Skin cancer is one of the most awful diagnoses that we can hand to one of our patients. Increasingly common and growing more prevalent across every population, the disease sickens and kills a lot of people around the world. And TSLMS members see many of these in our offices, clinics and medical spas. We covered this topic at our most recent SCALE Music City conference and meeting and we will continue to talk about it through these articles because it is a really important topic that impacts an incredible amount of people.
Skin Cancer Facts
According to the American Academy of Dermatology Association, these are the facts of skin cancer – and they are devastating:
- Skin cancer is the most common cancer in the United States.1-2
- Current estimates are that one in five Americans will develop skin cancer in their lifetime.3-4
- It is estimated that approximately 9,500 people in the U.S. are diagnosed with skin cancer every day.5-7
- Research estimates that nonmelanoma skin cancer, including basal cell carcinoma and squamous cell carcinoma, affects more than 3 million Americans a year.5, 8
- Research indicates that the overall incidence of BCC increased by 145 percent between 1976-1984 and 2000-2010, and the overall incidence of SCC increased 263 percent over that same period.9
- Women had the greatest increase in incidence rates for both types of NMSC.9
- NMSC incidence rates are increasing in people younger than 40.9
- More than 1 million Americans are living with melanoma.10
- It is estimated that 192,310 new cases of melanoma, 95,830 noninvasive (in situ) and 96,480 invasive, will be diagnosed in the U.S. in 2019.6-7
- Invasive melanoma is projected to be the fifth most common cancer for both men (57,220 cases) and women (39,260 cases) in 2019.6-7
- Melanoma rates in the United States doubled from 1982 to 2011 and have continued to increase.1, 7
- Caucasians and men older than 50 have a higher risk of developing melanoma than the general population.6-7, 11
- The incidence in men ages 80 and older is three times higher than women of the same age.6
- The annual incidence rate of melanoma in non-Hispanic Caucasians is 26 per 100,000, compared to 4 per 100,000 in Hispanics and 1 per 100,000 in African-Americans.6
- Skin cancer can affect anyone, regardless of skin color.
Sobering, right? And for so many with skin cancer their entire focus beyond just beating the disease is what treatment means and how that will end up making them look.
Skin Cancer Treatments
The treatment that is available for skin cancer depends largely on the type of cancer, its stage, and its location. The Skin Cancer Foundation outlines many of these options and specifically addresses the option for the most aggressive type of skin cancer we know of: squamous cell carcinoma, which when left untreated can metastasize to lymph nodes and other body parts – quickly becoming terminal. Most treatment options for this, and other skin cancers, involve surgical removal of the cancer itself along with some level of treatment to kill any growing or expanding cancerous cells. The surgical options include:
- Mohs surgery is the gold standard for treating many SCCs (as well as many basal cell carcinomas and melanomas)… recommended for skin cancers that are large, aggressive or growing rapidly, that have indistinct edges or that have recurred after previous treatment… The physician uses a scalpel to remove, or excise, the entire cancerous tumor along with a surrounding border of presumably normal skin as a safety margin. The physician bandages the wound or closes the skin with stitches and sends the tissue specimen to a lab to verify that all cancerous cells have been removed. If the lab finds evidence of skin cancer beyond the safety margin, the patient may need to return for another surgery. For tumors discovered at an early stage that have not spread beyond the tumor margin, excisional surgery is frequently the only treatment required.
- Excisional surgery can be used for squamous cell carcinomas as well as basal cell carcinomas and melanomas. For tumors discovered at an early stage that have not spread beyond the tumor margin, excisional surgery is frequently the only treatment required. This technique is usually reserved for small squamous cell carcinoma lesions. Using local anesthesia, the physician scrapes off part or all of the lesion with a curette (an instrument with a sharp, ring-shaped tip), then burns the tumor site with an electrocautery needle to stop the bleeding and kill any remaining cancer cells. The physician typically repeats this procedure a few times (often at the same session), scraping and burning a deeper layer of tissue each time to help ensure that no tumor cells remain… [and] leaves a sizable, hypopigmented scar.
- Cryosurgery is a procedure “used for superficial SCCs. The physician destroys the tumor tissue by freezing it with liquid nitrogen, using a cotton-tipped applicator or spray device. Later, the lesion and surrounding frozen skin may blister or become crusted and fall off, usually within weeks. There is no cutting or bleeding, and no anesthesia is required, though the patient may experience some mild stinging.”
- Laser therapy is not yet approved for SCC but is sometimes used for superficial SCCs, above all when other techniques have been unsuccessful. It gives the physician good control over the depth of tissue removed. The physician uses a beam of light of a specific wavelength to destroy certain superficial SCCs, without causing bleeding. The physician may remove the skin’s outer layer and/or variable amounts of deeper skin, so local anesthesia may be needed. The risks of scarring and pigment loss are slightly greater than with other techniques. Some lasers (such as CO2 lasers) vaporize (ablate) the skin cancer, while others (nonablative lasers) convert the beam of light to heat, which destroys the tumor.
While many of us will be called on to do surgery for patients; many others will be called on to solve the scar tissue that skin cancer treatment creates. One of the best options that we can recommend- besides a really talented surgeon – is the use of silicone to treat the scars left by skin cancer surgery.
Post Skin Cancer Aesthetics
The American Academy of Dermatology is quick to remind us that the best way to deal with a scar is to treat a scar. The question is, what is the best treatment? In our humble opinion it is the use of silicone gel pads. There is no lack of peer review studies published that address the impact that silicone can have on skin healing and scar reduction. The trick, we want to share, is that the earlier and more aggressively you treat the scar wounds, much like the cancer that instigated them, the more successful you will be in minimizing them.