Most of the time, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are not deadly. However, some of these cancers, called, aggressive non-melanoma cancers, can grow and spread quickly, especially when not treated early. When this happens, the cancer can lead to nerve damage, disfigurement and even death.
In an article in Sun & Skin News, Dr. Stephen Y. Lai, assistant instructor and staff physician in the Department of Otorhinolaryngology/Head and Neck Surgery, stated that the best defense is early detection and treatment that is aggressive enough to make sure all traces of cancer are removed. When even a small amount of cancer is left, the cancer can return, much more aggressively than the original cancer.
Because these aggressive types of BCC and SCC normally appear on the face, doctors and patients might be more cautious, taking cosmetic concerns into consideration. For example, if the cancer is on the nose, eyes or cheeks, wide excisional surgery might leave a undesired scar.Many of these cancers show up in the "H" zone of the face - from ear to ear and the sides of the face from the top of the chin to the forehead. When allowed to grow and return, these cancers can cause nerve damage, paralysis of areas of the face and can ultimately lead to death if the cancer continues to spread.
In The article, "The Hidden Dangers of Nonmelanoma Skin Cancer," Dr. Ariel Ostad points to some of the warning signs of aggressive BCCs and SCCs:
Aggressive Basal Cell Carcinoma Warning Signs:
- Lesion is growing in width or height
- Located in the "H" zone of the face
- May have pain or tingling in the area (although no pain does not mean it is not aggressive)
- Cancer returns
Aggressive Squamous Cell Carcinoma Warning Signs:
- Lesion grows to one inch in size
- Growth is rapid
- Lesion may be ulcerated
- Lesion is near the lips, ears or eyelids
- There may be pain near the lesion (again the absence of pain does not mean it is not aggressive)
While most skin cancer lesions are biopsied, this doesn’t always indicate that the cancer is aggressive. According to a study published in the Dermatologic Surgery in 2011, using Moh’s surgery can help to detect cancers that are aggressive. Researchers looked at 513 non-melanoma cancers that were treated with Moh’s surgery. Of those, about 20 percent of the cancers were considered aggressive during Moh’s surgery but had not been found to be aggressive during the original biopsy. The researchers did not believe the biopsy results were lacking because someone "missed" certain markers. Instead they felt that examination of the tissue during Moh’s surgery is a more accurate measurement of aggressiveness.
Dr. Ostad points out that some treatments for non-melanomas, such as surgical excision, do not allow the surgeon to determine if all of the cancer has been removed and radiation is often prescribed for this reason. In addition, he states, scars from previous surgeries are optimal places for cancer to recur and hide. Moh’s surgery, he believes is the best alternative when dealing with BCCs or SCCs on the face as it allows the surgeon to look at each layer of skin and continue the surgery until no cancer is detected. As the previous study also indicates, Moh’s surgery allows doctors to see the patterns of more aggressive cancers.
"Aggressive Nonmelanoma Cancers May Be Found During Mohs," 2010, January 28, Murad Alam, Dermatologic Surgery
"Melanomas Aren’t the Only Dangerous Skin Cancers," 2001, Staff Writer, Sun & Skin News, Vol. 18, No. 4
"Nonmelanoma Skin Cancer," Date Unknown, Rebecca Tung, Allison Vidimos, Cleveland Clinic
"The Hidden Dangers of Nonmelanoma Skin Cancer," 2012, Ariel Ostad, M.D., Skin Cancer Foundation Journal