Painless Skin Lesions Might Be Skin Cancer!

Recently, an elderly male patient visited the dermatology clinic, hoping to treat a rash plaque that he had been scratching on his scalp for quite some time. This rash has been present for quite a while, feeling more than a year, but it has not been red or itchy. The patient always felt a raised rash and habitually scratched and stimulated it repeatedly. Over time, the rash grew larger within half a year, especially in the last 2 weeks, there was a significant change in bleeding and scab formation, and the subcutaneous area was also red. To receive treatment as soon as possible, he came to the clinic.

From the perspective of a dermatologist, for middle-aged and elderly men with such non-painful and non-itchy rashes, especially rough, thickened plaques with bleeding, shouldn’t we feel more reassured by doing a skin biopsy? After all, non-painful, non-itchy, slowly growing plaques, the risk of skin cancer is not small at all!

After communicating with the family and the patient, a suspicious rash was removed for skin biopsy, and the pathology indicated early well-differentiated squamous cell carcinoma. After subsequent surgery and removal, the patient has now been cured.

For most adults, especially in recent years, tumors are becoming younger, so if you find some recurrent or special plaque-like changes on the head and face, you still need to be vigilant about skin tumor issues!

Common Malignant Tumors of the Head and Face Skin

Basal Cell Carcinoma
（BCC） is one of the most common types of skin cancer, especially prevalent among the elderly, with an increasing incidence rate year by year. Basal Cell Carcinoma usually manifests as a painless, non-itchy skin plaque nodule change, growing slowly, the surface can present skin color, light red, brown to blue-black, and dilated capillaries can be seen. The common types are nodular, superficial, and morpheaform. Specific skin rash manifestations are shown in the figure below.

Images are from uptodate

The diagnosis of BCC is mainly through clinical manifestations and dermatoscopy,
histopathology is the gold standard for diagnosis. Once a painless lump or rash is found on the scalp, it is best to visit a dermatology clinic as soon as possible, let the clinician through face-to-face consultation + dermatoscopy, or biopsy + pathological examination to further clarify the diagnosis, and then arrange surgical removal treatment according to the disease stage. Usually, early detection and removal are relatively easy to cure, and there is not much risk of recurrence, invasion of other tissues, or long-term metastasis.

Cutaneous Squamous Cell Carcinoma
（SCC） is a malignant tumor originating from the keratinocytes of the epidermis. In individuals with light skin tones, SCC usually occurs in areas of photodamaged skin, so among Asian populations, cutaneous squamous cell carcinoma occurring on the head and face is relatively common. SCC can manifest as a variety of skin lesions, including papules, plaques, or nodules, and the skin lesions may have a smooth surface, or they may be hyperkeratotic or form ulcers.

Image from uptodate

Early detection and confirmation of cutaneous squamous cell carcinoma, through surgical removal under local anesthesia and skin grafting, can achieve a cure. However, if treatment is too late and tumor cells invade deeper into muscle and bone, the difficulty of surgical treatment increases and recovery becomes more difficult. Therefore, it is necessary to pay attention early, detect early, and treat early, usually there will be no long-term metastasis, and it is not easy to affect life expectancy.

Although malignant melanoma is rare in China,
it has a high degree of malignancy, a significant risk of death, and can easily metastasize to other systems in the body early, leading to life-threatening situations. Malignant melanoma is common on the extremities, such as the palms, fingertips, and soles, and is relatively rare on the head and face.

However, if some older people have long-term sunburned areas of the skin, and suddenly appear in adulthood
patchy brown or brown macules, growing year by year, may appear darker, asymmetric pigmentation lesions, mottled color, and elevation, these changes suggest the possibility of in situ melanoma, also known as “malignant freckle-like nevus”, as shown in the figure below.

Image source: uptodate

Once rashes similar to the above image are found,
do not casually treat them with laser freckle removal or medicated freckle removal, it is essential to visit a dermatology clinic for a skin biopsy to confirm the diagnosis before further treatment.

There are also congenital melanocytic nevi on the head and face. If hard nodules, lumps, ulcers appear with age, and the lesions continue to grow, the possibility of developing into malignant melanoma should be considered, and it is recommended to visit a dermatology clinic in a timely manner for assessment. For malignant melanoma, international professional organizations have proposed the
ABCDE principle to help with self-examination:

Remember these ABCDEs, which can help with self-examination and self-diagnosis!

Causes of Attacks and Prevention Tips

The occurrence of various skin cancers on the head and face is related to multiple factors, such as ultraviolet exposure, genetic factors, chronic inflammation, etc.
Especially facial skin cancer, which is closely related to sunlight(ultraviolet radiation). For the Chinese population, many middle-aged and elderly friends, especially elderly male populations, do not pay attention to sun protection and like to be exposed to the sun for a long time for fishing, running, etc., which can lead to the appearance of skin tumors.

Therefore, it is recommended that middle-aged and elderly friends do a good job in daily sun protection, persist in applying sunscreen if possible, and if not, do physical sun protection, such as wearing hats, long-sleeved sun-protective clothing, etc., to avoid long-term and long-time exposure of the skin to ultraviolet radiation, which can help reduce the possibility of skin cancer attacks.

At the same time, once a
painless, non-itchy but persistent and slowly growing rash or plaque is found on the head and face,
do not scratch or stimulate it by yourself, and do not arbitrarily go to a clinic for treatment with medication
, seek professional dermatology outpatient services as soon as possible, choose the safest treatment method under the condition of clarifying the nature of the rash.

Disclaimer: The purpose of the article is to provide general health information. For personal medical issues, please consult a doctor. For article reprinting, please contact: medicine@distinctclinic.com.