Precancerous Skin lesions and skin cancer

2011-04-26

Of all the cancers that humans can get, skin cancer is the most common and increases in all races. Those with light skin who sunburn easily have a higher risk. Risk factors include: sunburns, family history of skin cancer, exposure to x-rays, weakened immune system, scarring caused by a disease or burn and exposure to cancer-causing compounds such as arsenic. Using solarium also increases the risk of developing skin cancer. 

There are precancerous lesions in skin that are not cancer but could become cancer over time if remained untreated:

Actinic keratosis (AK)

These dry, scaly patches or spots are considered the earliest stage in the development of skin cancer. In rare cases, an actinic keratosis (AK) can progress to a type of skin cancer called squamous cell carcinoma (SCC). People who get AKs usually have fair skin. Most people see their first AKs after 40 years of age because AKs tend to develop after years of sun exposure. But even teens can have AKs when they live in sunny areas or use indoor tanning. AKs form on skin that gets lots of sun exposure, such as the head, neck, hands, and forearms. Because AKs increase the risk of getting SCC, AKs are usually treated. Proper use of sunscreens can help prevent AKs.

Dysplastic Nevi (Atypical Moles)

Atypical moles are not cancer, but they can become cancer. They can be found in sun-exposed or sun-protected areas of the body. Atypical moles are larger (one-quarter inch across or larger) and more irregular in shape, with notched or fading borders. They may be flat or raised or the surface smooth or rough. They are typically of mixed color, including pink, red, tan, and brown.

Actinic Cheilitis

Related to actinic keratosis, actinic cheilitis is a precancerous condition that usually appears on the lower lips. Scaly patches or persistent dryness and cracking of the lips may be present. Less common symptoms include swelling of the lip, loss of the sharp border between the lip and skin, and prominent lip lines. Actinic cheilitis may evolve into invasive squamous cell carcinoma if not treated.

Cutaneous Horns

The cutaneous horn appears as a funnel-shaped growth that extends from a red base on the skin. It is composed of compacted keratin (the same protein in nails). The size and shape of the growth can vary considerably, but most are a few millimeters in length. Squamous cell carcinoma is often found at the base. It usually occurs in fair-skinned elderly adults with a history of significant sun exposure.

 

There are different types of skin cancer, and each tends to look a bit different:

Basal cell carcinoma (BCC)

This is the most common type of skin cancer. It frequently looks like a flesh-colored, pearl-like bump. It also can appear as a pinkish patch of skin. Like AKs, basal cell carcinoma (BCC) develops on skin that gets frequent sun exposure, such as the head, neck, and arms. Many BCCs also form on the trunk and lower limbs. BCC frequently develops in people who have fair skin, but it can occur in people with dark skin. BCC usually does not grow quickly, and it rarely spreads to other parts of the body. But it should be treated promptly. This cancer can invade the surrounding tissue and grow into the nerves and bones, causing damage and disfigurement.

Squamus cell carcinoma (SCC)

Squamous Cell Carcinoma (SCC) is the second-most-common type of skin cancer. This skin cancer often looks like a firm bump, scaly patch, or an ulcer that heals and then re-opens. SCC is usually reddish in color. It tends to form on skin that gets frequent sun exposure, such as the rim of the ear, face, neck, arms, and trunk. People who have light skin are most likely to develop SCC, but it can also develop in dark-skinned people, especially those who have scarring. Because SCC can grow deep, it can cause damage and disfigurement. Early treatment can prevent this and stop SCC from spreading to other areas of the body. 

 

Melanoma

This skin cancer frequently develops in a mole or appears suddenly as a new dark spot on the skin. Either way, melanoma can be deadly. A change is often the first sign of melanoma; therefore, it is important to know where moles appear and what they look like. When detected and properly treated before it spreads, melanoma has a high cure rate. The ABCDE warning signs of melanoma can help people detect change. Changes that can indicate melanoma are pain, itching or bleeding in a mole or new spot on the skin.

Several risk factors increase a person’s likelihood of getting melanoma. One risk factor is sun exposure. It is important to protect the skin with sunscreen and clothing, and never sunburn. Another risk factor is light skin. However, people with skin of color get melanoma. In skin of color, melanoma usually appears on the palms, soles, under the nails, in the mouth, or on the genitals. If one or more first-degree relatives (parent, sibling, or child) had melanoma, the risk significantly increases. Having many moles (50-100 or more) or several atypical moles also increases the risk. An atypical mole is not cancerous, but because of its different appearance, these moles need to be closely monitored for any changes. Having had melanoma also increases the chances of having additional melanomas.

Are skin exams important?

With early detection and proper treatment, the cure rate for BCC and SCC is about 95%. When melanoma is detected before it spreads also has a high cure rate.

One type of skin exam is the skin self-exam. During a self-exam, people examine their own skin for signs of change: if a growth, mole, sore or skin discoloration appears suddenly or begins to change should see a Dermatologist or a Plastic Surgeon. People who have spent time in the sun, have a family history of skin cancer (especially melanoma), have many moles or atypical moles, or have other risk factors for skin cancer should see a doctor for regular skin exams. Some people should have this exam once a year and others need more frequent exams.

If during the skin exam, the Plastic Surgeon sees a potential skin cancer will remove it in order to be examined under a microscope. This is called excisional biopsy and can be performed at the office. If the biopsy report confirms that the suspicious growth is skin cancer, more treatment may be needed. When caught early and the entire growth is removed, further treatment is not needed. If further treatment is needed, it varies with the type of skin cancer, the size, the location of the skin cancer and the needs of the patient.

How can I protect myself?

Sun exposure is the most preventable risk factor for all skin cancers, including melanoma. You can have fun in the sun and decrease your risk of skin cancer:

  • Generously apply a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of 30 or more to all exposed skin. Broad-spectrum provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Reapply approximately every two hours, even on cloudy days, and after swimming or sweating.
  • Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
  • Seek shade when appropriate, remembering that the sun rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade. 
  • Protect children from sun exposure by playing in the shade, wearing protective clothing, and applying sunscreen. 
  • Use extra caution near water, snow, and sand because they reflect the damaging rays of the sun, which can increase your chance of sunburn. 
  • Get vitamin D safely through a healthy diet that may include vitamin supplements. 
  • Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it. 
  • Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, visit a Dermatologist or a Plastic Surgeon. Skin cancer is very treatable when caught early

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