American Medical Association Family Medical Guide - American Medical Association [762]
Diagnosis and Treatment
If you have a lump on your skin that does not heal within 3 weeks, your doctor may take a small sample from the lump for examination under a microscope (biopsy). Most squamous cell cancers are removed by cutting them away. Other treatments include freezing (cryosurgery), burning with a high-frequency electric current (electrocautery), radiation therapy (see page 23), or Mohs surgery (in which progressive layers of the tumor and surrounding tissue are sliced off and examined for cancer cells until the layers are free of cancer; see page 22). You may need a skin graft (replacement skin taken from another part of the body) to fill in the area that was cut away. When treated early, most squamous cell cancers are completely cured. However, because the cancer can recur, you should see your doctor regularly for follow-up examinations for at least 5 years.
Squamous cell carcinomas on the face
Squamous cell carcinomas that appear on the face usually develop on the lower part of the face, particularly between the bottom of the nose and the chin.
Malignant Melanoma
Malignant melanoma (see page 119) is the most serious type of skin cancer because it can spread throughout the body quickly. Changes in the skin cells that make melanin (a skin-coloring pigment) can produce a life-threatening cancerous tumor. Melanoma usually develops in a mole or freckle that has formed after birth or in seemingly normal, unpigmented skin. In rare cases, melanoma occurs before adolescence, usually in a mole that has been present from birth. A melanoma can develop anywhere on the body (even on skin that is seldom exposed to the sun) and on any skin surface (including under a nail). However, having one bad sunburn in childhood, repeated sunburns over the years, or a family history of melanoma increases your risk of developing the cancer.
The incidence of melanoma is increasing faster than any other cancer, doubling in the United States since the 1970s. Doctors think this increase is related to the popularity of suntanning, tanning salons, and more leisure time in the sun. It also may be related to use of sunscreens (because people mistakenly think they can safely spend more time in the sun with sunscreen).
Symptoms
A malignant melanoma can be black or brown and may begin as a flat spot or look like a mole. Often you can see other colors in the melanoma, such as gray, red, blue, or white. Sometimes a malignant melanoma may have no dark pigment at all. Melanomas appear asymmetrical (one half of the melanoma doesn’t match the other half) and the edges may be jagged or blurred (a normal mole has a defined edge). Melanomas are usually larger than ¼ inch in diameter but can be smaller and can grow almost imperceptibly in an existing mole.
WARNING!
ABCDs of Skin Cancer
See your doctor immediately if you notice any of these signs of skin cancer in a mole, or if a mole seems to be growing:
• Asymmetry If you draw an imaginary line down the middle of the mole, each side is a different size or shape.
• Border The mole has an irregular or blurred border.
• Color The mole has more than one shade or color (such as black, brown, blue, red, and white).
• Diameter The mole is larger than ¼ inch (about the size of the tip of a pencil eraser).
Diagnosis and Treatment
If you have signs of melanoma, your doctor will remove part or all of the tumor for examination under a microscope (biopsy). If a diagnosis of melanoma is confirmed, the mole or tumor and some of the surrounding tissue is removed surgically. Usually a skin graft (replacement skin taken from another part of the body) is done at the same time to cover the area that was removed, especially if the melanoma is large. In addition, the doctor will test nearby lymph nodes (called sentinel nodes) to see if they contain cancer cells. If it is possible that the cancer has spread to other parts of the body, a doctor may recommend chemotherapy (see page 23) or immunotherapy (which