Tue07222014

Your Health

Subtle signs and symptoms can camouflage presence of skin cancer

Photo Photo Courtesy Of Dr. Patricia Wong The above patient thought the small indentation on the side of her nose was an acne scar. It's actually a basal cell carcinoma.
This is the first article in a two-part series on skin cancer. The second article will appear Sept. 21. As a dermatologist, I have observed an increase in the number of skin cancers being ignored or misdiagnosed by patients.

Such negligence has resulted in inappropriate home surgical procedures and delays in seeking proper treatment.

Skin cancer has a plethora of presentations. Early small cancers may resemble a pimple, wart, cyst or just a dry patch of skin.

Painful or bleeding lesions are signs of a more advanced stage of cancer. Don’t wait for a suspicious growth to develop such symptoms before seeking medical attention.

Diagnosing skin cancers One of my patients presented with what looked like a pimple on his nose. The bump continually bled, scabbed and healed.

Clues that this was not a benign pimple:

• The patient was not in the typical age group of acne sufferers. Although pimples can occur after age 60, they are much less common. An exception is someone with rosacea. In general, it is suspicious to suddenly develop a pimple when acne has not been present for years.

• Bleeding is always abnormal and should be evaluated. Skin cancers tend to bleed easily.

• Lesions that persist over a few months should be evaluated by a doctor, particularly those located on the nose, lips, ears and eyelids.

Another patient presented with a small growth just below the tip of the nose. It was a basal cell carcinoma, diagnosed during a comprehensive skin exam.

The patient was unaware that the cancer was present. Another thought that a small indentation on the side of her nose was an acne scar. However, the lesion showed the typical characteristics of a basal cell carcinoma, which can be subtle to untrained eyes. That’s just one of the reasons it’s important to get an annual comprehensive skin exam.

Other basal cell carcinomas are infiltrative. A microscopic view shows that strands of cells that spread in many different directions underneath the skin compose the carcinoma.

This type of basal cell carcinoma can be very destructive to surrounding tissues and can invade cartilage, muscle, nerves and even bone if neglected or unnoticed until it reaches an advanced stage.

Although basal cell carcinomas rarely metastasize, if allowed to grow for long periods of time, complex reconstructive surgery may be necessary to repair the surgical defect caused by removing the cancer.

We’ve seen bumps and indentations diagnosed as basal cell carcinoma. Another looked waxy and had a smoother, firmer texture compared to normal skin. And yet another was a little red spot above the upper lip that was surgically removed.

The patient now wears SPF 30 sunscreen – or higher – every day on sun-exposed skin, as well as a wide-brimmed hat, and returns every four months for a skin exam. Having one nonmelanoma skin cancer increases the chances of developing another skin cancer by 30 percent in the next five years.

Having a basal cell carcinoma and/or a squamous cell carcinoma increases the risk for developing malignant melanoma.

A growth on a patient’s hand that appeared rapidly over several weeks was causing pain because of mechanical trauma to the lesion. The elevated crusted plug at the apex of the nodule snagged on clothing and blankets.

Picking at it and digging at the central plug of dead skin only increased the pain – squeezing resulted in bleeding. Such maneuvers did not make the lesion smaller.

When it was surgically removed, lab tests confirmed a keratoacanthoma, a type of squamous cell carcinoma that resembles a little volcano and is typically a skin-colored or reddish nodule with a crusted center that grows rapidly.

The good news is that keratoacanthomas tend not to be aggressive, though surgical removal is recommended.

Dr. Patricia Wong is a dermatologist in private practice in Palo Alto.

For more information, call 473-3173 or visit www.patriciawongmd.com.

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