Skin Cancer

Overview

Skin cancer happens when the normal skin cells start dividing abnormally due to mutations. Skin cancers usually form in those body parts that are exposed to sunlight. However, these cancers can also be seen forming in body parts that are not exposed to sunlight.

It is one of the less common cancers in India.

Skin cancers can be treated successfully if they are detected early. It is important to not ignore any abnormal skin growths, as these may be indicative of skin cancer.

Types

Based on the cell type that they originate from, skin cancers are classified into the following types:

• 1. Basal Cell Carcinoma: This is the most common type of skin cancer, and it forms in the lowest layer of the epidermis. This cancer type progresses at a slower rate. In most cases, this cancer develops in the regions of the head and neck.
• 2. Squamous Cell Carcinoma: This is the second most common cancer of skin cancer, and this cancer type begins in the flat cells called the squamous cells present in the epidermis.
• 3. Melanoma: Melanoma forms in the melanin-producing cells, melanocytes. It is one of the rare and aggressive forms of skin cancer.
• 4. Merkel Cell Carcinoma: This is another rare form of skin cancer that forms in the hormone-producing cells present right below the skin. It is more common in the regions of the head and neck.

Other rare types of skin cancer include cutaneous T-cell lymphoma, dermatofibrosarcoma protuberans (DFSP) and sebaceous carcinoma.

Symptoms

The symptoms may vary depending on the type of skin cancer. Following are some of the main symptoms of skin cancer:

• Presence of bumps on the skin
• Scar-like lesions
• Sores that do not heal completely
• Red-coloured nodules
• A mole with its colour, size and texture constantly changing
• Irregularly shaped lesions whose colours could be white, blue, pink, red, brown or black
• Formation of lesions that may burn or itch

Causes

The exact cause of skin cancer is not known. However, a few risk factors are found to increase one’s chances of getting skin cancer:

• Skin Complexion: Those having fair skin complexion, i.e., having lesser melanin pigment in their skin are at a higher risk of developing skin cancer.
• Prolonged Exposure to Sunlight: Those who spend long hours under sunlight, especially without using any skin protection, have an increased risk of developing skin cancer.
• Moles: Individuals with many moles or abnormal moles, which appear larger in size than the normal moles, have a higher risk of getting diagnosed with skin cancer.
• Sunny Climate or High-altitude Climate: Those living in sunny and high-altitude climates are relatively exposed to more sunlight than those who don’t, and this can increase the skin cancer risk.
• Sunburns: Frequent sunburns are associated with an increased risk of skin cancer formation.
• Artificial Tanning: Those who opt for artificial tanning in the presence of sun lamps have a higher risk of getting melanoma.
• Family History of Skin Cancer: Those having a close relative diagnosed with skin cancer are also at a higher risk of getting skin cancer.
• Personal History of Skin Cancer: Those diagnosed with skin cancer in the past can get skin cancer again.
• Exposure to Radiation and Harmful Chemicals: Those who are exposed to radiation (from their previous treatments) and hazardous chemicals, such as arsenic, industrial solvents and other chemicals have a higher risk of getting diagnosed with skin cancer.
• HPV Infection: Chronic HPV infection can increase the risk of skin cancer.
• Compromised Immunity: Those with a weaker immune system are at a higher risk of getting skin cancer.

Diagnosis

Skin cancer is one of the few cancers that can be seen. And, it can be detected with very few tests:

a. Physical Exam: When a patient presents himself /herself with skin cancer symptoms, the doctor physically examines the patient first for any abnormal moles, skin outgrowths, sores, etc. If he/she suspects skin cancer, then additional tests may be recommended.

b. Biopsy: During the biopsy, a small sample of the abnormal tissue is collected and examined under the microscope for the presence of cancer cells. This test helps in obtaining a definitive diagnosis of the disease.

For staging, various imaging tests, namely PET CT scans, MRI scans, etc., may be recommended. Lymph nodes that are close to the tumour may also be collected and examined for the signs of metastasis.

Treatment

Before planning the treatment, various factors, such as the type of cancer, its stage, its location, the patient’s age and whether the disease is primary or recurrent, etc., are considered.

There are multiple treatment options available for the management of skin cancers.

a. Surgery: Surgery is the primary treatment for skin cancer. During this procedure, the cancer tissue is surgically removed by the surgeon. Surgery could be combined with other treatments to enhance the overall effectiveness of the treatment. There are different types of surgeries available for the management of skin cancer:

• Cryosurgery: Cryosurgery is one of the minimally invasive procedures wherein liquid nitrogen is sprayed onto the skin to kill the cancer cells. Over time, the dead tissue forms a scab and falls off. This treatment destroys the cancer cells present on the surface of the skin only. For the management of microscopic cancer, this treatment should be combined with other treatment options.
• Curettage and Cautery (Electrosurgery): Curettage is a surgical procedure that involves scraping away the cancer cells. This procedure is followed by cautery or electrosurgery, wherein electric current is used to destroy the residual cancer cells present in the edges of the treated area. Electrosurgery also helps in controlling the bleeding. This treatment is found to have excellent clinical outcomes, especially for early-stage skin cancers.
• Mohs Micrographic Surgery (MMS): Usually, the cancer cells are examined first, and the surgery happens later. However, during Mohs surgery, it is the other way round. During this procedure, thin layers of skin that contain cancers are gradually removed and inspected until the layers appear cancer-free during the analysis. The goal of Mohs surgery is to remove as much skin cancer as possible while reducing damage to the surrounding healthy tissues.
• Wide Excision Surgery: This surgical procedure can be used for the management of all types of skin cancer. During the wide excision surgery, the surgeon removes the cancerous tissue along with a small portion of surrounding healthy tissues, called the margin.
• Reconstructive Surgery: If the patient has lost a large portion of skin during the surgery, then, the doctor may recommend reconstructive surgery, which could involve a skin flap or skin graft. In most cases, reconstruction is done with the healthy tissue that is close to the region of the tumour.
• Lymph Node Removal: If the cancer is suspected to have spread to nearby organs, the doctor may recommend the examination of nearby lymph nodes. For this procedure, the lymph nodes are removed surgically, and their cells are examined for the signs of malignancy.

b. Radiation Therapy: This treatment uses powerful radiation beams, which could be X-rays or proton beams, to destroy the cancer cells. For skin cancer cases, radiation therapy may be combined with treatment options to the cancer cells completely, or ease the symptoms caused by the disease in the case of advanced-stage skin cancers.

c. Chemotherapy: For skin cancers that have not penetrated the deep layers of skin, the doctors may recommend topical chemotherapy, wherein creams containing anticancer drugs are applied on the lesions in order to kill the abnormal cells. As a localised treatment, topical chemotherapy helps in reducing damage to healthy tissues.

On the other hand, systemic chemotherapy may be recommended in cases where cancer has spread to other organs. This approach helps in destroying cancer cells throughout the body.

d. Photodynamic Therapy: This is a unique form of therapy recommended for skin cancer wherein a combination of high-energy laser beams and drugs is used to destroy the cancer cells.

Frequently Asked Questions

1. Are skin cancers treatable?

Yes, skin cancers are treatable. However, one needs to be mindful of the symptoms and report them to the doctor. This can help in early detection and appropriate treatment.

2. Can skin cancers be detected in the early stages?

Yes, skin cancers can be detected in the early stages, provided you are aware of the symptoms that you need to look out for.

Here is how you examine your skin for the signs of skin cancer:

• Adults should consider examining their skin for the signs of cancer every month.
• While examining your skin, you should pay attention to the changes in the colour, size and shape of the existing moles.
• Any abnormal growth that is increasing in size and has a pearly and transparent appearance should be brought to the attention of the doctor. Skin cancers are often characterised by a variety of colours ranging from tan, brown, black or even multi-coloured. If anything seems out of normal, you must consult a dermatologist immediately.
• Any lesions that do not heal even after three weeks could indicate skin cancer.
• Also, you need to pay attention to the spots or sores that itch, scab and bleed continuously.

3. Can skin cancers come back?

Yes, skin cancers can come back – they could recur in the same location or in regions that are far off. However, treating recurrent skin cancers successfully is possible.

Skin cancer patients should keep up their follow-up appointments without fail, as these can help in detecting recurring skin cancers in their early stages when doctors can treat them in the best way possible.

4. Can I prevent skin cancer?

There are a few measures that you can follow to reduce your risk of getting skin cancer:

• Avoid UV Exposure: Avoid prolonged sun exposure, especially between 10 am and 4 pm.
• Plan Your Clothing Carefully: To reduce your skin cancer risk, opt for clothing that covers your arms, neck and legs. You can consider wearing a hat to protect your face and neck areas. Sunglasses can protect your eyes against UVA and UVB rays.
• Protect Yourself with Sunscreen: Always slather some sunscreen on your skin before leaving your home – a good sunscreen with SPF 30 reduces not just reduces your melanoma risk but also other skin cancer types.
• Say No To Artificial Tanning: Avoid artificial tanning as it increases your melanoma risk.
• Self-Skin Exam: Always keep an eye on any mole that is forming or any mole whose appearance is changing.