The Skin Cancer Foundation Journal

MAY 2013

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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T hough many people do not think of them as serious, the nonmelanoma skin cancers (NMSCs) basal and squamous cell carcinoma can cause serious damage. If not treated promptly, they can spread locally, damaging the appearance and function of nearby organs. Since NMSCs are most commonly located on the face, severe disfigurement or even loss of the nose, eyes, ears and mouth can occur. In some cases, when treatment of NMSC is delayed, invasive squamous cell carcinoma (and, in far rarer cases, basal cell carcinoma) can spread (metastasize) throughout the body and become life-threatening. According to the American Cancer Society, NMSCs kill more than 3,000 people in the US annually.1 New skin cancers usually appear as a bump, sore, mole, or red scaly area with itching and/or bleeding. Some skin cancers progress rapidly, while others grow more slowly. Early diagnosis and treatment are the keys to a successful treatment outcome, and studies show that patients, their families, and friends fnd most new lesions.2 However, this early detection by non-physicians doesn't always lead to prompt treatment, since people wait an average of six months before seeing a physician about their suspicious lesions. Unfortunately, when ignored, skin cancers almost always just keep growing bigger. in larger tumors that can both be locally destructive and increase the risk of metastasis. In the study, almost 68 percent of patients had delayed more than one month after discovering their lesion before seeking a diagnosis. The patients reported many reasons for delaying a doctor's visit, including fear of disfgurement and scarring, time constraints, personal or professional problems, unrelated medical problems, physician scheduling delays, and perceived fnancial limitations [Table 1]. By far the most common reason for a delay in seeking treatment was denial, which comes in many forms: the assumption that the lesion will go away on its own; the belief that the lesion is unimportant; plans to self-treat; the fear that it could be something dangerous, or simply being too busy Limiting tumor size and depth… is paramount to preserving the integrity of the facial structures. also interfere with the proper functioning of vital anatomical structures such as the nose, eyes, ears and mouth. Limiting tumor size and depth in these key locations through early detection and treatment is paramount to preserving the integrity of the facial structures. WHAT YOU CAN DO Spots, blemishes, and minor injuries appear and disappear regularly on the skin, and it is sometimes diffcult to distinguish a cancerous bump or ulcer from a benign one. By that logic, it can seem reasonable for patients to wait for a period of time to watch what happens with new lesions. While there is no established acceptable waiting period, there are a number of warning signs that a new spot warrants prompt medical evaluation. Be aware of the most common NMSC warning signs, including: • anon-healingsorethatoozesor bleeds for weeks; • aredpatchorirritatedareathat repeatedly fakes, crusts, scabs, itches or hurts; • ascar-likeareaonskinthathasnot previously been injured; it will often with other things. Some forms of be white, yellow, or waxy, with poorly denial are normal psychological redefned borders; sponses to health issues, while others may indicate a lack of recognition or • ashinyorpearlybumporgrowth with a sunken center, and understanding of a medical problem. THE THREAT TO FACIAL FEATURES Top: Basal cell carcinoma seen as a persistent, shiny, pink-to-red bump on the cheek Bottom: Large, ulcerated squamous cell carcinoma on the upper arm © DermSurgery Associates, Houston How NMSCs impact on patients depends largely on the tumor location THE REASONS FOR DELAY and size. Cancers in cosmetically A new study found that 77 percent sensitive areas, like the face, often of patients discovered their own le- require complicated surgical removal sions. Most patients frst noticed their and reconstruction. As a tumor grows, lesions when they were an average so does the amount of tissue that of 2-3 mm in size. However, by the needs to be removed and the size of time skin cancers were diagnosed, the scar that will follow. It should also the lesions had grown to as large be noted that as a cancer grows on as 10mm in diameter (just under ½ the surface, it also grows under the inch) — a signifcant and potentially skin. The amount of cancer present dangerous degree of growth.3 Such de- may be signifcantly greater than what layed diagnosis and treatment of skin is obvious to the naked eye, resulting cancer is not uncommon, and it often in a much larger wound than would results in substantial tumor growth. have been anticipated. While the rate of tumor enlargement Local invasion and the required varies, delaying treatment can result surgical removal of the tumor may • anynew,unattractivespotthat grows rapidly or changes in any way. 55

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