Skin Cancer Diagnosis

It is critical to determine whether a skin lesion is cancerous or benign. If it is cancerous, our team of experts will then determine what type of skin cancer it is and what stage (how advanced) it is to decide on a course of treatment.

The skin is our body’s largest organ, and we often take many of its roles for granted. It’s not only the most important line of defense we have against germs and bacteria, hot and cold temperatures and chemicals, but it also produces important hormones your body needs and acts as a warehouse for fats, water and metabolic products.

Skin cancer occurs most often in older adults after years of repeated exposure to ultraviolet (UV) radiation from the sun. UV rays can damage the DNA of skin cells in the outer layer, leading to mutation. If this mutation happens repeatedly, the chances increase that our immune system will let malignant cells slip past its defenses, allowing cancers to take root and grow.

There are many different types of skin cancer and, therefore, many ways to treat it. Our team of experts treat the following types of skin cancer:

• Basal cell carcinoma — Also called epithelioma, this very common form of skin cancer occurs in the basal cells of the epidermis.
• Squamous cell carcinoma — Another common form of skin cancer, this type occurs in the squamous cells that make up the outer and middle layers of the skin.
• Cutaneous and malignant melanoma — This is one of the fastest growing cancers worldwide, but still one of the rarer forms. Melanoma grows from melanocyte cells in the skin that produce melanin.
• Merkel cell carcinoma — A very rare form of skin cancer that affects Merkel cells in the dermis (the middle layer below the epidermis), which help to regulate our sense of touch.
• Dermatofibrosarcoma protuberans — An uncommon form of skin cancer where tumors occur in the skin’s deeper layers.
• Cutaneous lymphoma or lymphoma of the skin — A rare type of non-Hodgkin lymphoma that occurs in T cells (or T lymphocytes) present in the layers of our skin.

It is important to check your skin regularly for any new moles or unusual growths, also called skin lesions. If you notice any change in your skin, however small it may be, contact your doctor right away.

Skin cancer typically appears as changes in your skin. You may notice a spot that looks or feels different from your other spots. One way to remember some of the worrisome signs of melanoma are ABCDEs:

• A (Asymmetrical) — Does the mole have an irregular shape to it?
• B (Border) — Does the mole have an uneven or jagged looking border?
• C (Color) — Is the color uneven or suspicious looking?
• D (Diameter) — Is the mole larger than the size of a pea?
• E (Evolving) — Has the mole changed over time in any way?

At Winship, we take great care in confirming a squamous cell carcinoma diagnosis, basal cell carcinoma diagnosis, melanoma diagnosis and other, rarer skin cancer diagnoses. The first step in getting a definitive diagnosis is to take a small sample, also known as a skin biopsy, of the mole or lesion in question and have it analyzed under the microscope by a skin pathologist. There are several ways to doing the biopsy, including:

• Shave biopsy: The top layers of the skin are removed.
• Punch biopsy: A small cookie-cutter shaped tool is used to remove several layers of the skin. This is usually done for lesions that the doctor suspects may penetrate deeper into the skin.
• Excisional biopsy: The entire affected area is removed and examined.

If the skin cancer is thought to have spread to nearby areas, additional tests and scans may be used to get a more detailed picture of where it has spread. These can be useful in determining a patient’s stage and treatment plan.