Skin Cancer

Skin Cancer: Frequently Asked Questions

Here are some frequently asked questions related to skin cancer.

Q: My husband was treated for small skin cancers on his forearms. The dermatologist said they were basal cell carcinomas. She used curettage and electrodessication to destroy the tumors, and told my husband it cured the cancer. Was the doctor being too confident?

A: The doctor was just being realistic. Basal cell carcinoma is the most highly curable form of skin cancer. Cancer is such a serious disease because of its tendency to spread. The tumor sheds cells that travel through the bloodstream and lodge in the lungs, brain, liver, or bone. The cells then grow new tumors that destroy vital organs. Basal cell carcinoma almost never spreads from the original location, and almost always can be cured. That’s fortunate because it also is the most common type of skin cancer.

Q: I’ve been referred to a dermatologist by my family doctor. She thinks that a growth on my back may be skin cancer. If it is skin cancer, what questions should I ask the dermatologist?

A: It’s important to ask questions and work with the doctor in planning treatment and follow-up care. Start the dialogue by asking about the exact kind of skin cancer you have, how serious it is, and whether to be concerned that the cancer has spread. Some other important questions include:

• What is the usual treatment?
• Will treatment cure the cancer?
• What type of scar will likely develop?
• How will I know if the cancer has come back?
• How often will I come back for follow-up care?
• What can I do to reduce my risk of getting skin cancer again?

Q: As I get older, I seem to be developing more and more moles, freckles, and other skin growths. I’m worried that some may be skin cancer, or change into skin cancer. What professional and self care would you recommend?

A: Encourage your primary care physician to do a total skin examination at each yearly routine physical examination and/or see a dermatologist yearly for a total body skin examination. That involves inspecting every inch of your skin, including the genital region and the area between the buttocks. If the doctor spots suspicious growths, you’ll probably get a referral to a dermatologist. Chances are good that these professional exams will put your mind at ease. That’s because most people have dozens of skin growths, and they usually are not cancer. Once you know that your skin is normal, get in the habit of doing a skin self-examination to watch for new growths or changes in existing growths.

Q: How can I tell if a skin growth is dangerous? Is there any special appearance that I should watch for?

A: Only a doctor can tell between a benign growth and cancer. Sometimes, it takes a biopsy for the doctor to be sure. In general, however, be alert for growths that enlarge and ooze fluid or blood, crust or clot over, and then ooze or bleed again. A sore that doesn’t heal after a week or two may be cancerous. Be on the lookout for moles or skin spots that are:

• Bigger from edge to edge than a pencil eraser
• Have uneven or ragged edges
• Show combinations of more than one color
• Have a different appearance on one half than on the other

Those are warning signs of possible skin cancer. Check with the doctor if they occur.

Q: The doctor on a radio talk show advised a man with skin cancer to see a “mole surgeon.” I heard only a few seconds of the show. What did he mean?

A: The talk show doctor probably was discussing Mohs micrographic surgery. It’s a special kind of skin cancer surgery that requires special training. Doctors who get the training sometimes are called Mohs surgeons. In Mohs surgery, the doctor tries to remove all of the tumor and as little surrounding normal tissue as possible. The doctor removes one layer of tumor, and examines it with a microscope. If cancer cells are present he removes another layer, and examines that. The process continues until all cancer cells have been removed. Mohs surgery has an advantage aside from the smallest possible scar. It has a very high cure rate. But Mohs surgery is not suitable for all kinds of skin cancer; it is very expensive and time consuming. People with skin cancer should talk with their doctor about the different treatment options.

Q: What is the best way of preventing skin cancer?

A: Avoid too much exposure to the sun. That’s the No. 1 cause of skin cancer. Try to avoid two kinds of exposure:

• The kind of constant day-to-day exposure that occurs in people who work outdoors or enjoy outdoor sports or leisure activities.
• Less-frequent but more intense exposure that causes sun burn. Vacationers and others who get intense sun exposure a few times a year may be at high risk for malignant melanoma, the most serious kind of skin cancer.

When you are in the sun, wear tightly woven clothing that shields the skin. A broad-brimmed hat is ideal in the summer. Be sure to use a “broad-spectrum” sun screen that protects again both kinds of ultraviolet (UV) light, UVA and UVB.

Q: If skin cancer occurs mainly in older people, why is it so important for children to avoid getting too much sun?

A: Childhood sun exposure may set the stage for adult skin cancer. The average person gets about 50% of his or her total lifetime sun exposure by age 18. Most severe sun burns also occur during childhood and adolescence. A single severe sunburn may increase an individual’s risk of skin cancer.

Q: After examining my skin, the family doctor said I have the warning signs of skin cancer. He said to be especially careful about avoiding excessive sun, get regular check-ups, and to do regular skin self-examinations. How could he tell?

A: The doctor probably discovered actinic keratoses, a pre-cancerous condition caused by long-term overexposure to the sun. An actinic keratosis feels like a small rough spot on the skin. It may be flesh-colored or reddish pink with whiteish scales. These growths often form on the backs of the hands, arms, face, and ears of individuals with sun-damaged skin. Most actinic keratoses do not change into skin cancer. Some, however, do. Doctors advise that actinic keratoses be destroyed as a precaution. Most are removed by freezing with liquid nitrogen or by using topical chemotherapy applied over several weeks.