Two out of three Australians will have skin cancer in their lifetime, almost all of them basal cell carcinoma (BCC), squamous cell carcinoma (SCC) or melanoma.
If the site removed was more like a lesion or lump than a mole, your doctor may be talking about basal or squamous cell carcinoma, also known as keratinocyte cancer or non-melanoma skin cancer. (See our piece on melanoma, which looks like moles, here).
Around 80% of all cancers treated in Australia are skin cancers – the majority of which are BCC or SCC. But since BCCs and SCCs are not noticeable diseases, there is no official tracking system for them.
It’s difficult to know exactly how many are diagnosed each year, but based on Medicare data, there are more than 900,000 treatments for BCC and SCC each year — some of which will be different treatments for the same cancer.
Although they are less likely to be fatal than melanoma (about 560 deaths per year in Australia), the vast majority of them cost more than $700 million per year to diagnose and treat.
When diagnosed early, BCC and SCC are usually straightforward to treat. But don’t be satisfied. Left untreated, they will become wider and deeper, as much as 20 cm across. They will invade and destroy surrounding tissue, even bone.
What is the treatment?
The treatment path is much less clear for SCC and BCC than for melanoma. There are some firm guidelines and many treatment options, but here are the most common strategies.
Excision is the first-line treatment because it is most likely to be curative and prevent recurrence, and the tumor may be referred to a pathologist for microscopic examination.
The pathology report will indicate if there are any signs of an unusually aggressive form of the tumor, and if the entire tumor and a safety margin of surrounding healthy skin have been removed. If not, your doctor will remove a little more to make sure the entire tumor is gone. The size of the safety margin depends on the size, type and location of the tumor, and can range from 2 mm to 1 cm.
Many BCCs and SCCs require only a simple excision to be treated. However, delicate parts of the face with many nerves and small muscles, or close to bones and cartilage, are difficult to cut safely. If they have developed into underlying fat, muscle, or bone, surgery may not be appropriate.
The correct treatment in this case depends on the size and location of the tumor, whether it has well-defined or blurred edges, is scar-like or gelatinous. Informed patient preference is also important. Your doctor may freeze the tumor, scrape it off with a pointed scoop and blot the wound, or prescribe a cream that encourages a stronger immune response or uses light to damage cancer cells. reacts with.
Your doctor may also refer you to a specialist for radiotherapy, which involves a very targeted dose of radiation, usually X-rays, to kill the tumor by damaging its DNA, and is performed by a specialist radiation oncologist. goes.
Can it spread?
If the pathology report shows that the cancer has invaded a nearby nerve, or if you have painful, tingling or crawling symptoms that indicate the nerve is compromised, suggest more aggressive excision or radiotherapy. can be given. In the case of SCC, you may also be offered an MRI scan to see how far it has spread.
You will be referred to a radiation oncologist to discuss whether radiotherapy will be helpful in this case. Radiotherapy may also be considered if BCCs have invaded the underlying bone, or if there is evidence of BCC cells in nearby lymph nodes.
It is extremely rare for BCC to spread beyond the original site: only about 0.1% spread to the rest of the body. However, if it is very thick, comes back several times, or has other aggressive features, your doctor may also refer you to a specialist to examine your lymph nodes.
The likelihood of an outbreak of SCC is high, but the actual rate is difficult to tell due to the lack of mandatory reporting. Some studies report that about 4% of SCCs spread to lymph nodes, but these are often drawn from high-risk cases, so the true rate is likely to be low.
If your SCC was more than 2 cm wide, or has spread to fatty tissue just below the skin, your doctor may refer you for lymph node examination. SCC on the head and neck, tender, swollen lesions with poorly defined edges, and sores sitting on the edge of the lip may also require more attention.
Is follow-up required?
Your GP or dermatologist will want to visit you for regular full body skin exams after your initial treatment. This is because 44% of people with basal cell carcinoma and 18% of people with squamous cell carcinoma will have another.
How often the test is recommended depends on the location of origin, pathology report, and treatment options, but is usually once a year. You will also be taught what to look for so that you can bring any suspicious skin spots to your doctor early.
People with strongly suppressed immune systems, such as organ transplant recipients, need to take special care to be screened regularly for skin cancer because their immune systems are not doing their regular job of finding and destroying all types of cancer in the early stages. will be doing. Routine screening can reduce skin cancer-related morbidity and death by up to a third in organ transplant recipients.
In areas of the skin where there is significant UV damage and early superficial skin cancer symptoms, your doctor may suggest “regional treatments” to remove the damaged skin cells. The most common is a cream used for four weeks, but other options include laser treatment.
It is never too late to reduce your risk of further keratinocyte cancer. Recent research has shown taking sun-smart behavior – slip, slope, slap, seek and slide – late in life significantly slows the rate of new skin cancers and in some cases allows the body to heal some of the precancerous lesions. allows to fix. ,
The author of this article is Katie LeePhD candidate at the University of Queensland, Erin McManimanSenior Lecturer at Princess Alexandra Hospital Southside Clinical Unit and H. Peter SawyerProfessor of Dermatology at the University of Queensland.
This article is republished from The Conversation under a Creative Commons license. Reading 80% of all cancers occur on the skin. What if I have one? completely in conversation.
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