Surgical Procedure: Carcinomas and Melanomas

CARCINOMAS & MELANOMAS - DEFINITION

There are different types of skin cancer: carcinomas and melanomas.

Les carcinomes

There are 2 types of carcinomas: superficial basal cell carcinoma and squamous cell carcinoma (nodular basal cell carcinomas).

Les premiers sont les plus fréquents. Ce sont des tumeurs d’évolution lente, essentiellement locales, qui ne métastasent jamais.

The latter are much more aggressive and can metastasize.

Melanoma

A melanoma is a tumor that develops from melanocytes, the cells responsible for skin pigmentation.

Melanoma accounts for 10% of skin cancers. It can occur at any age but is more commonly seen in individuals who experienced sunburns before the age of 8.

Melanoma is the most serious form of skin cancer. It must be removed as quickly as possible.

In general, skin exposed to the sun is most susceptible to skin cancers.

RISK FACTORS FOR SKIN CANCER

Skin cancers are common.

On reconnaît plusieurs facteurs de risque :

• Hereditary ;
• Sun exposure: chronic (carcinoma) or repeated (melanoma) ;
• Fair skin type: light skin, light eyes, light hair;
• Personal history of skin cancer;
• Immune deficiency.

SKIN CANCERS

Basal Cell Carcinoma

Basal cell carcinoma is a relatively common malignant skin tumor.

Comme toutes les tumeurs cutanées, elle est favorisée par l’exposition solaire. Son évolution est lente. Il touche davantage les patients âgés de plus de 50 years. Il est possible d’avoir plusieurs carcinomes cutanés.

This cancer is very treatable, as soon as it is diagnosed.

Its most common form is the «pearly pearl».

Le carcinome épidermoïde

Squamous cell carcinoma develops at the expense of the skin's squamous cells (keratinocytes).

To confirm the diagnosis before removal, a biopsy may be performed to examine the cancerous cells.

Additional examinations to assess locoregional extension are possible. These may include ultrasound or CT scans.

Melanoma

A melanoma is a tumor that develops from melanocytes.

Melanocytes are the cells that give the skin its pigmentation. They produce melanin.

Frequent and repeated sun exposure since childhood is the main risk factor. Repeated sunburns are also significant risk factors.

Diagnosing melanoma

The ABCDE rule helps in the diagnosis of melanoma:

• A for asymmetry ;
• B for Irregular edges ;
• C for a heterogeneous or very dark color ;
• D for a Diameter (size) ;
• E for Evolution rapide.

Melanoma treatment

Il est primordial d’effectuer rapidement une chirurgie du mélanome pour le retirer le plus vite possible. Plus un mélanome malin est rapidement supprimé, moins les chances de voir le cancer s’étendre sont fortes. De la même façon, les risques de récidive diminuent.

Your surgeon can remove the tumor through excision (removal using a scalpel) or via photodynamic therapy.

An exeresis-biopsy will be performed to determine the type of lesion and deep invasion.

A more general work-up may be prescribed to assess the possibility of locoregional (lymph node) or distant invasion.

Complementary treatments

In addition to surgical removal of the melanoma, complementary treatments are available:

- Lymph node dissection ;

- chemotherapy or immunotherapy.

SURGICAL TREATMENT

L’exérèse chirurgicale est le traitement le plus souvent préconisé. Un plastic surgeon ou un dermatologue peut réaliser cette chirurgie.

First, the lesion is visually identified and biopsied for histological diagnosis.

The histological type can be used to specify the surgical procedure, and in particular the margins of exeresis.

In fact, the safety perimeter (margin) can range from 2 mm to 2 cm, depending on the tumour.

Excisional surgery is usually performed under local anaesthetic.

Une fois la tumeur retirée, elle est envoyée pour analyse histologique.

The results of this analysis are generally reported in 10 to 15 days. Depending on the result, a dermatological follow-up is organized.