Adarsh Vijay Mudgil, MD: One of the most common reasons for a primary care visit is to address something that’s on the skin.
My name is Adarsh Vijay Mudgil, and I’m a dermatologist and dermatopathologist, practicing in New York City and Long Island. I’m going to share with you some of the ways to recognize when something is worrisome or when it’s not. Frequently, patients who visit their primary care physician want to know if a spot on their skin is skin cancer or if it’s not anything to worry about. One of the most common types of skin cancer is squamous cell carcinoma, which can present in a lot of different ways.
There should be a few key things that you should recognize and that should cause you to increase your level of concern if you’re seeing a patient with something on their skin. One thing to look for are red, scaly patches that don’t go away. If your patient tells you they have a red, scaly spot that’s been present for months and hasn’t changed at all, that’s a red flag. It is usually indicative of something that’s of a low grade, such as squamous cell carcinoma in situ, which is a superficial type of squamous cell carcinoma. Other things to look for are lesions that are red and scaly and look similar to warts that are just kind of hanging out and don’t go away. These could represent a more invasive type of squamous cell carcinoma. It could also be something that may be the more benign spectrum, such as a a keratoacanthoma. Both of those lesions need to be treated, and they should prompt either a biopsy or referral to a board-certified dermatologist for further evaluation.
Once squamous cell carcinoma has been diagnosed, the method of treatment needs to be addressed. For most squamous cell carcinomas that penetrate into the deeper layers of the skin (into the dermis, below the epidermis), surgery is the most common option. There are several surgical options for lesion removal.
Mohs surgery is a very specialized type of surgical procedure for squamous cell carcinomas in cosmetically sensitive areas like the face or sometimes the hand or the scalp. For other parts of the body (such as the trunk, arm, or leg), a more conventional surgical excision with stitches to the margin of normal skin is generally the preferred treatment strategy.
For more superficial types of squamous cell carcinoma, such as the aformentioned squamous cell carcinoma, other nonconventional treatments are available, such as creams that modulate the way the immune system works to attack the cancer cells within the epidermis. There are also topical chemotherapeutic agents that we can use. So there are several treatment options that are available, but the first step is determining whether the lesion is skin cancer. If is squamous cell carcinoma, distinguishing the type of squamous cell carcinoma is important as that will determine the course of treatment that we pursue.