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Why Early Detection is Critical

It is a foregone conclusion that the early detection of any type of cancer is always in a patient’s best interest. With regards to skin cancer, why are many cancers either left untreated or undetected at an early stage of development? I would like to address at least a few of these reasons and provide a few examples that illustrate the complications that are more likely to occur when a skin cancer is not treated in a timely fashion.

Warning: the following pages contain graphic images of skin cancer’s effects.

Some of the reasons why a skin cancer may not be detected in an early stage of development have been discussed in the section titled “What a Patient Should Expect from a Doctor,” but here’s a quick review:

  1. A skin cancer screening may not be the primary reason for which the patient goes to the doctor or dermatologist; therefore, a skin cancer may go unnoticed.
  2. The doctor may only examine a certain area of the patient’s skin.
  3. The problem may be present but is too subtle to be noticed by the unaided eye.
  4. The doctor may not be trained in the use of dermoscopy (see details in section titled “Dermoscopy”).

Patients’ Reasons for Not Seeking Treatment

Oftentimes, a patient may allow a skin cancer to persist without seeking the attention of a doctor. The patient may have recognized that a mole has changed or a new growth has not gone away, as one might expect from a typical “pimple.” And yet the patient does not seek consultation or treatment. Why? Some of the possible reasons are as follows:

  1. fear of the unknown;
  2. vanity;
  3. financial concerns;
  4. ignorance of potential danger;
  5. time or travel constraints;
  6. denial or ignorant optimism (“it’ll go away in time”);
  7. lack of pain or discomfort (“if it doesn’t hurt, it’s not a problem”);
  8. stubbornness (“I’m old, have lots of spots, and they haven’t killed me yet”); or
  9. willingness to put oneself on the back burner (“I’m too busy taking care of someone else who has worse problems”).

So many patients that I see with skin cancer fall in the first category. Perhaps they remember an earlier “less than pleasant” experience at a doctor’s office. I can identify with this feeling because I developed a fear of the dentist at a very young age. All I remembered was a harsh, bright light and the dentist’s threats about what would happen to me if I didn’t stop sucking my thumb. I finally did stop sucking my thumb; I think I was thirteen. Just kidding! The fact is that many of us fail to look into a potential problem because we are afraid of “the great unknown.” Usually, after the problem is addressed and properly taken care of, our fears subside, and we then realize that the problem was not nearly as great as our fears.

Another very common problem—believe it or not—is vanity. You may be surprised how many well-intentioned and respected people fail to see a doctor regarding a potential skin cancer because they are afraid of how the treatment may affect their physical appearance. So many individuals are more concerned about the attention they might draw from others than they are about a potentially life-threatening skin cancer. I remember one patient’s comment that his wife didn’t want him to “look bad,” and therefore he did not want the cancer on his nose to be treated. We all naturally want to look our best and may have busy schedules involving up close and personal encounters with others; thus, we find it inconvenient to make the time to have a potential problem addressed. These are difficult obstacles for all of us, but we need to overcome them and get beyond our vanity, which only serves to get in the way of that which is necessary for our own good and well being.

The third reason as mentioned above for failing to seek attention involves a rather common problem as well, and that is the lack of insurance or the inability to afford a medical procedure. I recall that the patient pictured below told me that she had no insurance, but she had noticed a problem on her nose at the age of 62. She had decided at that time that she would wait until she was 65, when she would qualify for Medicare, before seeking the treatment she knew she needed. Well, she made it to the age of 64, when the enlarging cancer on her nose began to bleed and cause her problems. By then, the cancer had eaten all the way through to the inside of her nose; her treatment then required extensive reconstruction, including cartilage grafts taken from her ear to repair this hole left by the cancer. Fortunately, she is 65 now and is doing very well, but everything would have been so much easier had she sought help earlier, regardless of her financial concerns.


Just recently, the patient pictured below finally came to see me with this skin cancer under her eye. She said that she had noticed something starting below her eye at least eight to ten years ago. She had been tending to a rather ill husband during that time and has admitted ignoring her own rather obvious problems.

The inside black-inked outline represents the obvious extent of this cancer, but the outside line likely represents the additional skin that will have to be removed to eliminate the roots. Because the cancer was allowed to grow unabated for years, it now represents a rather large challenge that will require a more extensive repair.

In fact, oftentimes there are multiple reasons that keep a patient from seeking necessary care in a timely fashion. For example, the patient pictured below had several other medical problems, was uninsured, and had limited financial resources; therefore, he did not seek necessary attention for this obvious longstanding skin cancer around his eye.

A team approach was necessary to remove this cancer and reconstruct the large defect that resulted from its removal. I have often found that such rare patients as this become hopeless and tend to not want to burden anyone with their problems. Such was the case with this gentleman, whose problem was finally addressed after he was hospitalized for a heart condition. As one might expect, having let this cancer grow for so long presented a real challenge, even for the most experienced of surgeons.

A few other reasons for failing to seek attention early are also mentioned above, but I think you get the message by now. While the above pictures certainly represent the extreme, my hope is that you realize that the longer you wait to have a problem taken care of, the more potentially dangerous, difficult, and costly the solution could become.

But There’s Good News for You…
with Early Detection

Of course, all of the above examples of large skin cancers could have been treated easily at a much earlier stage. Just look at the examples that follow of skin cancers that were discovered early, and therefore easily cured.

Basal Cell Cancer

Defect following removal

4 months after


The next example is of an early basal cell cancer on a nose of a patient that would have been very difficult to detect without the aid of a dermatoscope.

Difficult to detect without Dermatoscope. 


Basal Cell Cancer outlined with a circle.

Dermatosopic View


Roots as seen under microscopic vision.


The last example is that of a very early melanoma, known as a melanoma-in-situ, on the arm of a patient. Because of early detection, this melanoma was easily cured with a simple excision.

Earliest form of Melanoma

Closer View



Same Melanoma as seen under a Dermatoscope


The vast majority of the melanoma skin cancers that we diagnose and treat at the SKIN CANCER CENTRE are in this very early and curable stage. We strongly encourage you to educate yourself and your loved ones about the importance of the early detection of all types of skin cancers, which are the most common cancers known to mankind. When such skin cancers are detected and treated early, they are rarely life threatening and can be completely cured in the vast majority of cases without any disfigurement. 

Author: Dr. Richard DeAngelis
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