Contents of 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.

Page 61 of 103

HEALTH
t grow rapidly on the face, especially in an individual with a compromised or weakened immune system (such as a transplant patient).
t be ulcerated (open, raw, and possibly bleeding) and near important anatomical landmarks such as the lip, ear, and eyelids. SCCs often metastasize from lesions on these structures.
t be painful in or near the lesion. As with BCC, pain can indicate that the SCC has invaded a local nerve; but don't take painlessness as a guarantee that an SCC isn't aggressive.
t have microscopic presentation. As with BCCs, SCCs with certain microscopic tissue structures, such as poorly differentiated SCCs (those which look least like normal squamous cells), tend to be more aggressive.
RISKS OF AGGRESSIVE SCCs Locally aggressive SCCs can cause patients to lose eyes, ears, noses, and lips. I've seen SCCs on top of the head invade the outer bone of the skull and also involve the dura, the outer sheath covering the brain. While less than 10 percent of the SCCs I see metastasize, once an SCC has reached the local lymph nodes, there's a 10-50 percent risk it will travel to distant organs. With these SCCs, patients may need to have their lymph nodes removed and go through radiation therapy and sometimes chemotherapy. Metastatic SCC kills an estimated 2,500 people in the US every year.
THE PROBLEM OF RECURRENCE, AND A SOLUTION Of the lesions I see on the face, about 20 percent are recur- rences. Their relative frequency stems from several factors. For one, many skin cancer treatments don't allow the physician to confirm that all the cancer has been removed at the time of treatment. Therefore, in some cases, the roots of the skin cancer remain after the procedure has been performed. Scar tissue from prior treatment can cover
3,500,000
Basal and squamous cell carcinoma incidence add up to about 3.5 million cases total annually.
When untreated or improperly treated, some BCCs and SCCs can grow quickly and spread to other body areas (metastasize), resulting in problems from nerve damage and localized functional impairment to disfigurement and even death.
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these roots, so recurrences may not appear on the surface, but will instead grow deeper — making them harder to detect. Additionally, the scar tissue that develops following treatment provides an excellent growth environment for skin cancer. Nerve involvement also contributes to the problem. Once a nerve is invaded, the tumor is further hidden, and within the nerve sheath, the cancer can spread easily.
Locally aggressive SCCs can cause patients to lose eyes, ears, noses and lips.
However, Mohs surgery can minimize the risk of
leaving behind any cancerous tissue. It allows the surgeon to microscopically examine all tissue removed, during surgery, to make sure that no cancer remains; it thus has the highest cure rate for NMSC. It also allows the surgeon to save the greatest amount of healthy tissue, providing the best functional and cosmetic results. Mohs surgery is the treatment of choice for certain NMSCs, including recurrent cancers, large tumors, tumors at high risk for recurrence, and cancers in areas such as the face where it is important to conserve tissue.
ARIEL OSTAD, MD, is a dermatologist and Mohs surgeon in private practice in New York City, and an Assistant Clinical Professor of Dermatology at New York University School of Medicine. He is a member of The Skin Cancer Foundation's Amonette Circle.
2,500
Metastatic SCC kills an estimated 2,500 people in the US every year.
10-50%
Once an SCC has reached the local lymph nodes, there's a 10-50 percent risk it will travel to distant organs.
SK IN CANCER FOUNDAT ION JOURNA L