Spot The Cancer You Can See When Its Easiest To Treat
The worlds most common cancer is a relentless disease that strikes one in five people by age 70. The good news is that 99 percent of all cases are curable if they are diagnosed and treated early enough. But in order to stop skin cancer, we have to spot it on time.
Skin cancer is the cancer you can see. Unlike cancers that develop inside the body, skin cancers form on the outside and are usually visible. Thats why skin exams, both at home and with a dermatologist, are especially vital.
Early detection saves lives. Learning what to look for on your own skin gives you the power to detect cancer early when its easiest to cure, before it can become dangerous, disfiguring or deadly.
When Is A Mole A Problem
If a new or existing mole begins to change shape, color, size, or becomes flaky, crusty, or begins to bleed, it’s time to make an appointment with your dermatologist to get it checked out. A mole can turn into melanoma on rare occasions. In early melanoma, the shape of a mole becomes asymmetrical and uneven.
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Nodular basal cell carcinoma is a type of skin cancer that is most often found on the head. This type of cancer starts in basal cells, which are tasked with making new skin cells to push the old ones toward the surface of the skin. Nodular basal cell carcinoma is responsible for 60%-80% of all basal cell carcinomas. In the United States, its estimated that 4.3 million cases of basal cell carcinoma are diagnosed every year, with 2.5 to 3.4 million of those cases being nodular basal cell carcinoma.
This type of cancer appears as a pearl-like papule that is round and surrounded by threadlike red lines on the skin made up of tiny blood vessels. The risk of developing nodular basal cell carcinoma can be increased by spending a lot of time out in the sun, living in high-altitude and sunny locations, and radiation therapy.
Other risk factors include:
- Prolonged exposure to arsenic
- Certain rare genetic disorders such as basal cell nevus syndrome
Although this type of cancer is common, it is highly treatable, and the five-year relative survival rate is 100%.
What Can Patients Do
Some good advice from the experts:
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Estimated Costs To Medicare Of Extending Coverage
As discussed in , the cost estimation approach used by the committee follows the generic practices employed by the Congressional Budget Office in making estimates for Congress. A more detailed presentation of the committee’s cost estimates appears in , which was prepared by the Lewin Group in consultation with the committee and background paper authors. To illustrate how Medicare costs would be affected by different skin cancer screening strategies and behaviors, the committee developed estimates for the three models of screening described earlier. As summarized in and explained below, for the five-year period 2000 to 2004, net estimated costs to Medicare range from about $150 million for the most limited screening scenario to about $900 million dollars for the most expansive.
Summary of Estimated Costs to Medicare for Covering a New Program of Screening Asymptomatic Beneficiaries for Skin Cancer. Screening Strategy Assumptions Case Finding Approach 1. 30% of beneficiaries are screened each year by total skin examination during
Committee Findings And Conclusions
In developing its findings and recommendations, the committee recognized that the pathway from adoption of a new program of skin cancer screening to improved health outcomes for Medicare beneficiaries would have many uncertainties. illustrates a simple pathway and indicates some of the uncertainties associated with each element of the pathway. This figure does not include every possible step or uncertainty but rather summarizes some major variables that would likely affect the success of a screening program. These are the sort of potential issues to be weighed in the formulation of any final policy. Most of these uncertainties would affect the cost of covering screening.
Causal Pathway: Skin cancer screening, with examples of uncertainty that could affect outcome at several key points. Note: Events are in bold and in the main path examples of variables that increase uncertainty of outcomes are offset to the right.
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Can Blood Tests Or Scans Detect Skin Cancer
Currently, blood tests and imaging scans like MRI or PET are not used as screening tests for skin cancer. However, some national studies are underway to determine if concentrations of skin cancer DNA can be detected by blood tests. Occasionally, imaging detects signs of advanced disease. Sometimes, skin cancer that has spread to internal organs is detected incidentally when a patient is undergoing an imaging study such as MRI or PET scan for unrelated conditions.
Medical History And Physical Exam
Usually the first step your doctor takes is to ask about your symptoms, such as when the mark on the skin first appeared, if it has changed in size or appearance, and if it has been painful, itchy, or bleeding. You may also be asked about your possible risk factors for melanoma skin cancer, such as your history of tanning and sunburns, and if you or anyone in your family has had melanoma or other skin cancers.
During the physical exam, your doctor will note the size, shape, color, and texture of the area in question, and whether it is bleeding, oozing, or crusting. The rest of your body may be checked for moles and other spots that could be related to skin cancer .
The doctor may also feel the lymph nodes under the skin in the neck, underarm, or groin near the abnormal area. When melanoma spreads, it often goes to nearby lymph nodes first, making them larger.
If you are being seen by your primary doctor and melanoma is suspected, you may be referred to a dermatologist, a doctor who specializes in skin diseases, who will look at the area more closely.
Along with a standard physical exam, many dermatologists use a technique called dermoscopy to see spots on the skin more clearly. The doctor uses a dermatoscope, which is a special magnifying lens and light source held near the skin. Sometimes a thin layer of alcohol or oil is used with this instrument. The doctor may take a digital photo of the spot.
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What The Heck Is A Dermatopathologist
With seven syllables, thats a mouthful. First, the pathologist part: It comes from the Greek pathos , plus logia . A pathologist is a physician specially trained to study tissue under a microscope to diagnose diseases, determine the stage of a tumor or even help solve crimes through forensics, for example.
The dermato part comes from the Greek derma, meaning skin. Dermatopathology is a very specialized niche of pathology, where the only tissue that is being examined is skin, says Lyn Duncan, MD, director of dermatopathology at Massachusetts General Hospital, and professor of pathology at Harvard Medical School. These specialists are on the lookout for skin cancers as well as other skin conditions, and also diseases of the hair and nails.
To become a dermatopathologist, a physician must have completed a residency in either dermatology or pathology and then have additional training in dermatopathology, explains Michael G. Hitchcock, MBChB . He is a dermatopathologist in Winston-Salem, North Carolina, and president of the American Society of Dermatopathology, the largest professional organization devoted to the specialty. Were the doctors doctor, like the navigator of an aircraft, providing information and feedback to help them make the correct diagnosis.
Most of the time while a dermatopathologist is looking at a biopsy, says Lyn Duncan, MD, a diagnosis is clear. Thats where our training and experience come in, although we have to rule out other possibilities.
What Is Involved In A Skin Cancer Check
When you come in for a skin cancer investigation, you will be required to undress to your undergarments for a complete examination. The procedure requires your doctor to methodically assess every section of your skin, stopping at every mole or freckle that they think might be even remotely suspicious. They will use a sophisticated magnifying device called a dermatoscope, which shines polarised light when and where required to aid in diagnosis. At our clinics, all suspicious moles or freckles are photographed under high magnification and immediately transferred to the doctors computer for further analysis.
Youll be able to get dressed once your entire body has been screened as part of the skin cancer scan. Soon after, your doctor will discuss and show you the magnified images on the screen if necessary and will advise on a further course of action.
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How Is Skin Cancer Diagnosed
A skin biopsy is needed to diagnose skin cancer. Your doctor removes a sample of skin tissue, which is sent to a laboratory. In the laboratory, a pathologist studies the sample under a microscope. The pathologist looks for abnormal cells that indicate cancer. If it is cancer, the biopsy sample provides important information about the cancer stage.
Lymph node biopsy is done when there are signs of advanced melanoma, such as:
- Swollen, hard, and enlarged lymph nodes.
- Mid-thickness tumor , even without lymph node symptoms.9
Imaging tests are done for advanced melanoma. The purpose is to see whether the cancer has spread to distant parts of the body. Melanoma is most likely to spread to distant lymph nodes, lungs, liver, brain, and bones.10 These areas may be evaluated using:
- Computed tomography , alone or with positron emission tomography
- Chest x-ray
- Magnetic resonance imaging
- If distant metastases are found, a blood test may be done to check your lactate dehydrogenase levels. LDH is an enzyme found in the blood. The results of this test are used to classify Stage IV cancer. High LDH is a sign of cancer that is harder to treat.5
Evidence Of Benefits From Early Detection Of Skin Cancer Through Screening
The best evidence of benefit from skin cancer screening would come from a prospective randomized clinical trial that randomly selected people to be screened or not screened and then followed both groups long enough for differential outcomes to be evident. Because cancer screening trials typically require very large study populations, long follow-up periods, and significant administrative complexities, they usually have been undertaken only for cancers that affect many people and cause major mortality and morbidity.
The committee identified no randomized trials of clinical skin cancer screening. Discussions during the committee’s June 1999 workshop indicated that such a clinical trial would require from one-half million to one million participants and would not likely be funded in the United States. The committee heard that a trial is underway in Australia involving at least 500,000 people in 60 communities that have been randomly assigned to have a screening program established or to continue with current care. Current care includes intensive education and awareness campaigns for both the general population and the health professions. The study was reported to be in its first year of a 10-year follow-up period.
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Imaging Tests For Melanoma
Imaging tests are tests such as CT scans and PET-CT scans. They take pictures, and sometimes they give doctors important information.
If you have advanced-stage skin cancer, imaging tests may help. They can help your doctor see if the cancer has spread or come back after treatment.
But the tests usually dont help if you have early-stage skin cancer. Heres why.
What Is A Skin Cancer Test
Skin cancer is an incredibly common type of cancer. There are several different types of skin cancer, including squamous cell carcinoma, melanoma, and basal cell carcinoma. All of these types of cancer affect the skin in different ways.
Cancer of the skin usually makes an appearance on the skin as an initial abnormality. Bumps, moles, or lesions on the skin may indicate cancer. However, they could also be benign or caused by another issue.
A skin cancer test is used to determine whether or not an abnormality on your skin is cancerous. An initial examination may be performed by your general practitioner. If they find anything concerning on your skin, they may refer you to a specialist to investigate further.
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Possible Directions For Future Research
The committee identified several areas where further research would be helpful, although it did not attempt to set priorities. As noted above, a randomized controlled trial of skin cancer screening is underway in Australia, although substantial results are years away. Also, the much higher incidence of skin cancer in Australia would have to be taken into account in assessing the study’s relevance to this country.
In the absence of evidence from controlled trials, it would be useful to have more research on the early stages of cancerous and precancerous lesions and their progression to more advanced states. Such research would help answer questions about how quickly different kinds of melanomas progress in different risk groups and about how likely it is that earlier detection of disease through a new program of clinical screening would make a difference in outcomes. More research would also be useful to understand how frequently and how quickly actinic keratoses develop into squamous cell carcinoma and what factors predict such progression.
More generally, in addition to research that could clarify the benefits, harms, and cost-effectiveness of clinical skin cancer screening and primary prevention programs, other interesting lines of investigation exist in the area of treatment. These include more effective chemotherapy for nonlocalized melanoma and vaccination or immunotherapy for melanoma.
What Can You Expect From A Skin Cancer Exam
If youre scheduled for a skin cancer screening, here are a few things to help you prepare for the screening:
- Dont wear makeup. This will allow your doctor to more easily examine the skin on your face.
- Remove any nail polish. This will allow your doctor to fully examine your fingers, nails, and nail beds.
- Keep your hair loose so your scalp can be examined.
- Take note of any concerns, like skin spots, patches, or moles, and point those out to your doctor before the exam.
Before the skin screening exam begins, youll need to take off all your clothes and put on a gown. Depending on your skin cancer risk and medical history, you may be allowed to keep your underwear on.
Your doctor will conduct a head-to-toe examination of all your skin. It may include the skin on your buttocks and genitals. Your doctor will likely use a bright light and magnifying glass to examine your skin more thoroughly.
If your doctor finds anything suspicious, theyll decide if it should be monitored or removed. A mole or tissue sample can be removed immediately or on a return appointment.
The tissue will be sent to a lab to see whether it contains cancer cells. Your doctor should receive the results within a week or two, and will share the results with you.
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Causes Of Skin Cancer
Australia has one of the highest rates of skin cancer in the world. Anyone can be at risk of developing skin cancer, though the risk increases as you get older.
The majority of skin cancers in Australia are caused by exposure to UV radiation in sunlight.
Some factors that increase your risk of skin cancer include:
-
sunburn
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There Are Problems With Imaging Tests At An Early Stage
Some doctors will order imaging tests, such as a chest X-ray, brain MRI, CT scan, or PET-CT scan. They think the tests will help show if the cancer has spread or help the surgeon find all the cancer. But these tests do not find skin cancers very well. So they dont give doctors helpful information about the size of the cancer.
In addition, it is very unlikely that an early-stage melanoma has spread. Because of this, the test results wont give new information or change the treatment you would have had anyway.
The tests may find false alarms that can lead to more tests. Many of these tests use radiation, which can lead to new cancers. The tests can also be expensive.
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How To Spot A Bcc: Five Warning Signs
Check for BCCs where your skin is most exposed to the sun, especially the face, ears, neck, scalp, chest, shoulders and back, but remember that they can occur anywhere on the body. Frequently, two or more of these warning signs are visible in a BCC tumor.
Please note: Since not all BCCs have the same appearance, these images serve as a general reference to what basal cell carcinoma looks like.
An open sore that does not heal
A reddish patch or irritated area
A small pink growth with a slightly raised, rolled edge and a crusted indentation in the center
A shiny bump or nodule
A scar-like area that is flat white, yellow or waxy in color