Understanding basal and squamous cell skin cancers
Minimally-invasive surgery, such as Mohs, is one way to treat the two most common types of skin cancer
Based on the numbers alone – not to mention where we live – there is a good chance you know someone with, or may one day face yourself, a type of skin cancer.
Skin cancers are the most common type of diagnosed cancers, specifically basal and squamous cell skin cancers. The American Cancer Society estimates about 5.4 million basal and squamous cell skin cancers are diagnosed each year, occurring in about 3.3 million Americans because some people have more than one.
While those numbers are high, the good news is that basal and squamous cell cancers rarely lead to death. Only about 2,000 people in the U.S. die from these two types of skin cancers, and that rate has been dropping in recent years, according to the American Cancer Society.
Still, a cancer diagnosis of any kind can be scary and difficult. Basal or squamous cell skin cancer may not result in death, but the potential for disfigurement or scarring is upsetting for many.
“What I tell patients is that the good thing about these skin cancers is they are not the type of cancers that typically spread to other parts of the body and cause death,” says Dr. Timothy Minton, a double-board certified facial plastic and reconstructive surgeon with Savannah Facial Plastic Surgery. “However, they can be locally destructive, and when it’s on the face, that is a problem.”
Understanding basal and squamous cell skin cancers
The skin is made up of three layers – epidermis, dermis and subcutis. The epidermis is the thin outer layer of the skin, and it consists of squamous, basal and melanocytic cells. Squamous cells are the outermost layer and basal cells are found in the lower part of the epidermis. Centrally located, melanocytes give skin its color.
Skin cancer begins when cells in the skin start to grow uncontrollably.
About 8 out of 10 skin cancers are basal cell carcinomas. These cancers usually develop on sun-exposed areas, especially the head and neck. They rarely spread, unless untreated. Unfortunately, people who have had basal cell skin cancers are more likely to get new ones in other places of the body.
Squamous cell skin cancers occur less often than basal cell cancers but are still common, Dr. Minton explains. They too appear on sun-exposed areas of the body such as the face, ears, neck, lips and backs of the hands. Squamous cell cancer is more likely to spread than basal cell; however, it is still uncommon to behave like this if treated early.
Melanoma is another type of skin cancer. It develops from melanocytic cells which are responsible for producing pigment. Although not nearly as common as basal or squamous cell skin cancer, melanoma is more aggressive and likely to spread if left untreated.
How basal and squamous cell skin cancers are treated
A skin cancer diagnosis of any kind can be complicated and should always be handled by medical professionals. Each individual patient’s case can vary, and your healthcare team will help you make the best treatment decisions.
Surgery is the most common treatment for basal and squamous cell skin cancers. Sometimes it can be a simple in-office procedure to remove layers of skin containing tumor. Other times, your physician may recommend a procedure such as Mohs surgery. Determining which surgical technique depends on the type of skin cancer, how large the cancer is, where it is on the body and other factors.
Dr. Minton performs many skin cancer removals on the face, as well as reconstruction procedures to repair any disfigurations or scarring. He commonly performs excision with immediate frozen section pathological analysis, which is very similar to Mohs surgery.
Mohs is a surgical technique perfromed by a specially-trained dermatologist that removes thin layers of cancer-containing skin and, while the patient waits, examined until only cancer-free tissue remains, explains Dr. Minton. The advantage is the cancerous tissues are removed in one visit with minimal damage to surrounding healthy tissue.
Dr. Minton performs a similar proceedure to Mohs, in which the specimen is analyzed by a pathologist at Candler Hospital while the patient waits. Once the cancer is clear, he then immediately does any necessary reconstruction to repair the defect, which could consist of skin flaps or grafts. Dr. Minton also does reconstruction procedures for patients referred by other physicians and Mohs surgeons after the tumors have been removed.
Mohs is typically best suited for recurrent cancers, cancers in real sensitive areas, such as the eyelids or around the nose, or for tumors that have aggressive features.
“Basic basal cell cancers are fairly predictable, but there are some subtypes of basal cell cancers that are more aggressive and tricky,” Dr. Minton says. “What you see on the surface isn’t what is going on under the skin, and in those cases I think Mohs is helpful because it really can chase the tumor.”
Skin cancer reconstruction
For some skin cancer patients, they may be left with scarring or even portions of a body part missing following treatment. This is most common on the face because there is less tissue. Facial reconstruction is often needed to improve function and form.
For example, if a skin cancer is removed on the nose, this can affect one’s ability to breathe. Hearing can sometimes be impaired following the removal of a skin cancer on the ear. Even eyelids can be damaged, causing difficulty blinking and dry eye.
Dr. Minton also considers form when going into a reconstruction procedure.
“If you’ve got a big hole on the side of your nose, you don’t just want to pull the cheek up on to it because that blunts the natural change between the nose and the cheek.”
Dr. Minton uses skin flaps and cartilage from other body parts for optimal results. Take the nose for example; he uses cartilage from the ear to make a new nostril. He can use the same cartilage to provide form to a damaged eyelid.
The process can be one day for some or a longer period of time for others, depending on the damage. The time is worth the wait to not only be cancer free but also have no signs of surgery. Just look at some of Dr. Minton’s before and after photos for proof.