Squamous Cell Skin Cancers Can Kill

Skin CancerAs part of my office visits, I routinely question patients about health checkups and benchmarking. We talk about eye exams and glaucoma. We talk about women’s health issues and gynecologic exams plus mammograms and bone densitometry.  We talk about colon cancer screening and colonoscopies and immunochemical fecal occult blood slides.  We always ask about skin and whole body checkups with a dermatologist or a primary care physician.

Patients often ask me why I am constantly harping on looking at these issues. “I am old and have survived quite well without these checkups until now.”  

Florida is my home state and it is in the extreme Sun Belt and one of the skin cancer capitals of the world. MedPage Today, the University of Pennsylvania online journal justified my questions about skin cancer and skin exams by publishing a synopsis of Chrysalyne D. Schmults, MD and associates at Harvard University publication in the May issue of JAMA Dermatology.  They reviewed the pathology reports of skin cancer from Brigham and Women’s Hospital in Boston from 2000 through 2009 identifying 1,832 tumors in 985 patients. More than half of the patients were men, most were Caucasian and a suppressed immune system was present in almost 15%. Tumor diameter was less than 2cm (2.54 cm equal an inch) in 85%, was well differentiated in 66% and the tumor was limited to the upper skin level or dermis in 89.5%. The most common locations were the head and neck (28.7%), the legs or feet ( 23.7%), and the hands or arms in 21.6%. Treatment included standard excision in 69.5% and Moths Surgery in 20.2%

Analysis for spread to the lymph nodes, local recurrence, or death due to the disease directly or indirectly seemed to be related to certain factors.  Age over 70, male sex, poor tumor differentiation and perineural invasion all were considered poor risk factors. The death rate from the squamous cell skin cancer approached 3%

The data reviewed in this study will allow researchers to design evaluation and surveillance protocols for high risk skin cancer patients. Until now, no study actually defined what characteristics comprised a high risk skin cancer patient.  

As we head into the summer season it is a reminder of the need for us to use SPF 30 or greater sunscreen on all exposed areas and reapply liberally. Wear wide brimmed hats and clothing with a tight weave to protect your skin. Above all, see your board certified dermatologist for a whole body skin checkup regularly to prevent the growth and spread of a preventable killer disease.

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