What Are Basal and Squamous Cell Skin Cancers?

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common types of skin cancer, often associated with sun exposure. BCC accounts for about 8 out of 10 skin cancers and typically grows slowly on sun-exposed areas such as the face, head, neck, and arms. Although rare, untreated BCC can invade nearby tissues. Recurrence is possible if it is not completely removed, and those with BCC are prone to developing new ones elsewhere.

 

SCC, the second most common type, makes up roughly 2 out of 10 skin cancers and commonly appears on sun-exposed areas or in scars or chronic skin sores. It may begin in actinic keratoses, a pre-cancerous condition caused by sun exposure, often presenting as rough, scaly spots. While most actinic keratoses do not become cancerous, some may, so treatment is advisable. SCCs are more likely than BCCs to spread to deeper skin layers or other parts of the body but can usually be fully removed or treated.

 

What is the risk of developing BCC and SCC?

 Understanding the risk factors for skin cancer can help reduce the risk or detect it early for easier treatment. These risk factors include exposure to ultraviolet (UV) light, having light-coloured skin, age, male gender, exposure to certain chemicals or radiation, previous skin cancer, long-term or severe skin inflammation or injury, a weakened immune system, and smoking, which is linked to SCC of the lip.

 

What is the treatment?

If you are diagnosed with basal or squamous cell skin cancer, your surgical team will discuss the most suitable treatment options, considering benefits, risks, and side effects.

• Cryotherapy (cryosurgery): Liquid nitrogen can be used in the treatment of pre-cancerous conditions like actinic keratosis or certain very low-grade small basal cell carcinomas. It is applied to freeze and kill abnormal cells. This treatment is often repeated in the same visit. After the area thaws, it may swell, blister, and crust over, and there is potential for weeping and scarring.

• Topical chemotherapy: Anti-cancer drugs applied directly to the skin in cream or ointment form, targeting cancer cells.

• Excisional surgery: Different techniques are used depending on the type, size, and location of basal and squamous cell skin cancers. For large cancers where stitching wound edges together is not feasible, healthy skin from elsewhere in the body can be grafted over the wound. Other reconstructive procedures may involve moving nearby skin flaps to aid healing and restore appearance.

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The initial surgeries are usually done using local anaesthesia if possible, with sedation sometimes used as well. However, for high-risk cancers, additional surgery may be needed to remove any remaining tumour and/or nearby lymph nodes, which may require general anaesthesia. After these procedures, further treatments such as radiation or chemotherapy may be recommended.

What Is Melanoma Skin Cancer?

Melanoma is a dangerous type of skin cancer that develops from melanocytes, the cells responsible for skin pigmentation. Although less common than other types of skin cancer, it is more likely to spread if not detected and treated early. Early detection significantly improves cure rates. Risk factors for melanoma include exposure to UV light, the presence of moles, lighter skin, a family or personal history of melanoma, a weakened immune system, older age, and being male. Regular skin exams, especially for those with higher risk factors, are crucial for early detection. Total body photography or mole mapping may help in monitoring moles over time.

 

How can I spot an abnormal mole?

It is important to regularly examine your skin to catch skin cancer early. Doctors recommend checking your skin once a month in a well-lit room using a full-length mirror and a hand-held mirror to see hard-to-reach areas. Examine all body parts, including your scalp, ears, nails, and back. Normal moles are usually evenly coloured and less than 6 millimetres across, and they typically appear during childhood or young adulthood. You must see a doctor if you notice any changes in size, shape, colour, or texture.

 

Remember to follow the ABCDE rule:

• Asymmetry

• irregular Borders

• varied Colour

• Diameter larger than 6 millimetres, and

• Evolving features.

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If you notice any new or changing spots, get them checked by a doctor promptly.

 

What should I expect during a consultation for melanoma?

When assessing a skin concern, your plastic surgeon will ask about symptoms such as when they started, any changes, and associated sensations like pain or itching. They will also consider potential risk factors such as tanning history or family history of skin cancers. During the physical exam, they will observe the size, shape, colour, texture, and any bleeding or crusting of the area. They may also examine the rest of your body for related spots. Lymph nodes near the area may be checked for enlargement, as melanoma often spreads there first. Dermoscopy, a technique for magnified skin examination, may be used, sometimes supplemented by photography for documentation.

 

Skin biopsy

When a suspicious spot is suspected of melanoma, it is removed and sent for microscopic examination, called a skin biopsy. The method of biopsy depends on factors like size and location. Regardless of the method, the objective is to completely remove the lesion for laboratory study where possible. For very large lesions, the goal is to remove as much of the area as possible or a representative portion to try to achieve an accurate diagnosis. Biopsies are done under local anaesthesia to minimise discomfort. While scarring is inevitable, its extent may vary depending on the biopsy method. The biopsy results not only confirm or exclude melanoma but also guide further management.

 

What is the treatment?

The treatment plans for melanoma can vary based on the type and stage of the disease. In the early stages, simple surgery may be all that is needed for a potential cure. However, more advanced cases may require additional scans, tests, more extensive surgeries, and collaboration with specialists such as oncologists. Early detection is crucial for successful treatment. Advanced melanoma, particularly when it has metastasised, is more difficult to cure, even with advanced surgical procedures and adjuvant therapies such as chemotherapy, radiotherapy, immunotherapy, or other targeted therapies. Your surgeon will customise the treatment plan based on your specific situation, considering the extent and stage of the melanoma.