Step 4: A Diagnosis Is Made
After a week or two, your doctor will call you with the biopsy results. In the best-case scenario the spot is benign, and you breathe a sigh of relief, stock up on SPF 30 sunscreen and throw away that Groupon for a tanning salon visit. You could also be told you have an atypical mole (dysplastic nevus) that ups your chances of a melanoma later on or a precancerous growth (actinic keratosis). Both require removal or extra vigilance. Finally, there's a chance you'll be told you have cancer. As you recover from the shock, remember that most skin cancers are completely curable. They generally fall into three categories:
- Basal Cell Carcinoma: About 80% of skin cancers are basal, developing in the deepest layer of the epidermis. They're likely to appear on the parts of your body that see the most sun, such as your face, shoulders and neck. Since basal cell carcinoma can show up as a dry red patch or a pink translucent bump, it's sometimes mistaken for a pimple or callus that won't go away. This cancer rarely spreads to other parts of the body, but left untreated, it can damage surrounding tissue and become disfiguring.
- Squamous Cell Carcinoma: The second most common skin cancer, squamous cell carcinoma usually develops on the outer layer of the skin on sun-exposed parts like hands, lips and ears. It tends to travel a bit more than basal cell cancer but is rarely fatal. Squamous cell carcinoma can appear as crusty or bleeding growths, scaly red patches, open sores or warts.
- Melanoma: While melanomas account for less than 5% of all skin cancer cases, they are the most deadly and will kill approximately 9,500 Americans this year. Melanomas, which develop in the cells responsible for pigment, can pop up anywhere on your body, even places that rarely see the sun. They often look like an out-of-control mole -- a black, brown or multicolor spot, flat or raised, with a jagged border. If the cancer is detected before it spreads, the five-year survival rate is about 98%. But once malignant cells reach the lymph nodes, the survival rate decreases to 62%; it drops to 15% if the cancer spreads to other organs.
Step 5: Planning Treatment
Doctors have a range of options to consider -- everything from lasers to creams to radiation to surgery -- and even more promising new techniques are being tested every day. The critical goal is to get rid of the tumor and find any rogue cancer cells that have broken off and traveled to other parts of your skin or body. You and your doctor will choose a method based on several factors, including the type of cancer, the size and depth of the spot, the location and whether or not it has spread. There are three common surgical treatments:
- Curettage and Electrodesiccation: If you have a small, non-melanoma cancer, your doctor will probably remove it in her office by scraping off the growth with a sharp, ring-shaped instrument called a curette and then using an electric needle to burn off any remaining cells. (You'll receive a shot of local anesthetic first.) It may take multiple visits to get all the cancer cells, but this technique can be as effective as more invasive types of surgery.
- Mohs Micrographic Surgery: "This skin-saving procedure was created as a way to excise all the cancerous cells while removing the least amount of healthy tissue surrounding them," explains Dr. Kudchadkar. It's only for non-melanoma cancers and is recommended for sensitive spots, such as near the eyes or on the nose or hands. A dermatological surgeon uses a scalpel to remove malignant skin. The sample is biopsied in the office while you wait -- you may be there an hour or an entire day -- and if there's even a trace of cancer found around the edges, a little more skin is removed. The process is repeated until all the cancer has been cut out.
- Simple Excision: Melanomas are treated more aggressively with this standard excisional surgery. The doctor cuts out the melanoma plus a wide margin (from .5 to 2 centimeters) around it. The surgery will leave more of a scar, but it could also save your life. "If it's a very thin melanoma, the surgery may be performed in the office," says Dr. Kudchadkar. "But if it is thicker than 1 millimeter, we prefer the operating room, so we can do a lymph-node biopsy at the same time to see if the cancer has spread." Depending on the location and size of the melanoma, you may need a skin graft or some other type of reconstructive surgery afterward.
Step 6: Avoiding a Recurrence
Once your doctor gives you the good news that you're cancer-free, your next step should be figuring out how to best protect your skin in the future. "Use a broad-spectrum sunscreen that blocks both UVA and UVB rays, and reapply it every two hours whenever you're outside," advises Dr. Taylor. After you've had one skin cancer, you're at greater risk for another. If you've had a melanoma, you should typically circle back with your doctor every 3 to 12 months for several years. If you've had a basal cell cancer, you should likely circle back every 6 to 12 months, and with squamous cell cancer every 3 to 6 months, for the first few years. "I tell my patients, 'We're partners in this,' " explains Dr. Taylor. "Your job is to check yourself and come in to see me. My job is to examine you and detect anything as soon as possible so we can cure it."
Originally published in the June 2013 issue of Family Circle magazine.
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