CA: A Cancer Journal for Clinicians, Vol 2, 207-212, Copyright
© 1952 by American Cancer Society
CANCER CLINICS
Skin Cancer
The great majority of skin cancer occurs on the exposed surfaces of the head, neck, and hands. Only rarely is it found on the trunk and lower extremities. Skin cancer, more than any other type of cancer, should offer the highest rate of prevention, diagnosis, and cure, yet the mortality and morbidity caused by it are of considerable magnitude. An understanding of the life history of epidermoid carcinoma in its various locations is of fundamental importance. The locally infiltrating characteristics of the basal-cell type, the complications of intraepithelial extension, and involvement of cartilage, mucous membrane, and periosteum offer serious obstacles to eradication and frequently result in impaired function and disfigurement. The basal-cell type rarely metastasizes.
Squamous-cell carcinoma of the skin metastasizes to the lymph nodes, but an appreciation of its true potentialities must be understood in order to protect the patient from unnecessary treatment in the name of prophylaxis and at the same time anticipate the possible complications. Lymph-node metastases are relatively rare from skin cancer and certainly the least common of any anatomical location where epidermoid carcinoma occurs.
Many times it is possible to distinguish the basal-cell from the squamouscell type on clinical examination with the definite advantage of arriving at a correct treatment immediately. However, some epidermoid carcinomas are indistinguishable and indeed one cannot be sure of epidermoid carcinoma in some skin lesions until biopsy examination. Histological diagnosis is desirable in all cases whether obtained by biopsy or examination of the specimen for either immediate management or subsequent follow-up.
Prevention comes from protection of susceptible skin from undue exposure to direct actinic or radium and roentgenray radiation, the application of skin grafts to second- and third-degree burns, and the eradication of active keratoses.
Cure depends most on the thoroughness of the first treatment after the diagnosis is made, whether roentgenrays, radium, or surgery is used. Selection of the best of these methods may be equivocal in some cases, but general statements can be made concerning the advantage of both methods, whether used separately or in combination. Radiation is usually preferable on small and multiple lesions and where there is sufficient subcutaneous tissue. It should not be used on the extremities or where bone and cartilage or tendons may be injured, excepting possibly on small and superficial lesions in these locations. Surgery is usually preferable on the large, bulky tumors and in those areas where radiation is not desirable. In combination, surgery is used in instances after radiation has obtained its maximum effect and in other cases radiation is used for small recurrent areas after wide surgical extirpation. Surgery is usually preferable in the curative treatment of metastases from skin cancer, but radiation is invaluable as a palliative measure and indeed some of these attempts result in cure.
