By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine
READER WISE TO SEEK MEDICAL ADVICE ABOUT NEW SKIN GROWTH
Question: About two months ago I noticed a small red spot on my face. From certain angles in the mirror it looks a little wax-like in appearance. I’ve made an appointment with a dermatologist, but I have to wait a few weeks before I see him. In the meantime, could you tell me the likelihood that a new spot like this could be cancerous?
Answer: From your description, I would guess you might have a basal cell carcinoma. Fortunately, this is very curable. However, since skin cancers can be deadly, you made a wise decision to seek a medical opinion in a timely fashion.
One important clue in telling when a spot -- what we doctors call a lesion -- might need further study is its history. That is, your doctor will ask when you first noticed it and how it has changed over the last few months. He will then visually inspect your lesion. Most non-cancerous growths have a smooth border where they join normal appearing skin and are symmetrical in shape. Their coloration is uniform across the lesion, and the growth is slow. This history and examination may be all that’s needed to make a diagnosis. However, he may also remove all or part of the lesion to obtain a specimen that can be studied under the microscope.
The most common form of skin cancer, and also the most prevalent cancer in humans, is basal cell carcinoma. These raised skin growths usually develop on the head, neck, hands and trunk -- the areas that get exposed to the sun. They are often described, as in your case, as “waxy” in appearance. These lesions have 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 more than one million cases of basal cell cancer this year.
The next most common skin cancer -- squamous cell -- will affect 250,000 people this year, predominantly those over 60. These growths are reddish or pink and appear as raised, irregularly shaped, scaly or ulcerated nodules. Often found on areas like the lips, face, mouth, hands and ears, they may appear as a new growth or inside of an existing pre-cancerous skin lesion. Old scars or areas of chronic skin infection are also common sites. Left untreated, squamous cell cancer can spread to other parts of the body -- a process called metastasis -- and can cause new growths 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 and even death.
The deadliest of all skin cancers is melanoma. While it is still the rarest type, it has become increasingly common because of the popularity of sun tanning -- including “parlor tans.”
A melanoma, in its early stages, is a multicolored growth with a cobblestone-like surface that may be confused with a common mole. It may contain black, brown, blue and red pigments, or even 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. Melanoma that penetrates less than .75 mm (about 1/32 of an inch) is usually cured by simple removal. Deeper growth often indicates that metastasis has occurred, and a cure is less likely.
Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.