Skin Cancer

Pre-cancers and Skin Cancers are very common in Colorado due to the high altitude and plethora of outdoor activities year round. They can develop in any age group, but are the most common in the 4th, 5th and 6th decades of life. Often people will have pre-cancers and/or skin cancers and not even know they have them as they are often mildly symptomatic. They are most commonly formed from ultraviolet sun damage to the skin that occurs over time. They are most common in fair-skinned, blue eyed, light hair colored individuals, but can develop in any color skin.

Pre-cancers or Actinic Keratosis are the preliminary stages of skin cancer. These lesions form in sun damaged skin and will often appear as pink or red scaly plaques that are dry and flaky. They often will flake off, but will repeatly come back in the same place time after time. They are at times itchy or sensitive to the touch, but often have no sensation. They typically do not resolve on their own and will eventually develop into skin cancer if left untreated. Therefore, we typically treat pre-cancers when we see them to help prevent their progression.

Pre-cancers are treated topically. They are often treated with Liquid Nitrogen, CO2 laser, Photo-dynamic therapy, or prescription topical agents such as Carac, Effudex, and Zyclara. Liquid nitrogen is a very cold liquid that is applied to a pre-cancer with a spray or a Q-tip. It freezes the lesion and destroys the irregular cells. It often causes a red blister that takes about 7 to 10 days to crust and heal. It is effective to help remove pre-cancers, but at times does need to be repeated. In some people, Liquid Nitrogen, can cause a white de-pigmented scar in the treated area. Therefore, if the pre-cancer is in a very noticeable area on the face, or if there are a large number of pre-cancers, we often will use the CO2 laser or Phytodynamic therapy to treat the area where the pre-cancers are abundant. These treatments are very good for larger areas and do not cause a white de-pigmented scar to form after treatment. The topical prescription creams to treat pre-cancers are very effective and do not typically cause scarring, but they can be expensive. They also have to be applied faithfully on a daily basis for 3 to 4 weeks to achieve the best results. While the treatment is in place, the skin will appear red, scaly and crusty. This may be difficult for some patients to commit to.

Skin Cancer often will develop as a Basal Cell Carcinoma or a Squamous Cell Carcinoma. Basal Cell Carcinomas are the most common type of skin cancer. Skin cancers often develop as a sore that will not heal. They can form anywhere on the face or body and are curable by removing the skin where the irregular cells reside. This often requires a minor in-office surgical procedure to remove the lesion. Depending on the location of the skin cancer and the degree of tissue involvement, this surgery is often done with just local anesthesia, but in more extensive cases, sedation may be required. Basal Cell Carcinomas are localized and do not spread to surrounding tissues, but Squamous Cell Carcinomas, if left to grow long enough, may potentially spread thru the lymphatic system and develop systemically.

Pre-cancers and Skin Cancers are often detected with magnification glasses, but a skin biopsy is typically required to diagnose the type and extensiveness of the skin cancer. A skin biopsy can be performed by doing a shave or a punch biopsy. Depending on the size and location of the lesion, a shave or punch biopsy is done and sent to the pathologist to diagnose the type of lesion and the extensiveness of the cancer. This is important as it helps to determine the best way to remove the lesion and how wide of a margin is needed around the lesion to remove it effectively.