My Doctor Online The Permanente Medical Group

Causes

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The primary cause of both basal cell and squamous cell carcinoma is unprotected sun exposure over many years – especially for light-skinned blond or redheaded people. However, other causes and risk factors for these types of cancers include:

• Family history
• Occupational exposures to coal tar, pitch, creosote, arsenic compounds, or radium
• Previous skin cancers
• A weakened immune system due to organ transplant or HIV
• Human papillomavirus (HPV)
• Tobacco use
• Older age

Symptoms

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Symptoms for all skin cancers are similar, with slight variations. Be sure to regularly inspect your skin using a mirror for the places you cannot easily see. Call us for an appointment if you see any of the following symptoms:

• Changes in the skin, especially in the color or size of a growth, spot, or mole, or a new growth that seems suspicious
• Change in the appearance and texture of the mole or growth such that it is bleeding, scaling, oozing, or crusting

The 2 main non-melanoma skin cancers are:

Basal cell carcinoma

• Basal cell carcinoma (BCC) most often appears as a small, smooth, pearly bump. However, it can also be a pink to red color, an irritated area of skin, or a lesion that looks like a scar, or an area of skin that persistently bleeds.
• These growths are most often found on parts of the body that are exposed to sun such as the top of the head, ears, face, hands, and upper body.
• They grow slowly, and it takes years for them to reach the size of a coin.

Squamous cell carcinoma

• Squamous cell carcinoma (SCC) is more likely to look like a small red, rough, irritated bump on skin that has been frequently in the sun over many years.
• These growths are likely to be crusty, scaly, and thick, and they usually bleed easily, making them look like an unhealed sore.
• The color can vary from flesh-colored to red, brown, black, or yellow. SCC may have begun as an actinic keratosis or dry, scaly lesion.
• It is important to see us right away if you think you may have a squamous cell carcinoma, as these growths can spread to other organs (metastasize).

Diagnosis

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Although we can often tell what type of skin problem you have by examining the growth, we will confirm our diagnosis of both of these skin conditions with a skin biopsy. In a skin biopsy, we remove cells from the growth and send them to our laboratory for analysis.

As soon as we get the results, we will tell you whether your growth is benign (not cancerous) or cancerous. If it is cancerous, the lab analysis will tell us what type of skin cancer you have. We will, of course, make an appointment to see you for further testing or to remove the growth if the result of the biopsy shows skin cancer.

Treatment

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There are several ways to remove and treat both basal cell and squamous cell carcinomas. The treatment we choose will depend on many factors including the size of the skin cancer, location of the cancer, the condition of the skin around the cancer, your age, and overall health. Types of treatment include:

• Excision. Excision is the surgical removal of the affected skin. We will pay special attention to making sure that the borders of the lesion are clear of any cancerous cells. We will usually do this in our office using local anesthesia or in a special procedure room depending on the size and depth of your tumor.
• Mohs surgery. Mohs surgery is a specialized procedure used for certain types of skin cancers or cancers near vital structures. This procedure successively removes tiny layers of skin that are viewed under a microscope, making sure that no more tissue is removed than is absolutely necessary.
• Curettage. This technique involves scraping the skin's surface with a special instrument. Local anesthesia may be required.
• Electrocautery, or burning with an electric needle. This method is effective in non-melanoma cancers when used alone or with curettage. 
• Radiation therapy. For squamous cell carcinomas and basal cell carcinomas, radiation therapy using X-rays or electron beams damages cancer cells that cannot be removed surgically. It may also be an option for elderly or debilitated patients who cannot tolerate surgery, or as an alternative in an area where the cosmetic result with surgery would be poor. Radiation therapy may also be used postoperatively if the tumor is difficult to reach or if there is a high risk of microscopic residual cancer cells at the surgical site.
• Creams and salves. Sometimes we use cream medications to destroy the cells or to change the skin's immune response to eliminate the potentially cancerous cells.

Prevention

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Since non-melanoma skin cancers are caused by prolonged sun exposure over many years, the most important thing you can do to prevent them is to protect yourself from the sun.

Use sunscreen. Make sure that you use sunscreen prior to being in the sun. Use sunscreen with a 30 or above sun protection factor (SPF) that provides broad-spectrum coverage against both UVA and UVB light. Be sure to put sunscreen on your lips, ears, and the top of your scalp, particularly if you are male and losing your hair, as well as on your upper body if you are not wearing protective clothing. Remember to reapply sunscreen every 2 hours while outdoors.

Limit your time in the sun and avoid deliberate tanning. Be especially careful at the beach where the chance of burning is intensified by the reflection of the water and sand. Avoid tanning salons where you are exposed to intense UV light. Try to avoid the sun between 10 a.m. and 4 p.m. when light is most intense. Use an umbrella or parasol and find a shady place to sit. Sunless tanning creams or bronzing lotions can give you a tan without the risk of damaging your skin.

Wear hats and protective clothing. If you know you are going to be in the sun, wear a broad-trimmed hat and protective clothing with a tight weave, along with sunscreen, to minimize burning and exposure to the sun.

Check your skin regularly. Ask a relative or friend to check your skin or use a mirror to check your body for any unusual spots or growths. Make an appointment to see us if you think something looks suspicious.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might contact me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we may discuss your medical and family history and I will examine your skin. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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