Types of skin cancers and their prevalence

When people think regarding skin cancers, they tend to think immediately about melanoma. Melanoma is undoubtedly significant cancer. It's the skin cancer that that causes most deaths in the world. Melanoma comes from a certain kind of cells and epidermis called melanocytes. Those are the cells that give pigment and colour to our skin. When those cells go wrong, it gives rise to melanoma.

On the other hand, basal cell and squamous cell carcinoma grow from a different cell and epidermis. A completely different type of cell called the keratinocyte, which is the primary cell of our epidermis. Those cells are continually being damaged by ultraviolet radiation from the time that we're born. Our body has mechanisms always to be repairing that damage that ultraviolet light is creating inside the keratinocytes.

But over time and with certain underlying medical conditions, those mechanisms can be imperfect and age the chance. We'll have enough imperfections in those cells to cause cancer to start to go up. We're starting to see more basal cells more squamous cells in younger persons. It used to be very rare to see those types of tumours in persons of 20s and 30s. But this is expanding now. It's hard to know exactly why that is, but one thing implicated is tanning beds—people, especially young women, repeatedly gone to tanning beds. We're starting to see these basal cells and squamous cell cancers at a much younger age in those persons.

Skin Cancers Risk Factors

The main risk factor for basal cells and squamous cell carcinoma is sun exposure. Particularly sunburns persons with light skin who are susceptible to sunburns have developed these skin cancers. Tanning is also a risk factor, so people who seek out the Sun for many years. And get a lot of cumulative ultraviolet exposure through habitual tanning. They're also at an increased risk, but people who burn easily have gotten multiple sunburns, mostly multiple blistering sunburns.

Skin cancer Treatments:

The treatment for non-melanoma skin cancer depends on the skin if it's just right on the skin's very surface. Epidermis where most of the tumours start, then you may not require surgery. The basal epidermal cell and squamous cell carcinomas can be dealt with topical creams with light therapies. Just some very superficial scraping or freezing techniques and so for those epidermal tumours. Multiple treatment options are reasonably non-invasive then for those deeper tumours. The ones that have left the epidermis and are now growing down. Those are not very amenable to these topical therapies. Generally require surgical excision of some sort the surgical options for non-melanoma skin cancer.

standard surgical excision for skin cancers:

We're in the doctor's office. The tumour is cut out and sent to a pathology laboratory and processed and checked under the microscope and patients. In that scenario, get a pathology report back usually about a week or so later to let them know regardless of whether the disease is exact. There's another alternative to that called Mohs surgery, which I do for most of my time With Mohs surgery instead of having the patient wait a week. At the same time, the tissue is processed at an outside pathology laboratory. We remove the tumour, and we process it right there in our laboratory, while the patient's waiting, and we process it differently. We don't cut it like bread and look at representative slices. We look at the entire under the surface that we've removed and the whole perimeter around the tumour. So that we're looking at nearly a hundred per cent of that marginal surface, and we check that ourselves under the microscope.

Advantage of Mohs surgery for skin cancers:

The benefit of that is when I'm looking at that under the magnifying lens, I can see precisely where any lingering tumour is. If it's in the epidermis, I know if it's a dermis, I know if it's in the fat, I know if it's on the wound's right-hand side. When I go back and remove more tissue from the patient, I can remove additional tissue just in that area that's positive. So I'm both being very precise and making sure that I'm getting out of the whole tumour.

But I'm also not having to take away extra normal tissue to ensure that I have a clear margin. I can remove what needs to be removed. But nothing else once the patient has a clear margin microscopically. Then we reconstruct the wound. That same day, all office-based surgery done under local anaesthesia patients doesn't need to be sedated or asleep for these procedures in rare cases. When the tumours are massive, we work in conjunction with surgeons or plastic surgeons or surgical oncology.

Fortunately, those larger tumours are very uncommon and, most by far, of what we do. We can remove right there in our office setting under local anaesthesia and reconstruct it right. Therefore the patient all in one day knows that their tumours out and walks away with the correct reconstruction—a very nice cosmetic result. We can entirely remove cancer but not have to remove extra tissue to ensure that.

High-Risk non-melanoma skin cancer clinic:

When I arrived at Brigham and Women's, I founded the first clinic devoted to non-melanoma skin cancer patients in Boston. And in this clinic, we see patients who either have had difficulty with multiple non-melanoma skin cancers. The patients who I mentioned have multiple tumours over their bodies in different stages. And patients who have one particularly high-risk troublesome aggressive basal cell or squamous cell carcinoma. In this clinic, we see patients with rare non-melanoma skin cancer cases like dermatophyte Roma sarcoma bump and some other rare entities.