Surgical Procedure: Carcinomas and Melanomas

CARCINOMAS & MELANOMAS - DEFINITION

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

Carcinomas

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

The first are the most common. They are slow-growing tumors, primarily local, and never metastasize.

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.

Several risk factors can be identified:

• 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.

Like all skin tumors, it is promoted by sun exposure. Its growth is slow and it primarily affects patients over the age of 50. It is possible to have multiple skin carcinomas.

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

Its most common form is the «pearly pearl».

Squamous cell carcinoma

Squamous cell carcinoma develops from the squamous cells of the skin (the 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

It is essential to perform a melanoma surgery promptly to remove it as quickly as possible. The faster a malignant melanoma is removed, the lower the chances of the cancer spreading. Similarly, the risk of recurrence is reduced.

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

Surgical excision is the most commonly recommended treatment. An esthetic surgeon or a dermatologist can perform this surgery.

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.

Once the tumor has been removed, it is sent for histological analysis.

The result of this analysis is usually delivered within 10 to 15 days. Depending on the result, a dermatological follow-up is organized.