Malignant skin tumors

• Basal cell carcinoma (BCC)

Basal cell carcinoma is the most common form of skin cancer. It is related to sunlight, so it mainly affects those parts of the body that are sun-exposed (face, neck, hands, front part of the chest - décolletage, back during frequent sunbathing). It usually takes some time to develop, so the typical age category is around 50 years.

A typical BCC is a pale yellow nodule with small blood vessels. A larger basal cell carcinoma can ulcerate and form an ulcer. There are several subtypes of this cancer and thus it has different manifestations.

• Squamous cell carcinoma (SCC)

Cutaneous squamous cell carcinoma (CSCC) is a skin cancer similar to basal cell carcinoma (see above), but it is more aggressive, grows faster and can be metastatic (rarely). Its appearance is also associated with exposure to sunlight. It can also occur on skin that has been irradiated in the past. 

• Melanoma

Malignant melanoma is a highly malignant skin cancer that arises from melanin-producing cells (melanocytes). Melanin is a skin pigment that is produced after the exposure to the sun and has a protective function (that's why the skin turns brown when sunbathing).

Melanoma is a very serious skin cancer, spreads very fast to other parts of the body. Fortunately, this type of cancer is not very common (incidence is 14 cases per 100,000 population per year), but the number of cases is rising. About 30% of melanomas are derived from moles. 

As the melanocytes are found in different parts of body, some hidden-melanomes can occur, e.g. in the eye or genitals.

The appearance of malignant melanoma is directly related to sun exposure. When malignant melanoma is suspected, the ABCDE rule is important.

Each suspicious mole must be examined by a dermatologist and if cancer is suspected, the surgeon needs to remove it and send it for examination (histology). The result of the histology is only known after a few days.

Surgical excision followed by histology is the only safe procedure, as other methods of treatment (laser, cryotherapy, electrodesiccation) will not allow obtaining a sample for histological examinations.

The type of surgery depends on the location and size of the tumor: 

• Smaller skin tumors are surgically excised and the skin is primarily closed after mobilization.
• Larger tumors leave larger defects and require plastic surgery coverage (skin grafts, skin flaps, etc.) - consult your plastic surgeon about treatment options. Depending on the extent of the surgery, the type of anaesthesia and the need for admission for hospitalization are also discussed.

Further procedure depends on the histological findings:    

• If the diagnosis of basal cell carcinoma (BCC) is confirmed, it is necessary to inquire whether the cancer has been completely removed (even with the surrounding healthy skin) - we say that we have a safety margin. If this is not the case, reoperation is needed. A histological examination is always necessary.

Since this cancer rarely metastasizes, usually no additional treatment (chemotherapy or radiation with radiotherapy) is necessary.

However, relapses (skin tumor returns) can occur - a regular follow-up at the skin ambulance is necessary.

• Squamous cell carcinoma (SCC) treatment is also surgical, histology is required to determine the type of cancer and information whether the cancer was removed with a safety margins.

After the surgery, a follow-up through a dermatologist is necessary. As the tumour may form metastases, a lymph node examination (sonography) is necessary, depending on the site - neck, axillae, groin. Enlarged lymph nodes in the chest can also be seen by imaging methods (X-ray, etc.).

• The treatment of malignant melanoma is surgical and the most important point is the complete removal of the melanoma, histology examination (there are several types of malignant melanoma) and then (depending on its size and the degree of overgrowth into the skin and subcutaneous tissue) a sentinel node biopsy - the lymph node is taken, which is the first place where the metastasis would be directed. The presence of metastasis determines the next course of treatment.

As the treatment of malignant melanoma involves several disciplines (oncodermatologist, surgeon, plastic surgeon, oncologist, pathologist), patients are usually consulted in committees to determine the most appropriate procedure (chemotherapy, radiotherapy, immunotherapy).

The ABCDE rule will help us to distinguish a suspect mole.

•  A (Asymmetry) - irregularity of a shape. The skin formation is not nicely round, but has irregularities, protrusions (bulges).
• B (Border) - vague, unclear, imprecisely defined edges may indicate the expanding growth of a formation that invasively outgrows its surroundings.
• C (Colour) - an important sign is discolouration (change in color), we talk about depigmentation. A mole is suspicious if it has different colour, lighter and darker parts.
• D (Diameter) - any formation larger than 6 millimeters (0.2 inches) should be checked by a dermatologist.
• E (Evolution) - the skin formation behaves "alive" - ​​it grows, itches, bleeds, has scales.

Postoperatively, sun exposure should be avoided by using sunscreen, wearing clothing and headgear.

Regular check-ups  with a dermatologist are important.