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The Many Faces of Skin Cancer
Know Your ABCD's!

By David V. Poole, M.D.

Originally published in Massage Bodywork magazine.
Copyright since 2000. Associated Bodywork and Massage Professionals. All rights reserved.



I have had a patch of dry skin on my cheek for a long time. Recently it has begun to get red and itch. Just about the time I think I should have it checked, it gets better and goes away. I was worried about it being a skin cancer, but a friend told me that I shouldn't worry because if it were a skin cancer it wouldn't go away, it would just keep getting bigger. What do you think?


When In Doubt, Check It Out
This may be nothing more than a patch of irritated skin, or it may be a skin cancer. Skin cancers can have an innocent appearance. They often come and go, just as described. But one thing is for sure, an expert, such as a dermatologist, plastic surgeon or other physician who cares for skin cancers every day should check it out. If it is a skin cancer, every day you wait will allow the cancer to grow bigger making its treatment more difficult. While there are many different treatment options for skin cancers, if surgical removal is necessary, you want the cancer to be as small as possible. The smaller the skin cancer, the smaller the hole after it is removed, the easier the hole is to close, and the smaller the scar you will be left with.

The recommendation I give to my patients is that ANY mole or pigmented spot on their body that changes in ANY way should be checked. If it gets bigger, darker, changes shape, has irregular edges, is or becomes asymmetric, has light and dark areas in it, or ever bleeds, it should be checked immediately. The ABCD's of melanoma are:
A -- Asymmetry
B -- Borders that are irregular
C -- Color changes
D -- Diameter that is enlarging.

While there are several varieties of malignant melanoma, the only thing you absolutely need to know about them is that any of them can be deadly. With early detection and treatment most can be successfully removed and the patient completely cured. However, if not detected and treated early, these killers can spread to many different areas of the body including the lungs, the liver and the brain. With melanoma it is extremely important to follow the adage of when in doubt, check it out.



Skin Cancer In America
In this age of beauty, the old adage that "brown fat looks better that pale fat" appears to be taken to heart all too often in the United States. In spite of public education and the abundance of sunscreens on the market today, the incidence of skin cancer is on the rise. The increase in outdoor activities, both sports and leisure, have correlated with an increased exposure to the sun and the results are showing up everywhere -- especially on your clients' backs.

With proper knowledge, massage therapists and estheticians have an opportunity to inform clients or recommend they seek out the evaluation of a medical professional. Here is a brief overview of the most common types of skin cancer. The most important thing to take away from this information regarding your skin or your client's skin is quite simple -- when in doubt, check it out.


Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common form of skin cancer; if you have to have a skin cancer, pick this one. It arises from the basal layer of the epidermis, the outer layer of the skin and it has a strong relationship to sun exposure. It usually grows locally, meaning it invades and destroys tissue only in the area where it is, and metastasis (spreading to another part of the body) is rare. There are several different types of BCC: superficial, pigmented fibroepithe-liaoma nodular, noduloulcerative and sclerosing. The take-home message here is let an expert decide what your skin spot is. If you don't, it might be a Sclerosing BCC that can have little finger-like tentacles which spread out under the skin's surface, unbeknownst to you. This is not good. A typical BCC has a pearly or waxy nodule with a rolled border and tiny spider veins on and around it.


Squamous Cell Carcinoma
Squamous cell carcinoma (SCC) is the second most common form of malignant skin cancer. It accounts for about 10 percent of all skin malignancies. It is also most commonly seen on sun-damaged skin, but it can arise de novo (without sun exposure) or from various pre-existing skin lesions, such as actinic keratoses, burn scars, radiation-exposed or treated skin, or even in areas of chronic skin irritation. SCC is most often a locally growing skin tumor. It can, however, spread to surrounding tissues or even have metastasis to other parts of the body. SCCs most often are found in red, irritated sun-damaged skin. They often have a scaly, red, crusted appearance and may have an ulcer in them. The tissue is often fragile and may bleed easily when rubbed.


Malignant Melanoma
Malignant melanoma is the least common of the three main types of skin cancer, but it is the most dangerous. It can be deadly, and accounts for more than 70 percent of the deaths related to skin cancer. The most disturbing statistic is that despite public education campaigns about the dangers of sun exposure and skin cancer, the incidence of malignant melanoma in the United States doubles about every decade. Fair-skinned people, such as blondes and red heads, need to watch their skin closely.


Other Skin Things
Now that I have garnered everyone's attention, it is important to note that not everything that shows up on the skin is a skin cancer. Unfortunately, with maturity (age) often comes a lot of skin "things." Actinic keratoses (a patch of sun-damaged skin) are often seen as patches of dry, scaly skin which can be red and irritated. These are most often found on frequently sun-exposed areas of the body, such as the head and neck. It is important to note that if treated properly, these will go away. If left untreated, experts estimate up to 20 percent will turn into a skin cancer.

Seboreric keratoses are often scary-looking skin lesions that enlarge over time. They are generally pigmented, and have a raised, wart-looking appearance. Cosmetically they can be unsightly, but fortunately have little potential of turning into a skin cancer. Dermatitis (irritation of the skin) comes in as many different shapes, sizes, varieties and causes as you can think of. Things such as new laundry soap or a new piece of jewelry can cause what is know as contact dermatitis (irritation of the skin caused by something coming in contact with it).


Advice To Live By
Knowledge provides you with the power to make safe and effective choices -- for you and your client. Remember, most of the things you will find on the skin are not skin cancer. But for that small percentage that are, often the only way to know is to have it checked by a skin care expert. Early detection and treatment of skin cancer is the key to successful treatment and cure. In the case of malignant melanoma, what you don't know can kill you. Choose to have any questionable spot on your skin evaluated by your physician and recommend the same to your clients. If necessary, ask for a referral to a dermatologist or plastic surgeon in your area who treats skin cancers on a regular basis. And I can't say it too many times -- always remember, when in doubt, check it out.

David V. Poole, M.D., is a board certified plastic surgeon specializing in cosmetic plastic surgery. You can receive a complimentary information package on any of cosmetic plastic surgery procedures by writing to Ask the Doctor, c/o David V. Poole, M.D., at 773 Douglas Avenue, Altamonte Springs, Florida 32714, or by calling the Cosmetic Plastic Surgery Information Center Hotline at 407/788-8080 and ask for the patient care coordinator.




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