Brief Overview of Skin Cancer
Skin cancer is the most common type of cancer. Fortunately, the fact that the skin is not an internal organ but accessible and easy to inspect allows for its early detection while the cancer is still small and therefore easier to treat, and before it metastasizes. For this reason, skin cancer has the highest rates of cure and treatment compared to any other cancer.
The three main types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma. These three cancers arise from mutations in different types of skin cells: basal cells, squamous epithelial cells, and melanocytes, respectively.
Symptoms of Skin Cancer
Although there is no single characteristic symptom of skin cancer, any new skin lesion or change in an existing lesion or mole on our body should prompt us to check it, as it may have been caused by a mutation and led to cancerous changes. Therefore, both self-examination and prompt medical attention upon noticing changes are crucial.
Even better is a regular annual examination by a specialized dermatologist experienced in dermoscopy. Individuals with a history of skin cancer and their relatives should undergo mole mapping, too. In general, patients presenting for examination describe in their history that they have a wound that does not heal or that they have noticed a change in color or shape in a mole.
Causes and Risk Factors
Like any cancer, skin cancer is caused by mutations in the genetic material of cells, leading to their uncontrolled proliferation and invasion into neighboring tissues, as well as distant tissues like lymph nodes, in the form of metastasis. The causes for these mutations are both genetic and environmental. At a genetic level, it has been found that there is a hereditary predisposition to developing skin cancer, and this knowledge is crucial, especially in the case of melanoma, as all first-degree relatives of a melanoma patient should undergo annual regular mapping, as they have an increased risk of developing melanoma themselves.
In terms of environmental causes, by far the main factor leading to mutations is solar ultraviolet radiation. The use of tanning beds increases the likelihood of carcinogenesis.
Other factors include smoking, exposure to radiation (radiotherapy), the use of immunosuppressive and immunomodulatory drugs, and exposure to viruses such as HPV. In the latter case, we mainly refer to the appearance of squamous cell carcinomas in areas with giant warts and specific cases of squamous cell carcinoma of the mucous membranes.
Fair skin combined with chronic exposure to the sun, especially during the hours of most intense radiation, a history of sunburn, personal and family history of skin cancer, as well as the presence of many atypical moles in the patient and their family are the most common risk factors.
Types of Skin Cancer
The most common type of skin cancer, and the most common overall, is basal cell carcinoma, also known as basal cell epithelioma. It presents in various forms, from an ulceration often mistaken for a non-healing wound to a small lump. It usually appears in sun-exposed areas where there are hair follicles. Indeed, it is believed to originate from cells at the base of the hair follicle. Chronic accumulated sun exposure is crucial, and fortunately, it grows slowly. To metastasize, it must be severely neglected, but some forms of it can invade a nearby nerve and 'travel' within it, spreading further into the skin. It often appears on the face, especially on the nose, and for this reason, besides accurate diagnosis, its complete removal with healthy margins requires knowledge and experience to ensure that the resulting defect does not cause concern and heals with a good cosmetic outcome.
Squamous Cell Carcinoma
A second type of skin cancer is squamous cell carcinoma, which originates from cells of the epidermis. Sun exposure again is crucial, and it can appear anywhere on the body and face, but this type of cancer is characteristic of mucous membranes (e.g., on the lower lip). It can also appear on pre-existing scars or in areas that have been exposed to radiation. This cancer is more aggressive than basal cell carcinoma and can metastasize to lymph nodes, especially if neglected. The size of the lesion and its histological differentiation (seen in biopsy) is therefore crucial in determining the margins to be used in dermatological removal, while in large lesions, imaging preoperative evaluation may be necessary.
A common precursor lesion that sometimes evolves into squamous cell carcinoma is actinic keratosis, which more often appears on the face, especially in bald heads. Previously considered precancerous lesions, some now consider them as in situ cancer, starting and confined within the epidermis. These lesions can be treated with non-surgical methods if deemed appropriate after dermatological examination.
Melanoma
The third type of skin cancer we will discuss is melanoma. It is the most serious of the three and fortunately less common, but not so rare as to not concern us every year. The fact that it can metastasize and even lead to death underscores the crucial importance of early diagnosis and timely removal, which brings a cure rate of over 90%. Every year we hear about which 'moles' are dangerous, but the reality is that this advice is useful only as public awareness, as accurate diagnosis is not always an easy task even for colleagues from other specialties, especially in early lesions, which are the target. That's why specialized dermatological examination is required. Even more difficult is sometimes reassuring a patient who has been frightened and preventing the removal of a lesion that does not need to be removed for medical reasons.
The only safe advice we can give beyond the necessity of preventive examination and in some cases determining follow-ups is for the patient to see their dermatologist if they notice any changes in a 'mole'.
Treatment by Dermatologists
The role of the Dermatologist in the accurate diagnosis and appropriate treatment of skin cancer is crucial. Both for preventing unnecessary removals and for the most timely recognition and treatment of cancerous lesions with the correct clinical margins of excision. In most cases, surgical removal is the gold standard, although in some cases we can discuss and decide if another method is worth using, such as the application of immunotherapeutic cream, destruction with cryotherapy or laser, or the combination of cream with cryotherapy.
In our clinic, although we have experience with these methods, we generally prefer surgical removal because it allows both the identification of the lesion histologically and the control of the excision margins, as well as the recognition of risks that increase the chance of recurrence, e.g., the involvement of a nerve. On the contrary, in precancerous lesions such as actinic keratoses, non-surgical field therapy can be performed with certain creams or laser application, peeling, and other superficial destructive methods that lead to regeneration.
Indeed, in our clinic, we have specialized lasers that have been shown in the international literature to significantly reduce (by half) the likelihood of developing a second skin cancer in a patient who has already developed such a lesion. This is particularly important because these patients have increased chances of developing a second independent lesion (not metastasis or recurrence). Additionally, the application of these lasers leads to rejuvenation and renewal of the skin, essentially created as an anti-aging tool! Joy after benefit, therefore.
Surgical Removal of Skin Cancer
Is hospitalization required for the removal of skin cancer?
No. For many years, both abroad and in Greece, such removals have taken place in specially designed office spaces. Hospitalization is not required, and we avoid the risk of hospital infections and additional costs. If your insurance requires the procedure to be performed in a hospital, please contact us first.
Do I need to stop any of my medications before the procedure?
Η σύντομη απάντηση είναι όχι. Αν λαμβάνετε χάπια που κάνουν το αίμα σας πιο λεπτόρρευστο π.χ. Ασπιρίνη, Salospir, Plavix, Sintrom αυτό θα αυξήσει λίγο το χρόνο της επέμβασης καθώς θα υπάρξουν μικροαιμορραγίες κατά τη διάρκειά της. Λαμβάνουμε κάθε δυνατό μετρό ώστε να το αντιμετωπίσουμε, τόσο πριν την επέμβαση, με την επιλογή της κατάλληλης σύστασης τοπικής αναισθησίας όσο και κατά τη διάρκεια της επέμβασης, με διάφορους τρόπους. Οποιοδήποτε σκεύασμα λαμβάνετε ως θεραπεία πρέπει να το συνεχίσετε. Μόνο αν λαμβάνετε κάτι προφυλακτικά, χωρίς προηγούμενο ιστορικό συμβατός και μετά από σύμφωνη γνώμη του θεράποντος ιατρού μπορείτε να διακόψετε κάποιο χάπι.
Will I feel pain during or after the procedure?
No. After the initial sting and the sucking of local anesthesia, lasting 3 seconds, you will not feel any pain during the procedure. After the local anesthesia wears off, the vast majority of patients do not feel pain and do not take analgesics. In cases of large interventions, you may feel a slight pulling sensation at the site, and we recommend taking Depon for a day or two. The issue of pain doesn't need to concern you.
What will happen after the procedure?
After the procedure, the skin lesion will be sent for histological examination (biopsy) to confirm that it has been completely removed. Two days after the procedure, we recommend coming to our office for a wound check, where we clean the wound and close it again. The stitches are removed at least a week later, depending on the area from which the lesion was removed.