Skin Cancer

Understanding the disease Treatment options Results

Standard photograph for grading severe solar damage on the shoulders. Standard photographs for grading freckling of the back: (B) mild (C) moderate (D) extensive

People with a lot of sun damage are more prone to skin cancers

Journal of Clinical Oncology, Vol 24, No 22 (August 1), 2006: pp. 3590-3596

Basal Cell Carcinoma

Basal cell carcinoma (BCC): About 80% of all skin cancers are BCC, a cancer that develops in the basal cells - skin cells located in the lowest layer of the epidermis. BCC can take several forms. It can appear as a shiny translucent or pearly nodule, a sore that continuously heals and then re-opens, a pink slightly elevated growth, reddish irritated patches of skin, or a waxy scar.

Most BCCs appear on skin with a history of exposure to the sun, such as the face, ears, scalp, and upper trunk. These tumors tend to grow slowly and can take years to reach ½ inch in size. While these tumors very rarely metastasize

Typical basal cell on the nose

Typical basal cell below lower lip

Typical basal cell on the ear

Ulcer type of basal cell

superficial type of basal cell

Classic presentation of basal cell

Classic superficial basal cell

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC): About 16% of diagnosed skin cancers are SCC. This cancer begins in the squamous cells, which are found in the upper layer of the epidermis. SCC tends to develop in fair-skinned middle-aged and elderly people who have had long-term sun exposure. It most often appears as a crusted or scaly area of skin with a red inflamed base that resembles a growing tumor, non-healing ulcer, or crusted-over patch of skin. While most commonly found on sun-exposed areas of the body, it can develop anywhere, including the inside of the mouth and the genitalia. SCC requires early treatment to prevent metastasis (spreading).

Typical squamous cell cancer on the ear

Typical squamous cell cancer on the face and scalp

Squamous Cancer of the Lower Lip

Typical squamous cell cancer on the hand

More advanced squamous cell cancer on the finger

Typical squamous cell cancer on the leg

Typical appearance of a well differentiated squamous cancer on the shin called keratoacanthoma

Malignant Melanoma

Melanoma: Accounting for about 4% of all diagnosed skin cancers, melanoma begins in the melanocytes, cells within the epidermis that give skin its color. With early detection and proper treatment, the cure rate for melanoma is about 95%. Once its spreads, the prognosis is poor. Melanoma most often develops in a pre-existing mole or looks like a new mole, which is why it is important for people to know what their moles look like and be able to detect changes to existing moles and spot new moles.

Distribution of superficial spreading melanoma of the skin in men and women.

Superficial spreading melanomas in all stages of development. The small early lesions have irregular borders, irregular

pigmentation, and small white areas indicating regression. The largest tumors show an accentuation of all of these features. 

Superficial Spreading Melanoma

Nodular Melanoma

Lentigo Maligna Melanoma

Variety of Melanoma Skin Lesions

Twenty images of skin lesions. Images 1-6, 7-13, and 14-20 show atypical, benign, and malignant lesions, respectively.

Literature Review (untreated basal cell)

TechniqueNumber of

CasesLocal Control

surgical excision 2,606 90%

radiation therapy 4,695 91%

curettage and electr.

3,573 92%

cryotherapy 269 93%

Mohs' microsurgery

7,670 99%

Literature Review (recurrent basal cell)

TechniqueNumber of

CasesLocal Control

surgical excision 522 83%

radiation therapy 234 87%

curettage and electr.

115 60%

Mohs' microsurgery

3,009 94%

Control Rate with Radiation, 3 Large Series

Basal Cell 98% 95% 96%

Squamous Cell 92% 87% 88%

Control Rates with Radiation

Type Untreated Relapsed

Basal Cell 95% 82%

Squamous Cell

87% 65%

Control by Tumor Size

Size Control Rate

< 2 cm 99%

2 - 5 cm 92%

> 5 cm 60%

Skin Damage with Radiation

Size Skin Damage

< 1cm 0.9%

1 - 5 cm 6.5%

Radiation for Skin Cancer

Electron beam for large areas. Daily (Mon-Fri) for 3 – 6 weeks

With electron beam then skin will get moderately sun-burned by the last day, but usually heals up in 2 to 3 weeks

Radiation for Skin Cancer

HDR skin applicators – three times a week for 6 treatments over a two week period

Results with HDR for skin

Results with HDR for skin

Results with HDR Skin applicator for small basal cell cancers on the face

Small squamous cancer of the chin, appearance 3.5 weeks after radiation (HDR)

Results with Radiation

Results with HDR for skin on shin

Results with HDR for skin on shin

Radiation can be used for large areas of small recurrent basal cell cancers

Area treated with electrons

Appearance of skin two weeks after completion

Even large or neglected skin cancers usually heal well with radiation

Appearance at 2 months

Appearance at 3 months

Radiation for areas difficult to operate, squamous cancer of the finger before and 19 days after electron beam

Squamous Cancer of the Ear Helix

The radiation healed the cancer and prevented further destruction of the ear

Side Effects of Skin Radiation

The treated skin will get red, itchy and sunburned. There are a number of good creams than can be used including Aloe, Aquaphor, Sween, Biafine.

The skin reaction may show up in a delayed manner (worse at 1-2 weeks) and may develop slight, superficial ulceration or crusting, but heals quickly (1-2 weeks) except the shin which heals more slowly

Side Effects of Skin Radiationmost people get mild sun burn effect , but some get blistering or crusting (scab formation) but they heal quickly

Prior to radiation 1 week after radiation

Side Effects of Skin Radiation

Prior to radiation last day of radiation

Typical delayed reaction where the lesion forms a scab at 1 – 2 weeks after completion, the scab usually falls off in another week or two

Radiation side effects may show up in delayed manner after HDR

Basal cell

Last day

Three weeks later

Three months later

Delayed Skin Reaction with HDR

Skin reaction is often delayed with HDR and can take several weeks to return completely back to normal

Typical Time pattern for skin healing with HDR

Lesions on shin may heal more slowly

Typical delayed reaction with superficial ulceration but quick healing, the small ‘hole’ at the biopsy site may take 2-3 months to disappear

Skin healing over the shin in an elderly woman

Skin cancers on the shin in an elderly patient may take several months to heal

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