Your doctor speaks II; Skin Tumors - Skin Cancer

The University of Illinois Medical Center campus in Chicago presents your doctor speaks during the series doctors in the colleges of medicine dentistry pharmacy nursing and graduate college at the University of Iowa and I will discuss the latest advances in cancer and heart research. Painless dentistry psychiatry nursing care and modern drugs. All of these and more will be presented on your doctor speaks. Your host for this series is Jack Gray camera coordinator of public service radio and TV programming for the University of Illinois Medical Center campus and champagne Urbana. This is Jack programmer bringing another program that we did with members of our staff from the university on Medical Center campus in Chicago. Our guest today is Dr. Lawrence Solomon assistant Fessor dermatology universe Illinois College of Medicine. I'm going to talk with Dr. Song about skin tumors. Doctor what is a skin tone.

Well strictly speaking a skin tumor say any mass on the skin that protrudes from the normal surface of the skin. It can be an inflammatory mass such as a high or a bruise. But the generally the term tumor is reserved for a new growth of tissue and it's a very broad term including benign in the legs and tumors and generally the word tumor is further clarified by an additional word to indicate it's tissue of origin such as blood vessels are epidermis or something of that sort or the finding a location or the location of type for X was a type that's actually next question I should have. Either types and I soon There are tumors and how do you classify. Well the tumor generally is classified according to its tissue of origin as I've said and to the degree of differentiation and by that I mean the degree it has

developed to approximate the tissue from which it originates. For example we could say that there are benign tumors a very broad classification to include all tissues of origin. There are tumors that are malignant and there are group of tumors which are not strictly speaking malignant but if left alone long enough will become so. Now let's talk about before we get into the elective tumors which are the ones that you were concerned with I assume let's talk about the benign tumors are there certain kinds of benign tumors that one might get but doesn't have to worry about. Now there certainly are but I'd just like to correct your. I think that everyone is the hero. In fact we're very much concerned with benign tumors in the vast majority of tumors seen by dermatologists or in fact any practitioner will be benign. And

although it's true that the malignant tumors concern us more from the point of view of prognosis the benign tumors are far more common and constitute the cosmetic problems that many dermatologists are faced with or use before you go on is just. Also because I just thought of this ban when I asked a dumb question I have is it because my tumors could become a leg several can. But the majority don't. I screwed up by nine tumors. There are. Tumors which have which are viral in origin and in fact a common wart. It is a benign tumor of viral origin but very commonly there exists on the bodies of most people who have reached say 30 40 or 50 years of age and avoid He excrescence is which have a collie

flower like appearance that sort of look as if they're pasted on to the skin and almost as if they could be scraped up with a fingernail and they are often pigmented. And these are called Separate keratosis as their origin is unknown but it really is a proliferation of one type of cell found in the very surface of the skin. They are totally benign and really are a nuisance as far as the appearance of the individuals concerned. I mean any part of the body they can be found almost anywhere but mostly around the face chest and back and in the areas which are rubbed upon one another. There are also vascular tumors and very common ones too. Besides the grotesque mouth from nations that occur in newborn infants there are the little cherry spots that are found in many people on the chest and particularly in older people. There are also tumors that have their

origin in the pigment cells of the individual. And these can be totally benign we speak of them as me via M.A. CITIC referring to the melanocytes the pigment cell line acidic Neave I will speak more about those later I hope several tumors appear to to come about after a slight trauma. And these are totally benign. There although also the fatty tumors the sort of lump under the skin that many people notice after having them for many years and there are sebaceous cyst and that these these are system like structures strictly speaking not really sebaceous because they they sort of come from a an indentation of normal epidermis that that becomes lock you laid it underneath the skin looks over how do you mean by that. LOCKYER Well it's just so it's as if there is a piece of the

epidermis of the superficial part of the skin becomes locked in underneath the skin forms a little blind alley a little room and since the skin produces its own represents this itself and the cells continue to represent this riddle room fills up very quickly. With so debris and fat and hair and these will grow under the skin sometimes they have an opening and sometimes they don't and if they do they they can rupture Odone to the surface as a greasy material and sometimes they simply continue to grow under the skin. Commonly I think they're called Waynes but they are totally benign and under extremely rare circumstances may become malignant cancer or should occur that way.

Should persons who have any of these. And I'm telling you talk about what should they do for it to put it that way. Should they have removed her let alone her water. Or that depends I suppose on the position. Well the first thing is to identify this immediately logical reasons should this this suggest that one should see a physician if one doesn't know what a particular spot on the skin is. Having identified it it becomes a minor thing too. I'm looking I believe I have any I'm sure you do they're very common. Your course of action would be to remove somebody. It's not necessary to remove many of these but if they are a source of anxiety or of cosmetic significance or if they tend to become inflamed or irritated they certainly can be removed it's certainly a minor procedure to do so and he's going to ask you and it is not difficult to say you're not able. OK I'm not going to talk about the so called malignant tumor I said. What

are they. Well malignant tumors of the skin can generally be classified into three types. There are others but certainly the commonest ones can be put into three types. There is one which has its origin in the superficial layers of the skin called a basal cell carcinoma. Now it is an incompletely malignant tumor in the act. It doesn't go elsewhere and it doesn't as we say in medicine. Cast the size and spread of it doesn't spread beyond its original site. Although locally it can certainly spread becomes larger and it causes an ulcer and it can be extremely disfiguring So although it is classified among the malignant tumors the danger to life from such a thing is really not terribly great. The second one is more malignant

in that it occasionally does go to sites away from the skin and it can lead to serious complications. It is called a carrick nice thing. Empathy only Oma or square aim a cell carcinoma. You might remember these terms that go out in this kind of mess in the harbor. I think the importance here is to realize that there are three levels of malignancy one which is of no immediate danger to life but it it is disfiguring just one doesn't spread to the second one which is somewhat more malignant in that it does spread. But compared to a. A carcinoma in the lung it perhaps is not nearly as malignant You know there are degrees of malignancy as there are degrees of infectiousness. Well I don't think I know this but I think our current assessment on all this is that I'm glad you brought that out because if you had I

would have asked you how you can just rephrase it again and well chicken pox is an extremely infectious disease for example tuberculosis tuberculosis a little less so and leprosy much less again. So even though they are classified as infectious diseases there are degrees of infection so there are degrees of malignancy. And the most malignant of all skin tumors is the malignant melanoma. Yes it is a tumor which has its origin in pigment cells. And it does tend to spread beyond the sight of the original spot and although it is very unreliable yet predictable that is one cannot say with certainty about any one lesion whether it will go elsewhere or how soon or when. Statistically we can say we know enough about this unhappy tumor to say that it is certainly

the most malignant disease the most and malignant of skin tumors. How does this manifest itself from one form on the you know on the body is it just like a year or term older. I want to order does one see it. Well it's generally starts as a dark spot which may have symptoms associated with it. I think the common word applied to that is more a dark source bought one. On the surface somewhat enlarged gold which. Has within the frontal Aurora Derby died so the freckle itself is is probably the malignant melanoma. If it appears and it as such and it progresses to to invade the tissues beside it. OK let's just talk about some of the untreated malignant tumor. What's the prognosis for something like that.

Well and as I just mentioned there are three distinctly different tumors and the prognosis of the the untreated basal cell carcinoma. The first one that I mention is that it will just continue to erode and destroy anything beyond being beside it or underneath it. And it may attack an eye or destroy part of the nose or destroy a lip or the cartilage of an ear and it is it continues to do so and of course the tissue less extensive surgery is done cannot be replaced satisfactorily so cosmetically it leads to a great deal of disfigurement. If a basal cell carcinoma is left untreated for a long enough time it can erode right through the skull for example then attack the brain and may be fatal but very rarely so what can be done around some of these malignant tumors.

Well if you let me finish the other two I could sum it up in one word by how many were there IS an hour I mentioned the the basal cell carcinoma and the other two that's there's three when I saw a carcinoma in a malignant melanoma. If left untreated are almost invariably fatal. Now you ask me about imagine what can be done to prevent them. Well there are I guess two ways of preventing tumors of that is the correct word one is to prevent their appearance altogether and one could say that it is certainly light skin be fair skinned skinned individuals are more prone to certain tumors and I think it is being established with a reasonable degree of certainty that White plays a very important role in their occurrence that is

chronic exposure to light can lead to the appearance of basal cell carcinomas you know some the sun a lot. Exactly and of course in America we're becoming much more aware of reverse sun worshippers and you may be interested in some statistics yes. Yes. In America between 1951 and 53 the incidence of death dealing skin tumors. And I just like to remind you these are mostly malignant melanomas and squeamish Elop the illness was two point three two point three dollars per hundred thousand American men. Now in 1961 to 63 this had risen to 2.5 per 100000 American men and 9 percent increase in the death rate for women. The level has always remained the same at one point five per

100000. To translate this into numbers that are more readily understood. Approximately 3000 men and 2000 women will die in 1967 due to skin cancer. This number is very impressive but it must be remembered all the same. That there are at least 90000 reported cases of skin cancer every year. So although Yeah so I can see that so you have done a pretty good job of checking it. Yeah well that's what's very important of course is to realize that early detection early detection is is vital in the management of these cases and they lead to early detection leads to a much better prognosis. Who should they in their general physician meaning they are listed as would be one of the catch. Rather I'm siting on the Armor some with her was milling in and out and by all means you don't have to go to a dermatologist like yourself hard

to find out how to Certainly not I think most physicians are perfectly capable of recognizing those two MS which are harmful and and I'm glad you asked this question because. Even if recognition is not simple and sometimes it isn't. A biopsy of the skin which a very simple and harmless procedure can give you a tremendous amount of information not only about whether you have skin cancer but also the degree of malignancy of the skin cancer. Take us to get running into shortness of time here and let's get into it. Another aspect is turn to vu question of moles. What are they. And when should they be seen. My dermatologist such as yourself. Well compound question. There are models that have a wide meaning to the lay public but

generally. Most people refer to a moral as a somewhat pigmented a somewhat darkened area on the skin which may or may not be raised and it may be above the skin surface or may not be and it also may contain some hair and sometimes not. The degree of pigment is very variable. It can be very black or may just simply be to me like it can be black or light brown or not not colored at all and the old witch with a bump on her nose with hair growing out of it that bump on that nose with the hair was amoral or a mulatto CITIC needless tells us a lot about it that is it comes from the melanin producing cells the pigment cells that I've mentioned before. And it is a collection of cells now the cells can be collected in a very superficial part of the skin or in the middle of the skin Arriva down deep and the color

depends not only on the amount of pigment these cells produce but the depth at which they lie. And it is particularly the superficial ones the ones that are right on the very surface of the skin pract which are which occasionally become malignant melanomas. Those are the ones that should be watched and any more which is changed in any way should be seen by some. Some medical practitioner and the particular things one should watch for is pain or itching or any pigment change lightning or darkening bleeding. Changes in the consistency that is if it become a little bit harder a little bit softer changes in the size particularly if the changes are sudden or chronic irritation. These things I think are signs that everyone should pay attention to and

should approach a physician for advice. It should and you might be interested in knowing that many people who have little tags little skin things that hang underneath the armor around the neck little and nothing so nothing is right the best description of these these these little tags are probably a need by in which the the pigment cells have disappeared and they're replaced by fact they are harmless and really are cosmetic interest only. Oh every national doctor someone let's just talk about the present methods of treatment of malignant skin tumors. Tell us what they are affected or are they. Well again the intensity of the treatment will vary with the type of tumor one has dealing with. Generally it's a good idea to identify it first so a biopsy is usually done now. The

second aim is having identified it is to remove the thing completely. Now there are as I mentioned again there are three types of skin cancers and by far the commonest is the basal cell the least malignant of the three. And there are two ways to get rid of it. I'll mention a third one perhaps a little later you can excise it cut it out or you can scrape it out. Both methods are effective. It can be treated with X-ray as well. Now Node 2 tumors may be treated the same way because the treatment depends very much on where exactly it is found. For example one would not tend to cut out a large tumor under the eye for an hour of deforming the vision the forming the the the appearance of the guy. So that again treatment is aimed at removing tumors that's the main thing I believe.

Not TER Can a skin tumor be a sign of well some internal disease. Is this a possibility. Rarely it is a sign of some internal disease. There are superficial rather benign looking tumors that are accompanied by a high incidence of internal carcinoma 20 percent and one particular type of tumor called Bones bones disease. Occasionally it has been said that people who develop basal cell carcinomas will have a higher incidence of malignancy elsewhere but in general a skin tumor means a skin tumor or something else. Generally right. You know what. In a minute we have left what is the future outlook for the treatment of skin tumors which are malignant. Is it good. Well it outlook the outlook is very good first of all I think you'll realize what I've

said that the amount of cures are so great tumors are enormous procession especially if you consider the fact that they that if they're treated early it's a very high success rate in skin tumors and more recently there's some very interesting work going on at other centers in which skin tumors are treated with drugs and by applying a certain point meant a good percentage of tumors are destroyed locally leaving a very good cosmetic effect. So I think that the treatment of tumors with mince and lotions may very well be the future approach to this particular problem must be not unhappy not that I can. Thank you very much I guess even Dr. Lawrence Solow Sr. professor of dermatology universe on II College of Medicine. We're talking about skin tumors. You have just heard another in the series your doctor speaks produced by the University of

Illinois Medical Center campus in Chicago in cooperation with this station. During this series such topics as cancer and heart research painless dentistry psychiatry nursing care and modern drugs will be presented on your doctor speaks to your host for the series is Jack Graham or coordinator of Public Service Radio 1 TV programming for the universe their own AI Medical Center campus and Champaign Urbana. Your doctor speaks is produced and directed by Mr. Rickman. This program was distributed by the national educational radio network.