Skin cancer (skin carcinoma) is the most common cancer. Approximately 20% of Americans will develop cancer of the skin at one point in their lives. Most forms of skin cancer have a good or very good prognosis, which means that they are curable, often without major surgery. A minority of skin cancers are more problematic to treat.
We know that early diagnosis of skin cancers will allow better treatment and cure. In addition, up to 90% of skin cancers are associated with sun exposure (UV radiation) making prevention an important opportunity. Most specialists categorize skin cancers into two groups: melanoma and non-melanoma skin cancers. By far the most common form are non-melanoma type skin cancers including basal cell carcinoma and squamous cell carcinoma.
Being the most common type of cancer in the US, basal cell carcinoma is by default by far the most common skin cancer. Its cancer cells grow usually slowly and they originate from the deep layer of the epidermis called basal cell layer. Because sun exposure is one of the most important risk factors, most basal cell cancers appear on parts of the body frequently exposed to sunlight (face, ears, chest, scalp, hands, shoulders and back).
Other risk factors include fair skin complexion, blue or green eyes and red or blond hair. Basal cell cancers may not look alarming but rather appear like a new mole or sore.
Most basal cell cancers can be treated relatively easily, but a minority of them will aggressively invade and destroy surrounding tissues, sometimes without showing alarming outside signs. Therefore, early assessment and treatment by a specialist is important.
The dermatologist or plastic surgeon may take a diagnostic biopsy or simply remove the suspicious growth. Spread to lymph nodes is very rare, even in advanced forms of basal cell cancer.
More aggressive in nature than basal cell cancer, Squamous cell carcinoma also originates from the epidermis, the top protective layer of the skin. It makes up approximately 20% of all skin cancers. Just like for basal cell cancers, excessive sun exposure does play a role in the development of squamous cell cancers.
In addition, this form of skin cancer can develop in scars or chronic wounds. In addition to invading surrounding tissues, squamous cell cancer has a higher risk of spreading to lymph nodes or even distant sites of the body.
Melanoma is the rarest of the skin cancers but more precarious a disease. It originates from pigment producing cells within the skin called melanocytes. Therefore, most malignant melanomas are pigmented lesions which present the opportunity for early diagnosis. On rare occasion, skin melanomas may be without the darker pigmentation.
Aside from trunk and legs, the face and neck are some of the most frequent locations for melanoma to start. Although curable in its early stages of growth, malignant melanoma is known for its early spread (a.k.a. metastasis) to lymph nodes and distant sites. The likelihood for metastasis increases with the size and thickness of the skin melanoma. Because metastatic melanoma may still be an incurable disease, early recognition and treatment cannot be overstated.
Although facial skin cancer may be for many patients a preventable condition, the incidence of skin cancers, especially of the face, is still on the rise. The two most common skin carcinomas of the face are basal cell cancer and squamous cell cancer.
One main difference between these two cancers is that squamous cell carcinomas, once they have reached a certain size, can spread via the lymphatic drainage system to involve lymph nodes whereas basal cell cancers grow only locally.
Melanomas originate from pigment-producing cells within the skin. Because the usually produce melanin, melanomas have often, but not always, a brown color. Melanomas are feared because of their tendency to travel early within the lymph and blood stream to other sites within the body than the skin.
Therefore, the key to successful treatment to all skin cancers is early diagnosis. Commonly, the first step is biopsy of a suspicious lesion. Once the diagnosis of skin cancer has been confirmed, the treatment plan usually includes excision. Luckily, most malignancies of the facial skin are curable by surgical removal.
The second most important emphasis in the treatment plan for skin cancers is the cosmetic appearance after the cancer has been successfully removed. Given the aesthetically important and sensitive nature of the face, an unsightly scar from an excision site that simply has been pulled together is today often preventable and unnecessary. Luckily, various surgical and non-surgical techniques are available to the facial plastic surgeon for an optimal result.
For instance, if a skin graft is necessary to repair a skin defect, it is crucial to choose the donor site that lends the skin very carefully for optimal color, thickness and texture match and to prevent a final “patched-up” appearance.
In other scenarios, delicate skin flaps may be of advantage for best results. Choosing and designing these facial flaps carefully and executing the reconstruction with meticulous attention to detail is the secret to success for these restorative procedures. Most procedures for skin cancer excision and reconstruction are performed safely in an outpatient setting.
Equally important to preparation and careful execution of the reconstruction is attentive aftercare to ensure proper healing – sometimes with the help of ancillary measures. Dr. Fechner’s hands-on and close follow-up ensures a closely managed and supervised recovery.
FRANK P. FECHNER MD. All Rights Reserved.
428 Shrewsbury Street, Worcester, MA 01604