Cutaneous oncology is the study of cancers of the skin.  While most skin cancers are caused by the sun, there are others that are not sun related.  More people are diagnosed with skin cancers each year than all other cancers combined!  The three most common types of skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma.  Other malignancies such as merkel cell carcinoma, sebaceous carcinoma, microcystic adnexal carcinoma, pleomorphic sarcoma or atypical fibroxanthoma, cutaneous lymphomas, dermatofibroma sarcoma protuberans, extramammary paget’s disease and others are far rarer.

Basal cell carcinoma

Basal cell carcinoma is the most common form of skin cancer.  It commonly presents as a bleeding, pimple-like lesion that seems to heal partially or completely, but then never really goes away – recurring in the same spot.  They are pink, pearly appearing papules that can look whitish when pressure is applied.  They are usually slow growing and respond well to a variety of procedures depending on the type of growth pattern exhibited.  While we often say that basal cell cancers do not spread – they still require treatment as they can grow invasively in all directions.  An untreated lesion left on the face can spread deeply and go into nerves, muscles, or even through bone.  An untreated lesion on the trunk or extremities can cause a non-healing bleeding ulcer that never heals and is painful.

Squamous cell carcinoma

Squamous cell carcinoma is the second most common skin malignancy.  It often presents as a scaly pink patch of skin, sometimes with thick, hard, heaped up dry skin that is slightly tender.  There is a variant, called Keratoacanthoma, which presents like a rapidly growing wart or scaly cyst that “pops up out of nowhere”.  More than twice as many people die from squamous cell carcinoma than melanoma in the U.S. annually.  However, organ transplant patients are approximately 100 times more likely than the public to develop squamous cell carcinoma.  Higher risk areas to get an invasive squamous cell are on the lip or ear.  While basal cell carcinomas tend not to spread in other parts of the body, squamous cell carcinoma of the head and neck has a higher risk of spreading into the lymph nodes or along the nerves. 

Melanoma

Melanoma accounts for only about 1% of skin cancers but causes the majority of skin cancer deaths.  The most common signs of a melanoma are summarized with the ABCDE criteria: 

• Asymmetry of the lesion,

• Border irregularity,

• Colors are more than 2,

• Diameter is larger than 6mm,

• Evolving over time (or changing). 

On average a person’s risk for melanoma doubles if they have had more than five sunburns, but just ONE blistering sunburn in childhood or adolescence more than doubles a person’s chances of developing melanoma later in life.  Only about a quarter of melanomas are found in existing moles, whereas the remaining arise in what appears to be normal skin.  Melanomas on the surface of the skin can be treated by your dermatologist, but once they become invasive we often involve a team of surgical and medical oncologists to take care of the cancer.