Skin is the largest organ of the body. It covers the internal body organs and protect its from injury, serves as a barrier from any germs or bacteria and helps prevent any fluid loss. The skin also helps control body temperature and gets rid of certain body wastes. The cells in the skin communicate with the brain and allow temperature regulate, touch, and pain sensations.
|Primer On Skin Cancer|
Skin cancer is the most common type of all cancers. There are so many type of skin cancer.
Generally skin cancer divided in two group;
a. Melanoma skin cancer, is the most serious type of skin cancer, it’s far more dangerous than other skin cancers and causes most skin cancer deaths.
b. Non-melanoma skin cancer, because they tend to act very differently so skin cancers that are not melanoma are sometimes grouped together as non-melanoma skin cancers.
Non Melanoma types of skin cancer are;
BCCs is not only the most common type of skin cancer, but the most common type of cancer in humans. Also called basal cell cancers, is an uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin).
These cancers tend to grow slowly, but Its very rare to spread nearby lymph nodes or to distant parts of the body. Often look like open sores, red patches, pink growths, shiny bumps, or scars. It can be highly disfiguring if allowed to grow, but almost never spreads (metastasizes) beyond the original tumor site, but it can be damage the surrounding tissue, sometimes causing considerable destruction and disfigurement.
This skin cancer was found in middle-aged or older people as well as younger one that more exposed by sun continuously without protection, especially the head, face, ear, lips, neck and the backs of the hands.
BCCs are easily treated in the early stages and the treatment is very effective. When small skin cancers are removed, the scars are usually cosmetically acceptable. But if the tumors are very large, a skin graft or flap may be used to repair the wound in order to achieve the best cosmetic result and facilitate healing.
If a basal cell cancer is left untreated, it can be grow into nearby areas and invade the bone or other tissues beneath the skin.
After treatment, usually basal cell carcinoma can recur or come back in the same place on the skin. People who have had basal cell cancers are more likely to get the new ones elsewhere on the skin. Half of the people who are diagnosed with one basal cell cancer will develop a new skin cancer within 5 years.
2. Squamous cell carcinoma;
About 2 out of 10 skin cancers are squamous cell carcinomas, also called as squamous cell cancers. The cells in these cancers share features with the squamous cells seen in the outer layers of the skin. Its tend to grow and spread more than basal cell cancers, more likely to invade fatty tissues just beneath the skin and to spread to lymph nodes or distant parts of the body, although this is still uncommon.
This non melanoma skin cancer may appear as a firm red nodule, a scaly growth that bleeds or develops a crust, or a sore that doesn't heal.
It most often occurs on the nose, forehead, ears, lower lip, neck, backs of the hands, and other sun-exposed areas of the body. Affects men more often than women.
Squamous cell cancers may spread to lymph nodes or distant sites but it is in rare cases. But if it is happens, further treatment with radiation therapy and/or chemotherapy may be needed.
3. Squamous cell carcinoma in situ (Bowen disease);
Squamous cell carcinoma in situ, there are also called as Bowen disease. It is the earliest form of squamous cell skin cancer. “In situ” means that the cells of these cancers are still only in the epidermis and have not invaded the dermis.
Like invasive squamous cell skin cancers, the major risk factor is too much sun exposure. Bowen disease appears as reddish patches. If compared with actinic keratoses, Bowen disease patches tend to be larger (sometimes over 1/2 inch across), redder, scalier, and sometimes crusted.
Bowen disease can also occur in the skin of the anal and genital areas. This is often related to sexually transmitted infection with human papilloma viruses (HPVs), the viruses that can also cause genital warts.
4. Merkel cell carcinoma;
Merkel cell carcinoma is uncommon type of skin cancer develops from neuroendocrine cells in the skin. Neuroendocrine is a hormone making cells that resemble nerve cells in some ways.
It is appears as a flesh-colored or bluish-red nodule. Most often can be found on the face, head, arms and neck but can start anywhere.
The cause of Merkel cell carcinoma can be by sun exposure or Merkel cell polyomavirus (MCV). People with history of other skin cancer, have a weakened immune system, older age and light skin color are much more likely to be get merkel cell carcinoma.
About 8 out of 10 Merkel cell carcinomas are thought to be related to MCV infection. Eventhough people infected with MCV has no symptoms, but some changes in the virus' DNA can lead to this form of cancer.
Merkel cell carcinomas often spread to nearby lymph nodes and internal organs, like bones, liver, lung or brain. Unlike basal cell and squamous cell carcinomas. But they also tend to come back after treatment.
Kaposi sarcoma is cancer that usually starts within the dermis but sometimes came also form in internal organs. It is appear as bluish-red or purple bumps on the skin. The reddish-purple because they are rich in blood vessels. The lesions may first appear on the feet or ankles, thighs, arms, hands, face, or any other part of the body. They also can appear on sites inside the body.
The complication kaposi sarcoma are cough (possibly bloody) and shortness of breath if the disease is in the lungs. Also leg swelling that may be painful or cause infections if the disease is in the lymph nodes of the legs. It is related to infection with Kaposi sarcoma herpesvirus (KSHV), also known as human herpesvirus 8 (HHV8).
Kaposi sarcoma has become more common because it is more likely to develop in people with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS).
The treatments include antiviral theraphy against HIV, cryotherapy, radiation therapy and combination chemotherapy.
6. Actinic Keratosis (Solar Keratosis);
Actinic Keratosis also known as solar keratosis, is a pre-cancerous skin condition. It is looks small, rough and scaly patches on the skin, usually less than 1 inch in diameter. Sometimes its itching or burning sensation in the affected area, its flat to slightly raised patch or bump on the top layer of skin, with color ranging from pink to red to brown, or flesh-coloredussually. In some cases, it is hard, wart-like surface.
Actinic Keratosis caused by too much exposed by sun, including the face, lips, ears, back of the hands, forearms, scalp and neck. An actinic keratosis tend to grow slowly and sometimes resolves on its own, but typically returns again after additional sun exposure.
Actinic Keratosis is an early warning sign of skin cancer but early treatment can prevent the development to squamous cell skin cancer.
Most of risk people are middle-aged or older people, have fair-skinned, blond, or red-haired with blue or green eyes.
7. Actinic Cheilitis (Farmer's Lip);
Actinic cheilitis is a precancerous condition that usually appears on the lower lips, marked by solar-induced lesions. Scaly patches or persistent roughness of the lips may be present. Loss of the sharp border between the lip and skin, and prominent lip lines. The other noticeable symptoms are redness, dry crecked lips. persistent erosions, formation of crusty bumps, puffiness and whitish discoloration at the border of the lip.
Less common symptoms include swelling of the lip, It is related to actinic keratosis, Actinic cheilitis may evolve into invasive squamous cell carcinoma if not treated.
The casuses of Actinic cheilitis are exposure to the ultraviolet rays from the sun, regular use of tobacco, poor oral hygiene and some application of allergen-containing lip balms that causing irritation.
Actinic cheilitis is more common in older males and light-complected people.
The cutaneous horn appears as a funnel-shaped growth that extends from a red base on the skin. It is composed of compacted keratin (the same protein in nails). A cutaneous horn is typically a single growth that grows slowly over decades.
It is a specialized type of actininc keratosis. The size and shape of the growth can be vary considerably, but most are a few millimeters in length. Squamous cell carcinoma can be found at the base. The causes are frequently associated with exposure to the sun and other sources of UV radiation. Usually asymptomatic, but it can be injured causing pain and inflammation.
Cutaneous horn can occur anywhere on the body, but more common on sun-exposed areas especially the head, neck, ears, shoulder, chest, back of hands, forearms and penis.
Cutaneous horns are more common in older patients, in those between 60 and 70, with fairer skins, male are higher risk for the lession to being malignant.
9. Dysplastic Nevi (Atypical Moles);
A mole (nevus) is a benign growth of melanocytes, cells that gives skin its color. "Normal" moles can appear flat or raised or may begin flat then become raised over time and the surface is typically smooth. Moles that may have changed into skin cancer are often in irregularly shaped, contain many colors, and are larger than the size of a pencil eraser.
Atypical moles are not cancer, but if abnormal or more irregular than normal moles, it can develop into melanoma over time. They can become cancer.
Atypical moles may be larger (one-quarter inch across or larger) and more irregular in shape, with notched or fading borders, may be flat or raised or the surface smooth or rough. The moles are typically of mixed color, usually brown, red, tan, pink, or the same color as the skin.
They can be found in sun-exposed, such as on the back or sun-protected areas of the body, such as the scalp, breasts, and areas below the waist. Most moles develop in youth or young adulthood. It's unusual to acquire a mole in the adult years.
Lymphomas are cancers that start in cells called lymphocytes, which are part of the body’s immune system that found throughout the body, including in the skin.
Skin lymphoma or Cutaneous Lymphoma is a type of Non-Hodgkin lymphoma, which start only in the skin (not other organ or tissues). In the skin, though, T-cell lymphomas are more common than B-cell lymphomas.
The sign and symptom of skin lymphoma, can appear as Papules (small, pimple-like lesions), Plaques (thick, raised or lowered lesions), Patches (flat lesions) and Nodules or tumors (larger lumps or bumps under the skin).
The lesions are often itchy, scaly, and red to purple in color. Along with the skin problems, in rare cases lymphoma of the skin can cause general symptoms, such as: Severe itchiness, Fever, Unexplained weight loss and Profuse sweating (enough to soak clothing), particularly at night.
The risk facrtor people get Skin lymphoma are Age (most cases occurring in people in their 50s and 60s), more common in men than in women and also tend to be more common in African-Americans than in whites. People with weakened immune system (patient with HIV or and AIDS) and common in people who had an organ transplant (heart, kidney or liver).
Generally, the treatments for Skin Cancer Non Melanoma
a. Medicated creams or lotions; for very superficial cancers, you can apply a creams or lotions containing anti-cancer medications directly to your skin.
b. Simple excision; by cutting out the tumor, along with a small margin of normal skin.
c. Curettage and electrodesiccation; is useful for treating small squamous cell carcinomas (less than 1 cm across). By using curette to scrape off the cancer down to the dermis then electrodesiccation is performed over the raw surgical ulcer to denature a layer of the dermis. The curette is used again over the surgical ulcer to remove denatured dermis down to living tissue.
d. Cryosurgery; is a technique for freezing and killing abnormal cells. With extreme cold produced by liquid nitrogen (or argon gas) to destroy abnormal tissue. It is applied directly to the cancer cells with a cotton swab or spraying device. The side effect may cause scarring and swelling. If nerves are damaged, loss of sensation may occur, and rarely, it may cause a loss of pigmentation and loss of hair in the treated area.
e. Radiation therapy; is a good option for patients with large cancers and for patients who may not be able to tolerate surgery or after surgery which cancer was not removed (if the surgical margins were positive) or became too large or deep to be removed surgically. Especially in areas where surgery is difficult (eyelids, ears, or nose).
f. Laser therapy; by an intense beam of light vaporizes growths. The Laser treatment may be an option for very superficial skin lesions only, with little damage to surrounding tissue and with a reduced risk of bleeding, swelling and scarring.
g. Photodynamic therapy; is combines therapy photosensitizing drugs and light to treat superficial skin cancers. And during photodynamic therapy, some liquid drug that makes the cancer cells sensitive to light is applied to the skin. And later, a light that destroys the skin cancer cells is shined on the area.
h. Mohs surgery; has the highest cure rate. It is especially useful for squamous cell carcinomas larger than 2 cm (about 4/5 inch) across with poorly defined edges. The moh surgery usefull for tumors that have come back after other treatments or for cancers that are spreading along nerves under the skin and certain areas of the face or genital area.
i. Lymph node dissection; by removing regional lymph nodes nearby squamous cell carcinomas that are very large or deeply invasive. After the lymph nodes are removed, they will check it under a microscope to see if they contain cancer cells. In some cases, radiation therapy might be recommended after surgery.
j. Systemic chemotherapy; is an option for cancer patients has that has spread to lymph nodes or distant organs. It is combined with surgery or radiation therapy.