Skin cancer is the most common type of cancer, with more new cases than breast, prostate, lung and colon cancer combined. The Clifford Clinic together with the pathology labs in Singapore General Hospital can help to help analyze, detect and diagnose skin cancer in its early stages.
Skin cancer is an uncontrolled locally destructive cancerous growth of abnormal skin cells that originates from the cells that separates the outer skin layers from the deeper layers. It happens when unrepaired DNA damage to skin cells (such as exposure to ultraviolet radiation from the sun or tanning beds) triggers genetic defects or mutations that causes benign normal looking skin cells to rapidly divide uncontrollably and hence forming malignant tumors.
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Skin cancers don’t appear suddenly. This is a huge misconception. Very often, skin cancers arises from moles that have been around for years. It is all too common for patients to comment that the mole has been there since they were young and it is probably alright. It is in fact the exact opposite. The moles that have been there the longest may have changed over time and start to show malignant changes. These are the exact moles that need to be evaluated and suspicious ones excited and sent to the laboratory to be analyzed.
There are 3 most common types of skin cancer, basal cell carcinoma, squamous cell carcinoma and melanoma.
Basal Cell Carcinoma
Basal Cell Carcinomas (BCC) are usually caused by overexposure to intense but occasional sunshine, they are characterized by red patches, shiny bumps, open sores or scars. They are mostly found on areas of the skin exposed by the sun, such as head, neck and arms but can also occur elsewhere.
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) may occur anywhere on the body, but are mostly found on areas exposed to the sun or ultraviolet rays (sunshine or tanning beds). SCCs look like open sores, scaly red patches or warts. If allowed to grow, they may become deadly or cause disfigurement.
Melanoma is less common, but most dangerous form of skin cancer as it is more likely to grow and spread. They appear to resemble moles, but can also be skin-coloured, red, purple, pink, blue or white. Caused by intense, occasional UV exposure, it can be curable if treated early.
Atypical moles are benign moles that may resemble melanoma, and people with a large number of moles are at a higher risk of developing cancer. Family history plays a part in the formation of atypical moles, and tend to run more frequently in Caucasian families. Those with more than 10 moles, are at 12 times the risk of developing melanoma.
HOW TO SPOT AN ATYPICAL MOLE OR PRECANCEROUS OR CANCEROUS MOLE
- Asymmetry Atypical moles are commonly asymmetrical. If you were to draw a line down the middle, it would not create matching halves.
- Border Regular moles have defined borders. The borders of atypical mole may be fussy or fades into the surrounding skin.
- Colour Atypical moles have a variety of colours, with random colours of tan, black, brown, red, dark brown or blue.
- Diameter Atypical moles are usually larger in size (> 6mm), but can sometimes be smaller.
- Evolution Is the mole growing in size? Did the mole appear after 40 years old? That could be signs of an atypical mole.
GETTING IT CHECKED
If you are worried that an area on your skin might be skin cancer, visit your doctor to get it checked immediately. The skin experts at The Clifford Clinic will be able to perform a standard physical exam, use a technique called dermatoscopy to take a closer look at your skin. Often through years of experience, a doctor should also be able to detect suspicious looking moles and advise you accordingly.
If an area is suspected to be skin cancer, the doctors at The Clifford Clinic will perform a skin biopsy to remove the skin (or part of it) and have it sent to the pathology labs at Singapore General Hospital for an analysis. If the entire tumour can be removed during the biopsy, it’s often enough to cure basal and squamous cell skin cancers without any further treatment. There are different types of skin biopsies suited to different types of skin cancer. If the mole is small, an excision biopsy is the best way to analyze the specimen.
Under local anaesthesia, a small elliptical incision would be made surrounding the mole. You will not feel any pain so not to worry. This is because the local anaesthesia numbs the skin. The mole is then excised the stored in a container for transport to the laboratory. A few stitches would be made to close the wound and to ensure that the scar is as small as possible. These stitches would be removed in 5 days if the mole is on the face and removed in 10-14 days if the mole is on the chest, back, arms or legs. A bandage will be applied on after surgery that needs to be changed daily. This can be done by yourself at home. Stitch removal would take place subsequently and the wound will initially look slightly pink before fading off back to skin colour. Some lasers can be done if required to hasten this process.
IMPORTANCE OF EARLY DETECTION AND REMOVAL
Malignant Melanoma of stage 1a has an extremely excellent prognosis, with 5 year survival rates quoted above 95%. However stage 3 cancers this survival rate drops to 60-70% with stage 4 cancers dropping to 7-20% depending on the severity and extent of the cancer. Not all cancerous moles need to be extremely large in size as it is often the depth of the tumor that determines the degree of invasiveness and also the extent where the tumour has spread. This depth is not visible just by looking at the mole on the surface but it is measured under the microscope when the mole has been removed.
WHAT HAPPENS NEXT AFTER HISTOLOGY
Firstly the most important question is, is my mole cancerous? If it is benign, that’s the end of the case and you will require no further treatment.
However if the mole is cancerous, what follows next will be to establish what stage is your cancer at and what type of skin cancer it is. Depending on the extent, you may require a full body PET scan, CT scan and MRI to detect if there are any other lesions. Also depending on the severity and extent of your mole, options like chemotherapy and radiotherapy will be discussed with you. A repeat surgery called a wide local excision will also be discussed with you as the initial biopsy is only made for diagnosis and aesthetic purposes however a wide local excision is done to remove and clear all the surrounding tissue to remove all the cancer cells.