The Skin Cancer Foundation Journal

MAY 2012

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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The Hidden Dangers of Nonmelanoma Skin Cancer ARIEL OSTAD, MD T he predominant nonmelanoma skin cancers (NMSCs), basal and squamous cell carcinoma, affect more than two million people each year in the US alone, adding up to about 3.5 million cases total annually. In general, NMSC is very treatable. However, because it is not often life-threatening, some patients neglect to treat NMSC in a timely manner. But when untreated or improperly treated, some basal cell car- cinomas (BCCs) and squamous cell carcinomas (SCCs) can grow quickly and spread to other body areas (metastasize), resulting in problems from nerve damage and localized functional impairment to disfi gurement and even death. About 90 percent of the NMSCs I see in my practice are on the face. It is their proximity to the eyes, ears, and nose that can make them so dangerous, since locally aggressive tumors can invade these structures. Fortunately, fast-growing NMSCs often display certain warning signs. SIGNS OF AGGRESSIVE BCC BCC is the most frequently occurring skin cancer, with an estimated 2.8 million cases diagnosed every year in the US alone. Though they are generally easily treated, BCCs tend to keep growing if untreated, and in rare cases can start to spread. They often look like open sores, red patches, pink growths, shiny bumps, or even scars. A potentially aggressive BCC may: t be growing in width or height. t be located in the "H zone" of the face [Figure 1]. This includes the nose, around the eyes, in front of the ears, and the jaw line. In my experience, those cancers tend to grow faster and deeper by the nature of their location. t have abnormal sensation in the area. It's important to know that painlessness is no guarantee that a BCC isn't aggressive. Most BCCs aren't painful or symptomatic, so don't assume that because a growth doesn't hurt, it's not dangerous. However, pain or tingling in the area near the lesion can indicate that the BCC has invaded a local nerve — that it is neurotropic. Once inside the nerve sheath, BCCs tend to have an unobstructed aggressive growth pattern. Inability to make certain facial expressions near the area of a BCC may indicate involvement of the nearby nerve. Neurotropic and recurrent BCCs have a higher risk of local invasion. t be recurrent. BCCs that have been treated in the past are by nature more aggressive, since they continued to grow after the initial treatment. They may also have been hidden for some time beneath the scar from the initial treatment. t have microscopic presentation. Certain patterns of BCC seen under the microscope tend to be more aggressive. An example is a morpheaform or sclerosing (hardening) variant of BCC, which if not properly treated, frequently recurs. RISKS OF AGGRESSIVE FACIAL BCCs Some BCCs on the face can invade local structures, re- sulting in loss of function and leading to disfi gurement. For instance, due to the complexity of facial nerves and muscles, a BCC on the temple can damage the nerves that allow you to raise your eyebrow. If a BCC on the eyelid is not treated, it can travel into the orbit (socket), and the patient could lose an eye. 1 A potentially aggressive BCC may be located in the "H zone" of the face. SIGNS OF AGGRESSIVE SQUAMOUS CELL CARCINOMA (SCC) Every year in the US, about 700,000 squamous cell carcinomas are diagnosed. Again, most are easily treated, but if not removed, some can metastasize, spreading to nearby lymph nodes, which drain the area where the cancer is located; from the lymph nodes, the cancerous cells can easily spread to distant organs, becoming life- threatening. SCCs often look like scaly red patches, open sores, or warts; they may crust or bleed. A potentially aggressive SCC may: t be over 2 cm (about an inch) in size. 59

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