Is it a Mole? Or is it Skin Cancer

Skin Cancer

 Cancers that arise from the skin are due to the development of abnormal cells.

Skin Cancer

Our physicians have over 20 years of experience and are past members of the American Society for Laser Medicine and Surgery, and The Cosmetic Physicians Society of Australasia.

Our physicians have a broad range of experience in the treatment and removal of skin cancer.

There are three main types of skin cancers: basal-cell skin cancer (BCC), squamous-cell skin cancer (SCC) and melanoma. The first two, along with a number of less common skin cancers, are known as nonmelanoma skin cancer (NMSC). Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death. It often appears as a painless raised area of skin, that may be shiny with small blood vessel running over it or may present as a raised area with an ulcer. Squamous-cell skin cancer is more likely to spread. It usually presents as a hard lump with a scaly top but may also form an ulcer. Melanomas are the most aggressive. Signs include a mole that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.

Acral Lentigo Maligna

Is the most common form of melanoma in Asians and people with dark skin, accounting for 50% of melanomas that occur in people with these skin types. ALM is sometimes referred to as a “hidden melanoma,” because these lesions occur on parts of the body not easily examined or not thought necessary to examine. ALM develops on the palms, soles, mucous membranes (such as those that line the mouth, nose, and female genitals), and underneath or near fingernails and toenails.

ALM is often overlooked until it is well advanced because in the early stages, it often looks like a bruise or nail streak. As an ALM tumor increases in size, it usually becomes more irregular in shape and color. However, some ALM lesions can be lightly colored or colorless. The surface of the ALM lesion may remain flat, even as the tumor invades deeply into the skin. Thickening ALM on the sole of the foot can make walking painful and be mistaken for a plantar wart.

Superficial Type

Superficial spreading melanoma (SSM) is the leading cause of death from cancer in young adults.

  • A typical lesion has:
  • Irregular borders
  • Various shades of black, brown, grey, blue, pink, red, or white.

Within the lesion there can be a variation in color involving white, pink, brown, and black.

In the early stages, SSM usually appears as a flat spot that looks like a freckle that is spreading sideways on the skin. Over time, the pigmentation in the lesion may darken, and the lesion may grow, develop increasingly irregular borders, and have areas of inflammation within the lesion. The area around the lesion may begin to itch.

Nodular Type

Nodular melanoma (NM) is the most aggressive type of melanoma. It is most often darkly pigmented; however, some NM lesions can be light brown or even colorless (non-pigmented). A light-colored or non-pigmented NM lesion may escape detection because the appearance is not alarming. An ulcerated and bleeding lesion is common.

NM differs from other types of melanoma in three ways:

  • Tends to grow more rapidly in thickness (penetrate the skin) than in diameter
  • May not have a readily visible phase of development
  • Instead of arising from a pre-existing mole, it may appear in a spot where a lesion did not previously exist.

Early Stage (Lentigo Maligna)

Lentigo Maligna melanoma (LMM) typically occurs on sun-damaged skin in the middle-aged and elderly, especially on the face. This melanoma may be mistaken in its early, and most treatable, stages for a benign “age spot” or “sun spot.”

LMM begins as a spreading, flat, patch with irregular borders and variable colors of brown. This lesion is called “lentigo maligna.”This spreading brownish patch may grow slowly for years and is often mistaken for a pigmented sun spot.

As the lesion grows and evolves, both the pigmentation and borders tend to become more irregular. This often occurs slowly over a period of 10 to 15 years. It also can happen rapidly — in a matter of weeks or months. As the lesion grows deeper into the skin, it may turn into various shades of black and brown.

Acral Lentigo Maligna

Is the most common form of melanoma in Asians and people with dark skin, accounting for 50% of melanomas that occur in people with these skin types. ALM is sometimes referred to as a “hidden melanoma,” because these lesions occur on parts of the body not easily examined or not thought necessary to examine. ALM develops on the palms, soles, mucous membranes (such as those that line the mouth, nose, and female genitals), and underneath or near fingernails and toenails.

ALM is often overlooked until it is well advanced because in the early stages, it often looks like a bruise or nail streak. As an ALM tumor increases in size, it usually becomes more irregular in shape and color. However, some ALM lesions can be lightly colored or colorless. The surface of the ALM lesion may remain flat, even as the tumor invades deeply into the skin. Thickening ALM on the sole of the foot can make walking painful and be mistaken for a plantar wart.

Non Pigmented Melanoma

While uncommon, melanoma occasionally does not have brown or black pigmentation. An uncommon subtype called amelanotic melanoma, this usually appears as a pink or red nodule. Usually mistaken for sun damaged blotchy skin. The diagnosis is sometimes delayed which results in a poor prognosis.

Another uncommon subtype, desmoplastic neutrotrophic melanoma (DNM), usually looks like a non-pigmented scar. When a scar or keloid appears on the skin and the skin has not been injured, DNM is suspected. The lesion also can appear as a cyst that may or may not be pigmented. DNM tends to appear on sun-damaged skin in elderly patients, occurring mostly on the head and neck.

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common skin cancer. It rarely metastasizes or kills. However, because it can cause significant destruction and disfigurement by invading surrounding tissues, it is still considered malignant.

BCC appears as a small, shiny, skin colored or pinkish lump. Blood vessels cross its surface and it may have a central ulcer so its edges appear rolled. It often bleeds spontaneously and then seems to heal over. Cystic BCC is soft, with a jelly-like contents. An open sore may form. Micronodular and microcystic types may infiltrate deeply. BCC may also be superficial and appear as multiple pink or red scaly irregular plaques, which slowly grow over months or years. These lesions may bleed or ulcerate easily.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC ) is a cancer of a kind of epithelial cells, the squamous cell. These cells are the main part of the epidermis of the skin, and this cancer is one of the major forms of skin cancer.

SCC of the skin begins as a small nodule and as it enlarges the center becomes necrotic and sloughs and the nodule turns into an ulcer.

Intermittent bleeding from the tumor can occur, especially on the lip. The tumor may be in the form of a hard plaque or a papule, often with an opalescent quality, with tiny blood vessels. The tumor can lie below the level of the surrounding skin, and eventually ulcerates and invades the underlying tissue. The tumor commonly presents on sun-exposed areas (e.g. back of the hand, scalp, lip, and ear). Unlike basal cell carcinoma (BCC), squamous cell carcinoma (SCC) has a substantial risk of metastasis. Risk of metastasis is higher in SCC arising in scars, on the lower lips or mucosa, and occurring in immunosuppressed patients.

Photodynamic Therapy

Skin Cancer Therapy

Photodynamic therapy (PDT) is a treatment that uses a medicated solution, called a photo sensitizer, and a particular type of light. When the photosensitizer lotion is exposed to a specific type of light, a form of oxygen is produced that kills nearby cancer cells.

Each photosensitizer is activated by a specific wavelength of light. This wavelength determines how far the light can travel into the body. PDT is used to treat sun damaged skin, acne, rosacea and skin cancer.

How is PDT used to treat cancer?
In the first step of PDT for cancer treatment, a photosensitizing agent (ALA) is applied to the skin. The agent is absorbed by rapidly dividing cancer cells. The ALA is left on the skin and covered in plastic wrap for 3 hours. A Specific wavelength of light is then placed onto the skin cancer. This light activates the ALA within the cancer cell resulting in toxic destruction. The area is then covered with a dressing for 2 days so that the sunlight does not cause over activation of the ALA.The treatment is then repeated in 3 weeks with a further review of the results one month later. Although not applicable for all skin cancers, the results can be as high as 90% where PDT is
indicated.

Sun Damaged Skin – Pre PDT
Sun Damaged Skin – Post PDT

What types of skin cancer are currently treated with PDT?

  • Superficial basal cell carcinoma
  • Bowen’s Disease or insitu squamous cell carcinoma

What are the limitations of PDT?
PDT cannot be used in nodular basal cell carcinoma, squamous cell carcinoma or Malignant Melanoma

How much improvement can I expect?
Patients with severe sun damaged skin manifested by actinic keratosis (sunspots), texture, and tone changes including mottled pigmentation and skin laxity may see excellent results. Also refinement of pores and reduction of acne scars is evident.

How many treatments will it take to see the results?
To achieve maximum improvement of pre-cancerous (actinic keratoses) sun damage, skin tone and texture, a series of two to three treatments 2-4 weeks apart is the most effective. More treatments can be done at periodic intervals in the future if the skin suffers further sun damage.

What are the advantages?
Easier for patients than repeated topical liquid nitrogen, Efudex, or Aldara. The side effects are minimal, rapid healing, and only 1-3 treatments are required.

The ALA/PDT treatment at our clinic is less painful versus liquid nitrogen, Efudex cream, and Aldara.

Reduced scarring and improved cosmetic outcome compared with cautery or liquid nitrogen. Since it is well know that liquid nitrogen can cause permanent white scars.
PDT improves the whole facial area treated, creating all one color, texture, and tone rather than just spot treating with liquid nitrogen, cautery, and surgery

What are the side effects?
Following PDT, the treated areas can appear red with some peeling for 2-7 days. Some patients have an exuberant response to PDT, and experience marked redness of their skin. Temporary swelling of the lips and around your eyes can occur for a few days. Darker pigmented patches called liver spots can become temporarily darker and then peel off leaving normal skin. (This usually occurs over seven to ten days.)

35 East Parade

Sutherland, NSW, 2232

(02) 9521 4267

Phone Sutherland Skin Cancer & Laser Clinic

info@skincancerandlaserclinic.com

Email Sutherland Skin Cancer & Laser Clinic

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