Sunday, January 5th, 2020
Three groups of physicians see and evaluate patients with skin cancers, family physicians, dermatologists and plastic surgeons. We as plastic surgeons do so because we treat other skin problems related to sun damage and aging, we are good at excising lesions, and many skin cancers occur on the face and hands, areas where we have significant experience and are asked to treat by the other specialities.
There are three main types of skin “cancers.” The least common (fortunately) is melanoma, a true, aggressive cancer of the pigment cells. Next is squamous cell carcinoma, also a true cancer that destroys the local tissue and can spread to other parts of the body. The most common is basal cell, a tumor that destroys local tissue but does not spread except by direct extension. There are also multiple other cancers that can occur on the skin, mostly related to skin appendages like glands or metastatic from other areas. These, however, comprise only about 0.5% of skin cancers. Each requires different evaluation and treatment.
The problem with skin cancers is that they can look like each other or other entities. The first thing that must be done is recognizing what may be a skin cancer. That is where dermatologists and plastic surgeons excel. Once the possibility is recognized the exact nature of the lesion needs to be determined. This is usually accomplished with a biopsy, removing a piece for pathological evaluation. Shaving a piece of the lesion is the most common method of biopsy This takes a week or 2 to heal with several times a day antibiotic care. We prefer a punch biopsy that takes a small full thickness piece of the lesion. This heals quickly and takes no care, important if the lesion is not a cancer. It is also the best way to sample a melanoma, as lesion thickness is important in determining treatment. Once diagnosed, further tests may be required to decide on treatment, especially if the lesion is melanoma.
The lesion determines the treatment. We treat basal cells multiple different ways including chemotherapy, freezing, and excision depending on its characteristics. Squamous cell is treated similarly, but more aggressively. Melanoma always requires excision and may also need lymph node biopsy or excision.
If you have a lesion that you are concerned about or know needs treatment, call us at our Highlands, NC office at 828-526-3783.