Disease Description (Causes and Symptoms)
- Definition: Malignant tumors that develop in the skin, mainly classified as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (melanoma).
- Causes / pathophysiology: The most important cause is ultraviolet (UV) exposure. UV damages the DNA of skin cells, causing cancer-causing mutations. Other risk factors include arsenic exposure, chronic scars or burn sites, human papillomavirus (associated with certain SCCs), and immunosuppressed states (organ transplantation, HIV). Melanoma originates from melanocytes and has a tendency to metastasize rapidly.
- Main symptoms: Skin ulcers, nodules, scabs, pain, pigment changes (brown spots, changes in the color, size, or shape of a mole), bleeding, itching, or stinging. BCC is locally invasive but rarely metastasizes and may recur; SCC can metastasize (especially high-risk lesions); melanoma commonly metastasizes and has a poor prognosis.
Treatment Methods and Precautions
- Treatment principles after diagnosis: Treatment is selected according to the stage (depth of invasion and presence or absence of metastasis), type and location of the lesion, and the patient’s overall condition.
- Surgical treatment
- Local excision (wide excision): Used for most BCCs and SCCs; for melanoma, the extent of excision is based on Breslow thickness.
- Mohs micrographic surgery (Mohs): Recommended for BCC or SCC in areas where the risk of recurrence is high or preservation of function and appearance is important, such as the face.
- Lymph node evaluation/excision: Targeted lymph node testing (sentinel lymph node biopsy) may be considered for high-risk SCC or melanoma.
- Nonsurgical/adjuvant treatment
- Radiation therapy: Used when surgery is difficult or as adjuvant therapy, such as when there is invasion of surrounding tissue or incomplete excision.
- Topical medications: 5‑fluorouracil (5‑FU) and imiquimod for superficial BCC or SCC in situ (for certain indications).
- Systemic anticancer/targeted/immunotherapy: For metastatic or unresectable melanoma — anti-PD‑1 antibodies (e.g., pembrolizumab, nivolumab), CTLA-4 inhibitors (e.g., ipilimumab), and, when BRAF V600 mutation-positive, BRAF ± MEK inhibitors (e.g., vemurafenib + cobimetinib, etc.). Hedgehog pathway inhibitors (e.g., vismodegib) may be used for advanced or refractory BCC.
- Curettage and electrodesiccation, cryotherapy: Simple treatment options for low-risk small lesions.
- Lifestyle management and prevention
- Sun protection (sunscreen, hats and clothing), and avoidance of excessive UV exposure and tanning beds.
- Regular skin examinations are recommended for immunosuppressed patients.
- Precautions and risk of complications
- Treatment outcomes are favorable when treated early, but recurrence, local invasion, and metastasis are possible (especially with SCC and melanoma).
- Scarring and functional impairment after surgery (such as on the face or fingers), skin changes after radiation, and immune-related adverse reactions and drug side effects with systemic treatment are possible.
- High-risk lesions (depending on thickness, location, degree of differentiation, vascular or nerve involvement, etc.) may require additional imaging tests and lymph node evaluation.
Checklist Before an Outpatient Visit (Including Recommended Items and Example Questions)
- Recommended items to bring
- A list of current medications, including anticoagulants and antiplatelet drugs, and the times they are taken
- Previous pathology test results (biopsy/surgery) or photographs
- Photographs documenting recent changes in the skin lesion, if available
- Information about allergies, chronic diseases, and immunosuppressive treatment (transplantation, use of steroids or immunosuppressants, etc.)
- Items to record about symptoms
- When the lesion began, changes in size, and the presence or absence of bleeding, ulceration, pain, or itching
- History of sun exposure (tanning and occupational exposure) and family history of skin cancer
- Items that may be checked before testing
- If necessary, scheduling of a skin biopsy (under local anesthesia), photographic documentation, blood tests, and imaging (CT/MRI/ultrasound)
- Things to inform the doctor of in advance during the outpatient visit
- Whether you are taking anticoagulants (and whether they need to be stopped before a biopsy), and the possibility of pregnancy
Examples of General Questions to Ask the Doctor
- What is the likely diagnosis of this lesion? What additional tests are needed?
- What are the advantages and disadvantages and expected side effects of each treatment option (surgery, radiation, and medication)?
- What is the likelihood of a cure (prognosis), and how high is the risk of recurrence?
- What should I be careful about in daily life (work, exercise, and UV exposure)?
- How will follow-up examinations be conducted after treatment (schedule and method)?
Examples of Disease-Specific Questions
- Regarding malignant melanoma
- What is the Breslow thickness of the lesion, and is a sentinel lymph node biopsy necessary?
- Should BRAF mutation testing be performed? Will treatment differ depending on the result?
- Regarding basal cell carcinoma / squamous cell carcinoma
- Is Mohs surgery recommended for this area? What method is most appropriate for lowering the risk of recurrence?
- Is radiation therapy or a topical medication (imiquimod or 5‑FU) possible for this lesion, and what side effects may occur if it is appropriate?
(Note: The diagnosis and treatment plan may vary depending on the pathology test results, imaging findings, and the patient’s overall condition. Please consult the treating specialist regarding specific decisions.)