Related Document: Skin Cancer.pdf (Reprinted with permission
from the Messenger-Inquirer)
A patient relates how she felt after being diagnosed with skin cancer, and Dr. Crowe details the importance of early diagnosis and treatment.
Cheri Moss had a normal childhood. She played outside and went to the pool like any other kid. She got sunburned pretty badly several times, but didn't think much about it. After all, most people get sunburned at some point.
Fast forward to adulthood. About five years ago, Moss, now 43, noticed a small bump on her leg she thought was a pimple. It wouldn't heal, so she finally went to Dr. Michael Crowe at Owensboro Dermatology and found out she had skin cancer.
"I was devastated," she said. She was grateful, however, that she could be successfully treated. Dr. Crowe has treated her several times over the last few years as new skin cancers appeared on her legs, chest and face. She's fine now, but will most likely face the disease several times again.
Ninety-nine percent of skin cancer is caused by the sun, or ultraviolet (UV) light, Dr. Crowe said. Basal and Squamous cell carcinomas are the most common forms of skin cancer. According to the American Cancer society, more than a million cases occur in America every year. Basal and squamous cells are located in the epidermis, or outer layer of the skin, and they cover internal and external surfaces of the body.
The third and most deadly form of skin cancer is melanoma. It begins in melanocytes--cells that produce the melanin that colors our skin. The American Cancer Society estimates that around 54,000 melanomas occur every year. Melanomas cause about 7,600 of the 9,800 skin cancer deaths each year.
Dr. Crowe said skin cancer is common among 50-and 60-year olds, and people in that age group should keep a close watch on their skin. Dr. Alan Mullins of Ohio Valley Surgical Specialists agreed. "All cancer is a disease of aging," he said. "The prevalence of all types of skin cancer goes up as you age. The good news about skin cancer is that it's easy to find out. Don't ignore the obvious."
That means keeping an eye on any moles you have and watching for any new spots. "Our primary message is that the sooner we can catch it, the smaller the area is and the easier treatment will be," said Dr. Artis Truett, a partner with Dr. Crowe at Owensboro Dermatology.
"There's a lot of evidence that one of the most important criteria for a mole being suspicious is a history of recent change," he continued. If a mole darkens, bleeds, or is irritated and doesn't seem to heal, those are "signs of turning into cancer," Dr. Crowe said.
May is National Skin Cancer Awarness Month, so it's a good time to be sure you're in the clear. Moles should be checked for the ABCD's of skin cancer:
Asymmetry: If one half of a mole doesn't match the other, it may be cancerous.
Border irregularity: If the edges of a mole are ragged, notched or blurred, it may be cancerous.
Color: If the color varies from one area to another, with shades of tan, brown, red, white or blue, a mole may be cancerous.
Diameter: If a mole is larger than six millimeters (about the diameter of a pencil eraser), check with your doctor. Growth of a mole is also cause for concern.
In addition, Dr. Crowe said if you notice white bumps that scab or bleed and aren't healing after three or four months, you should have them checked. Ask your physician when you have your annual checkup if you have any questions about suspicious spots, especially if you've had skin cancer in the past. If you have one skin cancer, you're automatically at higher risk for having another," Dr. Mullins said.
The good news is that skin cancer is quite treatable, especially when caught early. "Almost all patients that have skin cancer that come in are cured," said Dr. Crowe. So what treatment options are available? That depends on what type of skin cancer a patient is facing.
Precancerous spots on the skin can be frozen off or lasered off. Small cancerous moles can be numbed and then burned or scraped off if they're on the back, arms or chest where the skin is thicker. For cancers on the face and neck where the skin is thinner and the cancer can reach farther into the skin, Mohs surgery is in order, Dr. Crowe said.
Mohs micrographic surgery is a specialized technique recognized by doctors as the most effective treatment available for the removal of basal and squamous cell cancers. Doctors carefully remove and examine a layer of the cancer at a time until they reach a layer where no more cancer is found. Dr. Crowe said the technique enables them to examine 100 percent of the skin edges to make sure the cancer is gone. It's much more accurate, leaves a smaller incision and has a higher cure rate than simply excising the cancerous spot.
Mohs surgery works on basal and squamous cell cancers because the cancer cells are all attached as one piece. Therefore, "If you're checking a very narrow edge, if there's nothing on the edge, you know you have it," Dr. Crowe said. Melanomas, however, are made up of cells that are not all attached, so a wide excision must be made in the hope that all the cancer in the area will be removed.
Dr. Mullins treats more serious forms of skin cancer as well. He said squamous and melanoma cancers can spread to lymph nodes in the body. Those types of cancer have the same potential as lung cancer or esophageal cancer, he said. Dr. Mullins thinks people tend to treat skin cancer as not really a cancer, but, "The take home message is particularly squamous cell and melanoma are real cancer. They can spread and they can kill you. They have to be thought of in a different way."
Another tool the doctors at Owensboro Dermatology employ is the FotoFinder dermoscope. Dr. Truett said when a person has a great deal of moles, it's often hard to track changes in them. The Fotofinder dermoscope uses a digital camera attached to a computer to take a high-powered photograph of the affected skin area. Moles are then scanned by the software developed by a university in Germany and the program indicates whether or not the spot is cancerous.
The patient can come back in a few months for another photograph, and the program will compare the two scans and tell if any of the moles have changed.
"It's a really nice tool," Dr. Truett said. "For certain high risk people it's a wonderful device." It's not an absolute test, but it's a fairly good indicator of cancer. The machine often helps decide whether or not to biopsy a certain mole.
The best way to deal with skin cancer is to avoid it in the first place. Dr. Crowe said 80 percent of the sun exposure a person gets in their lifetime comes before age 18. That sun can have lasting effects later in life. Many patients come in 20, 30, even 50 years after extensive sun exposure with skin cancers that are now surfacing due to that sun.
Both Dr. Crowe and Dr. Mullins said you don't have to hole up in your home to keep away from the sun. "You have to live your life," Dr. Crowe said. But they both recommend using caution outdoors. Wear sunscreen and a hat, expose as little skin as possible and avoid the hot sun in the middle of the day. Dr. Crowe recommends a sunscreen that sprays on like water and dries up in a few seconds, preventing the drippy mess that can get in your eyes and leave you greasy.
Taking care of kids is especially important. Make sure you put sunscreen on them when they're outdoors. With the spray version, Dr. Crowe said, "It takes 15 seconds to put it on a kid before he starts baseball practice."
Avoid tanning beds as well. "You want to limit any way you can the exposure of the skin to ultraviolet radiation which is damaging to the skin and eventually leads to cancer developement," Dr. Mullins said.
Moss' final thought: "My generation--we love the sun. If I hadn't come here I'm sure I would still be tanning. [Now] I don't get out in the sun--ever."
By Ben Hoak
Messenger-Inquirer Special Publication
