From Basal Cell Carcinoma to Melanoma: What to Know About Skin Cancer

Skin cancers range from potentially lethal, in the case of metastatic melanoma, to far more common skin cancers, such as squamous cell and basal cell carcinomas, most of which are detected early and removed. Early detection is one of the best defenses against skin cancer, while prevention is the best overall.

“I tell people it should be like brushing your teeth in the morning—make sure you're getting sunblock on,” says Kelly Olino, MD, a Yale Medicine surgical oncologist who specializes in treating skin cancer at Smilow Cancer Hospital and Yale Cancer Center.

In addition to applying sunblock of SPF 30 or higher, and re-applying every two hours, Dr. Olino advises having a dermatologist examine any concerning lesions or moles.

“If you're [someone] who notices something that started off small and innocuous, marble-like, and you're looking at it a month, or a few months, later and you say, ‘Man, this has doubled in size,’ or there really is a change in the color pattern, those are the ones you really need to get in and see the doctor about,” she says.

Even clinicians with decades of experience assessing skin issues still need to get a biopsy analysis to determine if a suspicious lesion is cancerous, making it all the more important to seek attention for any concerns about a change in a skin lesion.

Dr. Olino considered more skin cancer questions and offered answers.

Skin cancer is the most common cancer worldwide.

A lot of that is due to lower-risk skin cancers such as squamous cell cancer and basal cell carcinoma. The overwhelming majority of these are taken care of locally by your dermatologist, sometimes even by some primary care doctors. Most of these carry a good prognosis and are local problems that get dealt with in a small procedure where the lesion is removed. It's difficult to track the numbers, or to see trends, for these nonaggressive skin cancers because so many people just take care of them in their local doctor’s office.

For more serious issues such as melanoma, merkel cell carcinoma, and cutaneous sarcomas, those are usually treated by a more specialized group of clinicians, so it's easier to track that incidence rate.

Use the acronym ABCDE for what to watch for. Look for lesions that are asymmetrical, or with blurred borders, and with a difference in the color, and a growing diameter. See if it’s bigger than the tip of a pencil eraser, if it’s evolving. Evolution is the most important, as in something that is changing over three months and if it's growing, changing either in color, or how it feels, or if it’s more raised. I think those are really the most important characteristics that help us determine whether it requires a biopsy to determine if it’s cancer.

Again, most of these cancers are fairly noninvasive. But the only way we can diagnose it is underneath a microscope with the assistance of a pathologist.

For thinner melanomas, right now our standard is to take an extra centimeter around from where we think that the melanoma has ended. But we go all the way down to the casing of the muscle, which we call fascia, because we want to make sure we're also clearing the channels within the skin that can go to lymphatics and the fatty tissue. And we want to sample those. We do the same thing for Merkel cell cancer.

For melanoma, we actually have an open trial now that’s looking to see, for thicker melanomas, how much of a margin we need to take. Historically, we started at five centimeters for all melanomas. And we've gotten down to either two centimeters or one centimeter.

And we're currently studying, with the MelMART clinical trial, whether we could do one centimeter for all melanomas. If you have the same end result in terms of survival outcomes and you actually have less of an area removed, it means easier healing, less need for flaps, skin grafts, and so forth. Again, we would want to choose the lesser margin if everything is equal because it's less invasive to our patients.