Q: I’ve heard of people who put off surgery for years; do I have to get my skin cancer treated right away?
William Hanke, MD, MPH: Most of the time, skin cancers are caught early, when they are relatively small, and are treated with outpatient surgery, such as Mohs micrographic surgery. But sometimes they can grow to become very large. I have seen a few the diameter of a baseball or even larger!
These large skin cancers tend to be basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). These skin cancers will continue to grow if nothing is done to stop them. Extended growth can result in involvement of vital structures like the nose, eyes, ears, bone, tendon or muscle and can become disfiguring or even life-threatening. Fortunately, most of the time they grow very slowly.
While it is rare to see very large skin cancers today, one of the largest I ever treated was a patient in his 60s, with a football-sized BCC involving his right shoulder. He was one of my first patients early in my career. I performed Mohs surgery, and the skin cancer was completely removed. It never recurred. After a long life, his obituary contained heartfelt thanks, both to me as well as to a lifeguard who saved his life when he was child. The lifeguard’s name was Ronald Reagan — yes, the one who became our 40th president.
There are many reasons that some skin cancers are left untreated. A frequent scenario that I have experienced is a patient who lives in a nursing home and has a growing skin cancer that goes undiagnosed for many years. Finally, a loved one will point it out to them and get them to a physician for a biopsy.
I have patients who share that they were in denial and didn’t want to have an evaluation because they didn’t want surgery. We also see patients who delay because of fear of going to the doctor, or perhaps because of a previous poor experience with a physician. During the pandemic, we saw a delay in patients receiving medical care, and even after restrictions lightened, many patients were still hesitant to leave their homes to see the doctor.
Other patients delay because they think eventually it will heal on its own. We also see some skin cancers that grow very rapidly, and even though the patient went in to see the physician as soon as they could, it can be very large by the time of surgery.
My overall message would be that the earlier skin cancers are treated, the better the outcome and the easier the recovery. If you or a loved one has a spot that easily bleeds or won’t heal, please have a dermatologist evaluate it. You will be glad you didn’t wait. — Interview by Elizabeth Sutton, MD
About the Expert:
C. William Hanke, MD, MPH, is a Mohs surgeon at the Laser and Skin Surgery Center of Indiana. A senior vice president of The Skin Cancer Foundation and a member of its Amonette Circle, he has also served as president of 13 professional societies.