Skin Cancers of the Face and Scalp

Nearly everyone develops skin blemishes that cause them concern or embarrassment. Some of these skin lesions can be cancerous and require evaluation by a physician.

The skin of the face and scalp are particularly prone to develop skin cancers because these areas are frequently exposed to the sun and elements. Certain types of skin, particularly fair skinned individuals are more prone to the development of skin cancers. There also are certain areas, such as the scalp, lip, ears and nose, that tend to develop skin cancers more readily because of direct sun exposure and the lack of protection by clothing or sunscreens.

Skin cancer may develop in an area of previously normal skin or in a pigment spot on the skin, such as a mole. It is important to look for the danger signs in pigmented lesions of the skin. Characteristics to look for can be remembered by an easy A, B, C, D format.

Asymmetry of the lesion-one half is unlike the other half

Border irregularity- Scalloped or poorly circumscribed border

Color variation from one area to another- shades of tan, black, sometimes white, red or blue

Diameter larger then 6 mm as a rule (diameter of pencil eraser)

Precancers are conditions that are likely to give risk to malignant skin tumors. Solar or actinic keratoses occur as dry, rough, pink to tan scaly patches on sun-exposed, especially “weatherbeaten” skin.

The diagnosis and classification of skin cancer is done by examining a sample of the lesion for biopsy or, if the lesion is small enough, remove it entirely at the time of biopsy.

There are three basic types of skin cancers that differ in degree of aggressiveness. Below is a brief description of their characteristics.

Basal cell carcinoma:, the most common one, appears as a shiny, pearly plaque or bump and usually does not spread to other areas of the skin or body although it invades locally. They occur most often on the face and other exposed areas of the body, but can appear on other areas.

Squamous cell carcinoma: usually appears as a reddened, rough and scaly area which may bleed if rubbed or otherwise disturbed. They most often appear on exposed areas of the body, but also may appear elsewhere. It is a more aggressive tumor that can ulcerate and spread to distant sites.

Malignant melanoma: usually appears as a black pigmented or multi colored dark mole or plaque. It is often irregular in shape and surface, and it enlarges gradually. They may crust on the surface or bleed. Many of them arise in preexisting moles. It is the most aggressive skin tumor and can spread if not treated early. Fortunately, it is the least common type of skin cancer.

If the biopsy report states that the tissue is precancerous there are several options. You and your physician may opt for close follow-up looking for changes in symmetry, border irregularity, color and size. You may decide to have the lesion removed by a variety of methods that include surgical excision, electrosurgery, curettage, chemoexcoriation, or cryosurgery. Some precancerous, noninvase skin lesions can be treated with prescription creams that peel away the damaged skin.

Should the lesion be cancerous, additional therapy may be needed. If the lesion removed was completely excised and the skin cancer is low grade in nature, no further treatment may be necessary.

For larger tumors that have not been adequately excised, further treatment in the form of surgery will be needed. The additional surgery is done using techniques that evaluate the tissue edges (margins) right at the time of surgery to ensure that the cancer has been adequately removed.

Often there is a defect in the skin that will require various reconstructive techniques to close. If the skin is relatively relaxed then the edges can be easily brought together. Should the lesion be larger or in an area of the face or scalp where the skin is not very distensible (eg. Lip, nose, scalp and ear) special techniques to reposition the surrounding tissues are necessary in order to cover the defect created by the cancer removal.

Remember, the earlier a skin cancer is diagnosed the less complicated its’ removal and the grater chance for cure.