What about skin cancer?
Skin Cancer: An Overview
Skin cancer is a type of cancer that develops in the skin cells. It is one of the most common forms of cancer globally, with rates increasing in many countries due to greater exposure to ultraviolet (UV) radiation from the sun and artificial sources like tanning beds. While skin cancer can often be treated effectively when detected early, it can be life-threatening if allowed to progress.
There are three main types of skin cancer, each originating in different skin cells:
Basal Cell Carcinoma (BCC):
Basal cell carcinoma is the most common form of skin cancer, accounting for around 80% of all cases. BCC is usually slow-growing and rarely spreads to other parts of the body. It often appears as a small, shiny bump with small vessels around and on top of it or a sore that heals and then reopens.Squamous Cell Carcinoma (SCC):
SCC is more aggressive than BCC and can spread to other parts of the body if left untreated. It often presents as red, scaly patches, open sores, or warts that often ulcer and bleed. SCC is frequently associated with long-standing wounds or burns.Malignant Melanoma (MM):
MM is the most dangerous form of skin cancer. Melanoma can develop anywhere on the skin, but it is more likely to form in areas that have been sun-exposed. Unlike BCC and SCC, melanoma can metastasize (spread) to other organs if not detected early. It typically appears as an irregularly shaped mole or dark spot that may change in size, shape, or color over timeUse the ABCDE mnemonic to identify risk factors of a concerning mole that needs to be checked out:
A for Asymmetry: One half of the mole doesn't match the other half.
B for Border: The edges are irregular, jagged, or poorly defined.
C for Color: The color is uneven, with different shades of brown, black,or even red or blue.
D for Diameter: The mole is larger than 6mm (about the size of a pencil eraser).
E for Evolving: The mole changes over time in size, shape, or color.
Causes and Risk Factors
The primary cause of skin cancer is UV radiation from the sun or artificial sources. UV radiation damages the DNA in skin cells, leading to mutations that can cause cancer. There are several factors that can increase a person’s risk of developing skin cancer:
Sun Exposure: Prolonged or intense exposure to the sun, particularly during childhood, increases the risk of developing skin cancer later in life.
Radiation therapy
Tanning Beds: Use of tanning beds increases the risk of both melanoma and non-melanoma skin cancers (up to 10 times).
Fair Skin: People with lighter skin, especially those with red or blonde hair, blue or green eyes, and who tend to freckle or burn rather than tan, are at higher risk.
Family History and Genetics: A family history of skin cancer.
Immunosuppression: People with weakened immune systems, due to conditions like HIV/AIDS or immunosuppressive treatments for organ transplants, are more vulnerable.
Age: The risk of skin cancer increases with age, but melanoma is also common in younger adults, particularly young women.
Chronic wounds/burns
Symptoms and Signs
The most common symptom of skin cancer is a change in the appearance of the skin. Some warning signs include:
A new growth or sore that doesn’t heal > 3 weeks.
Changes in an existing mole or freckle, such as a change in color, shape, or size (use the ABCDE mnemonic).
Itching, bleeding, or tenderness in a mole or growth.
A rough, scaly patch or ulcer that doesn’t go away.
How is it diagnosed?
Skin cancer is usually diagnosed through an incisional skin biopsy = removing a part of the lesion (if the diagnosis is not clear, the lesion is large and/or needs a complex reconstruction), or an excisional skin biopsy = removing the whole lesion (all pigmented lesions, and small lesions that do not need a complex reconstruction). The tissue sample of the suspicious tissue is examined under a microscope.
If skin cancer is confirmed, the treatment depends on the type, size, location, and stage of cancer.
Surgical removal: The most common treatment for localized skin cancer, where the cancerous cells are surgically excised from the skin with lateral margins (start around 3 mm) that depend on the type of the tumor and the risk factors.
This is often followed by a a reconstruction that can include primary closure with sutures, a flap (reaarrangement of the tissues by rotation, transposition or advancement) or a skin graft.
I never attempt a reconstruction before making sure the margins are clear of any cancerous cells, especially for MM.
Surgery (with clear margins) has the lowest risk of recurrence at around 3-5% with surgery.
Cryotherapy: Freezing cancer cells with liquid nitrogen, often used for precancerous lesions or early-stage skin cancers.
Radiation therapy: Used for cancers that are difficult to remove surgically or in patients who cannot undergo surgery.
Chemotherapy or Immunotherapy: For advanced skin cancers, such as melanoma, drugs can be used to target cancer cells directly or boost the body’s immune system to fight the cancer.
How is it prevented?
Preventing skin cancer primarily involves protecting the skin from harmful UV radiation.
Using sunscreen: Broad-spectrum sunscreen with SPF 30 or higher should be applied generously to all exposed skin, even on cloudy days. Reapply every two hours or after swimming or sweating.
Wearing protective clothing: Long sleeves, hats, and sunglasses can help shield the skin from the sun.
Seeking shade: Particularly during peak sunlight hours (10 am to 4 pm), staying in the shade or indoors is advisable.
Avoiding tanning beds: These devices emit harmful UV radiation, increasing the risk of skin cancer.
Regular skin checks: Self-exams and professional skin exams can help detect early signs of skin cancer.
