The most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma. There are other types of skin cancers such as adnexal tumors, Merkel’s cell tumor and others. These tumors are more rare and will not be discussed on this web site. Approximately 90% of basal cell and squamous cell cancers and 65% of melanomas are attributed to exposure to the sun’s ultraviolet rays. Plastic surgeons treat all the following types of skin cancers:

BASAL CELL CARCINOMA

	Bowen's Disease (squamous cell carcinoma in situ)

Basal cell carcinoma (BCC) is the most common type of skin cancer and it accounts for more than 90% of skin cancers in our country. It occurs most commonly in people of European descent and it is believed to arise from cells of the basal layer of the epithelium or from the hair follicle. While basal cell carcinoma can occur in association with certain disease entitites (e.g. nevus sebaceous, basal cell nevus syndrome, xeroderma pigmentosum) it’s occurrence is directly related to ultraviolet radiation from sun exposure. Basal cell carcinomas most commonly occur on sun-exposed areas such as the head, face (especially the nose), arms, hands and front of the chest. The tumors are usually slow-growing and they rarely metastasize (spread to distant areas of the body), however, treatment is essential because they can invade or encroach upon underlying structures and orifices.

While basal cell carcinomas can have a typical appearance they can mimic virtually any other skin lesion and there are at least seven different types based upon their appearance. Definitive diagnosis is usually obtained by biopsy. All patients with a prior BCC are at increased risk for developing future skin tumors with approximately one-third of patients developing a new lesion within five years.

Depending upon the clinical circumstances a variety of techniques may be used to treat basal cell carcinomas including curettage and electrodessication, radiation therapy, cryotherapy and surgery including Mohs excision. Plastic surgeons commonly treat basal cell carcinomas with excision and are highly skilled in optimizing the aesthetic and functional result following surgery. Sometimes procedures such as skin grafts or flaps are used in reconstruction following removal of the cancer. Plastic surgeons are uniquely qualified to perform reconstructive procedures following removal of skin cancers. In 2004 over four million tumor removal procedures were performed by plastic surgeons who are members of the American Society of Plastic Surgeons.

SQUAMOUS CELL CARCINOMA

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is less common than basal cell carcinoma by approximately a 1:4 ratio. SCC is more common in males and although it can occur anywhere on the body, like basal cell carcinoma, it is most common on exposed areas such as the head, face and neck. SCC may develop in normal skin or from one of several premalignant lesions including actinic keratosis, leukoplakia and Bowen’s Disease. Compared to BCC, it grows more rapidly, invades underlying structures sooner and has a greater potential for metastasis. Like BCC it is believed that the prime cause of SCC is exposure to ultraviolet radiation.

Treatment of small squamous cell carcinomas is similar to that of BCC. Because SCC is more aggressive than BCC surgical excision tends to be used as a preferred treatment.

MALIGNANT MELANOMA

Malignant melanoma (MM) is the most dangerous of the major skin cancers and it is the leading cause of death from all diseases of the skin causing approximately 79% of skin cancer deaths. Although it is uncommon, its incidence and mortality rate is rapidly increasing. According to the Centers for Disease Control and Prevention the death rate from melanoma has increased in the U.S. by about 4% per year since 1973. The incidence of MM increases with age and females are more likely to develop MM at a younger age. There are approximately 47,000 new melanoma cases in the U.S. annually. Like SCC, both sun exposure and precursor lesions have been implicated in the cause of melanoma. In addition, genetics seems to play a significant role in the development of some malignant melanomas. It is especially important for those with a family history of melanoma to have an annual screening with a dermatologist.

Melanoma occurs most commonly on the skin but it may also occur in the eye, under the nail or in any area of the body containing cells capable of forming melanin. While melanomas are often dark in color and irregular in shape, their association with nevi mandates that every pigmented lesion be carefully evaluated. Note that melanomas need not be dark in color as amelanotic melanomas may occur. Any lesion of concern and any lesion with any change in size, shape or color with or without bleeding, itching or ulceration is suggestive of malignant change and should be immediately brought to the attention of a qualified physician. Patients with history of melanoma should have long-term follow-up with their dermatologist, ophthalmologist, and gynecologist and have regular chest x-rays and bloodwork.

For information regarding Dysplastic Nevi and Congenital Melanocytic Nevi, please continue to the section below.

Your Plastic Surgeon can treat other types of skin growths as well, such as:

Dysplastic Nevi: While more than 50% of melanomas occur in normal skin, they can arise from pigmented moles and from dysplastic nevi. Dysplastic nevi are a type of nevus (mole) that are associated with an increased risk of MM. Dysplastic nevi tend to be larger and more irregular in outline and in color than over nevi. Individuals with dysplastic nevi require careful lifelong observation because dysplastic nevi are both precursor lesions of MM and markers for increased risk of MM. Dysplastic nevi can run in families and for those with dysplastic nevi and a personal or family history of MM, the risk of melanoma approaches 100%.

Congenital Melanocytic Nevi: Congenital melanocytic nevi are simply benign nevomelanocytic proliferations that are present at birth. They occur in approximately 1% of newborns. Nevus tardive is a type of melanocytic nevus that is similar to a congenital melanocytic nevus that appears between one month and two years of age. Melanomas may develop from congenital nevi. All congenital nevi carry risk of malignant change and the malignant potential seems related to size. Giant congenital nevus is a rare type of nevus that carries a significant risk of melanoma that appears greatest in the first decade of life. Because prepubertal risk of melanoma in small congenital nevi is low there currently (as of 2005) is no concensus regarding their management. Children and adults with one or more melanocytic nevi should undergo screening and follow with a dermatologist.

Moles: These lesions are clusters of skin cells with or without pigment that may be flat or raised above the surface of the skin. While most moles are safe, some may develop into malignant melanoma (see above). Moles may be removed for cosmetic reasons or because of constant irritation from clothing or jewelry (which can cause pre-cancerous changes) or because of concern for current or future malignancy.

Keratoses: These lesions usually appear as red, brown or lightly-colored patches on the skin. The type known as actinic keratosis is a precursor of squamous cell carcinoma.

Dermatofibroma: This is a common, benign intradermal nodular lesion that is firm and ranges in color from pale skin hues through various shades or red, brown and yellow. They most commonly occur on the lower extremities but are also seen on the arms and trunk and there may be a relation to minor trauma.

Keratoacanthoma: This is a rapidly growing, firm nodule that is closely related to squamous cell carcinoma and is treated as a squamous cell carcinoma by many physicians.