Common types of skin cancers – BCC, SCC, Melanoma

Basal Cell Carcinoma or BCC

BCC or Basal Cell Carcinoma is the most common form of skin cancer. BCC almost always never spreads beyond the original tumour site, and the cure rate after a surgical excision is above 95 percent in most body areas.

So, is this form of cancer even something to worry about?

Even though BCCs are locally invasive and don’t spread to lymph nodes or blood stream usually, there can be some aggressive forms of BCCs which rarely can metastasise. In addition, BCCs in areas like lips, ears, nose and eyelids can create a lot of tissue destruction if not removed early. As they are very slow growing, patients take them very lightly sometimes and by the time the patient seeks a medial consultation, they start to bleed, ulcerate, and can be hard to remove and may need a skin graft or a skin flap repair especially around the eyes, ears and nose. BCCs over the lower part of the nose or in the ears can go deeper into the cartilage if left unattended, making surgery difficult. Once you’ve been diagnosed with a BCC, it’s very likely that you will develop more over the years, leading to continuous treatment and possibly even disfiguration.

Squamous Cell Carcinoma or SCC

SCC or Squamous Cell Carcinomas are the second commonest type of skin cancers. They can be quite aggressive at times. While the majority of SCCs can be successfully treated, if left to grow, they can become very invasive, can penetrate deeper layers of skin and spread to surrounding lymph nodes and to other parts of the body.

The pre-cancerous lesions for SCCs (Actinic Keratosis or Bowen’s disease) can grow over a few years before they turn into invasive Squamous cell carcinoma.

Actinic keratosis is the most common precancerous lesion that forms on skin damaged by chronic exposure to ultraviolet rays from the sun and/or indoor tanning. Actinic keratosis results from long-term exposure to ultraviolet radiation. Actinic keratosis often appears as small dry, scaly or crusty patches of skin. They may be red, light or dark tan, white, pink, flesh-toned or a combination of colours and are sometimes raised. Because of their rough texture, actinic keratoses are often easier to feel than see. The lesions frequently arise on sun-exposed areas of the face, lips, ears, scalp, shoulders, neck and the back of the hands and forearms.

Actinic keratosis that turns cancerous almost always turns into Squamous Cell Carcinoma, the second most common type of skin cancer. Untreated SCCs can become invasive, and even life-threatening.

Catching and treating the actinic keratosis before it becomes an SCC can make a huge difference in your treatment experience. You want to get them early, before they go invasive, mostly to prevent possible invasion into the skin and internal organs. This is especially important in the head and neck region, as those cancers can be more aggressive in these areas. You’re also going to get less scarring than if you waited to remove a growth until it was cancerous.

Only about 10 percent of actinic keratoses will eventually become cancerous, but the majority of SCCs do begin as actinic keratosis. Unfortunately, there’s no way to tell which actinic keratosis will become dangerous, so monitoring and treating any that crop up is the only way to be sure.

What do actinic keratosis look like?

They vary widely. They could be thick, red, scaly patches or they could be red bumps with a tan crust or could present with a raised little horn-shaped part, called a cutaneous horn. Pay attention to anything that keeps coming back or doesn’t heal, just as you would while examining your skin for signs of fully formed skin cancers. I tell my patients that if they have any concerning areas like that, to call the clinic and we will see them as soon as possible. That way we can treat them early and prevent formation of squamous cell carcinoma

Actinic keratosis can be treated easily with simple procedures like cryotherapy or with some cancer burning creams, laser ablation or with curettage and desiccation.

Actinic keratosis on lips is called Actinic Cheilitis. You might think you have severely chapped lips, but that could be a warning sign of actinic cheilitis. This precancerous condition typically appears on the lower lip as scaly patches or roughness. Left untreated, it can evolve into a Squamous Cell Carcinoma of the Lip which can be very aggressive.

The SCCs can also present as a wart-like growth or a cutaneous horn. You might think you’ve developed a wart, but these funnel-shaped growths that look like a tiny horn on the skin may have a SCC in the base.

A superficial form of SCC is called Bowen’s disease or Squamous Cell Carcinoma – in – situ. You might think you have a patch of dry skin. But if the patch doesn’t heal, looks scaly, red or crusty and starts spreading outward, it could be a superficial type of SCC called SCC in situ. At this stage, it is not dangerous and the treatment is easy, but if left untreated, it can progress and turn into an invasive SCC which will need a full excision and will leave a much bigger scar.

Melanoma

It can be difficult to comprehend just how big a difference early detection makes with melanoma, the most dangerous form of skin cancer. Treating a Melanoma early rather than after it is allowed to progress could be lifesaving. To fully comprehend the significance of timing, it can be helpful to understand exactly what happens to a melanoma when it advances to a later stage, and what it means when a melanoma spreads beyond the original tumour site.

Every melanoma has the potential to become deadly, but the difference between a melanoma-in-situ and one that has begun to metastasise cannot be overstated. There is a drastic change in the survival rate for the various stages of melanoma, highlighting the importance of detecting and treating melanomas before they have a chance to progress. It’s impossible to predict exactly how fast a melanoma will move from stage to stage, so you should be taking action as soon as possible.

There are different types of melanoma

• Superficial spreading melanoma – This is the most common type of melanoma making up about 50% of all melanomas diagnosed. This melanoma usually appears as a dark spot with irregular borders that spreads across the skin.
• Nodular melanoma – Nodular is one of the most rapidly growing types of melanoma. It appears as a raised lump or ‘nodule’ and can be brown, black, pink or red in colouring, or have no colour at all. About 15% of all melanomas are nodular.
• Lentigo maligna melanoma – Lentigo maligna melanomas begin as large freckles. They are commonly found in older people, often in areas that have received a lot of sun exposure such as the face, head, neck and upper body. This type of melanoma makes up 10% of all melanomas.
• Acral lentiginous melanoma – Acral is a rare type of melanoma that tends to grow on the palms of hands, soles of the feet or under the nails. It accounts for about 3% of all melanomas.
• Other, less common types of melanoma include desmoplastic and naevoid melanoma. Mucosal melanomas can be found in tissues in the respiratory, digestive, and reproductive tracts. Uveal (ocular) melanomas develop in the eye.

If you need help with skin cancer treatment in Newcastle, Hunter Valley then book an appointment with Elixir @ Hunter.

Skin ageing is a continuous time-dependent and multifactorial phenomenon of reduction in size and number of cells in the skin, and reduction in the rate of many organic functions in the skin. Many skin functions decline with age, such as cell replacement, response to an injury, barrier function of the skin, sensory perception of the skin, immune response of the skin and temperature regulation. In addition, the reduced production of sweat and reduced function of skin glands resulting in skin dryness.

The cutaneous stigmata of ageing may affect an individual’s mental wellbeing, body image and quality of life. Ageing, unfortunately, is a fact of life and the older population is increasing in number. Obviously, no one can remain young forever, but cosmetic innovations through scientific research are progressing very rapidly. Patients are able to significantly delay the visible ageing process by practising preventive skin care and taking advantage of many chemical treatments available for facial rejuvenation.

Elixir @ Hunter is a cosmetic and skin cancer clinic in Maitland, NSW. Visit our  skin rejuvenation page to learn more.

The various methods for skin rejuvenation are:

Cosmetics

Cosmetics are topical agents used to improve personal grooming, appearance and self-image.

The best cosmetic a person can wear for preservation of his or her youthful appearance is sunscreen. It can cause an apparent reversal of some signs of photoaging and keep the skin youthful looking.

Moisturisers reduce the loss of humidity from the surface of skin by deposition of an oil film, avoiding evaporation, and helps minimise the appearance of fine wrinkles, and maintain appropriate level of skin humidity. Fine wrinkles are more visible when skin is excessively dry.

Vitamin A based creams are used to rejuvenate the skin by creating peeling of the top layer of skin, triggering regeneration of the new skin cells.

Antioxidants like Vitamin C and Vitamin E creams work by reducing the number of sunburn cells which appear after exposure to UV radiation. Topical application of these cream decreases the redness and swelling, and number of sunburn cells.

Chemical peels

Chemical peeling involves the application of an acid to the skin to produce a controlled and predictable injury to the epidermis and variable portion of the dermis. Destruction of epidermis and, in some cases, superficial dermis produces oedema (swelling), and, hence, appreciable improvement in appearance.

A new era in dermatologic treatment began with the introduction of retinoids around 4 decades ago. Retinoids are Vitamin A based agents, and may be used orally or topically for a wide variety of skin disorders. Topically and in higher concentration than the ones used for the keratolytic effect, some retinoids may be used as a peeling agent with very good results.

Fillers

As part of the ageing, the face undergoes contraction or shrinking of facial fat pads and few areas of the facial bone. A variety of filling substances are available in the market to fill up the lost fat pads and bony projections, and some of the defects susceptible to improvement are furrows and wrinkles, depressed scars, and skin roughness. Each method is highly effective when used for its correct indications and by skilled physicians.

Intense pulsed light

IPL is useful for the treatment of prominent capillaries and veins on the face, redness on face and neck, freckles, fine lines and wrinkles. Its multiple effects have made it an interesting modality for non ablative skin rejuvenation. Several studies have shown remarkable improvement of photoaged skin, and although the degree of improvement of fine lines may not be as impressive, IPL causes significant simultaneous improvement of other photoaging features, such as redness, prominent capillaries and veins and dyspigmentation or irregular pigmentation. In addition to its combined effect, it has a good safety profile, making it a suitable modality for photoaged skin of all types, and in treating large areas as chest and neck.

Fractional Laser resurfacing

The carbon dioxide laser was developed in the 1960s for skin and eye procedures. The 10,600 nm emission wavelength is strongly absorbed by water, which is the main constituent in the tissues.

The principle of ‘selective thermolysis’ is applied to the development of lasers to be used for resurfacing. This theory states that selective heating and damage of a target chromophore and tissue is achieved when an appropriate wavelength is delivered to an absorbing chromophore.

Resurfacing Co2 lasers produce excellent results for fine and deep rhytides, surgical scars, acne scars and the treatment of photodamaged skin with a minimal risk of long term side effects. Co2 laser wounds produce a more intense inflammatory response, and induce increased neocollagenesis compared to short term pulsed laser wounds for the same depth of tissue destruction. Clinically, better cosmetic outcomes are achieved for moderate to severe wrinkles, photodamage and acne scarring with the Co2 laser.

In Fractional Co2 laser, the depth and area of the resurfacing can be calculated and controlled in a much better way, leading to a better controlled inflammation and a more predictive outcome with better formation of collagen and improved appearance of skin. A better understanding of wound healing from a biochemical and molecular perspective together with fundamental knowledge of laser-tissue interactions has led to a more scientific approach to the development and analysis of all skin rejuvenation procedures.

Radiofrequency Microneedling

Radiofrequency microneedling works by selectively delivering radiofrequency energy with microneedline to create a deep remodelling of the skin. The treatment triggers formation of collagen in deeper layers of skin to improve skin tightening. It is a relatively non-invasive treatment to deliver heat to the target tissues while the outer layer of the skin remains relatively intact. By formation of new collage, this treatment improves textural irregularities such as fine lines, atrophic scar, skin wrinkling and sagging.

Surgical procedures

There are many surgical procedures available for skin rejuvenation. Dermabrasion and Dermaplaning are procedures used to remove the top layer of the skin and this improves the skin’s contour as new collagen and epidermis replace the abraded skin. The new skin generally has a smoother appearance. It is indicated for fine wrinkles, scar correction and perioral wrinkles.

Summary

The cosmetic ageing changes of the skin are not a direct threat to the physical well-being of the patient, but their psychological impact, particularly in regard to self-perception, self-esteem, and quality of life, can be significant. Successful ageing is characterised by good mental health and adaptive psychosocial functioning, resulting in life satisfaction. Skin rejuvenation is a medical way to reverse the visible signs of ageing in the skin, and to delay the appearance of these signs of ageing.

Choosing the ideal skin rejuvenation procedure depends on several factors, like relative efficacy for a given medical indication, length of recovery period, expertise of the clinician, possible adverse effects, risks and complications, and the relative cost of these procedures.

Elixir @ Hunter skin cancer clinic provides comprehensive skin cancer checkup, skin cancer treatment and various forms of skin rejuvenation procedures.  To discuss what skin rejuvenation procedures are good for your skin and to discuss more about your skin, please call our friendly staff on 02 40674119 to book a cosmetic consultation.