It is inevitable that there will be some small pockets and moles on the body, and as we grow older, these small things will not stop, either the originally clean skin has many black spots and red dots, or the small pockets that have remained unchanged for years have grown. This is a common thing, but recently I encountered two cases that made me feel that I should not underestimate these little things. Xiaoxu, 55, recently retired, came to see a doctor for a “black mole” on the top of her head at the hairline. The lesion was a penny in size, bulging about half a centimeter high, very black in color, and surrounded by a light brown halo of nearly 3 millimeters. ”How long has this been there?” . The color was so black and somewhat hideous, and the surrounding area spread sinisterly, that it was unsettling to look at. ”I can’t remember, there are always ten years, the last two years grow a little faster. I retired last month, so I had nothing to do and came to take a look. Do you see the need for surgery?” ”You really do not need to keep it, cut it off as soon as possible.” If there is no doubt about the nature of the lesion, a cut of this size should be done in stages, and the wound will heal more easily. However, I am afraid that I can’t consider this method. It is safer to remove the lesion completely as soon as possible, even if the healing is delayed or the wound is worthy of a skin graft. These were only my mental activities, and I only told the patient the treatment recommendations in order not to put too much psychological burden on her. The pathologist informed me of the results directly. Despite the preoperative prognosis, I was still so, heartbroken when the photos of the cancer cells were placed on my desk. Although basal cell carcinoma is the least malignant of all body surface tumors, but…after all, it stuck to the word,… “Xiaoxu, your test results are out,…the cells are somewhat active and not very good in nature, come to the hospital for a review! ” There was a short silence on the other side of the phone, followed by a brisk reply, “Got it, Dr. He, I’ll review it on your next clinic day.” The patient did not collapse, so it seems I was overly concerned. When I arrived at the clinic, Xiaoxu was already waiting there, registered as number one. ”Dr. He, I’ve been speculating for the past few days, what could it be? Could it be cancer? Not to mention my husband, even my brother can’t sleep. If it is cancer, you can just tell me, I can bear it very well.” ”Your husband didn’t come?” ”No need for him to come, I’m fine.” While I examined the patient’s wound, I called the case room to ask for Xiaoxu’s medical records to be sent over. Luckily, the wound had already healed, and even though the scar area couldn’t grow hair, the hair around it covered over and didn’t affect the appearance. I took out the pathology report, and when I saw the words “basal cell carcinoma”, the expression on Xiao Xu’s face froze. The word “cancer” is a very heavy blow to the patient, no matter how much ambush and how well prepared she is, when the diagnosis sits on her head, she still cannot calm down. Before I recalled Xiaoxu, I repeatedly considered whether I should tell the patient the truth. Frankly, I did not see any benefit in letting the patient know the truth, because in this case, the anxiety and fear were likely to hit the patient much harder than the disease itself. However, as a rule, doctors are not in a position to make decisions for their patients and it is our duty to inform. All I can do is to minimize the risk of psychological burden on the patient’s health, so that the patient can live a normal life with a peaceful mind. So what is basal cell carcinoma? Basal cell carcinoma is a tumor of the body surface that predisposes to white people and less frequently occurs in yellow and black people. It begins as a small, translucent, raised papule with freckle-like dark spots or red blood, and later becomes an ulcer or increased melanin. Its occurrence is directly related to excessive UV exposure, and another proven trigger is the long-term intake of food or water containing inorganic arsenic. Basal cell carcinoma is of low malignancy and usually does not metastasize. It should be completely removed if available. There is a statistical overall recurrence rate of 3.5%, which mostly occurs within two years after treatment. Generally speaking, the recurrence rate should be reviewed in the hospital once every six months for two years after resection. It is important to strengthen self-examination. The “small black spot” in the corner of the eye is squamous cell carcinoma. Master Zhang is the owner of a home improvement electric store. When he was nearly fifty years old, he had a small nevus in the corner of his left eye, and his friends joked that he had a middle-aged spirit. So, he liked to touch this mole when playing mahjong, secretly thinking that a small mole brings good luck, and it really works, often a touch of the small mole can be a tile. However, three years ago, the mole secretly grew up and started to break out, itching and flowing, and it never got better, even the corners of his eyes started to sticky. Master Zhang visited many hospitals, and when he was referred to me, there was a brown moss as big as a dollar coin at the right temple, and the surrounding area was indistinguishable from the normal tissue, and even the conjunctiva was also involved. A large area of tissue was cut during surgery, and a portion of the eyelid was removed to ensure that the edges were clean. The wound healed as expected, but the face and eyelid were like patches, and no matter how fine the stitching was, they were not original. The good thing is that Master Zhang is an optimistic person, speaking with a Hunan accent, he said, “I have two sons, three stores, and now three eyes, so it seems I have to make a lot of money!” About squamous cell carcinoma According to statistics, the incidence of basal cell carcinoma is the highest among body surface tumors, but the incidence of squamous cell carcinoma in China is higher than that of basal cell carcinoma, with a prevalence age of 50 to 60 years old, which is related to ultraviolet radiation and frequent exposure to chemical agents. It starts as a small hard lump or monkey, often repeatedly breaks down and does not heal easily. It can cause lymphatic metastasis and rarely occurs hematogenous metastasis. Surgical excision is the treatment of choice, and the extent of excision should be adequate. Although the malignancy is somewhat higher than basal cell carcinoma, with proper treatment, the five-year survival rate can reach 90 percent. For example, Master Zhang has been followed up for three years and no recurrence or metastasis has been seen. In the movie, the hero, Li Xiangshan, learns that he has malignant melanoma and arranges his life afterwards in an entrepreneurial style. So what is malignant melanoma? Is it that terrible? Malignant melanoma ranks third in the incidence of body surface tumors after basal cell carcinoma and squamous cell carcinoma, while its malignancy is much higher than the first two. The pathogenesis of malignant melanoma is not cleared yet, but it is associated with nevi, ultraviolet radiation, race, heredity, trauma, and viral infection. All congenital nevi have the possibility of malignant transformation, but the probability is low, one in a million according to some scholars, but the chance of malignant transformation is much higher for nevi on the palms of the hands, soles of the feet, scrotum, and labia. Early diagnosis is crucial to the prognosis of malignant nevi. Therefore, identifying those small moles is not only a task for doctors, but should also become common knowledge for people. Be alert if the following changes occur in small moles: we can summarize them into five ABCDE points: A:asymmetry, asymmetry B:border-notching border unclear, C:color variegation with black, brown, red, blue, or white hues color mottling, which can have multiple shades of black, brown, red, blue, and white, D:diameter greater than 6 mm diameter greater than 6 mm, E: elevation augmentation. In addition to these morphological features, there are specific groups of people who should pay particular attention to their physical examination. First, people with family history, according to statistics, 5-10% of malignant black patients have family history; second, people who have more than 50 moles before 20 years old or after 50 years old; third, people who have more than 100 moles or more than 20 moles on the extremities and trunk. Complete removal of small moles before they have bad motions is an effective means to prevent malignant nevi, and treatment when malignant nevi have just started and have not metastasized is still optimistic in prognosis. Environmental changes promote many diseases, and body surface tumors are one of them. As we can see from the above description, all three types of diseases, either minor or major, are related to UVB overexposure, with UVB being a more serious hazard. The ozone layer is an effective barrier to UVB, but since the 1950s scientists have observed a tendency for the ozone concentration in the atmosphere to decrease, which has allowed more UVB to reach the earth. Therefore, in such a general environment, we have to pay great attention to our own protection. In fact, this is not a difficult task, as long as there is awareness of protection, the act is just a handful. Now it is the season of spring blossoms, trekking to enjoy flowers is often chosen by people leisure programs, remember to use sunscreen skin care products properly when outdoor activities. Summer is coming, fashionable people to the beach vacation do not just crave daylight. Parents with children should also know that the melanocytes in young children’s skin are still very unstable and cannot withstand prolonged exposure to the sun when they give their children sunlight for calcium. The other thing is to learn to be your own doctor, to check the skin of your whole body regularly and to visit the hospital in time if you encounter any suspicious situation. Also, even if a lesion of bad nature occurs, as long as it is treated in time, in most cases there will be good results and you can enjoy life as normal. What’s more, an optimistic and open-minded attitude can often have unexpected effects in the treatment of cancer. Many visceral tumors with extremely high malignancy will retreat when they encounter strong will, not to mention the small surface tumors.