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The Warning Signs of Skin
Cancer
1. A sore that doesn't heal is the usual way non-melanoma
skin cancer starts. These would be squamous
cell carcinoma [view photo]
and basal cell carcinoma [view
photo].
Although these generally do not metastasize and threaten life, the sooner
they are removed the better— at least the scar will
be smaller. If neglected, these common skin cancers can become extensive
with threats to important organs. It is sometimes necessary to remove an eye or an ear to remove all of a large skin cancer.
2. A mole that changes is the red flag for melanoma. The longer
a melanoma is present on the skin, the higher the risk of death. Fortunately
most melanomas grow and spread on the surface of the skin for a period
of time before they grow down into the deeper layers of the skin. The
deeper layers contain blood vessels and lymphatic vessels that can transport
cancer cells to distant parts of the body to create metastases. If a melanoma
is removed while it is still thin, the cure rate is 95 percent. Thick
melanomas have a much lower cure rate.
Dr. Lofgren uses many criteria as he examines lesions to try to determine
a diagnosis. Many of these are published in the media, but many more are
not. It takes years of experience to reliably diagnose skin cancer by
looking at it. He worries that some of the photos that are published in
the media can give a person a false sense of security if their particular
mole doesn't match the pictures. It is important to realize that pictures
deemed good enough to publish are the easy ones. The difficult-to-diagnose
skin cancers don't have all of those classic features, so their pictures
are never published.
Some melanomas don't fit the standard criteria and one would think by
just looking that they are benign. Then decisions are made based on risk
factors and subjective factors. Since biopsies and mole removals are relatively
easy to do, benign appearing moles can be removed just because the patient
has multiple risk factors for melanoma or if the patient cannot stop worrying
about it until it is removed. Every once in a while one of these benign
appearing moles in fact turns out to be a melanoma. It keeps one honest.
The ultimate test for skin cancer is the biopsy. Many of the skin
cancers are small enough that it is just as easy to remove the whole thing
as to do a small biopsy. So usually that is what Dr. Lofgren does. For
larger lesions, or where the best possible cosmetic result is desired,
a small biopsy is appropriate. Then, if the lesion in fact is not cancer,
less destructive forms of treatment can be used with better healing and
less scarring as a result.
Skin Cancer
Treatment
Melanoma
Suspected melanomas should be removed entirely the first time for two
reasons:
1. There is concern that cutting through a melanoma might precipitate
metastasis.
2. The pathologist needs to have the entire lesion available for study
to determine future treatments and tests.
If it is a thin melanoma, a wide re-excision is then done. If it is a
thick melanoma, an even wider re-excision is done and additional tests
such as lymph node dissection might be done. A new test for the intermediate
thickness melanomas is called the sentinal lymph node test. It allows
a determination to be made on lymph node metastases without the need to
remove all of the lymph nodes in question.
Variations
of Skin Cancer
The most common methods of removing skin cancer are to either cut it out
or burn it off. Certain types of skin cancer allow topical chemotherapy
and sometimes radiation therapy is used. Advanced or aggressive skin cancers
are often treated with Mohs surgery. This special form of surgery allows
microscopic examination of the entire surface of the lesion at the time
of surgery. The surgery is continued and specimens examined microscopically
until no tumor is left in the skin.
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Looks aren't everything!
It can be very difficult to tell
whether a mole is malignant
just by looking.
 
Which of these photos do YOU think is a skin cancer lesion?
Click on your choice to see
if you're right.
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Melanoma
is a life-threatening form of skin cancer that can be cured by early removal.
Dr. Lofgren tries to maintain a very high index of suspicion whenever
examining a patient for skin cancer. He is thrilled when a suspicious
looking mole turns out to be benign. Too often—and much more often
than 20 years ago—the pathologic diagnosis turns out to be melanoma.
Thankfully the vast majority of the melanomas are still curable by the
routine re-excision of the lesion with wide margins.