Skin cancer is the uncontrolled multiplication of the skin cells where cells behave independently of one another. If left untreated, these cancerous cells can spread to other places on the body. This abnormal, chaotic growth results in certain physical changes to moles or lesions that are described in the ABC of Skin Lesions.
The ABC of Skin Lesions defines the five signs of skin cancer as:
If you have a skin lesion that is demonstrating these changes, you should have it examined by your family doctor or dermatologist.
The most common skin cancers are Basal Cell Carcinomas, Squamous Cell Carcinomas, and Melanomas.
All three common skin cancers are directly related to sun exposure, especially childhood sunburns. They are often on the head and neck, arms, men's torso, and women's legs - areas that are most exposed to sun. Skin cancer is also more common in individuals who are immunosuppressed, such as transplant patients.
If skin cancers are very superficial, they may respond to certain topical creams or curetting (scraping) by your dermatologist. If there is a concern that they are thicker or are more advanced, surgical removal is the main treatment
The goal of your surgeon is to remove the lesion and reconstruct the area while preserving function and minimizing cosmetic impact. This can be accomplished by moving adjacent tissue to cover the defect (flap), or by bringing in fresh additional tissue to cover the defect (graft).
BCC is the most common skin cancer. It is slow growing and rarely spreads to other areas of the body. The BCC lesions are easily removed unless they have been ignored for a very long time.
In most cases, the lesions can be surgically removed without removing much of the skin bordering the lesion. The hole is then covered with healthy skin from the tissue adjacent to it. For larger lesions, however, a skin graft maybe required to cover the hole.
If adjacent tissue was used, stiches may need to be removed 7-10 days after. If absorbable sutures are used, then they will dissolve on their own. If a graft was required, the dressing should not be disturbed or removed until you see your surgeon in follow up. This is typically one week later.
With any surgery, there is a risk of infections or premature opening of the wound. If the skin cancer is not completely removed, it may require another surgery. Temporary distortion of neighbouring structures is also a possibility (e.g. distorting the shape of the eyelid).
SCC is the second most common type of skin cancer. It is more aggressive than BCC and can spread to other areas of the body if not treated earlier. In order to make sure that the cancer is completely removed, your surgeon will need to remove some adjacent tissue to create a wider margin and the nearby lymph nodes should be examined for evidence of spread.
Like BCC, surgical removal and coverage with adjacent tissue (flap) or additional tissue (graft) is the mainstay of treatment. If the lymph nodes are involved, then their removal may also be necessary.
If covered with a flap, non-absorbable sutures need to be removed in 7-10 days. As a wider margin is required, SCC's are more likely to be treated with a graft than BCC's as there may not be enough adjacent tissue to close the defect. If a graft was required, the dressing should not be disturbed or removed until you see your surgeon in follow-up. This is typically one week later.
There is always a chance of infection or the wound opening. There is a chance that the reconstruction does not work. There is a chance the margin is not clear and we have to remove more tissue.
A melanoma is a disorganized growth of the cells responsible for skin colour. This is why they are often very dark brown or even black. In some rare cases, you may have a melanoma that has no pigment at all.
Melanomas can spread to lymph nodes and then to organs such as the liver, lung, brain, and skeletal system. For this reason, it important to treat them thoroughly and have appropriate long term follow-up. The two key factors that determine prognosis is how thick the melanoma is and whether the lesion is ulcerated or breaking down and bleeding on its own.
Depending on how thick the melanoma is, fairly generous resection margins are required. For this reason, skin grafting is often required when the melanoma is too tight to cover the wound with adjacent tissue. Again, depending on the thickness of the melanoma, sentinel node biopsy may be indicated. This is a technique that uses combination of radioactive and pigmented dye to find the node looking after the melanoma and remove it so a pathologist can determine if cancer has spread to the node.
Like BCC and SCC, there is a risk of not removing the entire melanoma, infection, the wound opening, or the reconstruction not working. There is also a 2% chance that the sentinel node cannot be found.
MOH's is a special technique whereby the lesion is removed and the margins are immediately checked to make sure it is completely removed. Overall, it has the lowest recurrence rate for management of skin cancers. Only 2-3 physicians in British Columbia perform MOH's, and each procedure can take 4-8 hours.
Skin cancers are very common. There are not enough resources to offer MOH's to every skin cancer patient, nor is it indicated. The overwhelming majority of skin cancers can be safely removed and further resection can be done in the rare instance that the margins are not clear. For lesions that we cannot tell where the margin is, we would consider referring the patient to one of the MOH's physicians.