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Otolaryngology (ENT)/Head and Neck Surgery
Cancerous (skin cancer)
Skin cancer — the abnormal growth of skin cells — most often develops on skin exposed to the sun. But this common form of cancer can also occur on areas of your skin not ordinarily exposed to sunlight.
There are three major types of skin cancer — basal cell carcinoma, squamous cell carcinoma and melanoma.
Skin cancer develops primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it can also form on areas that rarely see the light of day — your palms, beneath your fingernails or toenails, and your genital area.
Skin cancer affects people of all skin tones, including those with darker complexions. When melanoma occurs in people with dark skin tones, it's more likely to occur in areas not normally exposed to the sun, such as the palms of the hands and soles of the feet.
Skin cancer begins in your skin's top layer — the epidermis. The epidermis is a thin layer that provides a protective cover of skin cells that your body continually sheds. The epidermis contains three main types of cells:
- Squamous cells lie just below the outer surface and function as the skin's inner lining.
- Basal cells, which produce new skin cells, sit beneath the squamous cells.
- Melanocytes — which produce melanin, the pigment that gives skin its normal color — are located in the lower part of your epidermis. Melanocytes produce more melanin when you're in the sun to help protect the deeper layers of your skin.
Ultraviolet light and other potential causes
Much of the damage to DNA in skin cells results from ultraviolet (UV) radiation found in sunlight and in the lights used in tanning beds. But sun exposure doesn't explain skin cancers that develop on skin not ordinarily exposed to sunlight. This indicates that other factors may contribute to your risk of skin cancer, such as being exposed to toxic substances or having a condition that weakens your immune system.
Your treatment options for skin cancer and the precancerous skin lesions known as actinic keratoses will vary, depending on the size, type, depth and location of the lesions. Small skin cancers limited to the surface of the skin may not require treatment beyond an initial skin biopsy that removes the entire growth.
If additional treatment is needed, options may include:
- Freezing. Your doctor may destroy actinic keratoses and some small, early skin cancers by freezing them with liquid nitrogen (cryosurgery). The dead tissue sloughs off when it thaws.
- Excisional surgery. This type of treatment may be appropriate for any type of skin cancer. Your doctor cuts out (excises) the cancerous tissue and a surrounding margin of healthy skin. A wide excision — removing extra normal skin around the tumor — may be recommended in some cases.
- Mohs surgery. This procedure is for larger, recurring or difficult-to-treat skin cancers, which may include both basal and squamous cell carcinomas. It's often used in areas where it's necessary to conserve as much skin as possible, such as on the nose.
During Mohs surgery, a specialist removes the skin growth layer by layer, examining each layer under the microscope, until no abnormal cells remain. This procedure allows cancerous cells to be removed without taking an excessive amount of surrounding healthy skin.
- Curettage and electrodesiccation or cryotherapy. After removing most of a growth, your doctor scrapes away layers of cancer cells using a device with a circular blade (curet). An electric needle destroys any remaining cancer cells. In a variation of this procedure, liquid nitrogen can be used to freeze the base and edges of the treated area.
These simple, quick procedures may be used to treat basal cell cancers or thin squamous cell cancers.
- Radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy may be an option when cancer can't be completely removed during surgery.
- Chemotherapy. In chemotherapy, drugs are used to kill cancer cells. For cancers limited to the top layer of skin, creams or lotions containing anti-cancer agents may be applied directly to the skin. Systemic chemotherapy can be used to treat skin cancers that have spread to other parts of the body.
- Photodynamic therapy. This treatment destroys skin cancer cells with a combination of laser light and drugs that makes cancer cells sensitive to light.
- Biological therapy. Biological therapy uses your body's immune system to kill cancer cells.
Benign skin lesions are non-cancerous skin growths. Benign skin lesions are common and any individual from any age group can get them. Common benign skin lesions include warts, moles, liver spots, and skin tags.
Common features for these skin lesions include:
- Symmetry in shape, color, and structure
- Stable or slow growing
- Absence of spontaneous bleeding
Most benign skin lesions do not require any treatment unless they become irritated or cause discomfort. It is important to regularly get skin lesions examined by your primary care doctor, an ENT specialist or dermatologist to watch for any new, changes or unusual changes to skin. For more information on what to look for or symptoms to be aware of, review the Skin Cancer Foundation’s slideshow of the ABCDEs of moles.