FY 2023 VA-Funded Projects
What Is Basal Cell Carcinoma?
Basal cell carcinoma—also known as basal cell skin cancer—is the most common type of skin cancer in the U.S. Basal cell carcinoma begins in the basal cells of your skin. The most common cause of this condition is basal cell damage from exposure to ultraviolet (UV) light from the sun or tanning beds.
The most common symptoms of basal cell carcinoma include a small sore or lesion that does not heal or a patch of scaly skin. Fortunately, when diagnosed in an early stage, basal cell carcinoma is very treatable. Your primary care provider and a dermatologist (or, a doctor who specializes in skin disorders) will likely work together to find the treatment options that are right for you.
Basal cell carcinoma is the most common type of skin cancer among people living in the U.S. Other types of skin cancer include: Squamous cell carcinoma: The second most common type of skin cancer in the U.S. Like basal cell carcinoma, this type of cancer also causes a sore on your skin that looks like it won't heal. Melanoma: A more serious type of skin cancer that appears as a dark brown or black mole. Merkel cell carcinoma: A rare type of skin cancer that appears as a bluish-red nodule on the skin. Basal cell carcinoma lesions or sores usually develop on the areas of the skin that receive the most sunlight. This often includes the face, neck, scalp, and ears. If you notice a sore develop on your skin, it's important to look for the following signs: Open sore: A sore that does not heal over time or a lesion that oozes or begins to look crusty Scar-like growth: A flat, firm sore that looks like a scar that is typically yellow or flesh-colored Red patch: An area of the skin that feels itchy and looks raised and reddish in color Pearly bump: A small, shiny bump that is pink or red in color and has specks of blue and black coloring Growth with raised edges: A pink growth that is lower in the middle and raised around the edges Bleeding: A lesion that feels sensitive and may bleed easily When the DNA in your basal cells in the skin becomes damaged, basal cell carcinoma can occur. DNA is the material in your cells that stores your genetic information. When there is damage to your DNA, your cells no longer grow and reproduce at a normal rate. Cells that have DNA damage may start to grow at an out-of-control rate, which can lead to cancer. The most common cause of skin cell damage is ultraviolet (UV) rays from the sun or a tanning bed. Risk Factors The most significant risk factor for basal cell carcinoma is time spent in the sun. A 2014 study found that an estimated 90% of non-melanoma skin cancers are directly caused by sun exposure. You may also be at an increased risk of basal skin carcinoma if you: Have a personal or family history of skin cancer Were assigned male at birth Use tanning beds Are over the age of 50 Experience chronic skin infections Live with an autoimmune disorder Basal cell carcinoma is a common type of cancer and most dermatologists are experts at recognizing the condition. If you are concerned about a sore that will not heal or any other abnormal area of the skin, it's important to see your healthcare provider or your dermatologist right away. They will likely start your appointment by performing a physical exam and asking about your medical history. If your dermatologist suspects skin cancer, they will typically recommend testing a sample of skin tissue with a biopsy—a common procedure that providers use to detect cancer. The most common types of biopsies providers use to diagnose skin cancer include: Shave biopsy: Shaves off the top layers of skin using a surgical blade Punch biopsy: Uses a round, metal tool to remove deeper layers of skin Excisional biopsy: Surgically extracts the entire tumor (for larger areas of concern) Incisional biopsy: Takes out part of the tumor Lymph node biopsy: Removes a sample of tissue from your lesion's nearest lymph node to determine if cancer cells have spread to other areas of the body Once your healthcare provider obtains a sample of your tissue for a biopsy, they will send it to the lab where a pathologist (a specialist who examines bodies and body tissue) examines the sample under a microscope to check for cancer cells. Stages of Basal Cell Carcinoma Basal cell carcinoma is considered a slow-growing cancer. Dermatologists are usually able to diagnose it in an early stage before the cancer has spread to other areas of the body. To determine the stage of basal cell carcinoma, your healthcare team will use the TNM system: Tumor: Measures the size of the tumor and determines if it has grown deeper into the skin Node: Notes if cancer cells have spread to the lymph nodes Metastasis: Determines if cancer has spread (metastasized) to other areas of the body The goal of basal cell carcinoma treatment is to cure the cancer. This involves removing the cancerous area from the skin and preventing it from coming back. A common treatment for basal cell carcinoma is surgery. A Mohs surgeon is a medical doctor who specializes in treating cancer with surgery. This type of provider may perform one of the following surgeries depending on your exact case of basal cell carcinoma: Excision: The surgeon removes the tumor and surrounding healthy skin with a surgical blade. Curettage and electrodesiccation: The dermatologist or surgeon uses a tool to scrape away cancer cells and then burns the skin to stop bleeding and prevent infection. MOHS surgery: The provider removes thin layers of your skin and examines them under a microscope until no cancer cells are visible. This type of surgery has the lowest recurrence rate. This means that it is the most effective at preventing cancer in the future. Rarely, basal cell carcinoma may spread to other areas of the body. If this happens, your healthcare team will discuss further treatment options with you. These options may include radiation therapy, immunotherapy, or chemotherapy. Fortunately, many cases of basal cell carcinoma are preventable. To protect yourself against basal cell carcinoma, take precautions when spending time in the sun. The UV rays from the sun or tanning beds are responsible for the majority of basal cell carcinoma cases in the United States. To protect your skin from UV rays, take the following precautions: Take frequent breaks or sit in the shade when spending time outdoors Apply sunscreen with a high sun protective factor (SPF) before going outdoors, even in the winter Wear skin-protective clothing like a hat, sunglasses, and a long-sleeved shirt Refrain from using tanning beds If you have a personal or family medical history of skin cancer, it's also a good idea to see your healthcare provider annually for a skin exam and screening. Most cases of basal cell carcinoma are curable. However, once you have had basal cell carcinoma, your risk for other types of skin cancer increases. You are at higher risk of developing basal cell carcinoma again, squamous cell carcinoma, and melanoma in the future. For this reason, see your dermatologist regularly for skin checks. Most people who develop basal cell carcinoma receive an early diagnosis and treatment. Because your risk of getting cancer increases if you've already had cancer, it's still important to see your dermatologist regularly after you finish treatment or if your skin cancer has been cured. It's worth noting that while this condition is curable, incorporating prevention strategies for the future can reduce your risk of your cancer returning.Six Bizarre Signs Of Skin Cancer Revealed After Radio Legend Chris Evans' Diagnosis
Broadcaster Chris Evans today revealed he has skin cancer - after his masseuse urged him to have a suspicious freckle checked out.
The 57-year-old today told listeners on his Virgin Radio show that his melanoma was found in the extremely early stages and he is hoping to make a full recovery.
He said: 'It's been caught so early, just so you know, that it should be completely treatable. [Treatment] will happen on September 14.'
It comes after a previous cancer scare in 2020 when he spotted concerning marks on his skin. But doctors told him he had 'nothing to worry about'. Before that, he was given the 'all-clear' in 2015 after fearing he had prostate cancer symptoms.
Here, dermatologists explain the early warning signs of skin cancer and how to protect yourself.
The broadcaster Chris Evans announced on his Virgin Radio show on Monday that he has skin cancer
Signs of skin cancer range from the innocuous to obvious, but experts warn that treating cases early is key to making sure they do not spread or further develop
Asymmetrical molesDermatologists follow the ABCDEs when diagnosing melanoma; that is, asymmetry, border, colour, diameter and evolving.
Most melanomas — the rarest but most dangerous form of skin cancer that is most likely to spread — present as moles that have uneven edges.
They look different from common moles — the round, brown or tan spots on the skin caused by growing clusters of cells in the skin called melanocytes.
Dr Nayoung Lee, a dermatologist at NYU Langone Health, said: 'If you can't fold the mole in half, if edges don't line up' it could be melanoma.
Irregular borders of a mole, the 'B' in ABCDEs, can also indicate melanoma. The edges of a normal mole are uniform and smooth.
The Skin Cancer Foundation advises people to look out for 'ugly ducklings' — unsightly moles that very clearly stick out from the pack all over the body.
The foundation says: 'This recognition strategy is based on the concept that most normal moles on your body resemble one another, while melanomas stand out like ugly ducklings in comparison.'
Moles of uneven coloursColour, the 'C' in ABCDEs, is a strong indicator of dangerous melanoma. Healthy moles are typically a single colour, from dark and light brown to pink and flesh-toned.
Some moles become cancerous and change colours gradually. Roughly 20 to 30 per cent of melanoma cases develop in existing moles.
The other 70 to 80 per cent of the time, cancerous moles arise on otherwise healthy-looking skin.
But a suspicious mole often contains several shades of brown, black, or tan, as well as spots of pink, red or purple.
It becomes more colorful as cancer progresses, so early action is crucial. In fact, 99 per cent of patients who detect and begin treating their melanoma early survive five years or more after their diagnosis.
Dr Zaineb Makhzoumi, a dermatologist at the University of Maryland who specialises in a type of surgery to remove cancerous moles, said: 'Once you start to get two, three, four colors fused within one mole, that should be a warning sign and you should have that mole evaluated by a board-certified dermatologist.'
Chris Evans shares three sons and one daughter with the professional golfer and part-time model Natasha, 38
Moles larger than a peaSize matters when it comes to suspicious moles. Melanomas typically present a bit bigger than a pea or a pencil eraser, about six millimeters or a quarter inch.
Dr Makhzoumi said: 'Most moles, if they're benign, are smaller than a pencil eraser.
'If you have a mole that's bigger than a pencil eraser that is not in and of itself a warning sign and concerning. But rather when taken with the other constellation of signs, that's something that you want evaluated by a dermatologist.'
Not all melanomas subscribe to the 'D' in ABCDEs where D means a diameter of at least six millimeters. In 2013, doctors in Queensland, Australia, treated a 38-year-old woman with invasive melanoma on her arm that measured just 1.6 mm in diameter.
The small cancerous mole also did not appear asymmetrical, meaning doctors must still keep an eye out for moles that appear darker than those around it, as was the case in the Australian woman.
Doctors must also monitor how a mole evolves over time. This is the 'E' in ABCDEs. Changes in the size, shape, color, or elevation of a spot or any new symptom such as bleeding, itching, or crusting, may be a warning sign of melanoma.
Dr Makhzoumi said: 'Moles tend to go through an evolution, but the evolution of moles tends to be that that they shrink, or they disappear.
'If you have a mole that's evolving in that it's growing, it's getting darker, it's elevated, that's really, really key for melanoma,'
Melanoma grows in two phases, horizontal and vertical. The horizontal phase can last years before the mole becomes dangerous and invasive, meaning it spreads to lymph nodes and organs. But in a later phase, the lesion grows vertically, at which point it becomes a tumor with the ability to spread elsewhere in the body, potentially proving fatal.
Dr Makhzoumi added: 'Once melanoma enters that vertical growth phase, they actually accelerate very rapidly. So if you have a spot that all of a sudden starts to develop a lump to it, that is highly concerning for malignant melanoma.'
Bleeding or scaly patchesThese will often appear on areas of the skin most often exposed to sunlight, such as the face and the top of the head.
Precancerous squamous cell carcinoma — the second most common form of skin cancer — leads to actinic keratosis leads to a skin disorder that causes rough, scaly patches. The patches can sometimes bleed and become ulcerous.
Dr Lee said: 'They just feel scaly so you can feel them more than see them.'
People that have a history of heavy sun exposure are most likely to experience this type of skin cancer.
With every bad, blistering sunburn comes a heightened risk of squamous cell carcinoma.
Fair-skinned people and those with light eyes who are more prone to sunburn are also more vulnerable to SCC.
More often than not, though, squamous cell carcinoma is curable when treated early. In fact, the survival rate is as high as 98 per cent.
Dr Nayoung Lee (left), a dermatologist at New York University, said that moles with multiple different colors within them can be a warning sign. Dr Zaineb Makhzoumi (right), a dermatologist at the University of Maryland, warned that multi-coloured moles are a sign of cancer
A sore that bleeds may indicate another type of non-melanoma skin cancer called basal cell carcinoma which, like SCC, has a high survival rate. Still, people should treat it aggressively once it's detected.
Dr Lee said: 'Depending on location they can grow deeper in muscle and bone, so they do become problematic if left to grow for a long period of time.'
Basal cell carcinoma is the most common type of cancer overall and the most common type of skin cancer more specifically.
Dr Lee added: 'Basal cell carcinomas, we don't even stage them because survival rates are good.'
Dark patches on genitalsMelanoma can present as dark lesions on the mucous membranes, meaning the inside of the nose, mouth, vagina, or anus, or the fingers and toes.
This subtype of aggressive cancer is exceedingly rare and accounts for less than two per cent of all melanoma cases.
Unlike other types of melanoma, mucosal melanoma is not affected by sun exposure. About half of the mucosal melanomas start in the head and neck, typically the nose, mouth, windpipe, or esophagus. Smoking, ill-fitting dentures, and ingesting or inhaling carcinogens all greatly compound the risk of sarcomas in the mouth.
Most of the remaining 50 per cent of melanomas begin in the anus or rectal region and the female genitals. Spots on mucosal areas might not be melanomas but rather squamous cell carcinomas.
Dr Lee said: 'Initially when it's early it kind of looks like a whitish bump or ridge on the mucosal surface. So as it grows it starts to look more like an ulcer, it can look fungated [like a fungal infection in appearance], or other things.'
While doctors have not pinpointed the exact cause of mucosal membrane melanomas and non-melanoma cancers, some believe they are linked to a viral strain of human papillomavirus (HPV).
HPV strains 16 and 18 are those deemed high risk and cause the vast majority of cervical cancers. But strains six and 11, lower risk varieties, are more commonly associated with non-UV-linked skin cancers inside our bodies' orifices.
Dr Makhzoumi said: 'The subtypes that are causing a cervical cancer are not the same subtypes that are causing skin cancer.'
Patients can sometimes mistake nonmelanoma cancers in the genital region with a sexually transmitted infection, but doctors want to drive home the fact that this type of cancer is not a sexually transmitted disease.
Waxy, pearly bumps on skinBasal cell carcinoma, which typically appears on sun-exposed parts of the body like hands, neck, arms, and legs, often present as a waxy lump or a small, smooth, shiny, or pale growth.
It does not always appear raised, though, and could resemble a flat scar.
Dr Makhzoumi said: 'You really want to look for a basal cell skin cancer, one of the really specific signs is that when you stretch the edges, it looks pearly. There's an opalescence to it, there's an opalescence to basal cells, they do really look like shiny or pearl-like.'
Melanoma: The most dangerous form of skin cancerMelanoma is the most dangerous form of skin cancer. It happens after the DNA in skin cells is damaged (typically due to harmful UV rays) and then not repaired so it triggers mutations that can form malignant tumours.
Causes
Treatment
This can be done by removing the entire section of the tumor or by the surgeon removing the skin layer by layer. When a surgeon removes it layer by layer, this helps them figure out exactly where the cancer stops so they don't have to remove more skin than is necessary.
The patient can decide to use a skin graft if the surgery has left behind discoloration or an indent.
This is needed if the cancer reaches stage III or IV. That means that the cancerous cells have spread to the lymph nodes or other organs in the body.
Prevention
Source: Skin Cancer Foundation and American Cancer Society
What To Know About Merkel Cell Carcinoma, The Cause Of Jimmy Buffet's Death
On September 1, singer-songwriter Jimmy Buffett passed away from a rare form of skin cancer called Merkel cell carcinoma.
According to his website, Buffett, who was 76, had battled the skin cancer for four years.
The singer continued to perform while receiving treatment. However, in recent weeks, his health started to decline.
Merkel cell carcinoma isn't as common as other types of skin cancers, like basal cell carcinoma or melanoma, and tends to be more aggressive.
"It is much rarer, more likely to spread quickly to other parts of the body, such as lymph nodes and organs, harder to treat, and more prone to come back after treatment," Dr. Wael Harb, a hematologist and medical oncologist at MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, CA, and Vice President of Medical Affairs at Syneos Health, told Healthline.
Merkel cell carcinoma is a rare type of aggressive skin cancer that takes root in Merkel cells, which are located at the base of the epidermis, the outer layer of skin.
Merkel cell skin cancer typically presents with a painless pink or blue-red nodule on the skin.
Usually, these tumors grow on the face, head, or neck, but they can grow anywhere on the body.
The cancer cells are known to grow quickly and metastasize, or spread to other parts of the body.
Merkel cell carcinoma also has a high rate of recurrence — at about 40% — compared to other skin cancers like melanoma, which has a 7% rate of recurrence, and basal cell carcinoma, which has a recurrence rate of less than 0.5%, said Dr. Lisa Zaba, PhD, the director of the Merkel cell carcinoma multi-disciplinary clinic at the Stanford Cancer Center.
This type of skin cancer is most prevalent in older adults who have had long-term sun exposure or a weakened immune system.
"The risk of acquiring MCC climbs steeply with age," said Zaba.
It affects 1 in 100,000 adults ages 40-44 and 9.8 in 100,000 adults over the age of 85 years.
About 80% of cases are triggered by an infection with a virus known as Merkel cell polyomavirus (MCP).
Most people are infected with MCP by age 6, and there are likely other factors that increase a person's risk of developing Merkel cell carcinoma.
It's more common in people with light-colored skin and a history of other types of skin cancer.
Merkel cell skin cancer affects approximately 3,000 Americans every year, however, that number has been increasing due to enhanced detection and longer lifespan.
According to Harb, survival rates depend on the stage of cancer and where the tumor is located.
The five-year survival rates are 75% for stage one cancer, 61% for stage two cancer, and 24% for stage three cancer.
Survival rates are higher when the tumor is located on the arms or the legs compared to when they're on the head or neck, said Harb.
Merkel cell carcinoma can be detected during skin examinations.
If your healthcare provider notices any unusual growths, they may take a biopsy of the tumor and examine it in a laboratory for signs of cancer cells.
To determine if the cancer has spread beyond the skin, they may also conduct a sentinel node biopsy or imaging tests that can identify cancer cells across the body.
With Merkel cell carcinoma, rapid treatment is crucial, says Zaba.
Treatment options include surgery, radiation therapy, immunotherapy, and chemotherapy.
During surgery, the tumors and nearby tissues are removed. In metastatic cancer, the lymph nodes may be removed, too.
Treating early-stage skin cancer is far more effective than treating late-stage cancers.
The best way to prevent Merkel cell skin cancer is to prevent sun damage and avoid viral infections.
Harb recommends the following strategies:
Those with weakened immune systems should work closely with their doctor and take extra precautions, as they have a heightened risk of infections.
Check your skin regularly for any changes or abnormal growths.
If you notice anything suspicious, schedule a visit to a dermatologist.
"Decreasing sun exposure is the most modifiable way to decrease [the] risk of Merkel cell carcinoma," said Zaba.
Jimmy Buffett passed away on September 1 from a rare form of skin cancer called Merkel cell carcinoma.
This type of skin cancer isn't as common as basal cell carcinoma or melanoma, however, it tends to be more aggressive and is quick to spread throughout the body.
Even when treatment is effective, Merkel cell carcinoma has a high recurrence rate of about 40%.
Comments
Post a Comment