Question:
I am 31 years old and just have been diagnosed with early squamous
cell skin cancer. I had a reddish, flaky lesion about a 1/4 inch in
diameter and was raised about a 1/4 inch that developed about 3 years
ago. It was diagnosed by my GP as eczema and I was given a
hydrocortisone cream. The lesion disappeared when I was using the
cream. Soon after I stopped using the cream, the lesion would come
back. For almost 3 years that cycle of appearance and disappearance
continued. My GP was not worried as he told me "since it responds to
the cream, it isnt skin cancer". I didnt use the cream continuously
through that 3 years as I was pregnant twice. During 18 months out of
the 35 total, I stopped the cream and the lesion just remained red,
flaky, and sore.
Something just didnt seem right, so I finally want to derm a few weeks
ago and a biposy of "my spot" (i had it so long, I had even given it a
name!) revealed early squamous cell cancer. I cant want to wait the 2
months to see a Moh's surgeon due to insurance reasons (insurance is
being cancelled at the end of the year) so the derm is going to do
excision surgery next week.
I have read a lot about squamous cell cancer since then and I admit
that I am worried about metastasis. I have probably had it for 3
years. My derm doesnt seem concerned about the possibility of it
spreading. She told me that at this stage it is more of annoyance
rather than a major problem. She is not sure when the cancer may have
developed. It may have been cancer from the start. It may have
developed from the chronic spot of eczema, or the eczema may have
actually been a misdiagnosed actinic keratosis that developed into
cancer over time. All she knows is that at this time it is early
squamous cell carcinoma. She said the skin underneath and around the
biopsy site look normal. I trust her judgement and the lab results
(she did get a second opinion from a dermopathologist) but that fear
of dying from cancer overwhelms me.
I do have several questions about my diagnosis. Please dont feel that
you have to answer all of them. Answer what you feel you can. I am
grateful for any and all help.
1. Has anyone had squamous cell cancer for several years without
metastasis? If it had spread, what symptoms would I have? I havent
been felling well lately (fatigue, chills, neck aches) and assume that
it must be secondary cancer. I may be over-reacting here as it was
"early stage". My symptoms may just be from having three children
under 3, winter coming, and poor posture.
2. Does the fact that I may have had undiagnosed cancer through 2
pregnancies affect the potential for metatasis? Does my having cancer
during pregnancy affect the future health of those children?
3. Am I a higher risk now for developing other cancers, such a breast,
lung, lymph, etc?
4. Is the fact that this appeared at a young age worrisome? Will it
effect my life expectancy? I am only 31. I feel too young to have
cancer. If i have cnacer now, what am I going to have in 30 years? I
do have fair skin so I knew I was at risk for skin cancer. I expected
to have it someday but not until I was in my 40s and 50s. It is
discouraging as I always have taken precautions in the sun, even as a
child. Guess it wasnt good enough.
5. Can early squamous cancer still spread? Would a squamous cancer
that spread have a different pathology? Or is staging based not upon
microscopic examination but upon whether cancer cells appear
elsewhere?
Answer:
Women with common, usually nonfatal forms of skin cancer face
double the risk of having unrelated cancers, according to a large study,
suggesting that the initial diagnosis may be more worrisome than previously
thought.
The skin cancer link was found for several malignancies, including cancer of
the brain, breasts, lung, liver, ovaries and uterus.
Previous studies have shown that men and women with skin cancer face an
increased risk of skin cancer returning. Some studies also have found that
people with non-melanoma skin cancer are prone to later developing non-skin
cancers.
But according to the new report's lead author, Dr. Carol Rosenberg of
Evanston-Northwestern Healthcare, part of Northwestern University's medical
school, the earlier research did not adequately consider other risk factors
that might explain the connection.
Her study, involving 92,835 post-menopausal women participating in a
continuing federal study, considered other factors that influence cancer
risk - including smoking, weight and education level - and still found an
increased risk of unrelated cancers associated with skin cancer.
Rosenberg said she suspects her results would also apply to men, since
previous studies involved both genders.
Given previous research, the authors presumed that skin cancer preceded
development of other cancers, though the study lacks information on which
developed first, Rosenberg said.
The results appear in the January issue of Cancer, an American Cancer
Society (news - web sites) journal, being published online Monday.
Of the more than 85,000 women who did not have skin cancer, just over 11
percent, 9,927, reported having had other cancers.
Of the 7,665 women who reported having had a mild form of skin cancer,
nearly 25 percent, 1,878, said they had also had other types of cancer.
The skin cancers implicated - basal cell and squamous cell - affect more
than 1 million Americans each year. Those skin cancers grow more slowly than
melanoma, the most serious skin cancer.
Eugenia Calle, the American Cancer Society's director of analytical
epidemiology, questioned whether the increased risk is as high as the study
suggests, considering that earlier studies found lower risks.
Calle said the study design may have exaggerated the risk, since women with
non-skin cancers might be more likely to remember having had mild skin
cancer than women who have only had mild skin cancer, especially since it is
often dismissed as a minor inconvenience, Calle said.
