The risk factors for development of NMSC include light-colored skin, eyes and hair, ultraviolet radiation (sun) exposure, outdoor activities, tanning parlor use, increased age, suppressed immune system, and certain genetic diseases. Basal cell carcinoma (BSC) is the most common type of NMSC, with squamous cell carcinoma (SCC) being the second most common type. Actinic keratosis, the most common neoplasm treated in humans, is the precursor lesion to SCC.
Basal cell carcinoma is the most common of all skin cancers. Basal cell carcinoma usually doubles in size yearly. It presents as a skin-colored to reddish bump that may bleed spontaneously. BCC is most commonly seen on sun-exposed skin, such as face, scalp, arms and legs. Traditionally non sun-exposed skin, such as mid-lower back and buttocks, may also be involved, especially in patients that frequent tanning parlors. These lesions usually double in size yearly and may invade into surrounding tissue, producing a destructive effect. Therefore, early detection and removal are very important. Multiple treatment options exist for basal cell carcinoma, including surgical excision, electrodessication and curettage (“scrape and burn” procedure), topical cream and Mohs surgery. The most appropriate treatment depends on the size, location and type of the basal cell carcinoma and should be discussed with your dermatologist.
Squamous cell carcinoma is the second most common type of skin cancer. It is usually seen on the balding scalp, face, ears, neck, as well as arms and legs (sun exposed areas). This skin cancer is slightly more aggressive than basal cell carcinoma, and rarely may spread to other organs (metastasize). The risk of spreading is higher in those patients with an abnormal immune system. Therefore, early detection and removal is important.
Patients usually present with red, scaly, scabbed bumps that may bleed easily. Multiple treatment options exist for squamous cell carcinoma, including surgical excision, electrodessication and curettage, topical cream and Mohs surgery. The most appropriate treatment depends on the size, location and type of squamous cell carcinoma, and should be discussed with your dermatologist.
Actinic keratosis (AK) are precursor lesions to squamous cell carcinoma. AKs present as reddish, scaly “sandpaper like” spots on sun exposed skin, most commonly on balding scalp, face, neck, arms and legs. Multiple treatment options exist for AKs. It’s important to use combination treatment in patients with AKs, to treat the visible lesions and also those that are “underneath the surface” (subclinical lesions).
Cryosurgery is the most common treatment — a dermatologist uses a cold spray to treat AKs, which blister and then scab off. A variety of topical creams are available, and can be used by the patient at home; this treatment is particularly good for subclinical lesions. AKs can also be treated using photodynamic therapy: a liquid medication is applied by the dermatologist and then after a 60 to 90 minute incubation the patient is exposed to blue light for 1,000 seconds. The most appropriate treatment depends on the size, location and number of lesions, and should be discussed with your dermatologist.
For additional information or to make an appointment with Dr. Goldenberg or any other dermatologist at Mount Sinai Dermatology Faculty Practice Associates, please call (212) 241-3050.
Dr. Gary Goldenberg is an assistant professor of dermatology and pathology and Medical Director of the Dermatology Faculty Practice at Mount Sinai School of Medicine, 5 East 98th St., 5th floor, in New York City.