Dear Dr. Roach: I am fair-skinned and have had sunburns in the past, so I have been diligent about looking for rough, scaly skin patches that might turn into cancer and dark irregular patches that might be melanoma. But I had not read anything about watching for a pore that bleeds, heals and bleeds again. I have a place like that on my nose and just thought it was thin skin. There was no bump, no redness, no scaling; just occasional bleeding. Then it would heal and everything seemed fine. Now I find out from my dermatologist that it is basal skin cancer, it grows down into the skin, and I will have to have Mohs surgery to remove the cancer and plastic surgery to repair it. I want everyone to know to watch for this kind of symptom and get to a doctor immediately if they have it.
A basal cell carcinoma is a skin cancer, probably the most common cancer in the U.S., and is most common among light-skinned people. It’s unusual in people with very dark skin. It is more common in men, and increases in frequency with age. As you note, sunlight is the major risk factor, although sunburns aren’t necessary to develop BCC. Use of tanning beds also greatly increases the risk for skin cancer, and I strongly discourage their use.
BCCs can appear in several different forms. They often appear as a nodule on the face, with dilated blood vessels that can bleed and ulcerate (causing a shallow pit). On the trunk, they can appear as a superficial red patch. They also can appear as firm, deeper, scar-like lesions.
Because they can appear in such a varied manner, ANY new skin lesion, especially in a light-skinned person with sun exposure, should be evaluated by a professional. Any nonhealing sore or one that periodically bleeds is particularly at risk.
Although BCCs rarely, if ever, spread outside the skin, they can grow locally and be disfiguring. Once one has occurred, additional skin cancers are much more likely, so a periodic total skin exam by a dermatologist is essential.
Dear Dr. Roach: My daughter recently was operated on for a large tumour in her head. They called it a paranasal sinus cancer, and said that it is very rare, with only a few other known cases. Can you help me know what caused this?
Paranasal sinus cancers are very rare. They usually have no symptoms until they get large enough to invade other structures, and so can be very advanced when diagnosed. They often present as pain in the teeth or face, bleeding or persistent nasal obstruction. They also can press up against the eye, causing double or blurry vision.
Treatment depends on the type of tumour cell, but it usually involves surgery and may include both radiation and chemotherapy.
As far as what caused it, there is no way for me to tell for your daughter. However, factors that increase risk for paranasal cancers include air pollution, tobacco smoke and occupational exposures, especially for leather, textile and wood workers. Human papillomavirus may be the cause in some people.
The prognosis also depends on the cell type. With rare cancers, it is very hard to make a general statement. Her doctor (or more likely, team of doctors) is really your only source of more information. I hope she has a good outcome.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.