Basal Cell Carcinoma – Squamous Cell Carcinoma – Malignant Melanoma
Basal Cell Carcinoma
The 2 most common skin cancers in Asians are Basal Cell Carcinoma and Squamous Cell Carcinoma. Malignant Melanoma is more common in the western population and end to be more aggressive in behaviour.
Basal cell carcinoma appears as skin nodules with non-healing ulcers and raised pearly edge. They tend to bleed when traumatized. In Asians, about 70% of them are pigmented. These cancers are slow-growing and localized. Wide excision with clear margins is sufficient treatment. When the defect is small, direct closure is done. When the defect is large, a skin flap or skin graft may be required.
Squamous Cell Carcinoma
Squamous cell carcinoma appears as more fleshy nodules on the skin. The surface tends to bleed when traumatized. When the lesion is large, it can invade into deeper tissues and spread to the lymph nodes. The treatment of choice is a wide excision with 5-10mm margin to get surgical clearance. If the lymph nodes are enlarged in the field of drainage, a dissection of the lymph nodes in the neck, axilla or groin will be required. Frequently the defect is covered with a skin graft or flap because the size of the defect is too large to close primarily. Adjuvant treatment with radiotherapy or chemotherapy may be required.
Malignant melanoma frequently presents as a pigmented lesion, which increased in size quite suddenly and associated with pigmentation changes. It may also be associated with ulceration of the skin and lymph node enlargement. An incisional or excisional biopsy is recommended if there is any suspicion of malignant change. Surgery is the mainstay of treatment. Wide excision with 5 – 20mm margin, depending on the stage or thickness of the melanoma, is recommended. The defect is resurfaced with skin grafts or reconstructed with skin flaps as necessary. A sentinel node biopsy in the field of drainage is done for the purpose of staging. If a positive node is found, a dissection of the lymph nodes in the neck, axilla or groin would be necessary. Post-operatively, chemotherapy or immunotherapy may be helpful in some cases.