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Information on Skin Cancer and Malignant Melanoma

In the United States, skin cancer is more common than all other forms of cancer combined. More than 400,000 new cases are diagnosed each year. In most cases, skin cancer is curable. Statistics predict that approximately 600,000 Americans will develop squamous cell and basal cell carcinoma of the skin. The predictions for 1993 estimate that melanoma skin cancer will amount to 2% of all cancer related deaths in males and 1% in females. This represents an estimated 32,000 total melanoma cases with 6,800 total deaths secondary to melanoma in 1993.

There are several types of skin cancer. First, we will consider suspicious skin lesions and "bumps" in general.

FIVE SIGNS OF A SUSPICIOUS SKIN LESION

1. Those that have an irregular or ill defined margin.

2. Those that bleed or crack.

3. Those that have inconsistent coloration, rather than one consistent color.

4. Those that change rapidly in size or shape.

5. Any "new" lesion, whether in a sun exposed, or other area.

TYPES OF SKIN CANCER

1. BASAL CELL CARCINOMA: the most frequently occurring form of skin cancer. Although this type of cancer may appear at any time, it appears most commonly in people over the age of 40. Most of these tumors will form on sun damaged areas which have received prolonged sun exposure. Basal cell carcinoma can spread and invade other tissue.

2. SQUAMOUS CELL CARCINOMA: also frequently associated with sun-damaged skin. The most commonly affected areas include the face, head, and hands. This form can also spread but is usually NOT life-threatening.

3. MALIGNANT MELANOMA: a form of skin cancer that is the leading cause of death attributable to skin lesions. An estimated 32,000 new cases of melanoma will be diagnosed in 1992, with approximately 6,500 deaths attributable to this disease. The median age for patients with melanoma is in the low forties. The incidence of malignant melanoma is increasing more quickly than any other cancer.Fortunately, there has been a marked concomitant rise in the survival rate from this problem. This increase is thought to be the result of earlier detection.

Several RISK FACTORS have been identified for the development of melanoma:

1. Family history of malignant melanoma.

2. Presence of blond or red hair.

3. Presence of marked freckling on the upper back.

4. History of 3 or more blistering sunburns prior to age 20.

5. History of 3 or more years of an outdoor summer job as a teenager.

6. Presence of actinic keratosis.

Persons with 1 or 2 of these factors have a 3.5-fold increased risk over the general population for malignant melanoma. Those with 3 or more of the factors have a risk of approximately 20-fold.

Melanoma often appears as a new "jet black" lesion in a sun exposed area. Some important factors to consider when assessing a questionable area, are these findings consistent with a melanoma:

1. Asymmetry of the lesion.

2. Irregularity to the border (regular moles "nevi" are round).

3. Variances in coloration (tans to brown to black).

4. Diameter generally greater than 6 millimeters.

Treatment principally involves surgical excision of the lesion. Some newer forms of therapy for advanced cases (metastatic) involve the use of chemotherapeutic agents and genetically altered lymphocytes (white blood cells) which carry a gene to produce a tumor killing factor. These cells act as "guided missiles" when transfused back to the patient.

REMEMBER the following:

Moles or old lesions that you have had for a long time should be observed closely for any changes in color, size, or overall appearance.

Those areas which are often exposed to the sun are at highest risk for the development of skin cancer. People who spend a lot of time in the sun without proper sunscreen protection (SPF 15), or those who regularly utilize tanning salons, are putting themselves at increased risk.

Routine self-examination of all skin areas is recommended on a regular basis.

For those at risk, see a dermatologist regularly.

Aging brings on many changes in the skin that are usually not serious.

An evaluation by a dermatologist of any suspicious lesion is recommended. If the doctor sees an area that is questionable, he may remove it by using a local anesthetic and take a skin biopsy (tissue specimen for study under the microscope). The Pathologist is trained to identify cancerous cells in biopsy specimens.

In most cases, cancerous skin lesions require surgical removal.