Skin Cancer | Stuart and Tequesta, FL

Board-certified dermatologists are thoroughly trained to identify subtle skin lesions that are suspicious for skin cancer. Devices, such as dermatoscopy, allow a dermatologist to evaluate features of skin lesions not easily seen by the naked eye. Suspicion of skin cancer may warrant a biopsy, a board-certified dermatopathologist will microscopically evaluate the lesion under greater scrutiny.

Skin cancer is the most common form of cancer in the United States and worldwide. Skin cancer tends to occur on sun-exposed skin and in those with lighter skin tones. A family history of skin cancer increases your risk. Early skin cancer diagnosis and treatment are important for a good prognosis.

Two main groups account for a large portion of cancers that originate in the skin: non-melanoma skin cancers (NMSC) and melanoma. The two most common NMSCs are basal cell carcinoma and squamous cell carcinoma. Basal cell carcinomas comprise nearly 80% of skin cancers, followed by 16% for squamous cell carcinoma, and 4% for melanomas. Most skin cancers have a good prognosis if caught early.

BCC is the most common type of skin cancer. The average lifetime risk for a Caucasian individual to develop a BCC is about 30%. It is slow-growing and rarely spreads to other areas of the body. But if undiagnosed and untreated, it can grow deep and destroy local tissues, like cartilage and bone. Although BCC is common in fair-skinned individuals, it can occur in people of color.

BCC develops on skin that has been exposed to the sun for years and from tanning bed use, caused by ultraviolet radiation. It is usually found on the face, chest, neck, and back of the hands, but can occur on any part of the body exposed to the sun. A BCC looks like a flesh-colored, pearly bump or pinkish patch of skin, frequently found on the nose, eyelids, cheeks, and lips.

Because BCC is typically found in areas that are of aesthetic importance, like the face, eyes, lips, and nose, Mohs surgical excision may be preferred to spare healthy tissues and prevent disfigurement. Mohs surgery is a microscopic surgery technique that allows for smaller areas of excision and better prognostic outcomes.

SCC is the second most common type of skin cancer. It develops on unprotected skin that has been exposed to intense, long-term sun and tanning bed ultraviolet radiation. SCC can spread to other parts of the body, become disfiguring, and even deadly. Every year more than 15,000 Americans die of SCC. When caught early, it can be treated with favorable outcomes.

SCC commonly develops on the face, ears, neck, chest, lips, back of the hands, and legs. It can also develop on the genitals, in burns, scars, ulcers, and in areas exposed to x-rays and chemicals. Women often get SCC on their legs, but it can develop anywhere on the skin that is exposed to long-term ultraviolet radiation. Indoor tanning increases the risk of SCC by 67%.

SCC lesions may appear as firm, red bumps or scaly patches, or sores that won’t heal. It can also appear as raised growths with a depressed center, and in wart-like growths, but can also be flat with minor skin changes.

Other than long term intense UV radiation, risk factors include:

• A prior BCC or SCC
• A family history of SCC
• A family history of melanoma
• Men are more frequently affected than women, but women are catching up
• The majority of diagnoses are made in people over the age of 50. However, women under 40 are diagnosed more often than in the past, likely due to the use of tanning beds.

As with BCC, because SCC is commonly found in areas of aesthetic importance like the face and ears, minimal surgical procedures such as Mohs surgery may be warranted to spare healthy tissues, reduce the risk of recurrence, and produce good aesthetic outcomes.

Melanoma is the deadliest form of skin cancer. It can appear as a newly formed pigmented lesion or from a pre-existing mole or birthmark. Melanomas can form virtually anywhere on the skin, including the palms and soles, underneath nails, the mouth, vagina, and the eye.

Everyone is at risk for developing Melanoma, but people with a family history of melanoma are at a 10% increased risk. When a first-degree relative has had melanoma, the risk increases to a 50% chance of developing this disease.

• Even a single blistering sunburn in childhood
• People who live in warm, sunny climates year-round
• The use of tanning beds in the teens and early twenties
• Fair-skinned people with light eye color and blond or red hair
• A large number of moles

• The development of a new mole or a change in the size, color, and shape of the mole
• A mole that is larger than 1/4 inch
• A sore that won’t heal
• Multicolored moles and spots whose borders extend into the surrounding skin
• Painful, tender, and itchy skin lesions
• Scaly, oozing, bleeding bumps or nodules

One in 27 men and one in 40 women will develop melanoma during their lives. The five-year survival rate for people diagnosed with melanoma that is treated before it has metastasized is 99%. Being aware of risk factors and practicing good sun protection are important first steps. Routine skin examinations by a board-trained dermatologist are essential for close evaluation and monitoring of suspicious lesions.

If you have a suspicious skin lesion and skin cancer is suspected, Dr. Ryan Schuering will perform a biopsy to determine the type of skin cancer. Once skin cancer is confirmed, treatment options will depend on numerous factors involving features of cancer as well as what approaches are most beneficial to the patient. Treatment options will take into consideration one’s age, health, and lifestyle.

Skin cancer treatment options may be used on their own or in combination and include:

• Simple excision is removal by surgery
• Mohs Micrographic surgery is a specialized surgical procedure where small layers of the cancer are removed one at a time and examined under a microscope. The procedure is done in stages repeated layer by layer until the last layer has no evidence of cancer cells. This allows for minimal removal of tissue and more accuracy in removal.
• Curettage and electrodesiccation involve using a tool known as a curette to scrape off and then burn the tissue containing the tumor using an electrical current.
• Cryosurgery is the use of liquid nitrogen to freeze and destroy abnormal tissues.
• Radiation therapy is the use of high-energy radiation to kill the cancer cells and shrink the tumor.
• Photodynamic therapy is a procedure where the cancer cells are treated with drugs that make them vulnerable to light. A medication is placed on the tumor where is it is taken up by the cancer cells. A specialized light then is shone on the skin, activating the drug and killing the cancer cells. Topical chemotherapy involves the use of anticancer drugs in a lotion or cream applied to the skin in a regimented sequence of treatments. The chemotherapy medication targets the cancerous cells.
• Topical Immunotherapy uses a drug called imiquimod. This drug can be used to treat early basal cell carcinomas. It activates the immune system to kill the abnormal cells.
• Targeted therapy uses certain drugs to identify and attack the cancer cells by blocking enzymes, proteins and other molecules that allow for the growth and spread of cancer cells. There are a large amount of targeted therapies depending on cancer type and severity.

Localized BCC treatment options:

• Simple excision
• Mohs Micrographic surgery
• Radiation therapy
• Curettage and electrodessication
• Cryosurgery Photodynamic therapy
• Topical Chemotherapy
• Topical Immunotherapy

Recurrent localized BCC treatment options:

• Simple excision
• Mohs surgery

Metastasized BCC treatment options:

• Targeted therapy
• Clinical trial

Localized SCC treatment options:

• Simple excision
• Mohs Micrographic surgery
• Radiation therapy
• Curettage and electrodessication
• Cryosurgery Photodynamic therapy – only for Squamous Cell carcinoma Stage 0 (carcinoma in situ).

Recurrent Localized SCC treatment options:

• Simple excision
• Mohs micrographic surgery
• Radiation Therapy

Metastasized SCC treatment options:

• Chemotherapy
• Retinoid therapy
• Immunotherapy Clinical trial

After melanoma has been diagnosed, tests will be done to see whether cancer has spread. Treatment options depend upon the stage of the disease. The stage is determined by the thickness of the tumor, whether it has spread to the lymph nodes or other parts of the body, and other factors.

Generally, treatment options include:

• Surgery
• Chemotherapy
• Radiation Therapy
• Immunotherapy
• Targeted therapy is a personalized cancer treatment designed to attack melanoma by inhibiting defective genes and molecules that play a role in the growth and spread of melanoma.
• Clinical trials

Localized melanoma that has not metastasized to the regional lymph nodes may be treated with surgical excision. In some specific cases, removal may be accomplished with Mohs Micrographic Surgery. If you are concerned about a specific lesion or seek a full-body skin cancer checkup, contact Dr. Ryan Schuering.

One in five Americans will be diagnosed with skin cancer at some time in their lives. Nonmelanoma skin cancers are most common and include Basal Cell Carcinoma and Squamous Cell Carcinoma. Melanoma is rarer but more dangerous. Early detection and treatment are the keys to skin health.

Learning the ABCDE’s of skin cancer can help you to identify skin cancer early when it is most effectively treatable. Use these warning signs when conducting a skin self-exam once a month. Look for changes in moles and other skin lesions. The American Academy of Dermatology reports that about half of all melanomas are self-detected. When any of these signs appear during a self-exam, contact Dr. Schuering to schedule an appointment.

• Asymmetry: The shape is irregular, unlike common moles that are typically round or oval. If you divide the lesion in half and the sides do not mirror each other, the lesion is asymmetrical.
• Borders: The borders of the lesion or mole are irregular, notched, scalloped, or blurred, not smooth and even as with common moles.
• Color: A moles that contain a variety of colors, including shades of brown or dark black with red, blue or white spots, indicate a problem. Common moles are typically skin-colored, brown or black.
• Diameter: A mole that is larger than a pencil eraser (greater than 1/4 inch or 6 mm).
• Evolving: This is the most important sign. It means the mole is changing in shape, size, color or elevation; or new symptom occurs such as bleeding, itching, crusting.

When conducting your own skin exam, make sure to check your face, ears, chest, and your entire body front and back, including under your arms, forearms, back of the upper arms, and your palms and fingers. Melanoma can arise under a fingernail or toenail. Check your legs and feet, soles of your feet, and in between your toes. Use a mirror to check your back, neck, and buttocks.

Skin cancers are caused by the ultraviolet light from the sun and tanning beds that damages the DNA in skin cells. Just one severe sunburn in childhood and adolescence can increase the risk of skin cancer. A previous skin cancer, a family history of skin cancer, and age increase your risk.

Skin cancer is THE most common cancer diagnosis, but it is also the most preventable cancer!

Steps you can take to prevent skin cancer include:

• Wear sunscreen with an SPF of 30 or more, even on cloudy days. Apply on all sun-exposed areas including your lips. Reapply every two hours while you are in the sun.
• Chemical sunscreens are different from blocking sunscreens. Mineral sunscreens that contain zinc oxide and titanium dioxide are the best.
• Invest in a good quality sunscreen. A 2017 study found that almost 3/4ths of the sunscreen tested doesn’t work or contains dangerous ingredients. Two toxic ingredients to avoid are oxybenzone and avobenzone.
• Protect your children from the sun and sunburns.
• Limit sun exposure especially between the hours of 10 am and 4 pm.
• Schedule an annual skin cancer screening with Dr. Ryan Schuering.

Florida is the sunshine state. Take time to protect yourself and your loved ones. When you need expert dermatological care, contact Dr. Ryan Schuering in Stuart and Tequesta, Florida to schedule a consultation.