Glossary of medical terms – In English – even Robyn can understand!
• What is a BCC?
Basal-cell carcinoma (BCC), is a slow-growing form of skin cancer and is the most common cancer and rarely metastasizes or kills. However, because it can cause significant destruction and disfigurement by invading surrounding tissues, it is still considered malignant. BCC’s fall into the non-melanoma skin cancer category.
Statistically, approximately 3 out of 10 Caucasians may develop a basal-cell cancer within their lifetime. In 80 percent of all cases, basal-cell cancers are found on the head and neck.
Basal cell carcinoma starts in the top layer of the skin called the epidermis. Most basal cell cancers occur on skin that is regularly exposed to sunlight or other ultraviolet radiation. This includes the top of your head, or scalp. They are most common in people over age 40. However, it occurs in younger people, too.
You are more likely to get basal cell skin cancer if you have:
• Light-colored or freckled skin
• Blue, green, or grey eyes
• Blonde or red hair
• Overexposure to x-rays or other forms of radiation
• Many moles
• Close relatives who have or had skin cancer
• Many severe sunburns early in life
• Long-term daily sun exposure (such as the sun exposure people who work outside receive)
Basal cell skin cancer grows slowly and is usually painless. It may not look that different from your normal skin. You may have a skin bump or growth that is:
• Pearly or waxy
• White or light pink
• Flesh-colored or brown
In some cases the skin may be just slightly raised or even flat.
You may have:
• A skin sore that bleeds easily
• A sore that does not heal
• Oozing or crusting spots in a sore
• A scar-like sore without having injured the area
• Irregular blood vessels in or around the spot
• A sore with a depressed (sunken) area in the middle
Your doctor will check your skin and look at the size, shape, colour, and texture of any suspicious areas and if necessary, a piece of skin will be removed and sent to a lab for examination under a microscope. This is called a skin biopsy and must be carried out to confirm basal cell skin cancer or other skin cancers.
Treatment depends on the size, depth, and location of the skin cancer, and your overall health.
Treatment may involve:
• Excision: Cutting out the skin cancer and stitching the skin together
• Curettage and electrodesiccation: Scraping away cancer cells and using electricity to kill any that remain
• Cryosurgery: Freezing the cancer cells, which kills them
• Medication: Skin creams containing imiquimod or 5-fluorouracil for superficial (not very deep) basal cell cancer
• Removing a layer of skin and looking at it immediately under a microscope, then removing many layers of skin until there are no signs of the cancer; Usually used for skin cancers on the nose, ears, and other areas of the face.
• Photodynamic therapy: Treatment using light
Radiation may be used if a basal cell cancer cannot be treated with surgery.
How well a patient does depends on many things, including how quickly the cancer was diagnosed. Most of these cancers are cured when treated early.
Some basal cell cancers may return. Smaller ones are less likely to come back. Basal cell carcinoma almost never spreads to other parts of the body. Basal cell skin cancer almost never spreads. But, if left untreated, it may grow into surrounding areas and nearby tissues and bone. This is most worrisome around the nose, eyes, and ears.
If you have had skin cancer, you should have regular check-ups so that a doctor can examine your skin. You should also examine your skin once a month. Use a hand mirror to check hard-to-see places. Call your doctor if you notice anything unusual.
Call your health care provider if you notice any changes in your skin. You should also call if an existing spot becomes painful or swollen, or if it starts to bleed or itch.
The best way to prevent skin cancer is to reduce your exposure to sunlight. Ultraviolet light is most intense between 10 a.m. and 4 p.m., so try to avoid sun exposure during these hours. Protect the skin by wearing hats, long-sleeved shirts, long skirts, or pants.
Always use sunscreen:
• Apply high-quality sunscreens with sun protection factor (SPF) ratings of at least 15, even when you are only going outdoors for a short time.
• Apply a large amount of sunscreen on all exposed areas, including ears and feet.
• Look for sunscreens that block both UVA and UVB light.
• Use a waterproof formula.
• Apply sunscreen at least 30 minutes before going outside, and reapply it frequently, especially after swimming.
• Use sunscreen in winter, too. Protect yourself even on cloudy days.
Other important facts to help you avoid too much sun exposure:
• Avoid surfaces that reflect light more, such as water, sand, concrete, and white-painted areas.
• The dangers are greater closer to the start of summer.
• Skin burns faster at higher altitudes.
• Avoid sun lamps, tanning beds, and tanning salons.
What is an SCC?
Squamous cell cancer may occur in normal skin or in skin that has been injured or inflamed. Most skin cancers occur on skin that is regularly exposed to sunlight or other ultraviolet radiation.
The earliest form of squamous cell skin cancer is called Bowen’s disease (or squamous cell in situ). This type has not spread to nearby tissues.
Risks for squamous cell skin cancer include:
• Having light-colored skin, blue or green eyes, or blond or red hair
• Long-term, daily sun exposure (such as in people who work outside)
• Many severe sunburns early in life
• Older age
• Having had many x-rays
• Chemical exposure
Squamous cell skin cancer usually occurs on the face, ears, neck, hands, or arm. It may occur on other areas.
The main symptom is a growing bump that may have a rough, scaly surface and flat reddish patches.
The earliest form appears as a scaly, crusted, and large reddish patch (often larger than 1 inch).
A sore that does not heal can be a sign of squamous cell cancer. Any change in an existing wart, mole, or other skin lesion could be a sign of skin cancer
Call your health care provider if you notice any changes in your skin. You should also call if an existing spot becomes painful or swollen, or if it starts to bleed or itch
• What is a Melanoma?
Melanoma is the fourth most common cancer diagnosed in Australia, which along with New Zealand, has the world’s highest incidence rate for melanoma.
This figure excludes non-melanoma skin cancer, which is the most commonly diagnosed cancer according to general practice and hospitals data, however there is no reporting of cases to cancer registries.
Melanoma is the seventh most common cause of cancer death in Australia
According to the Cancer Council figures for 2009, there were over 11,500 new cases of melanoma diagnosed in Australia, accounting for nearly one in ten cancer diagnoses. This figure has obviously increased over the past three years.
Melanoma is more commonly diagnosed in men than women. The risk of being diagnosed with melanoma by age 85 is 1 in 14 for men compared to 1 in 23 for women.
In Australia in 2011, there were 1544 deaths due to melanoma.
People who are at high risk of melanoma should be taught to check their skin for irregular or changing lesions, and have annual checks by a dermatologist.
Often melanoma has no symptoms, however it can be associated with changes that relate to ‘ABCDE’ – Asymmetry, irregular Border, uneven Colour, Diameter (usually over 6mm), Evolving (changing and growing). Other symptoms include dark areas under nails or on membranes lining the mouth, vagina or anus.
Melanoma risk increases with exposure to UV radiation, particularly with episodes of sunburn (especially during childhood).
Melanoma risk is increased for people who have:
• increased numbers of unusual moles
• depressed immune systems
• a family history of melanoma in a first degree relative
• fair skin, a tendency to burn rather than tan, freckles, light eye colour, light or red hair colour
• had a previous melanoma or non-melanoma skin cancer.
Diagnosis is by biopsy to remove the whole lesion. If the excised lesion is thick, a biopsy of the first draining lymph node is performed.
The most important feature of a melanoma in predicting its outcome is its thickness (stage 0 is less than 0.1mm, stage I less than 2mm, stage II greater than 2mm, stage III spread to lymph nodes and stage IV distant spread). The presence of ulceration also predicts a poor outcome. If distant spread is suspected, CT scans of the chest, abdomen and pelvis are performed. The blood test LDH can sometimes be useful to assess metastatic disease.
Avoid sunburn by minimising sun exposure when the SunSmart UV Alert exceeds 3 and especially in the middle of the day when UV levels are most intense. Seek shade, wear a hat that covers the head, neck and ears, wear sun protective clothing and close-fitting sunglasses, and wear an SPF30+ sunscreen. Avoid using solariums (tanning salons).
Surgery can be curative for thin melanomas and requires that the melanoma be removed with at least 1–2cm of normal skin around it. If the draining lymph nodes are involved they are removed.
For thick melanomas some cancer centres offer high dose interferon after surgery, however many offer clinical trials of vaccines because there is no routine therapy mandated. Surgery should be the mainstay of treating relapsed melanoma if it is possible to remove all of the disease.
An individual’s prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis. Five year survival for people diagnosed with melanoma is 91%, rising to 99% if the melanoma is detected before it has spread. If spread is within the region of the primary melanoma, the five year survival is 65%, dropping to 15% if the disease is widespread.
The above information has been obtained from the Cancer Council who have a Helpline on 13 11 20 (cost of a local call). If you have any concerns regarding changes to your skin, please consult your GP immediately.
• What is a Neck Dissection?
Neck dissection refers to the removal of lymph nodes and surrounding tissue from the neck for the purpose of cancer treatment. The extent of tissue removal varies considerably depending on the indication for surgery and the clinical circumstances. The procedure is done under general anaesthesia through an incision that runs along a skin crease in the neck. These incisions heal well with minimal scarring and provide safe access to identify the structures in the neck. There are several variations of a neck dissection so please discuss this with your medical practioner.
To remove my cancer, I underwent a neck dissection and spent 4 days in hospital (refer to my journal for my own personal account of the effects and outcome of my surgery but I am very proud to say I recovered extremely well and I do not have any sign of scarring, so do not be alarmed if you are facing this surgery).
• What is Lipoma?
A lipoma is a benign tumour composed of adipose tissue. It is the most common form of soft tissue tumour. Lipomas are soft to the touch, usually movable, and are generally painless. Many lipomas are small (under one centimetre diameter) but can enlarge to sizes greater than six centimetres. Lipomas are commonly found in adults from 40 to 60 years of age, but can also be found in children. Some sources claim that malignant transformation can occur while others say that this has yet to be convincingly documented.
During my initial weeks of tests, I discovered a lump on my left thigh which was diagnosed as a Lipoma and removed under a very light general anaesthetic.
• What are lymph nodes?
The lymphatic system is a network of channels distributed throughout the body. These are similar to blood vessels, but carry lymph (a liquid consisting of white blood cells and serum) from tissues back into the major blood vessels. Along the way, lymph nodes interrupt these channels and act like filters. These filters may swell when an infection is nearby as they remove infected material from the lymph. When a cancer is nearby, the lymph may carry cancer cells. These cancer cells may become trapped and begin to grow within the lymph node. This is known as a lymph node metastasis. Most head and neck cancers appear to spread from the site of origin (in the mouth, throat, salivary gland, or other organ) to the lymph nodes in the neck before spreading to other parts of the body.