Screening Moles for Cancer
If a mole looks or acts at all peculiarly it is best to have it evaluated by an expert. This frequently is a dermatologist. Most dermatologists can tell if the pigmented lesion is composed of melanocytes or is something quite different with no possibility of being a melanoma. Many dermatologists now use a hand-held magnifying device which produces polarized light to evaluate colored melanocytic tumors. The use of this instrument improves the doctor’s ability to identify suspicious lesions.
Evaluations of Moles
The decision on which melanocytic lesions need to be examined depends on the concern the doctor has that it may be cancerous. Since the procedure necessary to take off the suspicious bump is simple, requiring only local anesthesia and rarely is associated with complications, the threshold for this procedure is appropriately low. If the lesion is melanocytic in origin and it appears at all peculiar, exhibiting any of the features addressed in the ABCDE criteria and/or the patient complains that the bump bleeds or is irritated or itchy, that is often enough to trigger a biopsy.
A Briefing on Skin Cancer
Malignant melanoma is the most deadly form of skin cancer because it tends to spread at a very early stage to other parts of the body. The likelihood that it has spread is most directly related to the thickness of the melanoma as measured from its surface to its depth by a pathologist. This information is communicated to the doctor that submitted the nevus and subsequent treatment depends on this information.
Although it is possible for a previously benign mole to become malignant most of the time a melanoma begins as a single malignant cell in previously normal skin and then continues to grow in an uncontrolled manner.
Squamous Cell Carcinoma
Squamous cell carcinomas begin as malignancies of living epidermal cells which grow and invade into the deeper layers of the skin. They usually begin as an actinic keratosis and progress over many years. Although most actinic keratoses do not eventuate into squamous cell cancers, if one has a great many of them and they continue to receive sufficient ultraviolet irradiation producing sufficient mutational events, it is extremely likely that a squamous cell carcinoma will develop. They appear as thick, keratotic bumps on sun-exposed skin which continue to enlarge. They do not commonly spread to distant sites, but larger lesions can do this.
Bowen's Disease typically presents as a gradually enlarging, well-demarcated red colored plaque with an irregular border and surface crusting or scaling. Bowen's disease may occur at any age in adults, but is rare before the age of 30, most patients are over 60. The cells in Bowen's disease are often highly atypical under the microscope, and may in fact look more unusual than the cells of some invasive squamous cell carcinomas. Treatments include cyrotherapy (freezing, topical chemotherapy and excision. Because the cells of Bowen's disease have not invaded the dermis, it has a much better prognosis than invasive squamous cell carcinoma.
Basal Cell Carcinoma
Basal cell carcinomas arise from the layer of skin cells present along the lowest layer of the epidermis and are the most common form of skin cancer. Fortunately they rarely spread to distant sites unless they are permitted to attain gigantic proportions. They are locally aggressive so they ought to be treated before they get so large that removal becomes technically difficult. The tumor has a shiny surface, is pearly white in color, and tends to bleed quite easily. It often ulcerates.
Who Is At Risk for Skin Cancer and Why?
Sunlight is by far the most common cause of skin cancer. Most of the exposure occurs during leisure time or as a consequence of a desire to darken one’s basic skin color. The perceived benefits of exposure to sunlight seem to be confined mostly to the production of vitamin D in the skin, a belief that darker skin is more aesthetically appealing, and the warmth produced as the light as hits the skin. Vitamin D requirements can be easily satisfied with dietary supplementation. Light-skinned individuals with blonde or red hair who live in regions near the equator are most likely to develop skin cancer.
Reduce Your Skin Cancer Risk
It is important to avoid exposure to sunlight as much as is reasonably possible. Any time there has been a darkening of the skin after sun exposure it is a sign that some damage has been sustained. Since the incubation period for skin cancers and photoaging is quite long (5 to 15 years), it may be difficult to convince sun worshipers of the foolishness of this behavior. The use of clothing, searching for shade, and the application of effective, broad-spectrum sunscreens are all useful behaviors in limiting photodamage. Sunscreens that block all the wavelengths of ultraviolet light with an SPF (Sun Protection Factor) of 50 and that are reasonably durable are currently available.