Kenneth Beer, M.D. is a board-certified dermatologist and dermatopathologist in Palm Beach, Fla., and the director of scientificskin.com, an online skincare company. He is also the director of The Cosmetic Bootcamp, which trains physicians in best practices for cosmetic medicine. Dr. Beer is an instructor in dermatology at the University of Miami, and he is an A.B. Duke Scholar at Duke University. He obtained his medical degree from the University of Pennsylvania School of Medicine, and received his dermatology and dermatophathology training at the University of Chicago. Visit Dr. Beer's office at palmbeachcosmetic.com.
 
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Squamous Cell Carcinoma

Tuesday, 14 Aug 2012 07:45 AM


The second most common and deadly type of skin cancer is known as squamous cell carcinoma. These lesions tend to occur on sun-exposed areas of the skin. They are usually easy to identify and, when treated early, are simple to fix.
Squamous cell carcinomas (SCCs) are cancers that involve the middle cells of the skin layer, or epithelium. Under the microscope, an SCC has cells that are disorganized in contrast to normal skin. The cells are also abnormal in appearance, often larger than normal, and bizarrely shaped.
Patients with SCC come to my office with pink or red scaly bumps located on their hands, ears, neck, and nose. Other parts of the body may also be affected with this type of cancer, but it’s rare.
Before the spot becomes cancerous, it may have an intermediate stage known as an actinic keratosis. Under the microscope, the cells look the same but they don’t fill the entirety of the epidermis or invade underlying tissues. These actinic keratoses are among the most frequent problems that bring people to a dermatologist.
Treating actinic keratoses may involve using liquid nitrogen sprayed onto the spots, with topical medications (including Aldara, Efudex, Solaraze, and Carac). Alternative treatments involve using photodynamic therapy in which a dye is painted onto the skin and allowed to incubate for several hours.
Following the incubation period, the skin is treated with a special light source known as a Blu U light. This light corresponds to the absorption for the dye and effectively cooks the cancer cells. As with the topical creams, it will make the skin look red and raw, and this irritation may last about a week.
Depending on the size and type of SCC, treatments for it may involve surgery, radiation, topical treatments, freezing, or scraping out the base and burning the surface. Cancers that have not penetrated the base of the skin layer can be treated with freezing or topical medications.
Certain types of SCC (known as keratoacanthomas) grow quickly and may be painful. In about a quarter of the patients I see, they disappear after the biopsy and for some, observation may be adequate. This type is often seen following an injury.
SCCs on the face are usually removed surgically by either a dermatologic surgeon or a plastic surgeon. Removing a diseased part of the skin and patching the hole with another piece of skin will leave a scar.
When these lesions are on the face, I use a microscope to check the margins and make sure that all visible tumor is removed before I reconstruct the defect.
In general, the more fair the skin and the greater the amount of sun exposure (or tanning bed time), the higher the risk of developing an SCC. Common SCC patients in my practice are fair skinned with English, Irish, Scotch, German, or Nordic heritage.
During their 40s and 50s, they notice little pink scaly bumps on their hands, noses, lips, or ears. A few of these spots grow to become larger than a pencil eraser, and some may bleed. Biopsies of the spots can identify which need to be treated and what treatment is the most appropriate.
When SCC occurs on the face, particularly when it involves the nose, many of my patients want to get radiation because they believe that it offers a risk-free way to obtain a cure without a scar.
Geriatric patients who are not candidates for surgery are ideally suited for radiation. However, for the majority of younger patients, radiation is not the treatment of choice because it does not obtain surgically clear margins.
In addition, the changes to the skin that follow radiation may take years to manifest but can be significant. Before considering radiation, speak with a few dermatologists and radiation oncologists to make an educated decision.
Squamous cell carcinoma is a potentially deadly type of skin cancer that can be treated when identified early. If you have a pink or red scaly spot that won’t go away, point it out to a dermatologist and, as with other changes on the skin, remember that a skin biopsy is usually a good thing.

To learn more about Dr. Beer, visit www.idealskin.com and www.palmbeachcosmetic.com.



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The second most common and deadly type of skin cancer is known as squamous cell carcinoma. These lesions tend to occur on sun-exposed areas of the skin. They are usually easy to identify and, when treated early, are simple to fix.
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2012-45-14
Tuesday, 14 Aug 2012 07:45 AM
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