Skin Cancer

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What is Skin Cancer?

Skin Cancer is cancer that arises in the skin cells. It develops mostly in the areas of the skin that are exposed to the sun; however, it also can occur in other areas.

Is Skin Cancer a Medical emergency?

Skin Cancer is not a medical emergency; however, if left untreated it can grow larger and spread to other parts of the body.

Types

Skin Cancer is classified into two:

Keratinocyte carcinoma: Basal cell carcinoma and squamous cell carcinoma are grouped as keratinocyte carcinoma because they arise in the type of skin cells called keratinocytes.

  • Basal cell carcinoma: This type of Skin Cancer begins in basal cells. This is the most common type of Skin Cancer and about 90 percent of Skin Cancers are basal cell carcinomas.
  • Squamous cell carcinoma: Squamous cell carcinoma is a type of cancer that develops in the squamous cells. Squamous cells are present in the outermost layer of the skin. This is the second most common form of Skin Cancer. It occurs in sun-exposed areas such as the neck and face. It is slow-growing Skin Cancer.

Melanoma: Melanoma is a type of Skin Cancer that originates from pigment-producing skin cells called melanocytes. It develops on the face, trunk, and lower limbs. It also occurs in areas that are not exposed to the sun. In some people, melanoma occurs under fingernails and toenails. Melanoma is a rare type of Skin Cancer and only 1 percent of Skin Cancers are diagnosed as melanoma.

Actinic keratosis: Actinic keratosis refers to the abnormal growth of skin cells in the areas that are damaged due to excess sun exposure. Actinic keratosis is not cancerous in all cases; however, in a few cases, it can develop into Skin Cancer. They appear as red or pink patches on the skin. They are considered to be precancerous lesions.

Causes

Skin Cancers are caused by DNA mutations in the body. DNA mutations are induced by ultraviolet rays. Ultraviolet rays from the sun or tanning beds can damage DNA inside the skin cells, causing abnormal growth of skin cells. The cells grow uncontrollably and form a mass of cancer cells. Both basal cell carcinoma and squamous cell carcinoma are caused due to excessive exposure to sunlight. The exact cause of melanoma is unclear; however, melanoma can be caused by ultraviolet rays. Melanoma also occurs in parts of the body that are not much exposed to sunlight.

Risk factors

Factors that increase the probability of developing Skin Cancer include the following:

  • A lighter skin complexion
  • Exposure to sunlight for long hours
  • A sensitive skin that burns, freckles, becomes red or becomes painful when exposed to the sun
  • Family history
  • Previous history
  • Development of excessive moles on the skin
  • Individuals with blond or red hair and also individuals with blue or green eyes
  • Having exposure to toxic chemicals
  • Advancing age

Symptoms & signs

Signs and symptoms of basal cell carcinoma:

  • A pearly and waxy bump
  • A pink or brown color lesion that appears as a scaly patch
  • A flesh-colored mole or pimple that does not heal
  • An open sore that bleeds, oozes, or forms crust

Signs and symptoms of squamous cell carcinoma:

  • A dome-shaped bump that looks like a wart
  • A red, scaly patch that appears rough, crusty, and bleeds easily
  • An open sore that does not heal
  • A growth on the skin with raised edges with a depressed area in the middle

Investigations

It is diagnosed depending on the physical examination of the skin lesion. The shape, size, color, and texture of a skin lesion are first observed. Later the physician checks for any scaling, bleeding, or dry patches. A skin biopsy is performed to confirm whether the cells are cancerous or non-cancerous. Skin biopsy is a simple procedure. The skin on the suspicious area is scarped and sent to the lab for testing.

Diagnosis

Diagnosis of Skin Cancer is made on physical examination of the skin lesions and considering the results of the investigation tests.

Course/ Stages

To determine the stage of Skin Cancer, the size of the tumor and the extent it has spread to the deep layers and other parts of the body are taken into consideration. Basal cell and squamous cell carcinoma stages are as described below.

  • Stage 0: This is the first stage of Skin Cancer. The abnormal cells have not spread beyond the outermost layer of skin called the epidermis. They appear on the superficial layer of the skin.
  • Stage I: In this stage, the cancer cells may have extended 2 cm or less to the next layer of the skin called the dermis.
  • Stage II: In this stage, the cancer tumor is larger than two centimeters, but it has not spread to nearby sites or lymph nodes.
  • Stage III: In this stage, the cancer cells have spread from the primary tumor to nearby tissue or bone. It can be larger than three centimeters.
  • Stage IV: In this stage, cancer has spread to nearby lymph nodes, surrounding tissues, and bone. The tumor is also larger than three centimeters.

Melanoma cancer stages are as described below:

  • Stage 0: In this stage, Skin Cancer has not penetrated below the outermost layer of the skin called the epidermis.
  • Stage I: In this stage, the cancer cells may have spread to the second layer of skin, called the dermis; however, the size of the cancer tumor is small.
  • Stage II: In this stage, the cancer cells have not spread beyond the original tumor site, but it is larger, thicker, and may have other symptoms such as scaling, bleeding, or flaking of the lesion.
  • Stage III: In this stage, the cancer cells have spread to the nearby lymph nodes or the surrounding skin tissues.
  • Stage IV: This is the most advanced stage of melanoma. In this stage, the cancer cells have spread to the lymph nodes, organs, or surrounding skin tissues beyond the original tumor site.

Treatment options

Medical treatment

Treatment of Skin Cancer depends upon the size, location, type, and stage of Skin Cancer. Medical treatment includes:

  • Chemotherapy: Chemotherapy is a drug treatment that is prescribed to destroy cancer cells. It is given in the form of pills or IV.
  • Immunotherapy: These drugs are used to strengthen the immune system to fight against cancer cells.

Interventional treatment including surgery and indications for surgery/ Surgical treatment

Various interventions are used in the treatment of Skin Cancer. They include:

  • Cryotherapy: Cryotherapy is a treatment that involves using freezing or near-freezing temperatures to destroy the cancer cells.
  • Excisional surgery: A surgical excision of the skin lesion that surgically removes cancerous moles, lesions, and tumors on the skin along with a healthy margin around the tumor.
  • Mohs surgery: Mohs surgery is a precise surgical procedure that is performed to treat Skin Cancer. In this procedure, the skin is removed in layers and each layer is examined under a microscope until a cancer-free layer is reached. Mohs surgery effectively treats high-risk Skin Cancers by preserving the maximum amount of healthy skin.
  • Photodynamic therapy: This is a form of phototherapy involving light and a photosensitizing chemical substance to destroy cancerous cells.
  • Biological therapy: Biological therapy uses your body's immune system to kill cancer cells.
  • Curettage and electrodesiccation: A curette, which is a circular-shaped device is used to scrape the layers of the cancer cells. An electric needle destroys any remaining cancer cells. This procedure is used to treat basal cell and squamous cell cancers.

Radiation

Radiation therapy uses high-energy beams of x-rays or protons to destroy cancer cells. This therapy is used in combination with chemotherapy or it can be used after a surgical procedure. Radiation beams are directly focused on the affected area to shrink the tumor.

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

The following steps are to be followed to lower the risk of developing Skin Cancer:

  • Avoid excessive exposure to sunlight especially from 10 am to 4 pm
  • Avoid tanning beds and sun lamps
  • Apply sunscreen lotion to the skin when going outside in the sun
  • Wear sunglasses, wide-brimmed hats, and full sleeves clothing to protect from sunlight
  • Always observe changes on the skin. If any new growths or abnormal skin lesions appear consult a dermatologist for further diagnosis

Complications

The primary complication of Skin Cancer is recurrence. Even after treatment, it can come back either at the same place or at a different location.

Prognosis

The prognosis depends upon the stage and type of cancer. It is curable when detected and treated early. Once cancer has spread to the deeper layers of the skin or other parts of the body it becomes difficult to treat. In 99% of the cases, the life expectancy after treatment of Skin Cancer is 5 years.

When to contact the doctor? / How to identify complications?

Skin Cancers are not identical and they do not show up many symptoms. Therefore any of the following is observed it is always advisable to consult a doctor:

  • A new mole, abnormal growth, bump, or sore on the skin
  • Any scaly patch or dark spot that does not go away even after a few days
  • A lesion that has raised and uneven edges
  • A skin lesion that appears in white, pink, red, blue, or brown color
  • A skin lesion that increases in size gradually over days
  • Any skin lesion that changes in color, size, or shape requires medication attention

Indications for hospitalization

Hospitalization is not necessary in all cases; however, certain surgical interventions in the treatment of Skin Cancer may require hospitalization depending upon the general health condition of the individual.

Screening methods

Skin Cancer screening is a simple and easy procedure. If an individual is at risk of developing Skin Cancer, it is recommended to have Skin Cancer screening. Noting unusual moles or spots on the skin are signs of Skin Cancer. Skin Cancer screening can help to detect cancer beforehand. Early detection is the best way to ensure successful treatment.

Suggested clinical specialists/ Departments to consult for this condition

  • Oncology
  • Dermatology
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