Skin Cancer – Diagnosis and Treatment
Diagnosis
Checking the Skin for Signs of Cancer
Doctors begin by asking about symptoms and looking closely at the skin. They focus on spots, moles, and any unusual changes.
They use a dermatoscope to examine certain areas, such as pigmented lesions and moles. A list of questions can help check for signs of melanoma, basal cell carcinoma, squamous cell carcinoma, and other types.
Self-exams at home help with early detection, especially for people with many moles or a personal or family history of skin cancer.
Common signs noticed during a skin check:
- New moles or growths
- Changes in color or size of existing moles
- Sores that do not heal
- Areas that are bleeding, itchy, or painful
Removing Skin for Lab Testing
If a doctor finds a spot that might be skin cancer, they take a sample for testing. This is called a skin sample test.
Doctors may use a small blade (shave biopsy), a round cutting tool (punch biopsy), or remove the whole spot (excisional biopsy). Sometimes, they take only part of a larger area.
This usually happens in a clinic with numbing medicine to keep it pain-free. The doctor sends the skin sample to a lab.
Specialists look at the sample under a microscope to check for cancer cells. This test helps identify basal cell skin cancer, cutaneous malignant melanoma, squamous cell skin cancer, or another type.
Tests can also help tell apart conditions that look like cancer, such as actinic keratosis or dysplastic nevi.
Types of skin testing procedures:
| Method | When Used |
|---|---|
| Shave biopsy | Raised growths |
| Punch biopsy | Small, round spots |
| Excisional biopsy | Whole mole removal |
Tests to See if Cancer Has Spread
Some people with skin cancer need more tests to see if the cancer has spread deeper in the skin or to other parts of the body. Doctors call this process “staging.”
People with basal cell skin cancer or squamous cell carcinoma may not need these tests, since these types usually stay in the skin.
If cancer might spread, especially with larger growths or melanomas, doctors may suggest imaging scans or lymph node checks.
- Imaging Scans: Tests like CT or MRI scans create pictures of the inside of the body. These scans show the size of cancer and whether it is in other organs.
- Lymph Node Checks: Doctors may do a sentinel lymph node biopsy to remove a small sample of lymph nodes. This test shows if melanoma or other types, such as Merkel cell carcinoma, have spread.
Understanding the Different Levels of Cancer
After all the tests, doctors assign a stage to the cancer. The stage shows how big the cancer is and if it has spread to other parts of the body or lymph nodes.
Stages of skin cancer usually are:
- Stage 0: Only in the top layer of the skin.
- Stage 1: Small and only in the skin.
- Stage 2: Larger or has certain high-risk features.
- Stage 3: Reached nearby lymph nodes.
- Stage 4: Spread to distant organs or many lymph nodes.
The meaning of each stage may change based on whether it is basal cell cancer, squamous cell carcinoma, or melanoma.
Treatment
Doctors use several methods to treat skin cancer. The plan depends on the type, size, and location of the cancer.
Surgery
Surgeons remove skin cancer and some healthy tissue around it. This helps make sure all cancer cells are gone.
Mohs surgery removes cancer layer by layer. After each layer, the surgeon checks for cancer cells under a microscope. The process stops when no more cancer cells are found.
Skin-Directed Treatments
Doctors sometimes use treatments applied directly to the skin, such as special creams that deliver medicine to the cancer cells.
Curettage and electrodessication uses a tool called a curet to scrape off the cancer. An electric needle then treats the area.
Photodynamic Therapy
Doctors use a light-activated drug with a special light source. The drug collects in cancer cells. When exposed to light, the drug activates and kills the cancer cells.
Radiation Therapy
Doctors use focused beams of energy to destroy cancer. They often use this method when surgery is not possible or for certain places on the body.
Chemotherapy
Doctors use strong medicines to kill cancer cells. These medicines can be given by mouth, by vein, or applied directly to the skin.
Targeted Therapy
Doctors use drugs that block specific signals or chemicals in cancer cells. Blocking these signals stops cancer cells from growing or causes them to die.
Immunotherapy
Doctors use medicine to help the immune system find and kill cancer cells. This treatment boosts the body’s natural defenses.
Comparison Table of Treatments
| Treatment Method | How It Works | Where Used |
|---|---|---|
| Surgery | Removes cancer and some healthy skin. | Most skin cancers |
| Mohs Surgery | Removes cancer layer by layer, checking under a microscope. | Face, ears, other sensitive areas |
| Creams & Lotions | Kills cancer cells directly on the skin | Early or small skin cancers |
| Radiation Therapy | Uses energy beams to kill cancer. | When surgery isn’t possible |
| Chemotherapy | Uses strong drugs to kill cancer cells. | Advanced or spreading cancers |
| Photodynamic Therapy | Light-activated drug that kills cancer cells. | Certain skin cancer types |
| Targeted Therapy | Blocks specific cell signals in cancer cells. | Cancers with known targets |
| Immunotherapy | Boosts immune system to attack cancer. | Some advanced skin cancers |
Doctors may suggest one or a mix of these treatments depending on the case. Each option has risks and benefits that you should discuss with your healthcare provider.
Getting Ready for Your Visit
Steps You Can Take Before Your Appointment
Being organized helps you make the most of your time with the dermatologist.
Bring a Support Person: Take a family member or friend with you. They can help remember details and provide support.
- Write Down Important Details:
- List your medical history, including other conditions and treatments.
- Record all medications, vitamins, and supplements you use, with dosages.
- Note any family history of melanoma or other cancers.
- Prepare Questions in Advance:
Make a list of questions, such as:- What type of skin change or risk factor do I have?
- Is there evidence of skin cancer? If so, what kind?
- Will I need further tests?
- What treatment choices are available, and what are their risks?
- What can I do to help prevent new problems, like wearing protective clothing or using sunscreen?
- Should I schedule regular skin checks?
- Will surgery or other treatments leave marks or scars?
Practice Skin Safety: Wear loose clothing to your visit for easier exams. Avoid using makeup on your face and remove nail polish from fingers and toes for a complete skin check.
Tip: Do a self-exam before your visit and note any changes, new spots, or areas with sunburn. This helps you point out concerns during the checkup.
Questions Your Dermatologist May Ask You
The doctor will ask about any changes you have noticed in your skin.
Be ready to answer the following questions:
When did you first notice the skin change?
Have any lesions grown, changed, bled, or started to itch?
How severe are your symptoms?
What risks do you have, such as frequent sun exposure or past sunburns?
Is there a family history of skin cancer?
Table: Useful Topics to Discuss
| Topic | Example Questions |
|---|---|
| Medical history | Any past skin problems? |
| Risk factors | Recent sunburns? Family history? |
| Prevention | Do you use sunscreen? Protective clothing? |
| Next steps | Do you need follow-up care? |
