A co-worker of mine has a growth on his forehead that has been there for at least a year and has never gone away. It is pale, crusty and lumpy. It recently started to turn black on the top outer edge of the sore. He has never seen a doctor about this, and I’m concerned that it is cancer. Is skin cancer life-threatening?
We presume many things based upon the appearance of skin, some of which are valuable, some regrettable. Much can be learned of the age of an individual from looking at his or her skin. Some measure of a person’s overall health can be determined by skin features, and as you suggest, the skin sometimes reveals suspicious lumps and bumps, some of which can indeed kill.
If you can comfortably do it, you’d be doing your co-worker a favor by telling him: The changes you’re describing are worrisome, and would definitely warrant a doctor’s visit.
We didn’t always appreciate the hazard of skin cancer, or that its risk could be increased by exposure to sunlight. Up until the 20th century, and mostly among Caucasians, tanning was viewed as a sign of the laborer, of one relegated to working outdoors in the fields, under the hot sun and exposed to the elements. Those with pale, translucent skin were more privileged, having jobs that depended on a well-trained mind. Or it meant that no work at all was required: a person of leisure. At some point, tanning came into vogue and in the midpart of the last century, tanning became associated with health, leisure time, vitality and youth. Many middle-age adults today recall hours of basking in the sun, lying on aluminum reflecting blankets, maximizing the darkness of the skin for as long as possible through the summer months. Now that has begun to change, partially it seems out of a shift in values, partially out of fear of the consequences of prolonged sun exposure such as accelerated aging and skin cancer.
What can be made of a lump or growth on the skin? When is it cancer and when can it be ignored? There is not a simple answer to these questions. For one thing, there are an enormous variety of skin lesions, and it may take a bit of an expert eye to sort them out. There are also many different types of skin cancer. It might be useful, however, to discuss the three most common types.
The first and most infamous is melanoma. This is an aggressive, lethal cancer that usually begins in a mole. Characteristically it is brown or black in color, but sometimes the color is variegated, the margins irregular, and it may bleed when rubbed. By the time it is detected (and they are often very hard to detect even with an experienced eye) microscopic metastases have often spread to other parts of the body. Even after thorough removal of the original lesion, distant metastases may show up in the brain, liver, lungs or other parts of the body five, 10 or many years later. You never feel quite safe with this cancer unless it is of the most superficial type. In other words, at the time of diagnosis, the precise depth to which the melanoma invades the skin yields valuable prognostic information. Caught early, before invasion into the skin, it is curable.
The second type of skin cancer is called a basal cell cancer. These appear as pearly or red colored, painless and firm nodules. They are most commonly found on the face. These are readily removed surgically if caught early and can then be cured. If allowed to invade deeper skin structures, the surgery required for cure involves extensive removal of tissue with subsequent disfigurement. Special techniques are employed to minimize the removal of healthy tissue while ensuring that all of the cancer cells are removed. Distant metastases are not generally a problem with this form of skin cancer. And once completely removed, you may be free of worry about recurrence.
A third type of skin cancer is called squamous cell cancer. These may look rather trivial at first, and classically begin as a “sun spot” on the skin. A sun spot is a precancerous lesion that often looks like a small scaly spot on a red base. They are frequent in sun-exposed areas such as the forehead and forearms or back of the hands. The scale may fall off from time to time but the lesion persists and the persistence is a sign of potential trouble. These too are readily removed, often by freezing using liquid nitrogen. Like the basal cell cancers, catching it early facilitates easy treatment and cure. Indeed, I rarely worry about squamous or basal cell cancers as long as they are found early.
But marks like these should not be allowed to go unexamined. Better to be safe than sorry, since early detection is so important to easy removal and cure.
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