Healthy Living

Nonmelanoma Skin Cancer: Warning Signs and Treatments

Skin cancer is the most common type of cancer in the U.S. Most people are familiar with the ABCDEs for identifying suspicious moles: A for asymmetry, B for border irregularity, C for color, D for diameter (greater than 6mm) and E for evolving. These are important guidelines to follow when performing self-exams, which the Skin Cancer Foundation recommends doing every month. Self-exams can help to identify potential skin cancers early when they might be more easily treated.

However, the ABCDE rule mostly pertains to melanoma, not nonmelanoma skin cancer (NMSC), which is the most common form of skin cancer. NMSC affects three million people in the U.S. each year and this number is projected to increase in the years ahead. In fact, between 40 and 50 percent of Americans who live to age 65 will have NMSC at least once in their lifetime.

How to Identify NMSC

NMSC cannot be identified using the ABCDE method because this type of cancer is not usually pigmented; NMSC are often flesh-toned or appear as red sores or rough bumps or growths. They might also be tender, painful or bleed easily. Most people associate skin cancer with the characteristic dark, misshapen moles of melanoma, so NMSC can be easily overlooked. There are two major types of NMSC: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BCC often appears as small bumps or itchy red, pinkish spots that can bleed easily from slight friction. BCC also often develops on the face, where it might be confused with a pimple. Meanwhile, SCC often appears as a rough or warty growth that is thicker and more irregular compared to BCC and can be extremely painful.

Most NMSC occurs in people over the age of 50, however even people in their 30s and 40s can develop NMSC, especially if they are very fair skinned and have excessive sun exposure. Both basal and squamous cell skin cancers are usually caused by chronic sun exposure and appear mostly on the head, neck, back, chest, hands or shoulders. Any unusual growths or changes should be reported to a doctor immediately.

There are three options for treating NMSC: surgery, chemotherapy or radiation. Mohs micrographic surgery is the standard of care for treatment of NMSC. While it has been shown to be effective for many patients, it can result in serious disfigurement depending on the size and anatomical location of a lesion. In severe cases, some patients may require corrective plastic surgery procedures following Mohs surgery, resulting in additional procedures, costs and an increased risk of complications. Also, about 50 percent of patients with one NMSC will develop additional skin cancers within five years. With each additional skin cancer, the risk of disfiguring scarring increases.

A Painless, Non-invasive Treatment Option

There are several different types of radiation treatments available. For many dermatologists, electronic brachytherapy (eBx) is an attractive option because it has been shown to be safe and effective, it is painless and non-invasive, and involves a shorter course of treatment compared to other forms of radiation. eBx uses a miniaturized high-dose rate X-ray source to deliver targeted radiation directly to the cancerous site. The goal is to direct the radiation dose to the size and shape of the cancerous area, sparing healthy tissue and organs. With this targeted approach, eBx leaves virtually no scarring and has a reduced risk of other complications compared to traditional surgical options.

In addition, most clinicians agree that tumor control rates following treatment with eBx are generally equivalent to surgery. Recent clinical data has also shown 5-year local control rates above 90 percent for both BCC and SCC.

At Spokane Dermatology Clinic and Werschler Aesthetics, we offer eBx with the Xoft® Axxent® Electronic Brachytherapy System®. With the Xoft System, eBx is typically delivered two times a week for four weeks – a total of just eight treatments compared to more traditional radiotherapy that can require 20-40 treatments. Each eBx treatment session takes less than three minutes. This option is often an important advantage for patients with lesions in anatomically challenging locations (ear, nose, scalp, neck, shin), patients who may have trouble with wound healing, patients who are on anticoagulants, or those with medical comorbidities that may preclude them from surgery. Also, some patients for personal reasons decline surgery. Patients prefer the added convenience, with fewer treatments compared to traditional radiotherapy while offering excellent clinical results. In one study, patients unanimously agreed the treatment with eBx was convenient, and most patients said they would recommend the treatment to a friend with NMSC.

A growing body of evidence supports the use of eBx for NMSC patients who meet specific selection criteria. However, eBx may not be appropriate for everyone, so it’s important to have an open dialogue with your doctor regarding the available treatment options including the associated benefits and risks so you can make an informed decision about your care.

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