Skin Cancer
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What is Skin Cancer?
Skin cancer is a type of malignancy characterized by the abnormal growth of skin cells. It often occurs due to exposure to ultraviolet (UV) radiation from sunlight, especially in cases of repeated or long-term exposure. Skin cancer is one of the most treatable types of cancer and has a high success rate if detected and treated early.
Types of Skin Cancer
Do My Moles Show I Have Skin Cancer? How to Spot Skin Cancer:
There are three main types of skin cancer that are commonly encountered:
1. Basal Cell Carcinoma (BCC)
- BCC is the most prevalent form of skin cancer. It typically develops in areas of the skin that are frequently exposed to sunlight, such as the face and neck.
- The appearance of BCC usually presents as a raised, shiny bump with rolled edges, which may ulcerate. Additionally, it can manifest as a red, scaly patch or resemble a scar. This type of cancer tends to grow locally and does not usually spread to other parts of the body.
2. Squamous Cell Carcinoma (SCC)
- Squamous cell carcinoma is the second most common type of skin cancer. It is particularly prevalent among organ transplant recipients who are on immunosuppressive medication.
- SCC typically occurs in areas such as the face, ears, neck, arms, and hands. It may present as a raised bump or a flesh-colored nodule that can ulcerate. This type of cancer tends to grow more quickly than basal cell carcinoma and has the potential to spread to other parts of the body.
3. Melanoma
- Melanoma is the most aggressive form of skin cancer and is responsible for the majority of skin cancer deaths. It arises from abnormal growth of melanocytes, the cells that produce pigment in the skin. While melanoma is less common than BCC and SCC, it poses a much greater risk due to its potential to metastasize, or spread, to other parts of the body.
- It often appears as a dark spot or a change in an existing mole.
- The highest incidence rates are found in the Australian population, followed by North America and Europe. Common sites for melanoma include the back in men and the legs and torso in women. It can also occur in African American and Asian populations, typically in areas that are not sun-exposed, such as the palms, soles, and nails.
Risk Factors for Skin Cancer
What Are the Risk Factors for Skin Cancer? Is Skin Cancer Related to Sun Exposure or Skin Types?
Several factors can increase the risk of developing skin cancer:
- Ultraviolet (UV) radiation: Repeated or prolonged exposure to UV radiation from sunlight.
- Tanning beds: Use of tanning beds before the age of 35.
- Frequent sunburns, especially during childhood
- Previous radiation therapy: History of radiation treatment for other conditions.
- Chemical exposure: Contact with certain chemicals, such as arsenic.
- Skin type: Individuals with fair skin, blue or green eyes, red or blonde hair, and numerous freckles are at higher risk.
- Moles: Having more than 100 moles increases the risk of melanoma by 8-10 times compared to the general population.
- Family history of skin cancer
- Smoking: Tobacco use is associated with a higher risk of skin cancer.
- Genetic conditions: Certain hereditary conditions, like xeroderma pigmentosum and oculocutaneous albinism, increase susceptibility to skin cancer.
- Immunocompromised state: Individuals on immunosuppressive medications or those with AIDS have a higher risk.
- Chronic wounds: Non-healing wounds or sores.
- Human papillomavirus (HPV): Infection with certain strains of HPV can increase risk.
What are the Symptoms of Skin Cancer?
Symptoms that may indicate skin cancer include:
- New growths: A raised bump or nodule that appears suddenly or changes in size or shape.
- Chronic non-healing wounds: Any sore or ulcer that does not heal.
- Persistent bumps: Nodules that persist despite treatment.
- Mole changes: Changes in existing moles can be identified by the ABCDE criteria:
A – Asymmetry: Irregular shape, not symmetrical.
B – Border: Borders that are uneven or not well-defined.
C – Color: Variegated colors within a single mole.
D – diameter: A mole larger than 6 mm or the size of a pencil eraser.
E – evolving: A mole that changes in size, shape, or color, or develops new symptoms like bleeding or crusting.
Protecting Yourself Against Skin Cancer
Skin cancer is one of the most common types of cancer, but it is also one of the most preventable. Here are some essential tips to help you protect your skin and reduce your risk of skin cancer.
1. Sun protection
- Seek shade: Try to stay in shaded areas whenever possible.
- Avoid peak sun hours: Limit sun exposure, especially between 10 AM and 2 PM when the sun’s rays are the strongest.
- Wear protective clothing: If you need to be outdoors, wear a wide-brimmed hat, UV-blocking sunglasses, and long-sleeved clothing in darker colors. An umbrella treated with UV protection can also be helpful.
- Using sunscreen
- Choose the right sunscreen: Select a broad-spectrum sunscreen that protects against both UVA and UVB rays, has an SPF of 30 or higher (suggested 50 for outdoor activities), and is water-resistant.
- Reapply regularly: Apply sunscreen every two hours, or more often if swimming or sweating.
- Apply sufficient amount:
For the face (excluding the neck), use about two fingertip lengths of cream sunscreen or an amount equivalent to a 10-baht coin for liquid sunscreen. - Don’t forget other areas: Be sure to apply sunscreen to all sun-exposed areas, including the neck, ears, back, arms, and legs.
2. Avoid smoking
3. Regular skin checks:
- Conduct self-examinations of your skin monthly. If you notice any suspicious bumps or changes, consult a dermatologist for accurate diagnosis and treatment.
- Recommend cancer-related check-ups for persons aged >20 years by having periodic evaluations.
- Individuals at higher risk for skin cancer or with a history of skin cancer should have more frequently, to screen for skin cancer.
Treatment of Skin Cancer
Do Skin Cancer Patients Need Chemotherapy?
Most skin cancers can be effectively treated with surgery alone. However, if the cancer has spread to other areas, chemotherapy or radiation therapy may be necessary. For non-aggressive skin cancers that are limited to the epidermis, treatments such as curettage combined with electrodessication, cryotherapy, or topical medications like imiquimod or 5-fluorouracil may be used.
Currently, there is a specialized surgical technique known as Mohs Micrographic Surgery (MMS), developed by Dr. Frederic E. Mohs. This method combines surgical excision with immediate pathological examination, ensuring that the entire cancerous tissue is removed during the procedure, even if the cancer’s borders are not well-defined. This technique minimizes the loss of surrounding normal tissue and is considered one of the most effective treatments for non-melanoma skin cancer.
References:
- Kang S., Amagai M., Bruckner A.L., Enk A.H., Margolis D.J., McMichael A.J., Orringer J.S., editors. Fitzpatrick’s Dermatology. 9th ed. McGraw Hill; New York, NY, USA; 2019.
- Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. 5th ed. Elsevier; 2024.
- Krakowski AC, Hafeez F, Westheim A, Pan EY, Wilson M. Advanced basal cell carcinoma: What dermatologists need to know about diagnosis. J Am Acad Dermatol. 2022 Jun;86(6S):S1-S13.
- Fania L, Didona D, Morese R, Campana I, Coco V, Di Pietro FR, Ricci F, Pallotta S, Candi E, Abeni D, Dellambra E. Basal Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines. 2020 Oct 23;8(11):449. doi: 10.3390/biomedicines8110449. PMID: 33113965; PMCID: PMC7690754.
- https://www.aad.org/public/diseases/skin-cancer/find/mole-map
- Rigel DS, Taylor SC, Lim HW, Alexis AF, Armstrong AW, Chiesa Fuxench ZC, Draelos ZD, Hamzavi IH. Photoprotection for skin of all color: Consensus and clinical guidance from an expert panel. J Am Acad Dermatol. 2022 Mar;86(3S):S1-S8.
- Perez M, Abisaad JA, Rojas KD, Marchetti MA, Jaimes N. Skin cancer: Primary, secondary, and tertiary prevention. Part I. J Am Acad Dermatol. 2022 Aug;87(2):255-268.
- Rojas KD, Perez ME, Marchetti MA, Nichols AJ, Penedo FJ, Jaimes N. Skin cancer: Primary, secondary, and tertiary prevention. Part II. J Am Acad Dermatol. 2022 Aug;87(2):271-288.
- Henrikson NB, Ivlev I, Blasi PR, Nguyen MB, Senger CA, Perdue LA, Lin JS. Screening for Skin Cancer: An Evidence Update for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2023 Apr.
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