An encounter with skin cancer

Last June 15, 2013, I went to my dermatologist to have my mole removed.  I’ve been planning to have this surgery for a long time but due to many reasons It has never become my priority.  I eventually decided to have it done because this mole was painful sometimes, especially if it does not like the soap I’m using or anything that touches it. So there I was on the table fully conscious as the doctor injected anaesthesia on it after which she prick it with a needle to test if it still hurts.  She kept on asking me if I feel anything when she did it, I kept telling her that it hurts a bit but it is tolerable. So she did her thing, performing the incision to remove the mole and we decided to have a skin biopsy on the skin sample. Then she stitches it with a thick strong surgical thread just to ensure that it will not break open, by the way it’s three stitches.  My mole is located on my upper trunk (on my back).   She have prescribed that I take 500 mg. Cephalexin three times a day for one week to aid in the healing of the wound.  She told me that she will just call me if the result of the skin biopsy is already available.  After eight days I went back to the clinic to have the surgical thread removed.  After that I forget about it but then last July 12, 2013 her secretary text me and told me that my doctor ask for me to visit her in her clinic because of the result of the skin biopsy.  I became worried because she told me before in her clinic during the incision that she will just call or text me if there is something to worry about with the result. I did not get there right away because during that time my son got admitted in the hospital because of Dengue Hemorrhagic Fever.  Life sometimes tests you…but of course you just have to be strong. So I finally got there the day after my son got discharge from the hospital on July 16, 2013 and got the news. 

My dermatologist explained that the mole that was removed is consistent with Basal Cell Carcinoma, a type of skin cancer but there is nothing to worry about.  She inspected the scar and prescribed Imiquimod cream to be applied every other night for three months.  She said that skin cancer is different from other cancer because usually when it is removed it is already cured but there is also a possibility of recurrence.  She advised me to visit her clinic every six months so that she can inspect my skin if ever it will reoccur. 

close up picture of the scar

I had this mole for more than fifteen years and I only found out now that it was cancerous, but of course I had my doubts because unlike my other moles it’s colour is more like flesh and sometime it forms a crust over it and got easily irritated.  I read on the internet about this type of skin cancer and here are some of the facts. 

Basal cell carcinoma (BCC) is the most common form of skin cancer. More than two million cases of this skin cancer are diagnosed in the United States each year.

This skin cancer usually develops on skin that gets sun exposure, such as on the head, neck, and back of the hands. BCC is especially common on the face, often forming on the nose. It is possible to get BCC on any part of the body, including the trunk, legs, and arms.

People who use tanning beds have a much higher risk of getting BCC. They also tend to get BCC earlier in life.

This type of skin cancer grows slowly. It rarely spreads to other parts of the body. Treatment is important because BCC can grow wide and deep, destroying skin tissue and bone. 

Basal cell carcinoma: Diagnosis, treatment, and outcome

The only way to diagnose any type of skin cancer, including basal cell carcinoma (BCC), is with a skin biopsy. Your dermatologist can perform this procedure during an office visit.

A skin biopsy should not cause anxiety. To perform a skin biopsy, your dermatologist will remove the entire growth or part of it. Your dermatologist may send this to a laboratory or look at it under a microscope. The findings will be communicated in a biopsy report.

If the biopsy report states that you have BCC, your dermatologist will consider many factors to determine which treatment will be best for you. There are several ways to treat BCC:

Excision: This is a surgical procedure that your dermatologist often can perform during an office visit. It involves numbing the area to be treated and cutting out any remaining tumor plus some normal-looking skin around the tumor.

Like the skin biopsy, this removed skin is examined under the microscope. This may be done at a laboratory or by your dermatologist. The doctor who looks at the removed skin needs to see whether the normal-looking skin is free of cancer cells. If not, more skin will need to be removed. This is a common way to treat BCC.

Curettage and electrodessication: This treatment consists of two steps. First, your dermatologist scrapes away the tumor. Then electricity is used to destroy any remaining cancer cells. The two steps are then repeated.

Mohs surgery: Named for the doctor who developed this surgery, Mohs (pronounced "moes") is a specialized surgery used to remove some skin cancers. It offers the highest cure rate for difficult-to-treat basal cell cancers. Your dermatologist will tell you if Mohs is right for you.

If Mohs is recommended, this is what you can expect. The surgeon will cut out the tumor plus a very small amount of normal-looking skin surrounding the tumor. While the patient waits, the Mohs surgeon uses a microscope to look at what was removed. The surgeon is looking for cancer cells.

If necessary, the Mohs surgeon will continue to remove a very small amount of skin and look at it under the microscope. This continues until the surgeon no longer sees cancer cells.

Cryosurgery: This treatment uses liquid nitrogen to freeze cancer cells, causing the cells to die.

Radiation: This treatment usually is reserved for BCCs that cannot be cut out, or when surgery may not be the best choice. A patient may need 15 to 30 radiation treatments.

Photodynamic therapy (PDT): This treatment uses light to remove early skin cancers. PDT is a two-step process. First, a chemical is applied to the skin. The chemical remains on the skin for some time so that it can be absorbed. Then the skin is exposed to a special light to kill the cancer cells.

Medicated creams: Creams that contain a drug, such as imiquimod or 5-fluorouracil, can be used to treat early BCC. A patient applies the medicated cream at home as directed by his or her dermatologist.

Pills: While extremely rare, there are reports of BCC spreading to other parts of the body. Patients who have BCC that spreads may be prescribed vismodegib. This medication also may be prescribed for patients who have advanced BCC that cannot be cut out or treated with radiation.

Outcome

Nearly every basal cell cancer can be cured, especially when the cancer is found early and treated. 

BCCs are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars. Usually caused by a combination of cumulative UV exposure and intense, occasional UV exposure, BCC can be highly disfiguring if allowed to grow, but almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can BCC spread to other parts of the body and become life-threatening.  BCCs are easily treated in their early stages. The larger the tumor has grown, however, the more extensive the treatment needed. Although this skin cancer seldom spreads, or metastasizes, to vital organs, it can damage surrounding tissue, sometimes causing considerable destruction and disfigurement — and some BCCs are more aggressive than others.

When small skin cancers are removed, the scars are usually cosmetically acceptable. If the tumors are very large, a skin graft or flap may be used to repair the wound in order to achieve the best cosmetic result and facilitate healing

People who have had one BCC are at risk for developing others over the years, either in the same area or elsewhere on the body. Therefore, regular visits to a dermatologist should be routine so that not only the site(s) previously treated, but the entire skin surface can be examined.

BCCs on the scalp and nose are especially troublesome, with recurrences typically taking place within the first two years following surgery.

Should a cancer recur, the physician might recommend a different type of treatment. Some methods, such as Mohs micrographic surgery, may be highly effective for recurrences. BCCs and other skin cancers are almost always curable when detected and treated early