One of the popular forms of human cancer is skin cancer which is also known as skin neoplasia. The most common warning for skin cancer is the changes, growth, or sore on the skin that does not disappear or keeps recurring. The increasing cases lead to a rising public concern as over 1 million new cases occur yearly and still increasing. Three forms of skin cancer are: basal cell carcinoma (basal cell carcinoma epithelioma), squamous cell carcinoma (which is the first stage – actinic keratosis), and melanoma (the most dangerous). Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the two most common forms of skin cancer usually referred to as non-melanoma skin cancers, the latter being less common. Non-melanoma skin cancers are generally curable. Melanoma is considered to be the most dangerous and serious form of skin cancer because it is most likely to spread or metastasize.
Basal cell carcinoma is the most common skin cancer. This form rarely metastasizes and almost never leads to fatality. Nevertheless, it damages the surrounding tissue of the affected part of the skin. Ultraviolet radiation from the sun is the main cause of skin cancer. This explains why the greatest rates of skin cancer are found in Australia and Africa where relatively greater amount of UV rays is received. Ultraviolet radiation in tanning booths, popular among adolescents, may cause skin cancer. Therapeutic radiation from treatments of other health problems or cancers increases the risks of having skin cancer. Usually, even though skin protection should start at an early age, skin cancers appear after fifty years of age. People with lighter skin are more prone to skin cancer. Exposure to the sun, exposure to ultraviolet radiation, therapeutic radiation, age, and light skin color are risk factors involved in the development of basal cell carcinoma.
A basal cell carcinoma begins to appear as a small bump covered by telangiectases. The bump may be pearly or dark (melanin pigmented). It is difficult to tell the difference between a basal cell carcinoma from benign growth without a biopsy. Basal cell carcinomas often on the chest or back and grow slowly for a period of months or years. If such growth develops near the eye, ear, or nose, such facial parts may be damaged or disfigured.
Biopsies are performed to diagnose a skin condition displaying similar characteristics to what is skin cancer. The method wherein a small piece of skin is scraped as a sample is called shave biopsy. Presence of cancer cells can then be examined with the use of a microscope.
The main goal in treating basal cell carcinoma is to completely take out the cancer leaving the smallest scar possible. Treatment success rates present a ninety percent chance or more. Before treatment, information such as position and size, age, general health, medical history, and the risk of scarring are considered.
Squamous is from the Latin squama which means fish scale or serpent. Squamous cell carcinoma looks like fish scales under the microscope and unlike basal cell carcinomas, they metastasize. Squamous cells are in the tissues forming the skin, the lining of hollow organs of the body, and the passageways of the respiratory and digestive tracts. Therefore, squamous cell carcinomas may develop in any of these tissues. Actinic (or solar) keratosis is the earliest form revealing coarse, reddish bumps on the scalp, face, ears, and hands. Actinic keratoses may invade deeper into the skin leading to full development of squamous cell carcinoma. When it grows rapidly forming a mass with a central crater it leads to keratoacanthoma. Other squamous cell carcinomas that does not involve invasion deeper into the skin yet are: actinic cheilitis, Bowen’s disease, and Bowenoid papulosis.
Light-colored skin and frequent exposure to the sun are more accountable for this kind of cancer than basal cell carcinoma. Males are more prone than females. Clothing patterns and hairstyle also play a role. Females with hair covering their ears are less prone to squamous cell carcinomas than males. Uncommon factors may lead to squamous cell carcinoma including exposure to arcenic, hydrocarbons, heat, or X-rays. Squamous cell carsimomas may sometimes arise from tissue scars. The human papillomavirus responsible for causing genital warts can promote development of squamous cell carcinoma around the anogenital region. Infection or drugs may also promote cancer growths.
A punch biopsy is usually performed to arrive to proper diagnosis in squamous cell carcinomas. Local anesthesia is injected and a small piece of skin is punched out with a circular punch blade. Under the microscope, the skin that is removed will be examined.
Dermatologists can scoop out the basal or squamous cell carcinoma using a curette. This process is called curettage. Desiccation is the use of an electric current device to prevent excessive bleeding and kill cancer cells. Together, this combination of curettage and desiccation is applicable to non-critical areas like extremities. The tumor is cut out and stitched up in a surgical excision. For areas where surgery is difficult to perform, radiation therapy is done involving numerous treatment sessions. Cryosurgery is a technique performed by way of freezing and killing cancer cells with the use of liquid nitrogen. Mohs micrographic surgery (microscopically controlled excision), named after Dr. Frederic Mohs, is the removal of small pieces of the tumor in a repetitive manner removing the least amount of healthy normal tissue possible. Such treatment is preferred for larger or recurring basal or squamous cell carcinomas. Medical therapy using creams that target cancer cells may be performed at home with better aesthetic results. However, this may be associated with discomfort and a lesser cure rate.
Melanoma is the least common but is responsible for most skin cancer related deaths. Melanoma begins in the basal or squamous cells of the epidermis where cells that color the skin or melanocytes are found. Melanoma is more common in adults but may occasionally occur in children and adolescents. The skin is man’s first line of defense against pathogens and water loss. It is made up of two main layers: the epidermis (the top layer) and dermis (the inner layer). Melanocytes produce melanin. Massive and abnormal production of cells is found in the epidermis may be cutaneous melanoma or malignant melanoma. Melanoma may also be found in the eye (ocular or intraocular).
The risk of having melanoma may be intrinsic or environmental, intrinsic being a patient with history of cancers in the family and environmental where exposure to the sun is still the most relevant factor. Warning signs of melanoma include change in size, color, or shape; secretion; itchiness or irritation; or appearance of moles. Men usually get melanoma on the trunk, head or neck, while women get them on the arms and legs.
Excisional biopsies must be performed to diagnose a melanoma. The doctor removes the entire suspicious looking growth. If it is too large to remove, a sample of the tissue is taken out. Shave or punch biopsies are never performed if melanoma is suspected.
A second opinion may be pursued before a patient agrees on a treatment. The doctor and the patient must work together to determine the treatment plan that best suits the condition of the patient. Treatment decisions rely on the extent of the disease, age, general health condition, and medical history of the patient. Melanoma patients are usually treated by a team of specialists including a dermatologist, surgeon, plastic surgeon, medical oncologist, and radiation oncologist.
What is skin cancer patients faced with? Shock and stress make it hard for skin cancer patients to think clearly on the decisions to be made with regard to the disease. Cancer in general has physical, emotional, and financial impacts on the patient and their loved ones. It is important for patients to thoroughly understand the specific case and have an open mind to be able to identify the most practical way through the challenge. Moral support from a social support system (friends or family) is significant.
