Skin Cancer

Telling a dermatologist that you've had skin cancer is sometimes not very helpful. If you walk into the office and have had years and years of unprotected sun exposure, we can probably guess you have had (or have) this nebulous entity called "skin cancer."

"Skin cancer" is the most common cancer in the entire United States. However, it is quite a broad term. There are MANY types of skin cancer. Three of the most common (the rest will not be discussed in this post) are (in order of decreasing frequency):

1) Basal cell cancer (referred to as BCC)

2) Squamous cell cancer (referred to as SCC)

3) Melanoma (referred to as MELANOMA)

1 - Basal cell cancer is THE most common skin cancer in the United States. If the type of "skin cancer" you've had is BCC, you still need to see your dermatologist, but breathe a sigh of relief. These cancers, we often tell our patients, are like cavities on the skin. If you deal with them early, you're golden. But, if you wait a decade or two, they can become nasty looking cavities. We've seen the earliest...and the latest... of them.

Below are some examples of BCCs:

(The one above is your classic "pearly" slightly eroded papule)

(Note the very characteristic arborizing telangiectases (superficial blood vessels))

(The photo above is what happens when you take too much time before seeing a dermatologist)

2 - Squamous cell carcinoma is the second most common skin cancer in the United States. It is undoubtedly related to the amount of one's cumulative sun exposure. I cannot emphasize enough that you will avoid these skin cancers with adequate sunscreen and sun-protective clothing. The most common locations for these critters are on the backs of the hands (wear sunblock while driving!), face, scalp (Wear a hat!), and tips of the ears (Make that a wide-brim hat!). Unlike BCCs which have little, if any, potential to spread to other parts of the body, SCCs have a higher potential for spread. High risk locations for SCCs include in particular the ears and the lips. Don't put off treatment of SCCs if you don't have to.

Below are some examples of SCCs:

(This is your typical SCC - note the keratotic central core)


(The lip area is a higher risk area for metastatic spread - you definitely don't want to let these go untreated)


(Again - these don't pop up overnight, most of the time. They take many months to grow. You really should have seen someone by this stage)

3 - If there's any cancer you don't want, it's melanoma. Melanoma can be invasive or "in-situ." Melanoma in-situ refers to melanoma that is sitting on top of your skin and doesn't have access to your blood vessels. These are the best melanomas to have because they are stage ZERO. They are nearly 100% curable with surgery and have a 99%+ 5-year survival rate. Melanomas that are invasive originally come from melanomas that are in-situ, so treat these as soon as they're found! Invasive melanomas are graded by various characteristics and will be discussed in a separate post. In the interim, learn how to recognize these suckers. They are *usually* pigmented with various colors - light brown, dark brown, black, blue, & red (a mix of any). They are generally irregular in shape and may be large in size. If you have a mole that looks *different* (we call this the ugly duckling sign), appears to be changing, itching, or bleeding, consider having it looked at.

Below are some examples of melanomas:

(Irregular, asymmetric, with variegated pigment)


(Not good)

(Nails can be involved, too!)

Treatment of skin cancers will be discussed separately.
BCCs, SCCs, and melanomas have intra-individual lesion variability. Hence, do not take the above images to represent these classes of skin cancers in their entirety.

(Courtesy to Google for providing the images above from some of the following sites: USUHS, UCSF, skincancerspecialists.org)