Skin cancer

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Skin cancer is a type of cancer that develops from epidermal cells. It is the most common type of cancer, and is very common in countries with increased solar radiation, such as Greece. The number of cases of skin cancers has increased rapidly around the world in recent years. In Greece, approximately 30,000 incidents of skin cancer are recorded each year of which 1,500 are people with melanoma.

 

Skin cancers are divided into the following types:

  • Melanoma developed by melanocytes.
  • Non-melanomas that occur 20 times more often than melanoma. They include the following skin lesions:
  • Basal cell carcinoma developed by the basal cells of the deep layer of the epidermis.
  • Acanthocytic carcinoma developed by keratinocytes.
  • Other rare types of carcinomas (Merkel carcinoma etc).

Basal cell carcinoma

It is the most common skin cancer in white, blond people and the least dangerous. It occurs more often in the elderly. Patients over 75 years of age are 5 times more likely to develop basal cell carcinoma than patients 50-55 years of age. It has a slow growth and very rarely gives metastases. However, it is characterized by local tissue infiltration and expansion, and that is why it should be treated immediately. Basal cell carcinoma develops mainly in areas of the body exposed to the sun (head, neck, upper extremities), but its occurrence in other areas of the body is not ruled out.

Clinically distinguished various forms, such as:

 

  • nodid (as a skin nodule with varicose veins)
  • ulcerative (as a wound that does not heal and often bleeds)
  • the melanchloric (looks like a mole)
  • the surface (as eczema plate)
  • the hardener (looks like a scar)

Acanthocytic carcinoma

Second in incidence of skin carcinoma in white, blond individuals. Rare in people with dark skin. More common in elderly people. Patients over 75 years of age are 35 times more likely to develop this carcinoma than patients aged 50-55 years. Typically it develops on the face and bald scalp like a small scaly nodule with a red or rosy base. It grows faster than basal cell carcinoma, develops and destroys the subject tissues. Acanthocytic carcinoma can give metastases. Chronic exposure to sunlight is the cause for most cases. Frequent use of artificial tanning (solarium) doubles the risk of developing acanthocytic carcinoma. Other risk positions may be burns, scars, ulcers, time wounds and skin spots exposed to either radiation or specific chemicals. Immunosuppression is also a very important factor in the occurrence of acanthocytic disease.

Melanoma

Melanoma is rarer than other skin cancers, but it is also the most dangerous because it quickly gives metastases. It is the second most common cancer in people aged 15-34. Usually, it appears as a small black spot on the skin or can develop on a pre-existing mole (25%).

Compared to moles, melanomas show:

 

  • asymmetry,
  • irregular edge,
  • color unevenness (2-3 shades),
  • size larger than a normal mole.

Switching color, size, shape, appearance of bleeding or itching raise the suspicion of melanoma development.  The etiology of most skin cancers is associated with excessive exposure to sunlight, especially during childhood. Approximately 9 out of 10 skin cancers (excluding melanoma) and 6 out of 10 melanomas are due to excessive sun exposure. Old sunburns increase the risk of melanoma.


Factors contributing to the development of Skin Cancer

The most important factors that play a role in the development of skin cancer are:

 

  • Sun exposure – People with light skin are more sensitive to UV radiation and therefore more likely to have some type of skin cancer.
  • Solarium (artificial tanning) – In addition to sun exposure, solarium exposes the skin to radiation and can have the same effects as those of the sun.
  • Weak immune system – This can come from chronic diseases or infections, such as HIV (AIDS) or from a weakened body e.g. due to chemotherapy or strong medication.
  • Age – The elderly are the main group of people with skin cancer.
  • Skin moles on the skin – Normal or abnormal skin moles, which are larger than normal, are more likely to turn into carcinomas.

Skin Cancer Symptoms

Symptoms in skin cancer types occur in the areas most exposed to UV radiation (face, hands, ears, neck, legs).

In the case of basal cell carcinomas the symptoms are minimal. Often the way they manifest themselves resembles other skin conditions such as psoriasis. Its form can be:

 

 

  • A white spot that gives the feeling that the skin stretches and shines.
  • Spot with red tint, which can cause pain and itching.
  • Wound that bleeds, secretes fluid and can create a crust.
  • An ozos that often looks like a mole. It is pink, brown or reddish and shines.

Acanthocytic carcinomas can cause pain and occur in the form of:

 

  • Red spots with an irregular shape, which often results in bleeding.
  • Open wound that bleeds and secretes fluid, while persisting for some time.
  • Damage with elevated formation and hard surface.

 

Melanoma is manifested by moles, which in the pre-cancer stage are called dysplastic moles and show changes in their form. Thus, the moles become asymmetrical, without formed boundaries, their color changes and they are usually larger than 1 cm. Rarely do moles develop into skin cancer.

Diagnosis

Diagnosis for skin cancer types is carried out by a qualified doctor, such as a dermatologist, surgeon or oncologist, who will rely on symptomatology and examine the form of skin manifestations. The procedure is completed by removing part of the suffering area, which will be given for biopsy.

Specifically for the case of melanoma, the diagnosis is based on the ABCDE guide (5 first letters of the English alphabet):

 

  • Asymmetry (asymmetry in shape)
  • Border (unclear limits)
  • Color (uneven color)
  • Diameter
  • Evolving (the evolution and change of the mole)

Skin Cancer Treatment

The method of treatment is defined according to the type of cancer, the age of the patient, the morphology and the general condition of the body.

The way to treat and manage skin cancer can be:

 

  • Surgery in which the tumor and the area around it are removed with a surgical scalpel. To close the wound, a suture is applied, while the tissue is sent to the laboratory to certify that all cancer cells have been removed. The success rate of this method is 92%.
  • Diathermopiosis and hexation where the tumor is slicing and cauterized. The procedure is easy, however it has an increased chance of recurrence of cancer.
  • Cryosurgery through which the tumor is destroyed by freezing it with liquid nitrogen. This is an economical and easy solution, but the success rates of this method are low.
  • Radiotherapy, which usually requires many sessions (1-4 weeks). This treatment is applied in cases where the surgery is not workable, while its success rate is 85%-95%.
  • Application of drugs locally, which are designed to strengthen the immune system and thus perform the production of interferon that treats cancer.
  • Laser surgery where using a carbon dioxide laser removes the base layer, as well as part of the deeper layer of the skin.

Prevention of skin cancer

Early detection and prevention of melanoma is achieved in three main ways:

A. Regular examination of the skin by a dermatologist.

B. Proper application of sun protection rules.

C. Periodic self-examination of the skin (by the patient himself)

Excessive sun exposure is a pre-availability factor for the onset of the disease. Prevention of skin cancer is based on compliance with sun protection rules, i.e.:

 

  • Limit sun exposure, especially at noon
  • Frequent application of sunscreen with a wide range of protection (UVB + UVA) and high protection index (SPF> 25), 15 to 30 minutes before sun exposure
  • Good eye protection with sunglasses with lenses that absorb UV radiation
  • The use of a hat with a wide brim and protective clothing. There are fabrics that help absorb UVA and UVB radiation. Caution: ultraviolet radiation can penetrate light clothing, car windshield and window

 

Also, avoid burns as well as artificial tanning (solarium). Artificial tanning sources emit radiation that can cause the same problems as natural sunlight, and long-term use can lead to skin cancer.

 

How is the Self-Examination performed?

 

  • Check for specific skin changes:
  • A new nevus (mole), which looks abnormal.
  • A change in the size, shape, color or texture of the nevus
  • A wound that does not close.
  • A bleeding nevus

The examination is done by careful observation of the skin in 8 stages:

 

  • The face, not forgetting the ear area
  • The scalp, with the help of a hair dryer.
  • The palm, nails, and area from the wrists to the elbows.
  • The elbows, the arms, the armpits.
  • The neck area, chest (carefully examining the area just below the chest for women), and the abdomen.
  • In front of a mirror, and holding a smaller mirror in hand, the neck, the back of the ears, the shoulders and the back.
  • The buttocks and the back of the thighs.
  • In a sitting position, thighs, calves, legs and feet, without forgetting the nails and the genital area with the help of a mirror.
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