The Skin Cancer Foundation Journal

MAY 2014

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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61 kin cancers are the most common malignancies in humans. 1,2 The three most common forms are basal cell carcinoma (BCC), squamous cell carci- noma (SCC) and melanoma, with the frst two comprising the majority of the 3.5 million skin cancers occurring in the US each year. 2-4 While melanoma accounts for less than fve percent of skin cancer cases, it causes the vast majority of skin cancer deaths. 5 Though their potential for aggressive behavior is often underappreciated, SCCs can also metastasize and result in death. SCCs in patients in the southern part of the US demonstrate death rates that approach that of melanoma as well as those of renal and oropharyngeal carcinomas. 6 While BCCs are rarely fatal, delays in treatment can mean that a more signifcant surgery is needed to remove them. If detected and removed at an earlier stage, their removal may require a less extensive procedure. Neglecting these tumors during these earlier, more treatable periods may produce functional or aesthetic consequences as a result of the cancer's treatment. UV Damage: the Common Thread T he development of one skin cancer is a sign of broader sun-related damage to one' s skin. Having one BCC, for example, places you at higher risk for developing other types of skin cancer such as SCC and melanoma. Ultraviolet radiation (UVR) is the pri- mary driver in the development of BCC, SCC and melanoma through damage it causes to var- ious cell types in our skin. Thus, minimizing excessive sun expo- sure and avoiding tanning beds is vital in reducing one' s risk of skin cancer development. 7-10 How Serious Is It? R egardless of the type of skin cancer, treatment is necessary. If left untreated, skin cancers will continue to grow locally, and, in the case of mela- noma and SCC, have a high likelihood of regional and distant metastatic spread. 6 Treatment of skin cancers at these more advanced stages may require, in addition to surgical remov- al of the primary tumor, adjuvant treatments such as lymph node sampling and/or removal, radiation or chemotherapy. Although BCC only rarely exhibits metastatic spread, 11 its propensity for local destructive growth warrants appropri- ate and timely treatment. Tumors which have been left un- treated for years may require signifcant amounts of tissue to be removed in the process of tumor extirpation. Treatment Options A variety of treatments exist for skin cancer, ranging from surgical removal and destructive treatments to topical medications, photodynamic therapy (PDT) and radiation. The most appropriate treatment for a given type of skin cancer is dependent upon the tumor's specifc characteris- tics as well as a number of patient-related variables. Melanoma T he primary treatment for melanoma is surgical excision. For more deeply invasive lesions, surgical excision may be combined with sentinel lymph node biopsy. This is a proce- dure in which the primary or frst ("sentinel") lymph nodes to receive lymphatic drainage from a tumor are removed and examined for tumor involve- ment. This provides prognostic information which may guide additional therapies. 12-14 If senti- nel node tissue proves negative, no further lymph nodes are re- moved; if positive for tumor, ad- ditional lymph nodes are often removed therapeutically to pre- vent further melanoma spread. Once melanoma has reached regional lymph nodes or spread to other distant organ sites, addi- tional treatments such as chemo- therapy, radiation therapy, immu- notherapy or "targeted" therapies (systemic medications which act on abnormal, tumor-promoting proteins) are employed. 14 Squamous Cell and Basal Cell Carcinoma Many of the same treatments may be employed for both basal and squamous cell carcinomas. Superfcial BCCs as well as in situ SCCs in lower risk locations on the trunk or extremities may be treated with various topical medica- tions. These medications are typically applied by patients at home for several weeks, and close clinical follow-up with a dermatologist is warranted to ensure resolution of the can- Squamous cell carcinoma in patients in the southern part of the U.S. demonstrates death rates approaching those of melanoma...

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