Non-Melanoma Skin Cancer

Further Reading

Total Skin: The Definitive Guide to Whole Skin Care for Life

Chapter 23. Basal Cell Cancer and Squamous Cell Cancer

There are two principal kinds of non-melanoma skin cancers: basal cell cancer and squamous cell cancer. Basal cell cancer is the most common cancer in the world. Squamous cell cancer is the second most prevalent skin cancer. Still, basal cell cancer outnumbers it four to one. The good news is that each is easily treated and cured in most cases.

The primary cause of basal cell cancer is overexposure to the sun and those with fair complexions are especially susceptible. For the same reason, it occurs most often on sun-exposed areas of the body, which include the head and neck, the legs in women, and the trunk in men. Basal cell cancer is a cancer that has the least potential to spread in the bloodstream or metastasize. Worldwide there have been only about two hundred reported cases, in total, of basal cell cancer metastasizing, and those have usually been huge, neglected tumors. In part because it tends to be diagnosed early, basal cell cancer has a very high cure rate, if treated with the appropriate techniques. The majority of basal cell cancers occur on the face. For this reason, the treatment that you select will have an impact on your appearance and on how you feel about yourself. In addition, this treatment choice must take into account first and foremost the cure rate.

Squamous cell cancer is another common skin cancer that is thought to result most often from sun exposure. It arises from plate-like cells in the epidermis. Unlike basal cell cancer, squamous cell cancer can metastasize to the lymph nodes and even to internal organs. Squamous cell cancer usually appears as a crusty, scaly, warty bump. It may range in size from pea-sized to chestnut-sized and is usually raised. Although squamous cell cancers grow slowly, the sooner you see your doctor and the cancer is diagnosed and treated, the less complicated the surgery to remove it will be and the faster you will make a complete recovery. The treatment for squamous cell cancer varies according to the size and location of the lesion. The surgical options are much the same as those for basal cell cancer.

If you have been diagnosed with a basal cell cancer or a squamous cell cancer, a variety of treatments are available, all of which yield a far less noticeable scar than you might fear-as long as the cancer is treated early. The best treatment approach depends on the type of cancer, its location, your age, and whether the cancer is recurrent or not. Most of the treatment options are surgical and have varying cure rates.

In surgical excision, which is really a simple form of plastic surgery, the skin cancer and the area around it are numbed with a local anesthetic such as lidocaine. The doctor then makes an incision through the full three layers of the skin around the obvious area of the skin cancer. The specimen is removed and the edges of the wound are pulled together using plastic surgery techniques. The benefits of surgical excision include an improved cosmetic result, compared with scraping and burning. The cure rate with this technique is in the 90 percent range for a first-time basal cell cancer. If, after the specimen has been removed and has been evaluated by a dermatopathologist, it turns out that residual cancer cells are present at the margin, meaning that it has not been completely removed, further treatment is often necessary.

For basal cell cancers that are superficial and confined to the top layer of the skin, a simple treatment is available that has an 80 to 90 percent cure rate. Scraping and burning, also known as electrodessication and curettage, is a quick and easy technique for removing a skin cancer. It should be used only for superficial basal cell cancer and small nodular basal cell cancer on the arms, legs, and trunk. It will usually leave an innocuous round pale scar. Scraping and burning is not appropriate for morpheaform basal cell carcinomas, recurrent basal cell carcinomas, or large, nodular basal cell carcinomas.

The most thorough method for treating basal cell cancer and squamous cell cancer is a technique called Mohs micrographic surgery. Mohs micrographic surgery is a tissue-sparing method. Therefore, it has the best cosmetic outcome. The Mohs technique is based on the notion that normal pathology specimens, cut like a bread loaf, evaluate only about 3 percent of the total surface area of the margins of the cancer. By contrast, the Mohs technique allows evaluation of the complete surface area. This is important because many basal cell cancers grow with fingerlike projections or roots, and the random sampling of the specimens used by conventional pathology may not permit a thorough assessment of residual cancer. Mohs surgery has the highest cure rate of any of the methods mentioned, approaching 98 to 99 percent in most cases. Click here to read more about Mohs Micrographic Surgery, Total Skin: The Definitive Guide to Whole Skin Care for Life, Copyright © 2000, Chapter 23, pages 262-267, David J. Leffell, MD. All rights reserved.