Skin Cancer & What It Looks like
In the first week we were open, in February 2009, we had a very kind, but very ill lady see us for a severe bronchitis she had. There was no doubt she had bronchitis: she also had Basal Cell skin cancer on her right antecubital area (mid-arm crease). We treated the bronchitis and saw her back for her 2 week follow-up at which time we discussed her more serious condition and scheduled a minor surgical treatment on the following Saturday morning, (we do our minor surgey on Saturday mornings for best outcomes).
Being near a major blood vessel, the surgery was technically challenging, but with over 2 decades of surgical experience, our medical director was able to remove the entire abnormal lesion safely and completely. Basal Cell skin cancer is very common in Santa Fe and represents about 75% of all skin cancer. Squamous Cell cancer is responsible for about 20% of skin cancers and Melanoma is present in about 5% of skin cancer cases. Needless to say, after being cured of severe bronchitis and Basal Cell skin cancer- she was very happy.
However, as in most cases, once a person has one type of skin cancer they're more at risk for another skin cancer, either of the same or of a different type as the skin is now defined as one of their 'weak' areas. About 18 months later, following advice that no 'new' spots should appear, she came in after finding a 'new' spot on her lower right leg. The right leg lesion turned out to be Melanoma- the most dangerous and deadly of all skin cancers.
We saw her again, on a Saturday morning and removed the entire cancerous area. The key to good outcomes with skin cancer: being observant and coming in at the earliest possible moment.
Basic 'Rules' to Prevent Skin Cancer
Basic rules for preventing skin cancer include: to make sure you come in and see us whenever you have a skin lesion (spot) that changes in size, shape, or color, or is new. You should not be getting any 'new' spots. Next, we want to make sure that none of your current spots has more than one color and that none has an irregular border or outline.
Prevention is critical at 7,000 ft elevation. We have 37% more solar radiation and the skin both burns and has a greater chance of developing abnormalities at this high altitude. So, please wear a full, wide brimmed hat, not a baseball cap. Those New Mexico cowboys we have wear their hats for good looks... and for safety.
Below we've assembled a moderate collection of Basal Cell, Squamous Cell, and finally Melenoma skin cancers. We call it our 'dirty picture' library, and it has some really disgusting shots to look at; but they're shots you need to see!
Surgery for Abnormal Lesions
After over 2 decades of surgical experience, we obtain excellent results in our procedures. However, when a lesion is in a difficult area, or appears as though it may have 'gone deep' we do not refer patients to dermatologists or plastic surgeons- two specialists groups who 'typically' get the more complex cases. Instead we've been referring these challenging cases, for the last decade, to 'Mohs' surgeons.
Mohs' surgeons are the most scientific and exacting of surgeons who will not only perform surgery, but will, in real time, examine each area of tissue sample as a pathologist would do using a microscopic for evaluation of each tissue sample, and do so in the operating room. These fine surgeons 'drill down' deep into tissue to follow trails of abnormal lesions which would take a dozen or more procedures for anyone else. Moh's surgeons are extremely talented and have prevented at least 2 of our patients from having 'small' sized lesions on their nose, from causing sinus and then brain cancer. Each of these patients had very large sections of their superficial and deep nasal tissue excised, and spontaneously reconstructed. They each look great, almost as though no lesion was ever present and as though no surgery had ever been performed. Now that's science with great outcomes!
Some Basics: Sun Time, Cancer Areas on Men and Women
At 7,000 feet elevation we have about 37% more solar radiation exposure than at sea level. That means in the same 30 minutes at sea level where you'd get the start of a 'nice tan' you'd be working on a 'sun burn' at 7,000 feet. That's quick!
Depending on the weave of your clothing, and the types of rays hitting you, the burn can occur through your clothes! That's right- wear a certain type of shirt and you'll get a sun burn despite wearing that shirt!
From the diagram, you can see the dominant type of cancer we see and surgically remove most often in Santa Fe is Basal Cell cancer: a full 75% of the cases. Next is Squamous Cell cancer at 20%; and finally, although it's the rarest, its also the deadliest: Melanoma is only 5% of the cancers we see and treat, but its also the deadliest. In the last photo at the bottom of the page, you'll see how superficial or deep each cancer typically occurs. Melanoma is the deepest and the quickest, which makes it easy for this cancer to get down deep into and enter other tissues and spread throughout the body.
From the diagram at right, you can see that while both sexes have a 100% risk for skin cancer: women are more likely to get cancer in the legs; men more likely to get skin cancer on the trunk. Think of all those 'leggy' female movie stars and models; then think of Matthew McConnahey taking off his shirt- for multiple reasons to show his chest (our favorite was the Letterman show where he was in a full Astronaut outfit, with his shirt off and bare chest exposed while standing atop the moon while holding the American flag).
Those two examples exagerate, yet accurately describe much human activity, which poses and which exposes the sexes to increased solar radiation, sun bun, and skin cancer.
Dirty Picture library: Basal Skin Cancer (75% of Skin Cancers)
Below are a dozen images of 'typical' views and locations of basal skin cancer. Please look at each photo. Ask yourself: do you or somebody you care about have one of these lesions, or something that looks like one of these nasty things?
Squamous Cell Cancer: 20% of Skin Cancers
Below are Squamous Cell cancers which make up 20% of skin cancers. While far less than Basal Cell cancer at 75%- these are some deadly skin lesions which need to be identified and cut out. Check out the dozen 'dirty photos' below:
Melanoma: Treat Before it's Malignant Melanoma!
That's right: these are the dirtiest, nastiest photos you'll see. Best part is, with your help we can find these nasty cancers, and we can cut them out, and the person lives. If caught late: these cancers are fast, destructive and deadly!
Imagine you see a man or lady at the check-out at the grocery, and they have one of these nasty spots on their body. A few kind words from you to help or encourage getting this person into evaluation and treatment could save this person's life. What's that worth to you? Do you believe in Karma? Now what's it worth?
Back in 1994 our medical director was seeing a forest ranger after the man had fallen 25 feet out of an observation tree stand. There was little doubt he'd broken part of his back (he'd partially crushed a single L-4 Lumbar vertebrae). While it 'hurt like hell', what we discovered when we looked at the skin (after x-rays were taken) revealed WAY more than the ranger provided in his history. No he didn't have a stick or another forest creature protruding from his body.
Yes, he had a partial compression fracture of the 4th Lumbar vertebrae, (which would heal and stabilize without further treatment, besides some pain medication), he also had an abnormal lesion on the skin of his back which was about 7.5 x 4.5 x 10.5 cm in diameter. This abormomally shaped lesion was: black, blue, dark brown, lite brown, tan, white, red, and purple!! Do you think he was in some serious denial about what was going on with his back?
All his wife said was, 'I told you it didn't look right.'
Then she was quiet and let our director explain to 'knuckle head' how he'd not been acting 'real bright' in ignoring this cancerous lesion 'Stevie Wonder' could not miss!
His question: 'What are you gonna do doc?
The answer: 'We were going to cut it out , 'deep and wide". Of course he asked what that meant, and when repeated he understood! Deep and wide!
The ranger's back pain was non-existant at 6 months. He had a deep excision of the cancer, and had ALL margins of the abnormal lesion cut out 'en-toto' completely. Also, at 6 months, there was no cancer and no spread! Also the scar was very small and barely noticable!
So, after it was explained how deep he'd stepped into it, do you think he was thrilled at how safe he was post-op? No more cancer? The man was thrilled. Most important he admittted that 'de nile' was a river in Egypt he was unwilling to return to. This 'rarely ever seen' man came for evaluation every 4 months and never had a reoccurrance of cancer. Do you think he was happy? What do you think that was worth to a man with a beautiful 4 year-old daughter?
We, at Adobe Family Practice, want you to help us find this man's brother, sister, or cousin with a similar problem. Please be our eyes and ears. Help us find and help these people who you've seen out in public to not develop malignant melanoma- where this cancer spreads to every organ system in the body and causes a horrible, painful, and preventable death. What would that be worth to you?
Some Final Skin Cancer Thoughts
On the Left you have the very superficial Squamous Cell Skin Cancer: we have more time to find and treat this lesion due to slower growth and smaller depth. Next we have the deeper Basal Cell Cancer: you can see it's deeper and grows faster. Recall 75% of skin cancer is Basal Cell Cancer. Finally, we have the damned Melanoma Skin Cancer which, due to rapid growth and depth, will end up system wide killing people quickly.
How quickly: a melanoma can take a healthy person from a needle sized lesion on the nose, and 'no problems' to a horrible painful death in under 2 years! Please never 'ignore' that small spot on your nose, or chest, or leg. You know you should not be 'developing' new lesions or spots anywhere on your body. If you feel they're 'normal' age spots, rest assured, many 'age spots' are pre-cancerous or cancerous! Come on in and let us take an objective look at the 'spot'. Most 'age spots' can be treated in less than 10 minutes in the office. Worse we do is save your life!
Our medical director has surgically excised lesions from sergeants in the special forces of our country (they tend to get more sun and more gun shot wounds) to generals, Congresmen and Senators, diplomats and ambassadors, and most important: regular working people who want to be healthy for their families. Our soldiers, sailors and airmen risk their lives so 'we the people' can live safely. Please make sure these honorable peoples' sacrifices protect you and those you care about! Our soldiers' sacrifices matter only if you help them to matter! Do the right thing!