Lower Extremity Skin Cancers

April 15, 2011
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In last weeks article we discussed the ABC’s of Skin Care and stressed the importance of self-skin evaluations in helping to catch early signs of changing lesions that may be indicators for larger problems. This week we will cover some of the specific types of skin cancers seen on the lower extremities, helping you develop an understanding of why prevention and early recognition are key.

We will discuss three types of skin cancers that can be seen on the lower extremity: Basal Cell Carcinoma, Squamous Cell Carcinoma and Malignant Melanoma. The major risk factors for all three types of skin cancers discussed this week are chronic sun exposure especially in individuals with fair skin, in addition to increased age, a history of skin cancer and a compromised immune system.

Identification and diagnosis of any cancer begins with suspicion. As was stressed last week, if you are suspicious about any lesions or review of your “ABC’s” you should see your doctor as soon as possible. If they evaluate the lesion and there is reason for suspicion on their behalf they will either refer you to a specialist for further evaluation or take a biopsy of the questionable lesion. There are a variety of ways to biopsy lesions and the choice largely depends on your doctor’s preference and the presenting lesion, but some form of biopsy with evaluation by a pathologist is required for diagnosis.

Basal Cell Carcinoma: This is the most common malignant skin cancer and is typically slow growing and locally destructive. Cells in the basal layer of the skins epidermis are actively growing and when their growth is disrupted or kicked into high gear, basal cell carcinoma can result. Basal cell carcinoma has several subtypes, as do the other skin cancers discussed, with the classification largely dependent on the presentation of the initial lesion. There is very little potential for this type of cancer to metastasize (spread to other areas of the body), making treatment >95% curative.

Squamous Cell Carcinoma: This type of skin cancer is typically slow growing, and if caught early on can be treated with high likelihood for a full recovery, which is why following the ABC’s of skin care are so important. Changes in cells within the top layer, or epidermis of the skin can progress to squamous cell carcinoma when they are no longer pushed to the top and sloughed off as dry skin. In addition to the major risk factors for the three types of skin cancer discussed this week, exposure to chemical carcinogens and prior radiation therapy can specifically predispose a patient to development of squamous cell carcinoma. There are several forms of squamous cell carcinoma with some types more apt to metastasis than others, thus early identification is key!

Malignant Melanoma: This is the most dangerous form of skin cancer and is also the most common life-threatening problem in dermatology today, especially in young-persons. Most types are darkly pigmented, as melanocytes are the cells that go awry in melanoma and are also responsible for the color of our skin. Melanoma can be divided into 5 sub-types depending on the characteristic appearance of the lesion and the cancers ability to spread. You should pay particular attention to darkly pigmented toenails, as most are benign, but should the pigmentation spread beyond the nail itself and onto the surrounding skin, see your Podiatrist as soon as possible.

Treatment for each type of skin cancer described above depends on a variety of factors including how far the lesion has spread both in length and depth through the skin layers. Most will require excision of the lesion, but more aggressive forms or those lesions which are deeper into the layers of the skin may require radiation, chemotherapy, or other medicines for treatment and remission potential.

To reiterate, prevention is your best friend when it comes to skin cancer and with sun exposure being the greatest risk factor, never forget to wear your sunscreen! However, we are all human and we sometimes forget, so following the ABC’s and checking your skin on a regular basis will help catch any changing lesions early on and improve your chances of recovery should one of those lesions turn out to be a form of skin cancer.

Never hesitate to consult your Podiatrist and Dermatologist if you have concerns!

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