Skin Cancer Treatment

Skin cancer is the most common type of cancer. It results from uncontrollably developing skin cells. By examining the cells, doctors can also identify the sort of skin cancer. Areas of skin exposed to the sun, such as the scalp, face, lips, ears, neck, chest, arms, and hands, as well as the legs in women, are the main sites where skin cancer occurs. All skin tones are affected, including those with darker complexions. People with dark skin tones are more prone to develop melanoma on parts of their bodies like the palms of their hands and the soles of their feet that are not often exposed to the sun.

Types Of Skin Cancer

Skin cancer comprises several types, each with distinct characteristics and potential risks. The three primary types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma. 

• Basal Cell Carcinoma (BCC): Basal cell carcinoma (BCC) is the most common type of skin cancer, making up about 80% of cases. It often shows up as a small, shiny bump or a reddish, scaly patch on areas that get a lot of sun, like the face, neck, or hands. Treatment options include surgery to remove it, freezing the cancer cells (cryotherapy), laser treatment, and special creams applied to the skin.
• Squamous Cell Carcinoma (SCC): Squamous cell carcinoma is the second most common type of skin cancer, accounting for around 15% of cases. SCC often presents as a firm, red nodule or a rough, scaly patch that may bleed or develop into an open sore. Treatment includes surgical removal, radiation therapy, or, in some cases, chemotherapy.
• Melanoma: Melanoma is the most dangerous and potentially deadly form of skin cancer, accounting for a smaller percentage of cases but a disproportionate number of skin cancer-related deaths. It originates in melanocytes, the cells responsible for producing melanin, the pigment that gives color to the skin. Treatment typically involves surgical excision, and in advanced cases, it may include lymph node removal, chemotherapy, immunotherapy, or targeted therapy.

Causes Of Skin Cancer

Skin cancer occurs when the skin's cells grow abnormally and uncontrollably, often due to damage from various factors. Here are the main causes of skin cancer:

• Ultraviolet (UV) Radiation:The most common cause of skin cancer is exposure to UV radiation from the sun or tanning beds. UV rays damage the DNA in skin cells, leading to mutations that can cause cells to grow uncontrollably, forming cancer.
• Genetics:Family history plays a role in skin cancer risk. If close relatives have had skin cancer, there's a higher chance of developing it as well. This is particularly true for melanoma, a dangerous form of skin cancer.
• Fair Skin: People with fair skin have less melanin, the pigment that helps protect skin from UV damage. As a result, they are more susceptible to UV-induced skin damage, which can lead to skin cancer.
• Weakened Immune System: Individuals with a weakened immune system, whether due to diseases like HIV/AIDS or medications that suppress the immune system, are at a higher risk of developing skin cancer.
• Exposure to Toxic Substances: Certain chemicals, such as arsenic, can increase the risk of skin cancer. Arsenic is sometimes found in contaminated water or certain industrial environments
• Chronic Skin Inflammation: Long-term skin inflammation or scars from burns or other injuries can increase the risk of skin cancer in those areas.
• Age: The risk of skin cancer increases with age, as the cumulative exposure to UV radiation over the years can eventually lead to cancerous changes in the skin cells.
• Moles: Having many moles or unusual moles (atypical moles) can increase the risk of melanoma, a type of skin cancer.

Symptoms Of Skin Cancer

Skin cancer symptoms vary depending on the type, but here are some common signs to watch for:

• Changes in Moles or Skin Growths:
  • New Growths: Skin cancer often starts as a new growth or sore that doesn’t heal. It might be small and grow over time.
  • Changes in Existing Moles: Moles or spots on the skin that change in size, shape, or color could be a sign of skin cancer. Look out for moles that become asymmetrical or have uneven edges.
• Color Changes:
  • Irregular Colors: Skin cancer can cause moles or spots to become multiple colors or have uneven color distribution. This can include shades of brown, black, red, white, or blue.
• Itching or Tenderness:
  • Itching: A spot or mole that itches, burns, or feels tender could indicate skin cancer. It might also feel painful or sore.
• Bleeding or Oozing:
  • Unusual Bleeding: Skin cancer can cause sores to bleed or ooze. If a mole or spot bleeds easily or has a crusty surface, it’s important to get it checked.
• Changes in Skin Texture:
  • Texture Changes: Skin cancer might cause a mole or spot to become rough, scaly, or crusty. It might feel different from the surrounding skin.
• Non-Healing Sores:
  • Sores That Don’t Heal: Any sore or ulcer on the skin that doesn’t heal within a few weeks should be evaluated by a doctor.
• Unusual Growths:
  • Growths: Skin cancer can appear as a bump or growth that is different from other skin growths. It may look like a wart or an ulcer with no clear cause.
• Changes in Skin Color:
  • Redness or Darkening: Areas of skin that turn red or darker than the surrounding skin could be a sign of skin cancer.

Skin Cancer Diagnosis

Diagnosis of skin cancer has many steps, and it is very important to have self-assessments for accurate assessment by professional health care. To give you a glimpse of the entire process, check out the diagnostic steps below: 

• Self-exams: The best way to detect a change is to do it regularly. Any new growth, change in mole color, or any sore that does not heal should be noted. Remember the ABCDE- Asymmetry, irregular Border, uneven Color, Diameter over 6mm, and Evolving features.
• Clinical examination: A dermatologist looks at your entire skin and may magnify the view using a dermatoscope for suspicious lesions.
• Biopsy: Biopsies such as shave, punch, excisional, or incisional, take out a part of the skin and allow pathologists to study it under the microscope for the type of skin cancer diagnosis.
• Imaging tests: CT scans, MRI scans, and PET scans confirm whether the cancer has spread to other body parts. 
• Lymph Node Biopsy: To study whether the cancer has spread into lymph nodes.

Skin Cancer Stage

The important distinction to make when staging skin cancer is between melanoma and non-melanoma skin cancers as their staging is dissimilar. 

Melanoma Staging:

Melanoma is assigned a stage from 0 to IV, based on TNM results:

• Stage 0 (Melanoma in situ): The cancer only exists in the epidermis (outer layer of skin).
• Stage I: Melanoma has not spread but remains localized.
• Stage II: The melanoma is deeper and may ulcerate but is not in the lymph node.
• Stage III: To belong to this stage, the melanoma should involve regional lymph nodes or local extension into nearby skin.
• Stage IV: The melanoma has spread to distant lymph nodes or organs.

Non-Melanoma Skin Cancer Staging (Basal Cell and Squamous Cell Carcinoma):

Basal cell carcinoma staging is not common due to the limited distribution of the disease. More common for those aggressive cases that are categorized as at risk, the staging of squamous cell carcinoma follows the TNM system and all its stages 0-IV.

• Stage 0: The cancer is located only in the very superficial layers of skin.
• Stage I: The cancer is present in the superficial and depth levels comprising the skin.
• Stage II: The cancer is located in the superficial and intermediate areas of the skin and has become attenuated in its capacity to reach nerve structures or deeper skin layers.
• Stage III: The cancer has now involved the lymph nodes outside the skin.
• Stage IV: The cancer has now been spread to various parts of the body and the solid organs inside, such as the liver, lungs, or brain.

Risk Factors of Skin Cancer

Your risk for skin cancer is influenced by a few factors. The following is a breakdown of important risk factors:  

1. UV Exposure: This is the foremost risk factor. This is due to the excessive sun exposure during primary hours. Also, blistering sunburns, with either tanning beds or artificial sources of UV rays, raise risk factors for skin cancer.  

2. Skin Condition: Lighter-skinned individuals with less melanin and with light-colored hair and eyes, many moles, and easy freckling are highly susceptible to skin cancer.  

3. Medical History: Family history, past diagnosis, weakened immune system, precancerous lesions, and specific genetic conditions make you more susceptible to skin cancer.  

4. Other Risk factors: It include age, exposure to pollutants such as arsenic, previous radiation therapy, among other genetic factors, can influence skin cancer risk.

Complications of Skin Cancer

Skin cancer is treatable but has potential complications, especially when they are detected late or left untreated. The variation is according to the type (melanoma versus non-melanoma) and the stage of skin cancer.

1. Local Complications: These skin cancers can destroy tissues and lead to visible disfigurement, especially of the face. The surgical excision will cause much scarring. Pain becomes unbearable with advanced cancer as it attacks the nerves, leading to painful ulceration and functional impairment. 

2. Metastasis: Skin cancers like melanoma and squamous cell carcinomas spread away to regional lymph nodes or distant organs, making the treatment difficult and life-threatening. 

3. Treatment Complications: Post-operative infection or nerve damage complicates the operation. Radiation therapy may cause skin irritation. Common systemic side effects of chemotherapy and immunotherapy include nausea, fatigue, and immune suppression. 

4. Recurrence: Skin cancers can come back either locally or distantly post-treatment, and one skin cancer increases the risk of skin cancer in another site. 

Prevention

The cornerstone of skin cancer prevention is avoidance of UV radiation and protective behavior.

• Do not intentionally sunbathe between 10 a.m. and 4 p.m.
• Apply a broad-spectrum sunscreen with SPF 30 or greater to all exposed skin every two hours.
• Wear long-sleeved shirts and pants, a wide-brimmed hat, and sunglasses that block UVA and UVB rays.
• Look for shade while outdoors, and be aware of surfaces like water, sand, and snow that reflect UV rays and can increase your exposure.
• Avoid the use of artificial sources of UV radiation, such as tanning beds.
• Scheduled skin checks for changes, and seek a dermatologist when needed.
• Be mindful of sun-sensitizing medications, and teach others, especially children and teens, about skin cancer prevention strategies.

The stages of cancer indicate the extent of cancer in your body. Skin cancer can be diagnosed at any point between stage 0 and stage IV. The greater the number, the more widespread the cancer has become and the more challenging it is to treat. However, the staging for melanoma is different from non-melanoma skin cancers that start in your basal or squamous cells. Treatment depends on the stage of cancer. Sometimes, a biopsy alone can remove all the cancer tissue if it’s small and limited to the surface of your skin. 

The procedure for treating skin cancer varies depending on the type, size, location, and stage of the cancer. There are several treatment options available, and the choice of treatment is determined by a healthcare professional, typically a dermatologist or an oncologist. Common methods for treating skin cancer include:

• Surgical Excision:

  • This is one of the most common methods for treating skin cancer, particularly for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
  • The surgeon removes the cancerous tissue, as well as a margin of healthy tissue surrounding it to ensure complete removal.
  • The excised tissue is sent to a laboratory for examination to confirm that no cancer cells remain.
  • This procedure is typically performed on an outpatient basis, and local anesthesia is used.

• Mohs Surgery:

  • Mohs micrographic surgery is a precise technique often used for BCC, SCC, and some cases of melanoma, especially when the cancer is large or located in critical areas like the face.
  • The surgeon removes the cancerous tissue layer by layer, examining each layer under a microscope in real-time. This process continues until no cancer cells are detected.
  • Mohs surgery preserves as much healthy tissue as possible and is highly effective in eliminating cancer.

• Electrodesiccation and Curettage (EDC):

  • EDC is primarily used for small, non-melanoma skin cancers.
  • The cancerous tissue is scraped away with a curette, and then an electric current is applied to destroy any remaining cancer cells.
  • The process is typically repeated a few times during the same appointment.

• Cryotherapy:

  • Cryotherapy involves freezing the cancerous tissue with liquid nitrogen, causing it to peel away as it thaws.
  • It is commonly used for pre-cancerous lesions, such as actinic keratoses, and for very early-stage skin cancers.

• Radiation Therapy:

  • Radiation therapy may be employed for skin cancer in areas where surgery is not feasible or for patients who are not good candidates for surgery.
  • It can be used as a primary treatment or after surgery to eliminate any remaining cancer cells.
  • Radiation therapy uses high-energy X-rays to target and destroy cancer cells.

• Chemotherapy:

  • • Chemotherapy is rarely used for skin cancer, as it is not typically effective for non-melanoma skin cancers like BCC and SCC.
    • However, it may be considered for advanced or metastatic melanoma.