Recognize the signs: When to see a dermatologist

May is Skin Cancer Awareness Month! This year, dermatologist Emily Ruiz, MD, MPH, from Brigham and Women’s Mohs and Dermatologic Surgery Center at Brigham and Women’s Faulkner Hospital, breaks down the warning signs that it might be time to see a dermatologist.

“Most non-melanoma skin cancers (NMSCs), which include squamous cell and basal cell carcinomas, are slow growing and can be cured with a minor surgical procedure,” says Dr. Ruiz. “However, some squamous cell carcinomas are more aggressive. We estimate that approximately the same number of individuals die each year from squamous cell carcinoma as do from melanoma. It is important to recognize features of squamous cell carcinomas that are associated with more aggressive disease.”

Dr. Ruiz says to look for these common signs associated with more aggressive skin cancers.

• Rapid growth: since most squamous cell carcinomas are slow growing, rapid growth can indicate a more aggressive skin cancer. If you develop a pimple that starts to increase in size, you should have it evaluated by a dermatologist.
• Recurrence: if you have a skin cancer arising in an area that was already treated, this may be a sign that the cancer is more aggressive. It is important to mention to your dermatologist if you develop a new skin cancer in an area that was already treated.
• Large size: larger tumors are at risk for developing poor outcomes. While it is best to treat skin cancers when they are small, it is important to seek care immediately if you have a larger skin cancer.
• Histologic features: there are certain pathology features that can indicate that a skin cancer is more aggressive. This includes the “differentiation” of the cells, in particular poorly differentiated squamous cell carcinomas, and the presence of perineural invasion. There are other less common findings that can indicate a more aggressive skin cancer and so it is important to have a dermatologist closely review all pathology reports.
• Deep invasion: tumors that spread deeper are more aggressive. This is most often detected during surgery.
• Patients who are immunosuppressed: individuals with conditions such as chronic lymphocytic leukemia and solid organ transplants may develop more frequent or aggressive skin cancers. If you have one of the conditions, it is important to have regular dermatology care to identify skin cancers earlier.

While most squamous cell carcinomas will not behave aggressive, Dr. Ruiz suggests routine skin evaluations by a dermatologist to help identify skin cancers earlier when they are easier to treat. “And, of course, don’t forget to help prevent skin cancers by wearing sunscreen and sun protective clothing!” she says. 

To make an appointment with Dr. Emily Ruiz or another dermatologist at Brigham and Women’s Faulkner Hospital, call 617-983-7500.