Skin cancer

By Jack Krayenhoff, M.D.

Let’s start with the cancer that does not seed itself. That sounds like it isn’t cancer at all, but what does the pathologist say? A pathologist decides. He looks at it through the microscope, and what does he see? Cancer cells, typical cancer cells. Whether this cancer spreads itself or not is not his worry. So he calls it cancer, basal cell cancer. Basal, because it starts in the basal layer of the skin. The basal cells push their offspring to the surface, where they form the horn layer, and are rubbed off, or fall off.

How common are they? Very common. One out of three people get it. Some people get several ones in their life, especially the fair complexioned. It is worth knowing what they look like, for when they are small they are easy to remove. They form a lump; initially a small lump, but you can always feel it when you run your finger over it. They call it the colour of apple jelly. If you let it grow, it gets a dimple in the middle and eventually an ulcer may form. This bleeds occasionally, forms a scab, the scab falls off, it bleeds some more. In the meantime it gets bigger, eats away the surrounding healthy tissues, and it now becomes harder to remove. Now it becomes clear why it is called cancer, because it never stops growing.

They grow 80% on the face and neck, so they thrive on sunshine.  In fact some people with a fair complexion routinely use sun screen lotion on their face, to prevent basal cell carcinoma. I suppose you have to have parents who had a lot of trouble with cancer to start such a severe regimen just to prevent a cancer.

For treatment, the old longitudinal excision with a rim of healthy-looking skin is the best. But burning it off with an electric needle, followed by curettage, is also good. Finally there is fluorouracil ointment that works well. It is the only skin cancer that responds to that ointment.

Now there are rare forms of basal cell cancer that grow flat, or with nodules, or in forms that are different from the ones that are above described. They cannot be diagnosed by their appearance; they will need a biopsy. They don’t occur on the face and neck by preference. In any event, if something keeps growing: let your doctor look at it, even if it is not bumpy.

In summary, if you see a lumpy spot on your face or neck, especially if it looks like apple jelly: go to your doctor and ask him, “Is this little lump a basal cell carcinoma?” He’ll be impressed.