Treatments Save Lives When Skin Cancer Is Detected Early

Skin cancer is the most common of all cancers in America, and the number of cases continues to increase. It is also one of the most preventable cancers, and if detected and treated early, one of the most curable.

Melanoma
Melanoma, the rarest but most serious of all the skin cancers, originates in the pigment-producing cells of the skin. Even though it is the least common form of skin cancer, melanoma accounts for most skin cancer deaths. White men 50 and older make up the majority of those diagnosed with it, although today, according to a Newsweek report, it's the second most common cancer (after thyroid cancer) among women in their 20s.

Why is melanoma so deadly?

"It's the growth pattern," says Marcy Neuburg, MD, an Associate Professor of Dermatology at the Medical College of Wisconsin. "Most cancers have to be fairly large before they metastasize and spread to other structures in the body. With melanoma, a tumor the size of a pencil eraser can actually grow quickly and deeply in its later stages, and spread widely from a small primary lesion." Dr. Neuburg is Director of the Dermatological Surgery Unit practice at Froedtert & The Medical College. Her practice is limited to patients who have already been diagnosed with skin cancers and are referred by other physicians.

Although melanomas and non-melanoma skin cancers can be strongly influenced by sun exposure, sun is not always the cause. In fact, Dr. Neuburg says, "the most deadly melanomas often are not."

The National Cancer Institute (NCI) lists these risks for melanoma:

• Unusual moles
• Exposure to natural sunlight
• Exposure to artificial ultraviolet light (tanning booth)
• Family or personal history of melanoma
• Being white and older than 20 years
• Having red or blond hair
• Having white or light-colored skin and freckles
• Having blue eyes

Treating Melanomas
"The likelihood that a particular melanoma will spread is directly related to how thick the tumor is when a cross-section is viewed under a microscope," Dr. Neuburg says. "Tumors that are less than 1 millimeter thick (a fraction of an inch) have an excellent prognosis, with a five-year survival rate of 98%. Beyond 1 millimeter, the thicker the primary tumor, the greater the chance for metastasis and the lower the five-year survival." Currently, Dr. Neuburg says, "surgery remains the best chance for cure."

For patients with advanced disease, Dr. Neuburg works in collaboration with colleagues in the Division of Neoplastic Diseases, Department of Plastic Surgery, and the Department of Radiation Oncology. Some of these patients may be offered additional treatments such as chemotherapy or radiation.

Non-Melanoma Skin Cancers
The most common skin cancer is basal cell carcinoma, accounting for about 75% of all skin cancers. The second most common type is squamous cell carcinoma. These two cancers are described as non-melanoma skin cancers. An August 2005 report published in the Journal of the American Medical Association says non-melanoma skin cancers have tripled in women under 40 over the past 30 years.

Basal Cell Carcinomas
These carcinomas rarely metastasize, or spread to other sites, and almost never lead to death. According to the NCI, basal cell carcinoma "usually occurs on areas of the skin that have been in the sun, most often the nose. Often this cancer appears as a small raised bump with a smooth, pearly appearance. Another type looks like a scar and is flat and firm to the touch."

Squamous Cell Carcinomas
Squamous cell carcinomas can metastasize to distant sites such as lymph nodes and organs and cause death. NCI says squamous cell carcinoma occurs on areas of the skin that have been in the sun, such as the ears, lower lip and the back of the hands, or areas that have been burned or exposed to chemicals or radiation. Often this cancer appears as a firm red bump. Sometimes the tumor may feel scaly, or bleed or develop a crust.

In addition to people with damaged skin, those taking immune-suppression drugs after transplant surgery are also at risk for squamous cell skin carcinomas. These patients have a depressed ability to fight off common infections and frequently become infected with human papilloma virus, which causes common warts. In some of these patients, the combination of ultraviolet radiation and wart virus leads to squamous cell carcinoma, says Dr. Neuburg. "It's a major problem in transplant patients and those with HPV wart infections," she says, adding: "They need more upfront education" about the risks of sun exposure.

Treating Non-Melanoma Skin Cancers
Many non-melanoma skin cancers can be diagnosed and removed by primary care physicians. After the doctor or nurse examines the skin, checking for bumps or spots that look abnormal in color, size, shape or texture, suspicious lesions can be biopsied. Treatment options depend on type of the cancer, its location and the patient's overall health. If a biopsy indicates the cancer has spread deeper into the skin or to other places in the body, the patient might be referred to specialists like Dr. Neuburg.

Non-melanoma skin cancers can be removed using a number of different methods, including cutting, scraping, freezing, lasering, and dermabrasion. Most of these treatments are highly effective, with cure rates of more than 90%. The choice of procedure depends on a number of clinical factors including tumor location, size, pathology, and whether the cancer has been previously treated, Dr. Neuburg says.

Dr. Neuburg specializes in a removal method called Mohs micrographic surgery. In this procedure, the tumor is cut from the skin in thin layers. During surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This procedure removes as little normal tissue as possible. It is often used to remove skin cancer on the face. Mohs micrographic surgery is primarily used to treat basal and squamous cell carcinomas, and has a success rate of up to 99%, even if other forms of treatment have failed.

Dr. Neuburg is also experienced in the treatment of extensive or difficult-to-manage skin cancers, and she frequently approaches treatment in an interdisciplinary manner, integrating the management of complex cases with other surgical subspecialties.

In the 1930s, only 1 American in 1,500 developed invasive melanoma annually. By 1960, that had risen to 1 in 600. Today, it's more than 1 in 66 and growing. The lesson, says Dr. Neuburg, is fairly obvious. "People should protect their skin - and their children's - from sunburn and extensive sun exposure. Practice 'sun sense.'"

Barbara Abel
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.