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HEALTH - SKIN CANCER (SYMPTOMS - TREATMENT - PREVENTION)
What is Skin Cancer?
Skin cancer is the uncontrolled growth of
abnormal skin cells. If left unchecked, these cancer cells can spread
from the skin into other tissues and organs. Skin cancer is the most common form of cancer in the Unites States, with doctors finding skin cancer in about one million Americans each year.
The annual rates of all forms of skin cancer are increasing each year, representing a growing public concern. It has also been estimated that nearly half of all Americans who live to age 65 will develop skin cancer at least once.
The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal.
The skin, the body's largest organ, protects against infection and injury and helps regulate body temperature. The skin also stores water and fat and produces vitamin D. Skin is made up of two main layers: the epidermis (outer layer of skin) and the dermis (inner layer of skin).
There are three major types of skin cancer — basal cell carcinoma (the most common), squamous cell carcinoma and melanoma, which is the most dangerous of skin cancer. All three types of skin cancer are on the rise — but most skin cancers can be prevented by limiting or avoiding exposure to ultraviolet (UV) radiation and by paying attention to suspicious changes in your skin. And with early detection, you can receive successful treatment for most skin cancers, even the most aggressive forms.
Three main types of skin cancer
Squamous cell carcinoma. Most of the
epidermis is made up of flat, scale-like cells called squamous cells.
Approximately 10% to 20% of skin cancer resembles these cells and is
called squamous cell carcinoma. This type of cancer is mainly caused by
from sun exposure, but it can appear on skin that has been burned,
damaged by chemicals, or exposed to x-rays. This skin cancer makes up roughly 20% of all skin cancers and may grow faster than a basal cell carcinoma.
Basal cell carcinoma. Cells in the lower epidermis are round
cells known as basal cells. About 80% of skin cancer develops from this
type of cell that has been exposed to the sun and is called basal cell
carcinoma. Basal cell carcinoma most often forms on the head and neck. This is the most common type of skin cancer. Basal cell carcinoma
grows slowly and does not usually spread. They can, however, cause damage
by growing and invading surrounding tissue. Nearly half of people with
one basal cell carcinoma develop another one within five years.
Melanoma. Where the epidermis meets the dermis, there are
scattered cells called melanocytes, which produce the melanin that
gives skin color. Melanoma starts in melanocytes, and it is the most
aggressive of the three types of skin cancer. See Melanoma for details.
Squamous cell carcinoma and basal cell carcinoma are known as
non-melanoma skin cancers, to distinguish them from melanoma, which
arises from very different cells and is treated differently.
Typically, non-melanoma skin cancer can be treated with relatively
simple surgery. If the cancer is very small, cryosurgery (freezing) or
laser surgery may be used. Basal cell carcinoma grows slowly and rarely
metastasizes (spreads) to other parts of the body. Squamous cell
carcinoma also rarely spreads, but it is more likely to spread than
basal cell carcinoma.
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Health: Risk Factors of Skin Cancer
The following factors can increase a person’s risk of developing skin cancer:
- Fair skin. Having less pigment (melanin) in your skin provides less protection from damaging UV radiation. If you have blond or red hair, light-colored eyes, and you freckle or sunburn easily, you're much more likely to develop skin cancer than is a person with darker features.
- Gender. Rates of skin cancer in white males have increased in recent years.
- A history of sunburns. Every time you get sunburned, you damage your skin cells and increase your risk of developing skin cancer. After a sunburn, your body works to repair the damage. Having multiple blistering sunburns as a child or teenager increases your risk of developing skin cancer as an adult. Sunburns in adulthood also are a risk factor.
- Exposure to sunlight/UV radiation. Anyone who spends considerable time in the sun may develop skin cancer, especially if your skin isn't protected by sunscreen or clothing. Ultraviolet B (UVB) radiation causes sunburn and plays a role in the development of basal and squamous cell cancers. Ultraviolet A (UVA) penetrates the skin more deeply and contributes to photoaging (premature aging of the skin) or wrinkling. Tanning also puts you at risk. A tan is your skin's injury response to excessive UV radiation.
- Sunny or high-altitude climates. People who live in sunny, warm climates are exposed to more sunlight than are people who live in colder climates. Living at higher elevations, where the sunlight is strongest, also exposes you to more radiation.
- Viral infection. People infected with a specific type of human papillomavirus (HPV) are at increased risk for developing squamous cell carcinoma, particularly if their immune system becomes suppressed.
- Moles. People who have many moles or abnormal moles called dysplastic nevi are at increased risk of skin cancer. These abnormal moles — which look irregular and are generally larger than normal moles — are more likely than others to become cancerous. If you have a history of abnormal moles, watch them regularly for changes.
- Precancerous skin lesions. Having skin lesions known as actinic keratoses can increase your risk of developing skin cancer. These precancerous skin growths typically appear as rough, scaly patches that range in color from brown to dark pink. They're most common on the face, lower arms and hands of fair-skinned people whose skin has been sun damaged.
- A family history of skin cancer. If one of your parents or a sibling has had skin cancer, you may be at increased risk of the disease. Some families are affected by a condition called familial atypical mole-malignant melanoma (FAMMM) syndrome. The hallmarks of FAMMM include a history of melanoma in one or more close relatives and having more than 50 moles — some of which are atypical. Because people with this syndrome have an extremely high risk of developing melanoma, frequent screening for signs of skin cancer is crucial.
- Previous skin cancer. People who have had any form of skin
cancer are at a higher risk for developing another skin cancer.
Thirty-five percent (35%) to 50% of people diagnosed with one basal
cell cancer will develop a new skin cancer within five years. Thus,
people who have had one skin cancer need ongoing, follow-up care to
watch for additional cancers.
- A weakened immune system. People with weakened immune systems are at greater risk of developing skin cancer. This includes people living with HIV/AIDS or leukemia and those taking immunosuppressant drugs after an organ transplant. And those who use certain medications (such as immunosuppressive drugs, certain steroids, and drugs that make the skin sensitive to light) are at higher risk for developing skin cancer, particularly squamous cell cancers. People with very rare predisposing genetic conditions, such as xeroderma pigmentosum, nevoid basal cell carcinoma syndrome, or albinism are at much higher risk for developing skin cancer.
- Fragile skin. Skin that has been burned, injured or weakened by treatments for other skin conditions is more susceptible to sun damage and skin cancer. Certain psoriasis treatments and eczema creams might increase your risk of skin cancer.
- Exposure to environmental hazards. Exposure to environmental chemicals, including some herbicides, increases your risk of skin cancer.
- Age. The risk of developing skin cancer increases with age, primarily because many skin cancers develop slowly. The damage that occurs during childhood or adolescence may not become apparent until middle age. Still, skin cancer isn't limited to older people. Basal cell and squamous cell carcinomas are increasing fastest among women younger than 40.
Health: Symptoms of Skin Cancer
Skin cancer develops primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it can also form on areas that rarely see the light of day — your palms, beneath your fingernails, the spaces between your toes or under your toenails, and your genital area.
Skin cancer affects people of all skin tones, including those with darker complexions. When melanoma occurs in those with dark skin tones, it's more likely to occur in areas not normally considered to be sun-exposed.
A cancerous skin lesion can appear suddenly or develop slowly. Its appearance depends on the type of cancer.
The
skin features that frequently occur in basal cell or squamous cell
carcinoma are listed below. If you are concerned about a symptom or a
feature on this list, please talk with your doctor or health care provider. Changes in the skin are the main warning sign for skin cancer. Each
type of skin cancer can appear differently, and an accurate diagnosis
by a doctor or other health-care professional is essential. Squamous cell cancer can often crust and bleed and appears as: Early detection: Finding skin cancer early
For basal cell cancer, two or more of the following features may be present:
Regular self-examinations may help find skin cancer early. Examinations
should be performed in front of a full-length mirror in a brightly lit
room. It helps to have another person check the scalp and back of the
neck. Non-melanoma skin cancer most often begins on skin that has
frequently been exposed to the sun.
A doctor should be consulted for:
Less common skin cancers
Other, less common types of skin cancer include:
- Kaposi sarcoma. This rare form of skin cancer develops in the skin's blood vessels and causes red or purple patches on the skin or mucous membranes. Like melanoma, it's a serious form of skin cancer. It's mainly seen in people with weakened immune systems, such as people with AIDS, and in people taking medications that suppress their natural immunity, such as people who've undergone organ transplants.
- Merkel cell carcinoma. In this rare cancer, firm, shiny nodules occur on or just beneath the skin and in hair follicles. The nodules may be red, pink or blue and can vary in size from a quarter of an inch (about 6 millimeters) to more than 2 inches (about 50 millimeters). Merkel cell carcinoma is usually found on sun-exposed areas on the head, neck, arms and legs. Unlike basal and squamous cell carcinomas, Merkel cell carcinoma grows rapidly and often spreads to other parts of the body.
- Sebaceous gland carcinoma. This uncommon and aggressive cancer originates in the oil glands in the skin. Sebaceous gland carcinomas — which usually appear as hard, painless nodules — can develop anywhere, but most occur on the eyelid, where they're frequently mistaken for benign conditions.
Precancerous skin lesions, such as an actinic keratosis, also can develop into squamous cell skin cancer. Actinic keratoses appear as rough, scaly, brown or dark-pink patches. They're most commonly found on the face, ears, lower arms and hands of fair-skinned people whose skin has been damaged by the sun.
Not all skin changes are cancerous. The only way to know for sure is to
have your skin examined by your doctor or dermatologist. If you notice any suspicious change in your skin, consult your doctor
right away. As with most cancers, early detection increases the chances
of successful treatment. Don't wait for the area to start hurting —
skin cancer seldom causes pain.
Health: Diagnosis of Skin Cancer
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
- Age and health condition
- The type of cancer
- Severity of symptoms
- Previous test results
Because basal cell and squamous cell cancers rarely spread, a biopsy is often the only test needed to determine the stage of cancer. In a biopsy, the doctor removes all or part of the growth, and the tissue is examined under a microscope to check for cancer cells. No further treatment beyond the biopsy may be necessary if the entire cancer is removed. If the cancer is present at the edges of the tissue taken during the biopsy (called the margin), additional surgery will usually be necessary.
Health: Staging of Skin Cancer
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery).
Basal cell and squamous cell rarely spread. On rare occasions, the patient’s lymph nodes may be removed to determine if the cancer has metastasized. The doctor may perform other tests, including a blood sample, chest x-ray, and diagnostic scans of the liver, bones, and brain, but this is uncommon.
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Health: Conventional Treatment for Skin Cancer
The treatment of skin cancer depends on the
size and location of the tumor, whether the cancer has spread, and the
person's overall health. In many cases, a team of doctors, including a
dermatologist (a doctor who specializes in diseases and conditions of
the skin), surgeon, radiation therapist, and medical oncologist, will
work with the patient to determine the best treatment plan.
Often the abnormal cells are surgically removed or destroyed with topical medications. Most skin cancer treatments require only a local anesthetic and can be done in an outpatient setting. Sometimes no treatment is necessary beyond an initial biopsy that removes the entire growth.
Surgery
Many skin cancers can be removed from the skin quickly and easily, and
often no further treatment is needed. Most of these treatments use a
local anesthetic to numb the skin and can be done outside of a
hospital, either by a dermatologist, general surgeon, or plastic
surgeon. Different types of surgical procedures are used depending on
the size of the cancer and where it is located.
Curettage and electrodessication. In this common procedure, the
cancer is removed with a curette, which is a sharp, spoon-shaped
instrument. The area can then be treated with electrodessication, which
uses an electric current to control bleeding and kill any remaining
cancer cells. This simple, quick procedure is
common in treating small or thin basal cell cancers. It leaves a small,
flat, white scar after this procedure.
Mohs surgery. This technique involves removing the visible
tumor, in addition to small fragments of the edge around where the
tumor existed. Each small fragment is examined under a microscope until
all cancer is removed. This is typically used for larger tumors, those
in hard to reach places, and for cancers that have come back in the
same place.
Freezing. Used most often on precancerous skin conditions, this
procedure (known as cryosurgery) uses liquid nitrogen to freeze and
kill cells. The skin will later blister and shed off. This procedure
will sometimes leave a white scar. More than one freezing may be needed.
Laser therapy. A precise, intense beam of light vaporizes growths, generally with
little damage to surrounding tissue and with minimal bleeding, swelling
and scarring. A doctor may use this therapy to treat superficial skin
cancer or precancerous growths on lips.
Grafting. When a large tumor is removed, surgeons may use a
skin graft from another area of the body to both close the wound and
reduce scarring.
Radiation therapy
This procedure can be used for skin cancer that is hard to treat with
surgery, such as skin cancer that appears on the eyelid, tip of the
nose, and ear. Radiation therapy is the use of high-energy rays or
other particles to kill cancer cells, and several treatments may be
needed. The treatment may produce a rash, make the skin dry or red, or
change the color of the skin.
Topical chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. For cancers
limited to the top layer of the skin or to treat precancerous skin
conditions, doctors may prescribe chemotherapy in a cream or lotion
formula. These drugs are usually applied daily for several weeks. They
may cause inflammation, which later goes away after treatment ends.
In addition to the topical chemotherapy drugs that have been used for many years, some clinicians are using Imiquimod (Aldara), a topical immune response modifier, to treat early basal cell carcinomas, actinic keratoses (squamous cell carcinoma precursors) and very thin squamous cell carcinoma. Iimiquimod is applied several times a week.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications.
Advanced skin cancer
In rare cases, squamous cell cancer can grow deeper into the skin and
can spread to other parts of the body. Sites of a chronic inflammatory
skin condition, mucous membranes (skin that lines the mouth, nose,
vagina, and anus), and the lips are most susceptible to squamous cell
cancer.
Surgery alone is not effective in treating skin cancer that has
metastasized. To control this distant spread, a person’s health-care
team may recommend chemotherapy, radiation therapy, or immunotherapy
(which boosts the body’s immune system in order to enhance its ability
to fight the cancer.)
Treatments for skin cancer under study include:
- Photodynamic therapy (PDT). This treatment destroys skin cancer cells with a combination of laser light and drugs that makes cancer cells sensitive to light. Photodynamic therapy for precancerous skin lesions is currently available by prescription. If you have PDT, you will need to avoid direct sunlight for at least six weeks after treatment.
- Biological therapy (also called immunotherapy). Immunotherapy medications such as interferon and interleukin-2 are under study to treat melanoma and nonmelanoma skin cancers. These types of drugs stimulate your immune system to fight cancer. Other medications applied to your skin, such as imiquimod (Aldara), enhance your immune reaction to skin cancer.
Health: Prevention of Skin Cancer
Reducing exposure to sunlight and other sources of UV radiation lowers the risk of skin cancer. This is important for all age groups, but is especially important for people who have risk factors for skin cancer. Sun damage is cumulative, meaning it builds up over time. Steps to reduce exposure and help prevent many cases of skin cancer include:
- Avoid the sun between 10 a.m. and 4 p.m. Because the sun's rays are strongest during this period, try to schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy. You absorb UV radiation year-round, and clouds offer little protection from damaging rays. Remember, sunburns and suntans cause skin damage that can increase your risk of developing skin cancer. Sun exposure accumulated over time also may cause skin cancer.
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Wear sunscreen year-round. Sunscreens don't filter out all harmful UV radiation, especially the radiation that can lead to melanoma. But they play a major role in an overall sun protection program. Sunscreens that contain ingredients such as titanium dioxide and mexoryl do a better job at blocking UVA rays. Choose a broad-spectrum sunscreen that has a sun protection factor (SPF) of at least 15. Use a generous amount of sunscreen on all exposed skin, including your lips, the tips of your ears, and the backs of your hands and neck.
For the most protection, apply sunscreen 20 to 30 minutes before sun exposure and reapply it every two hours throughout the day, as well as after swimming or exercising. Apply sunscreen to young children before they go outdoors, and teach older children and teens how to use sunscreen to protect themselves. Keep sunscreen in your car as well as with your gardening tools, and sports and camping gear.
- Wear protective clothing. Sunscreens don't provide complete protection from UV rays. That's why it's a good idea to also wear dark, tightly woven clothing that covers your arms and legs, and a broad-brimmed hat, which provides more protection than a baseball cap or visor does. Some companies also sell photoprotective clothing. A dermatologist can recommend an appropriate brand. Don't forget sunglasses. Look for those that block both UVA and UVB rays.
- Avoid tanning beds and tan-accelerating agents. Tanning beds emit UVA rays, which may be as dangerous as UVB rays — especially since UVA light penetrates deeper into your skin and causes precancerous skin lesions.
- Be aware of sun-sensitizing medications. Some common prescription and over-the-counter drugs — including antibiotics; certain cholesterol, high blood pressure and diabetes medications; birth control pills; nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin, others); and the acne medicine isotretinoin (Accutane) — can make your skin more sensitive to sunlight. Ask your doctor or pharmacist about the side effects of any medications you take. If they increase your sensitivity to sunlight, be sure to take extra precautions.
- Check your skin regularly and report changes to your doctor. Examine your skin often for new skin growths or changes in existing moles, freckles, bumps and birthmarks. With the help of mirrors, check your face, neck, ears and scalp. Examine your chest and trunk, and the tops and undersides of your arms and hands. Examine both the front and back of your legs, and your feet, including the soles and the spaces between your toes. Also check your genital area, and between your buttocks.
- Have regular skin exams. Consult your doctor for a complete skin exam every year if you're older than 40, or more often if you're at high risk of developing skin cancer.
Health: Self-examination: A guide to skin cancer
To detect melanomas or other skin cancers, use the A-B-C-D-E skin
self-examination guide, adapted from the American Academy of
Dermatology:
- A is for asymmetrical shape. Look for moles with irregular shapes, such as two very different-looking halves.
- B is for irregular border. Look for moles with irregular, notched or scalloped borders — the characteristics of melanomas.
- C is for changes in color. Look for growths that have many colors or an uneven distribution of color.
- D is for diameter. Look for growths that are larger than about 1/4 inch (about 6 millimeters).
- E is for evolving. Look for changes over time, such as a mole that grows in size or that changes color or shape. Moles may also evolve to develop new signs and symptoms, such as new itchiness or bleeding.
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Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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