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SKIN CANCER – Prevention, Detection & Treatment

Skin cancer is the most common type of cancer and it is estimated that as many as 1 in 15 Americans will develop one of many skin cancers during their lifetime. There are multiple risks factors involved in the development of skin cancer, but in general, individuals with lighter skin tones, people with family history of skin cancer, and those that are immunocompromised (patients with inherited or acquired immunodeficiency’s, those receiving immunosuppressive medications for autoimmune disorders, prevention of transplant rejection or cytotoxic chemotherapies) are at higher risk of developing a skin cancer.

Nevertheless, the most important modifiable risk factor to prevent the development of skin cancer is sun protection. Ultraviolet light (both type A and B) induce mutagenic changes in the DNA of our skin cells that result in disorganized proliferation and expansion of mutated cells with increased resistance to cell death and invasive potential.

Generally speaking, skin cancer can be divided into 2 different categories: melanoma and non-melanoma skin cancers (squamous cell carcinoma, basal cell carcinoma). Melanoma is the abnormal proliferation of mutated melanocytes (cells that give pigment to the skin) and is thought to be an aggressive type of skin cancer.

History of intermittent sunburns, especially blistering sunburns, and tanning bed usage before age 18 have been directly linked to the development of melanoma. Hence, the importance of using broad spectrum (UVA and UVB) sun protection from early ages (6 months and older). Patients with large congenital moles, those with higher than average number of moles and with first-degree relatives with history of melanoma are also at increased risks of developing melanoma. Keep in mind that melanomas can also occur in sun covered areas (mouth, eye, anus and vagina) and have the capacity of invading into deeper tissues and disseminating to other parts of the body including lymph nodes and distant organs.

Squamous cell carcinomas of the skin are the second more aggressive type of skin cancer after melanoma. Squamous cells are the differentiated cells that form keratin and conform the multiple layers of the epidermis (superficial part of our skin). Risk factors for the development of squamous cell carcinomas include chronic sun exposure, infection with certain strains of human papilloma virus (HPV), and immunosuppression. In contrast to melanoma where a cancer precursor has not been clearly identified, there are pre-cancerous lesions called actinic keratosis (gritty scaly papules on sun exposed areas) that precede the development of squamous cell carcinomas. While less aggressive than melanoma, squamous cell carcinomas also have a metastatic potential.

Basal cell carcinomas are the least aggressive type of skin cancers and occur predominantly in sun exposed areas. They look like pink shiny papules with broken blood vessels and bleed easily. The nose and cheeks are common locations. If left untreated, basal cell carcinomas can erode into deeper tissues including bone but their capability of traveling to other organs or to cause death are limited.

How do I know if I have skin cancer?

The development of new or changing skin lesions in patients can be a sign of alert. The following characteristics can make a lesion more suspicious:
• Asymmetry (when half of the lesion is different from the other half)
• Borders (irregular borders or uncertainty of where the lesion
starts and ends)
• Color (multiple colors or uneven pigmentation)
• Diameter (6 mm or more)
• Evolution (a lesion that is new or changing, bleeds, itches or has become tender)

A full body skin exam including the scalp, face, trunk, extremities (toes and web spaces), external genitalia and perianal region performed by a trained dermatologist or equivalent is recommended. Early diagnosis is important to prevent further complications, therefore, reaching out to your primary care physician or consulting a dermatologist promptly is recommended.

How is skin cancer diagnosed?

Dermatologist are assisted by dermatoscopes or fancy magnifying lenses with polarized light that allow them to distinguish benign from concerning features in individual lesions. Nevertheless, obtaining a skin biopsy and pathology confirmation is the standard of care to make an accurate diagnosis and treatment plan. Newer and non-invasive forms of diagnosis like confocal microscopy or tape sampling to obtain DNA are currently under investigation but are not yet available.

How is skin cancer treated?

Once a diagnosis of skin cancer has been made and the type of lesion and level of invasion have been identified, there are multiple treatment options that we can offer to our patients. The standard of care is surgery, which allows the microscopic evaluation of the lateral and deep margins to confirm that the surrounding tissue is clear of cancer.

Thin melanomas (those that are limited to the superficial layer of skin or minimally invade it) are treated with surgery alone and do not require further investigation or treatment. Deep melanomas typically warrant a more extensive investigation including imaging studies and sentinel lymph node dissection and when metastatic they need to be treated with systemic medications.

Fortunately, over the past ten years, novel medications that specifically target mutated cells (Vemurafenib or BRAF inhibitors) or those that enhance the patient’s own immune system have saved thousands of lives. Pembrolizumab (PD-1 inhibitor) and Ipilumimab (CTLA-4 inhibitors) are cancer immunotherapy drugs that alone or in combination have been incredibly successful in treating metastatic melanoma (long term follow-up data is still needed).

Squamous cell carcinomas or basal cell carcinomas can successfully be treated by multiple modalities based on the depth of invasion and microscopic features. Pre-cancerous lesions (actinic keratosis) are typically treated with cryotherapy (liquid nitrogen spraying), light curettage, photodynamic therapy or with topical chemotherapy (5-fluorouracil). Early squamous cell carcinomas and thin basal cell carcinomas can potentially be treated with similar modalities. Deeper squamous cell carcinomas and basal cell carcinomas are treated with surgery alone. Micrographic skin cancer surgery (also known as Mohs surgery) is an intervention that allows real-time margin confirmation and tissue sparing in cosmetically sensitive areas like the face, genitals and distal extremities. This type of surgery has well defined criteria for use and your dermatologist will provide you with therapeutic options that best suit your condition. Tumors that cannot be operated because of the patient’s overall condition, size or location of tumor can be treated with radiation and/or intralesional injection of chemotherapy but these approaches are typically suboptimal.


For more information, you are welcome to contact doctor
Dr. Filiberto Cedeño Laurent
3030 S. Mason Rd, Katy, TX 77450
16926 Southwest Fwy, Sugar Land, TX 77479

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