Skin Cancer Essays - Dermatologic Surgery, Carcinoma, RTT

Skin Cancer Every hour one American is killed by skin cancer and every thirty seconds one American gets skin cancer. Cancer is a deadly disease that alters the DNA of a skin cell and causes it to reproduce at a rapid pace. This overproduction of cells can be harmful and in many cases deadly. Out of these cancers the most common is Basal cell carcinoma. Many steps have been made in the treatment of Basal Cell Carcinoma, some have been very successful and some not. The cells that have the altered DNA are called malignant or cancerous cells. These cells are found in the outer layers of the skin. The skin's main job is protect the body from infections and to insulate the body to keep it at the proper temperature. The first layer of skin is called the epidermis. This is the layer that is closest to the surface of the skin. There are three types of cells in this layer. The first is the squamace. The squamace cells are flat and scaly and are located closest to the surface of the skin. Second are the basal cells and finally are the melanocytes which give the skin its color. The second layer of skin is the dermis, which is much thicker than the epidermis. This layer contains sweat glands, nerves and blood vessels. The dermis also contains follicles which are tiny pockets from which the hair grows. (Jablonski) The most common malignant cells are the basal cells. Cancer in the basal cell is called nonmelanoma cancer. This means that the cancer did not start in the melanocytes located in the epidermis. (Prestan 1650) Basal Cell Carcinoma is caused by overexposure to the sun. The sun gives off ultraviolet rays which are harmful to the human body. Basal cell carcinoma will affect body parts such as the eyes, ears and nose. If it is detected before it gets deep into the skin there will most likely be no problem treating the cancer. The problem is when it is detected after it has progressed into the deep portions of you tissue. If Basal cell carcinoma is left untreated it can be very hard to treat and may even cause death. (Elson, 1) The common methods of treatment involve the use of Mohs micrographic surgery, radiation therapy, electrodesiccation and curettage, and simple excision. Each of these methods is useful in specific clinical situations. Depending on the case, these methods have cure rates ranging from 85% to 95%. Mohs micrographic surgery, a newer surgical technique, has the highest cure rate for surgical treatment of both primary and recurrent tumors. This method uses microscopic control to determine the extent of tumor invasion. Although Mohs micrographic surgery method is complicated and requires special training, it has the highest cure rate of all surgical treatments because the tumor is microscopically outlined until it is completely removed. While other treatment methods for recurrent basal cell carcinoma have failure rates of about 50%, cure rates have been reported at 96% when treated by Mohs micrographic surgery. (Thomas 135-142) "Mohs micrographic surgery is also indicated for tumors with poorly defined clinical borders, tumors with diameters larger than two cm, tumors with histopathologic features showing morpheaform or sclerotic patterns, and tumors arising in regions where maximum preservation of uninvolved tissue is desirable, such as eyelid, nose and finger." (Thomas 135) Next there is a treatment involving simple excision with frozen or permanent sectioning for margin evaluation. This traditional surgical treatment usually relies on surgical margins ranging from three to ten millimeters, depending on the diameter of the tumor. (Abide 492-497) Tumor recurrence is not uncommon because only a small fraction of the total tumor margin is examined pathologically. Recurrence rate for primary tumors greater than 1.5 cm in diameter is at least twelve percent within five years; if the primary tumor measures larger than three cm, the five year recurrence rate is 23.1%. Primary tumors of the ears, eyes, scalp, and nose have recurrence rates ranging from 12.9% to 25%. Third there is electrodesiccation and curettage. This method is the most widely employed method for removing primary basal cell carcinomas. Although it is a quick method for destroying tumor, adequacy of treatment cannot be assessed immediately since the surgeon cannot visually detect the depth of microscopic tumor invasion. Tumors with diameters ranging from two to five mm have a fifteen percent recurrence rate after treatment with electrodesiccation and curettage. When tumors larger than three cm are treated with electrodesiccation and curettage,