How a mole turned into a wound — and skin cancer

I am quite fortunate to stumble upon extraordinary cases of dermatologic problems appropriate for book exhibition. It was in the morning of Feb. 3 when I first met with Patient G.  I just arrived at St. Luke’s Global for my first patient that day when I saw a male patient in the receiving area of my clinic, who had a T-shirt on top of his head covering the left side of his face.  At first I thought he had a severe rash, but I had the shock of my life when I saw what was under that shirt.  Despite his appearance, he looked at me with a smile I will never forget.  With half of his face almost gone, he still managed to greet me.  I greeted him back and blurted out, “What on earth happened to you?” 

According to Patient G, 16 years ago, he accidentally shaved what appeared to be a mole on the left side of his face.  After that incident, the resultant wound never healed.  It gradually grew bigger and deeper.   If you encounter patient G at night, you will surely scream your heart out.  It is like you are in a scene of the movie Night of the Living Dead. What with all his skin and flesh (soft tissues) almost totally gnawed through!  His left eyeball totally destroyed, his jaw and cheekbone popping out, his jaw and teeth dropping out every time he attempted to move it.  He looked everything like a zombie who has lost half of his face (with almost the facial skeleton showing).  I asked Patient G why he had to wait 16 years before he sought help.  He said that he was accidentally discovered, after a man who took pity on him posted his picture on Facebook.  He also tried to seek help before but was told he would need P65,000 for surgery and since he could not afford it, he did not go back.  So, his was a case of a neglected skin cancer.

There are two main types of skin cancer: melanoma and non-melanoma skin cancer.  Patient G has what we call a non-melanoma skin cancer (meaning it did not come from moles).  Because if it was indeed melanoma, Patient G would be 6 feet under by this time.  He probably has what is called basal cell carcinoma, stage IV (as of this writing, I’m still waiting for the biopsy result).  But we cannot totally rule out the more aggressive squamous cell carcinoma.

Basal cell carcinoma (BCC) is a type of skin cancer that develops from the lowermost layer of the epidermis, the stratum basale.  It is a very slowly growing cancer.  BCC is a non-melanoma skin cancer, and is the most common type (greater than 80%) of all skin cancers.  BCC is sometimes referred to as rodent ulcer (because it appears to be chewed on by rats).  BCC is prevalent in elderly males although Patient G is still in his 40s.

Risk factors include the following:  previous history of basal cell CA on the skin; repeated prior episodes of sunburn; sun damage as in photoaging; a person with fair skin, blue eyes, and blond or red hair; previous skin injury like burn; patient with other health problems like lupus, nevus sebaceous (birthmark) and inherited conditions the likes of xeroderma pigmentosum, basal cell naevus syndrome etc.; those who underwent radiation or are immunosuppressed secondary to intake of drugs. 

A modest increase in the lifetime risk of BCC has been noted in chronically immunosuppressed patients, such as recipients of organ or stem cell transplants and patients with AIDS.  Patient G is fair-skinned and is a construction worker.

BCC occurs commonly on areas that are often exposed to the sun, like the face, head, neck and ears.  It is also common for a BCC to develop where burns, scars or ulcers have damaged the skin.

BCC can vary greatly in its appearance, but people often first become aware of it as a scab that bleeds occasionally and does not heal completely.  Some BCCs are very superficial and look like a scaly red flat mark; others have a pearl-like rim surrounding a central crater.  If left for years, the latter type can eventually erode the skin, causing an ulcer, hence the name rodent ulcer.  Others are quite lumpy, with one or more shiny nodules with small blood vessels seen on the surface.  They are mostly painless although sometimes they can be itchy or can bleed if caught in clothes or picked on.

BCCs can be cured in almost every case. But treatment becomes complicated if they have been neglected for a very long time and also if they are in places near the eyes, nose or ears. BCC very rarely spreads to other parts of the body (in less than one in 20) except if neglected for years.

The best way to prevent skin cancer is to reduce your exposure to sunlight and boost your immune system. Eat healthy food.  Get plenty of sleep, exercise, and water.  Avoid stress. Apply sunscreen with sun protection factor (SPF) of at least 30, even when you are going outdoors for a short time. Apply a large amount of sunscreen on all exposed areas, including ears and feet. Look for a sunscreen that blocks both UVA and UVB light. Use a water-resistant sunscreen. Apply sunscreen at least 30 minutes before going out. Follow package instructions on how often to reapply. Be sure to reapply after swimming or sweating. Use sunscreen in winter and on cloudy days, too.

Other measures to help you avoid too much sun exposure: Ultraviolet light is most intense between 10 a.m. and 4 p.m. So try to avoid the sun during these hours. Protect the skin by wearing wide-brimmed hats, long-sleeved shirts, long skirts, or pants. Avoid surfaces that reflect light more, such as water, sand, concrete, and areas that are painted white. The higher the altitude, the faster your skin burns.

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For questions or inquiries, call 09174976261,  09177137878 or 263-4094 or email gc_beltran@yahoo.com.