By Rex Amonette, MD
Dr. Amonette is past president of the American Academy of Dermatology, and currently clinical professor of dermatology at the University of Tennessee. He is also co-founder of The Skin Cancer Foundation's Rex and Johnnie Amonette Circle.
Q: I have had two different types of skin cancer on my face, basal cell carcinoma and squamous cell carcinoma, and both times the surgery to remove them left me with some scarring. I now have another growth on my nose, and I'm convinced that it's another skin cancer, but I haven't been to the doctor. It's not that big, and because of what happened before, I'm thinking about not going in to have the growth removed. Would this be so bad? What happens with a basal or squamous cell cancer if you just leave it alone?
A: While patients seem to know that melanomas are dangerous skin cancers, the same often isn't true with respect to the nonmelanoma skin cancers basal and squamous cell carcinoma (BCC and SCC). All dermatologists sooner or later are asked by patients whether they can forgo surgery for these cancers. The answer is of course not.
Generally, basal cell carcinomas are the least dangerous of skin cancers. They rarely metastasize (spread) or become life-threatening. Often they barely appear to grow or change for years, and people may leave them alone until they finally become too unattractive to bear or begin bleeding. The problem is that even when they appear small, they may be invading deeper into the skin. Ultimately, the tumor starts altering facial or bodily structure — contracting the lip into a snarl, say, or eroding part of the nose. The longer you wait, the more damage and disfigurement the tumor can do and the more difficult it is to treat without a poor cosmetic outcome. The key is to find it as early as possible, when it is very small above and below the surface.
Squamous cell carcinomas tend to reveal themselves earlier - they grow large on the surface sooner and cause more discomfort and pain, becoming sensitive to the touch. This is fortunate, actually, because they are much more dangerous. If not adequately treated at an early stage, they can spread to the lymph nodes and distant organs, sometimes becoming life-threatening. They are especially dangerous around the face and neck, where the skin is so close to the bloodstream — they have a high potential to go into the lymph nodes of the neck and metastasize. Those most at risk are transplant patients and older men in their 80s and older, whose immune systems are suppressed or weakened and who are often in poor health. Squamous cell carcinomas for these patients can be especially aggressive and lethal.
Neither basal cell carcinoma nor squamous cell carcinoma is anything to trifle with.