OVERVIEW: For many of the more than 2 million people in the United States diagnosed annually with non-melanoma skin cancer – including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) – the diagnosis may come as a welcome relief since it’s not a more serious diagnosis of melanoma, the deadliest form of skin cancer. However, dermatologists are concerned that patients are not taking a non-melanoma skin cancer diagnosis as seriously as they should and point out that there are common misconceptions among the public that these types of skin cancer do not spread and do not require surgical treatment.
AMERICAN ACADEMY OF DERMATOLOGY EXPERTInformation presented at the American Academy of Dermatology’s Summer Academy Meeting by Fiona O’Reilly Zwald, MD, FAAD, a board-certified dermatologist and assistant professor of dermatology, Mohs micrographic surgery and transplant dermatology at Emory University in Atlanta.
THE DANGERS OF NON-MELANOMA SKIN CANCERSBasal cell carcinoma and squamous cell carcinoma are the two most common forms of skin cancer and can pose a significant health threat if left untreated. Dr. Zwald reported that a study found that both BCC and SCC are increasing in both men and women under age 40, and future generations may continue to be more at risk for these types of skin cancers if they do not change their attitudes and behaviors when it comes to sun exposure and tanning.
BCC•More than 2 million cases of this skin cancer are diagnosed in the U.S. each year•BCC grows slowly and rarely spreads to other parts of the body•Treatment is important because BCC can grow wide and deep, destroying skin tissue and bone•If left untreated, BCC can also get infected or cause disfigurement
SCC•More than 700,000 new cases of this skin cancer are diagnosed in the U.S. each year•Treatment is important because SCC can grow deep, destroying tissue and even bone. In some cases, SCC spreads to the lymph nodes and other parts of the body•Like BCC, SCC can get infected or cause disfigurement SURGERY STILL REIGNS FOR SKIN CANCERSBy current estimates, both BCC and SCC have cure rates approaching 95 percent if detected and treated early.¹ While several non-surgical therapies can be used successfully to treat superficial or early stage non-melanoma skin cancers, Dr. Zwald emphasized that surgery (including local surgical excision, Mohs surgery, and curettage and electrodesiccation) is still the most recommended treatment option for many skin cancers.
Local surgical excision•Performed in a dermatologist’s office, the dermatologist numbs the skin and then surgically removes the skin cancer and an additional amount of normal-looking skin (known as the margin).•This skin will be reviewed under a microscope, either in the dermatologist’s office or at a laboratory to determine if all the skin cancer was removed. •Another surgery may be scheduled, if not all the skin cancer was removed.
Mohs surgery•This procedure performed in the office allows a dermatologist with advanced training in Mohs surgery to more precisely remove the entire skin cancer and preserving as much normal skin as possible.•While the patient waits, each layer of skin is examined under a microscope by the Mohs surgeon, in the office, to look for cancer cells. If cancer cells are found, the surgeon will remove another layer of skin only in the area where the skin cancer was found.•This continues until the Mohs surgeon no longer finds cancer cells at the margin. This technique allows the Mohs surgeon to preserve as much healthy tissue as possible yet remove the entire cancer and achieve the highest cure rate for these tumors.•Most Mohs surgeries can be completed within a day or less, and have an extremely low risk of pain and infection.
Curettage and electrodesiccation•This surgical procedure may be used to treat small BCCs and SCCs of the head and neck area that have not grown beyond the surface of the skin.•This procedure involves scraping the tumor with a curette (a surgical instrument shaped like a long spoon) and then using an electric needle to gently cauterize (burn) the remaining cancer cells and some normal-looking tissue.•This scraping and cauterizing process is repeated up to three times.•The wound from this procedure tends to heal without the need for stitches.•Dr. Zwald notes that there is a slightly higher BCC or SCC recurrence rate with this procedure than with excision or Mohs surgery because the doctor does not remove or check the normal-looking skin surrounding the skin cancer.
NON-SURGICAL TREATMENTS FOR SKIN CANCER AND PRE-SKIN CANCERS CONTINUE TO GROWOver the years, a number of topical therapies to treat or even prevent future skin cancers have been introduced and shown to be very effective. Dr. Zwald explained that typically these types of treatments are used for superficial and less aggressive forms of BCC and SCC and for pre-skin cancers known as actinic keratoses (AKs), especially when there are multiple pre-cancerous lesions spread over the skin. In instances where skin cancer is more aggressive, a combination of surgery and topical therapy used to treat the lesions and prevent recurrence may be recommended.
Dr. Zwald explained that some topical therapies can be done at home by the patient, while others need to be supervised in the dermatologist’s office.
In addition, a new oral chemotherapeutic pill has been approved by the Food and Drug Administration (FDA) for patients with a high risk of developing non-melanoma skin cancer, such as those who received an organ transplant.
WHAT PATIENTS CAN EXPECT WITH TREATMENTDr. Zwald noted that a dermatologist uses personalized medicine to determine the treatment for each individual patient. It’s important for patients to discuss the different treatment options, including what is expected before, during and after a procedure, with their dermatologist prior to undergoing treatment. The risks and benefits of surgery must always be weighed against the risks of the cancer itself, and the risks and benefits of other treatments.
AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE:“The best medicine in fighting skin cancer is prevention, as sun protective behavior – such as using sunscreen and wearing sun-protective clothing, seeking shade, and avoiding tanning beds – has been proven to reduce the risk of all skin cancers, even in those patients with a history of prior skin cancer,” said Dr. Zwald. “For those diagnosed with non-melanoma skin cancer or AKs, a wide array of surgical and medical therapies can be used alone or in combination to successfully treat, and in many cases, cure or even prevent skin cancer. The earlier non-melanoma skin cancer is treated, the better chance that it can be cured.”
Celebrating 75 years of promoting skin, hair and nail healthHeadquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 17,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org. Follow the Academy on Facebook (American Academy of Dermatology) or Twitter (@AADskin).
1Christenson, LJ, Borrowman, TA, Vachon, CM, et al. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA 2005 Aug 10; 294(6): 681-90