Skin cancers is the enlargement of abnormal cells that originates from the skin . These cells have
the ability to invade or spread to other parts of the body. It is the most common form of cancer and worldwide it consists 40% of the cases.
Classification:
There are three main types of skin cancer:
bumps that may bleed causing minor injury. It may have small superficial blood vessel or may present as a raised area with an ulcer. It rarely undergoes metastasis. It can be easily treated by surgery and radiation.
Squamous cell cancer (SCC): It is less common than basal cell cancer. It appears in people with weak immune system. It is dull red, rough scaly raised skin lesions. It undergoes metastasis more rapidly than basal cell cancer. It usually presents as a hard lump with a scaly top but may also form an ulcer. It occur most commonly on sun exposed areas (head, neck, ears, lips, back of the hands and forearms). The increased risk for recurrence or metastasis occurs in ear, lip/perioral, nose, periorbital, genitalia. It may be more invasive and more aggressive in transplant patients.
Melanomas: It is the most aggressive. It is the neoplasm of pigment (melanin) producing cells. It
is brown or black skin lesion with irregularites in border, coloration and symmetry. Signs include
a increase in size, shape, colour of mole with irregular edges, and is itchy and bleeds. It is least
frequent among the three common skin cancers. They rapidly undergoes metastasis, and can cause
death on spreading.
Less common skin cancers include: Dermatofibrosarcoma protuberans, Merkel cell carcinoma ,
Kaposi's sarcoma ,keratoacanthoma , spindle cell tumors, sebaceous carcinomas , microcystic
adnexal carcinoma , Paget's disease of the breast, atypical fibroxanthoma, leiomyosarcoma , andangiosarcoma .
Causes:
Exposure to ultraviolet radiation from sun and also artificial ultraviolet radiation (tanning beds) is the primary cause of skin cancer. Other cause of skin cancer are: Smoking tobacco, HPV infections increase the risk of squamous cell carcinoma. Some genetic syndromes including congenital melanocytic nevi syndrome which is characterized by the presence of nevi (birthmarks or moles) larger than 20 mm which is present either at birth, or appear within 6 months of birth are at higher risk for becoming cancerous.
Chronic non-healing wounds known as Marjolin's ulcers based on their appearance, and can develop into squamous cell carcinoma.
Ionizing radiation , environmental carcinogens, old age, and light skin color. The use of many immunosuppressive medication increase the risk of skin cancer. Cyclosporin A, a calcineurin
inhibitor for example increases the risk approximately 200 times, and azathioprine about 60 times.
Signs and symptoms:
There are a variety of skin cancer symptoms. It include delay healing of wound in the skin, ulcering in the skin, discolored skin, and changes in existing moles , such as jagged edges to the mole and enlargement of the mole.
Basal cell carcinoma:Basal cell carcinoma is usually presents on the sun-exposed skin of the head, neck or shoulders as a raised, smooth, pearly bump. Sometimes small blood vessels (called telangiectasia ) can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring.
Squamous cell carcinoma: Squamous cell carcinoma is second most common skin cancer. It is commonly a red, scaling, thickened patch on sun-exposed part of skin. It has a firm hard nodules and is dome shaped. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. It is dangerous, but not as much as dangerous as a melanoma.
Melanoma:Most melanomas appears with colors from shades of brown to black. Very less amount of
melanomas are pink, red or fleshy in color and are known as amelanotic. They are more aggressive.
Warning signs of malignant melanoma:
Change in the size, shape, color or elevation of a mole. Other signs are pain, itching, ulceration, redness around the site, or bleeding at the site when a new mole appears during adult. An often-used mnemonic is "ABCDE", where A is for "asymmetrical", B for"borders" (irregular: "Coast of Maine sign"), C for "color" (variegated), D for "diameter" (larger than 6 mm—the size of a pencil eraser) and E for "evolving."
Surgical treatment: Surgical treatment is possible when the cancer has not spread. Surgery to remove skin cancer are the following:
Excision : It is done by the dermatologist. He numbs the skin and then surgically cuts out the skin
cancer and a small amount of normal-looking skin. This normal-looking skin is called a margin.
Mohs surgery : A dermatologist who has completed additional medical training in Mohs surgery performs this procedure. After the completion Of the training, the dermatologist is called a Mohs surgeon. Mohs surgery begins with the surgeon removing the visible part of the skin cancer because cancer cells are not visible to the naked eye, the surgeon also removes some skin that looks normal but may contain cancer cells. This part of the surgery is performed one layer at a time. After removing a layer of skin, it is prepared so that the surgeon can examine it under a microscope and look for cancer cells. If the surgeon sees cancer cells, the surgeon removes another layer of skin. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less. The cure rate for skin cancer is high when Mohs surgery is used.
Curettage and electrodesiccation : It is the surgical procedure oftenly used to treat small basalcell and squamous cell skin cancers. The tumor is scrapped with a curette (a surgical instrument shaped like a long spoon) and then an electric needle is used gently to cauterize (burn) the remaining cancer cells and some normal-looking tissue. This scraping and cauterizing process is typically repeated 3 times. The wound tends to heal without stitches. Sometimes, curettage is only used.
Other treatments for skin cancer are:
Immunotherapy : The patient’s own immune system is used as treatment to fight the cancer. The patient applies a cream (generic name is imiquimod) to the skin as directed by the dermatologist.
Cryosurgery : The dermatologist freezes the skin cancer. Freezing destroys the cancer cells to
slough off.
Chemotherapy applied to the skin: The generic name for the medicine used in this treatment is 5-
fluorouracil or 5-FU. The patient applies 5-FU to the skin cancer. It destroys the cancer skin cells.
When the skin heals, new skin appears.
Chemotherapy : Chemotherapy kill the cancer cells if the cancer spreads beyond the skin. Chemotherapeutic drugs may be swallowed, injected (shots), or infused (given with an IV). The drugs travels throughout the body and kills the cancer cells. These drugs also destroys some
normal cells. This can cause side effects, such as vomiting and hair loss. When chemotherapy
stops, the side effects usually disappear.
Photodynamic therapy : It consists of 2 phases. First phase, a chemical is applied to the skin cancer. This chemical stay on the skin cancer for several hours. During the second phase, the skin cancer is exposed to a special light. This light destroys the cancer cells.
Radiation therapy: Radiation may be used to treat older adults who have a large skin cancer, skin
cancers that cover a large area, or a skin cancer that is difficult to surgically remove. Radiation
therapy gradually destroys the cancer cells through repeat exposure to radiation. A patient may receive 15 to 30 treatments. This treatment is often only recommended for older adults. Many years after a person is exposed to radiation, new skin cancer can develop.
the ability to invade or spread to other parts of the body. It is the most common form of cancer and worldwide it consists 40% of the cases.
Classification:
There are three main types of skin cancer:
- Basal cell cancer (BCC)
- Squamous cell cancer (SCC) and
- Melanoma
bumps that may bleed causing minor injury. It may have small superficial blood vessel or may present as a raised area with an ulcer. It rarely undergoes metastasis. It can be easily treated by surgery and radiation.
Squamous cell cancer (SCC): It is less common than basal cell cancer. It appears in people with weak immune system. It is dull red, rough scaly raised skin lesions. It undergoes metastasis more rapidly than basal cell cancer. It usually presents as a hard lump with a scaly top but may also form an ulcer. It occur most commonly on sun exposed areas (head, neck, ears, lips, back of the hands and forearms). The increased risk for recurrence or metastasis occurs in ear, lip/perioral, nose, periorbital, genitalia. It may be more invasive and more aggressive in transplant patients.
Melanomas: It is the most aggressive. It is the neoplasm of pigment (melanin) producing cells. It
is brown or black skin lesion with irregularites in border, coloration and symmetry. Signs include
a increase in size, shape, colour of mole with irregular edges, and is itchy and bleeds. It is least
frequent among the three common skin cancers. They rapidly undergoes metastasis, and can cause
death on spreading.
Less common skin cancers include: Dermatofibrosarcoma protuberans, Merkel cell carcinoma ,
Kaposi's sarcoma ,keratoacanthoma , spindle cell tumors, sebaceous carcinomas , microcystic
adnexal carcinoma , Paget's disease of the breast, atypical fibroxanthoma, leiomyosarcoma , andangiosarcoma .
Causes:
Exposure to ultraviolet radiation from sun and also artificial ultraviolet radiation (tanning beds) is the primary cause of skin cancer. Other cause of skin cancer are: Smoking tobacco, HPV infections increase the risk of squamous cell carcinoma. Some genetic syndromes including congenital melanocytic nevi syndrome which is characterized by the presence of nevi (birthmarks or moles) larger than 20 mm which is present either at birth, or appear within 6 months of birth are at higher risk for becoming cancerous.
Chronic non-healing wounds known as Marjolin's ulcers based on their appearance, and can develop into squamous cell carcinoma.
Ionizing radiation , environmental carcinogens, old age, and light skin color. The use of many immunosuppressive medication increase the risk of skin cancer. Cyclosporin A, a calcineurin
inhibitor for example increases the risk approximately 200 times, and azathioprine about 60 times.
Signs and symptoms:
There are a variety of skin cancer symptoms. It include delay healing of wound in the skin, ulcering in the skin, discolored skin, and changes in existing moles , such as jagged edges to the mole and enlargement of the mole.
Basal cell carcinoma:Basal cell carcinoma is usually presents on the sun-exposed skin of the head, neck or shoulders as a raised, smooth, pearly bump. Sometimes small blood vessels (called telangiectasia ) can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring.
Squamous cell carcinoma: Squamous cell carcinoma is second most common skin cancer. It is commonly a red, scaling, thickened patch on sun-exposed part of skin. It has a firm hard nodules and is dome shaped. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. It is dangerous, but not as much as dangerous as a melanoma.
Melanoma:Most melanomas appears with colors from shades of brown to black. Very less amount of
melanomas are pink, red or fleshy in color and are known as amelanotic. They are more aggressive.
Warning signs of malignant melanoma:
Change in the size, shape, color or elevation of a mole. Other signs are pain, itching, ulceration, redness around the site, or bleeding at the site when a new mole appears during adult. An often-used mnemonic is "ABCDE", where A is for "asymmetrical", B for"borders" (irregular: "Coast of Maine sign"), C for "color" (variegated), D for "diameter" (larger than 6 mm—the size of a pencil eraser) and E for "evolving."
Surgical treatment: Surgical treatment is possible when the cancer has not spread. Surgery to remove skin cancer are the following:
Excision : It is done by the dermatologist. He numbs the skin and then surgically cuts out the skin
cancer and a small amount of normal-looking skin. This normal-looking skin is called a margin.
Mohs surgery : A dermatologist who has completed additional medical training in Mohs surgery performs this procedure. After the completion Of the training, the dermatologist is called a Mohs surgeon. Mohs surgery begins with the surgeon removing the visible part of the skin cancer because cancer cells are not visible to the naked eye, the surgeon also removes some skin that looks normal but may contain cancer cells. This part of the surgery is performed one layer at a time. After removing a layer of skin, it is prepared so that the surgeon can examine it under a microscope and look for cancer cells. If the surgeon sees cancer cells, the surgeon removes another layer of skin. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less. The cure rate for skin cancer is high when Mohs surgery is used.
Curettage and electrodesiccation : It is the surgical procedure oftenly used to treat small basalcell and squamous cell skin cancers. The tumor is scrapped with a curette (a surgical instrument shaped like a long spoon) and then an electric needle is used gently to cauterize (burn) the remaining cancer cells and some normal-looking tissue. This scraping and cauterizing process is typically repeated 3 times. The wound tends to heal without stitches. Sometimes, curettage is only used.
Other treatments for skin cancer are:
Immunotherapy : The patient’s own immune system is used as treatment to fight the cancer. The patient applies a cream (generic name is imiquimod) to the skin as directed by the dermatologist.
Cryosurgery : The dermatologist freezes the skin cancer. Freezing destroys the cancer cells to
slough off.
Chemotherapy applied to the skin: The generic name for the medicine used in this treatment is 5-
fluorouracil or 5-FU. The patient applies 5-FU to the skin cancer. It destroys the cancer skin cells.
When the skin heals, new skin appears.
Chemotherapy : Chemotherapy kill the cancer cells if the cancer spreads beyond the skin. Chemotherapeutic drugs may be swallowed, injected (shots), or infused (given with an IV). The drugs travels throughout the body and kills the cancer cells. These drugs also destroys some
normal cells. This can cause side effects, such as vomiting and hair loss. When chemotherapy
stops, the side effects usually disappear.
Photodynamic therapy : It consists of 2 phases. First phase, a chemical is applied to the skin cancer. This chemical stay on the skin cancer for several hours. During the second phase, the skin cancer is exposed to a special light. This light destroys the cancer cells.
Radiation therapy: Radiation may be used to treat older adults who have a large skin cancer, skin
cancers that cover a large area, or a skin cancer that is difficult to surgically remove. Radiation
therapy gradually destroys the cancer cells through repeat exposure to radiation. A patient may receive 15 to 30 treatments. This treatment is often only recommended for older adults. Many years after a person is exposed to radiation, new skin cancer can develop.
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