One in five people are expected to develop skin cancer by age 70. According to the Skin Cancer Foundation, more people are diagnosed with skin cancer annually in the United States than all other cancers combined.
The good news is that, in general, surgical excision is a very effective treatment for most skin cancers, said Endeavor Health Plastic and Reconstructive Surgeon Iris A. Seitz, MD, PhD, an expert in melanoma and skin cancer reconstruction.
The majority of skin cancers are non-melanoma skin cancers with basal cell carcinoma (BCCa) followed by squamous cell carcinoma (SCCa) being the most common, highly treatable forms of skin cancers.
Causes
Exposure to ultraviolet (UV) rays from the sun or tanning beds is the largest known risk factor for developing skin cancer. UV rays damage skin cell DNA, which can lead to altered skin cell growth and skin cancers.
It’s important to protect yourself from damaging UV rays by limiting sun exposure, wearing sunscreen and UV-blocking clothing. Since much of the damage to your skin was likely done when you were younger, it’s critical to be screened by a dermatologist on an annual basis, explained Dr. Seitz.
The risk of developing skin cancer grows with age. “I’ve had patients say, ‘I don’t understand, I wear sunblock’ after being diagnosed with skin cancer, but sun burns and exposure in earlier years can lead to skin cancer much later in life,” said Dr. Seitz.
Signs
Most BCCa and SCCa start as a small skin lesion that won’t heal, often associated with on and off crusting and bleeding. Most melanomas arise in normal skin, but some can develop from atypical moles known as dysplastic nevi.
“If you see a mole that is new or changing, or a skin lesion that won’t heal it’s time to get it checked out,” she said.
For anyone who has already experienced skin cancer, or has light-colored skin, which puts them at a higher risk for developing skin cancer than people with darker skin, more frequent screening may be warranted.
Diagnosis
Incidences of skin cancer are on the rise, particularly in younger women. However, survival rates for most skin cancers are excellent and even for advanced stages of skin cancers including melanomas, survival rates are improving dramatically thanks to advances in adjuvant and neoadjuvant treatment options such as immunotherapies and targeted therapies.
Dependent on the type of skin cancer and the extent, sentinel lymph node biopsies might be indicated to see if the cancer has spread to nearby lymph nodes.
Advanced sensitive imaging technology such as indocyanin green (ICG) fluorescence lymphangiography was recently approved by the FDA to assist in lymphatic mapping and staging. This helps surgeons like Dr. Seitz more precisely map sentinel lymph nodes to determine how far cancers have spread. The sophisticated imaging technology makes use of a fluorescent dye utilizing infrared cameras to visualize lymphatic channels and sentinel lymph nodes that drain the area of the skin cancer.
Treatment
For melanoma that has spread to a regional lymph node the standard of care used to be to remove the entire lymph node basin, increasing overall surgical risks as well as the risk of developing lymphedema. With the success of immunotherapies and targeted therapies, a complete lymph node dissection is now rarely indicated, allowing for a less invasive surgical approach.
Enhanced treatment options are providing better outcomes for all skin cancers including advanced melanomas, but early detection is still the best path to curative treatment, emphasized Dr. Seitz.
Dr. Seitz works closely with a multidisciplinary team of surgical oncologists, dermatologists, medical oncologists, pathologists and radiologists. She also participates in tumor board conferences for more advanced and complex cases to determine the best possible treatment plans.
Endeavor Health patients also have access to a wide range of clinical trials offering advanced adjuvant and neoadjuvant systemic treatment options such as immunotherapies and targeted therapies.
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