FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

VISUAL SURVEY CAN OFTEN DETECT SKIN CANCER

Question: I've been to my doctor because of a rough, raised area of skin on my lower arm. He said that it wasn't a cancer and told me to "just keep watching it." Obviously, I'm uncomfortable with his evaluation of my skin problem. Can you tell if a growth is not a cancer by its appearance alone?

Answer: The different types of skin cancer usually have a fairly distinctive look, but it is possible to confuse them with other skin abnormalities. One important clue in telling when a spot what we doctors call a lesion might be cancerous is to find out its history. That is, how it developed and how it has changed.

While visual inspection and a careful history are often sufficient to make a diagnosis, some skin diseases can only be differentiated by their appearance under a microscope. For these, all or a portion of the lesion is surgically removed to obtain the necessary specimen.

My own experiences --- and national statistics show that non-cancerous skin growths are far more common than skin cancers. It may be that you have a common, non-cancerous growth that your doctor quickly identified and then dismissed your concerns as being unfounded. While that may be a satisfactory way to treat your skin, it's not good medicine for the rest of you.

One health-care problem that has become very common in the last 20 to 30 years is the impersonal physician. There are many proposed reasons why doctors seem to take care of diseases rather than the people who have them. Increasing medical technology or the impact of payments coming from impartial third parties are often cited. But, in my opinion, there is no excuse for it.

I'll try to pick up where your doctor left off and give you some information on the three basic types of skin cancer. The most common form of skin cancer, and also the most common cancer in humans, is basal cell carcinoma. These raised, "waxy-appearing" skin growths usually develop on the head, neck, hands and trunk the areas that get exposed to the sun. They develop a rolled border with an open, un-healing sore in the center. Over a course of years, if left untreated, the cancer slowly gets larger. The Skin Cancer Foundation predicts over 500,000 individuals will develop basal cell cancer this year.

The next most common skin cancer is squamous cell carcinoma, which will affect 100,000 people this year, predominantly those over 60. These growths are reddish or pink in color and appear as raised, irregularly shaped scaly or ulcerated nodules. They are often seen on areas like lips, face, mouth, hands and ears. This type of lesion may appear as a new growth or inside of an existing pre-cancerous skin growth. Old scars or areas of chronic skin infection are also common sites. Left untreated, the cancer can spread to other parts of the body a process called metastasis and cause new cancerous growth in other organs or tissues.

These two types of skin cancer are very curable and recovery is almost certain, if treatment is begun when the growth is small. However, failure to treat these common skin cancers can lead to serious problems. In fact, about 2,000 people will die of untreated basal or squamous cell cancers this year.

The deadliest all skin cancers is melanoma. It's much rarer than the other types, fortunately. A melanoma, in its early stages, is a flat multicolored tumor with a cobblestone-like surface that may be confused with a common mole. They are usually multicolored including black, brown, blue, red, or even with areas of almost no pigment at all. The border between colors is usually indistinct. As the melanoma enlarges, it becomes raised above the surface of the skin. At the same time, it penetrates more deeply into the skin, and this is quite serious. Melanoma that penetrates less than .75 mm (about 1/32 of an inch) into the skin is usually cured by simple removal. Deeper growth usually indicates that metastasis has occurred, and a cure is probably not possible with today's medical technology.

So if your skin lesion has any of the features of melanoma, please go see your family doctor again, or a see dermatologist.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.