My Doctor Online
The Permanente Medical Group

Risk Factors

The primary risk factor for basal cell and squamous cell skin cancers is unprotected sun exposure over many years. The risk is higher for light-skinned blond and redheaded people. 

Additional risk factors include:

• Family history of skin cancer
• Exposure at work to coal, tar, pitch, creosote, arsenic compounds, and radium
• Previous skin cancers
• A weakened immune system, such as from an organ transplant or HIV
• Human papillomavirus (HPV) infection
• Tobacco use
• Age 65 or older

Symptoms

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Basal cell skin cancer

Basal cell skin cancer most often appears as a small, smooth, pearly bump. It can also be:

• Pink to red in color.
• An irritated area of skin.
• A sore that looks like a scar.
• An area of skin that persistently bleeds.

These growths are most often found on parts of the body that are regularly exposed to sun, such as the:

• Top of the head
• Ears
• Face
• Hands
• Upper body

Basal cell skin cancer grows slowly. It takes years for these growths to reach the size of a coin.

Squamous cell skin cancer

Squamous cell skin cancer usually appears as a small, red, rough, and irritated bump. It often affects areas of the skin that are exposed to the sun over many years. 

These growths:

• Are crusty, scaly, and thick.
• Bleed easily, making them look like an unhealed sore.
• Appear red, brown, black, yellow, or similar to your own skin color.

Squamous cell skin cancer can begin as a precancerous growth (actinic keratosis) or a dry, scaly sore.

Squamous cell skin cancer can become more serious over time. Ask your doctor to evaluate any suspicious skin changes.

Diagnosis

We may identify the type of skin problem you have by examining the growth. However, we usually confirm a skin cancer diagnosis by removing a sample of the growth (skin biopsy). The sample is sent to our lab for evaluation.

Once we get the results, we’ll discuss them with you. You may need a follow-up appointment to have the growth removed or to have further testing. 

Treatments

Treatment of skin cancer depends on the:

• Size and location of the growth. 
• Condition of the skin around the growth.
• Your age and overall health. 

Excision is the surgical removal of the growth. It may be done in our clinic. 

We’ll give you medicine (local anesthesia) to numb the area before removing the growth. A lab checks the edges (margins) of the removed skin to make sure the cancer is completely removed. 

Mohs surgery is a specialized procedure that removes several tiny layers of skin. The skin is viewed under a microscope to: 

• Confirm the cancer is completely removed.
• Make sure no extra tissue is removed. 

After these procedures, the skin is stitched closed and a small scar will eventually form. These treatments have a high cure rate.

Curettage and electrocautery involves:

• Scraping the skin's surface with a special instrument (curettage).
• Burning the area with an electric needle (electrocautery). 

This can be done in our clinic, using local anesthesia. You won’t need stitches and will develop an oval or round scar. This treatment also has a high cure rate.

Other Treatments

We may recommend that you have another type of treatment for your skin cancer.

Radiation therapy uses X-rays or electron beams to damage cancer cells that can’t be surgically removed. It’s used to treat

• Older or frail people who can’t have surgery.
• Areas where the cosmetic result with surgery would be poor. 
• Areas after surgery if it was too difficult to reach a growth or there’s a high risk of cancer being left behind. 

Cream medications are sometimes used to:

• Destroy skin cancer cells.
• Change the skin's immune response to eliminate potentially cancerous cells.

You’ll apply the cream on the skin cancer for the time we recommend. The area will become red and irritated during treatment. 

This treatment often has a good cosmetic outcome. It can work well for treating basal cell and squamous cell skin cancers. 

Prevention

Basal cell and squamous cell skin cancers are caused by sun exposure over many years. The most important thing you can do to prevent them is to protect yourself from the sun.

Use sunscreen with a:

• Sun protection factor (SPF) of 30 or above. 
• Broad-spectrum coverage against both UVA and UVB light. 

Before going out in the sun, apply sunscreen to your lips, ears, scalp, and upper body. Reapply it every 2 hours.

Limit your time in the sun. Be careful near water and sand, where the chance of burning is intensified by reflection. 

• Avoid intense sun exposure between 10 a.m. and 4 p.m. 
• Use an umbrella or parasol.
• Sit in the shade.  

Avoid tanning salons and intense UV light. Sunless tanning creams and bronzing lotions work without the risk of skin damage.

Wear hats and protective clothing. Avoid sunburns by wearing:

• A broad-brimmed hat.
• Protective clothing.
• Sunscreen.

Check your skin regularly. Look for unusual spots or growths.

When to Call Us

The symptoms for all skin cancers are similar. 

• Check your skin regularly. 
• Use a mirror to view areas on your body that you can’t easily see. 
• Ask a friend or relative to check your skin.

Call us for an appointment if you see:

• Changes in your skin. The color or size of a growth, spot, or mole might change. Or you might notice a new, suspicious growth. 
• Change in the appearance and texture of a mole or growth. It might bleed or ooze or appear scaly or crusty. 

You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

For non-urgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.

If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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.

Coordinating Your Care

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.

Convenient Resources for You

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.