There are three major forms of skin cancer – basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Other types of cancers occur in the skin, but these are rare and beyond the scope of this discussion.
Basal cell carcinoma is the most common of these three. It usually appears on sun-exposed skin and looks like a flesh-colored or pink bump, or a sore that bleeds and does not heal. There is great variability in its location and appearance. When diagnosed by biopsy, basal cell carcinoma is usually surgically removed; however, immunotherapy and photodynamic therapy can often be used successfully. Occasionally, MOHS surgery or radiation surgery is needed.
Squamous cell carcinoma is the second most common type of skin cancer. It too appears on sun-exposed skin. Generally it starts as a crusted patch that refuses to heal. Biopsy and surgical treatment is the most common choice because these tumors can recur and rarely metastasize.
Malignant melanoma is the most serious type of skin cancer. Approximately 55,000 new cases are diagnosed in the U.S. per year. It often appears in sun-exposed skin, but may occur anywhere, including the eye. It also occurs, rarely, in skin of color. If detected early, it is 100% curable. If, however, it has progressed beyond superficial levels of the skin, it is a very serious disease requiring extensive evaluation, surgery, and possible chemotherapy or a trial of vaccine therapy. The signs which suggest that a lesion may be a malignant melanoma are:
A – Asymmetry
B – Borders that are irregular
C – Color variation
D – Diameter larger than 6 millimeters
The number of melanomas diagnosed in the U.S. per year is steadily increasing up to 55,000 per year. Clearly, the diagnosis is being made more often and earlier. Unfortunately, the number of deaths per year has not decreased and remains constant at 7800 per year.
Cancers of the skin are the most common of all malignancies and are increasing in number. Most are treatable and curable if diagnosed early. Expert examination and biopsy, when needed, is the first step toward prevention of this disease.
Aldara (imiquimod) is the first of a class of drugs called immune modulators. This drug induces the formation of interferon in the skin. Interferon has antiviral, anti-tumor, and anti-proliferative activities. The drug has been used for years to treat viral warts and has just been accepted in the treatment of actinic keratoses (precursors to skin cancers). There is also a great deal of interest and practical experience in using it to treat small and superficial skin cancers, or skin cancers in patients where surgery is not a good option. Early results of this experience is very promising.
If you have questions, do not hesitate to discuss them at the time of the office visit, or via telephone.