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Skin Cancer

Clinical Oncology

Symptoms

Non-melanoma and melanoma skin cancers have different characteristics.

Basal Cell Carcinoma	This type of skin cancer constitutes approximately 70% of skin cancer cases. It typically occurs on the head, neck, and upper body and appears as small, smooth, pearl-like skin patches with a shiny surface or as raised red firm bumps, occasionally bleeding. It may also develop into what looks like scaly, flat red scabs. Patients may experience itching in the affected area. This type of skin cancer grows slowly and rarely spreads to other sites. If detected early, it is usually manageable.
Squamous Cell Carcinoma	Squamous Cell Carcinoma accounts for about 30% of skin cancer cases. Patients may develop raised, scaly, firm lumps that can occasionally bleed. They often appear on areas exposed to sunlight, such as the face, neck, forearms, backs of hands, or lower legs. When not located on the lips or ears, the cancer cells typically grow slowly and are generally treatable.
Melanoma Skin Cancer	Patients with melanoma typically experience the appearance of new dark spots on the skin or gradual enlargement, distortion, or colour change of existing freckles or moles over a period ranging from weeks to months. Melanoma usually has an irregular shape, uneven surface, and no fixed colour, possibly brown, black, white, blue, red, grey, or other colours. Additionally, some patients may develop nodular melanoma, which looks like raised small round bumps, appearing black, red, or even pink. It proliferates and can spread to other areas, requiring prompt removal.

Factors

Skin cancer is often associated with prolonged exposure to ultraviolet (UV) rays. Usually, the skin needs to absorb UV rays to produce vitamin D, which promotes bone growth. However, long-term exposure to intense sunlight can cause the skin to turn red and feel hot, followed by peeling. This prolonged exposure can also damage the skin's genes, leading to genetic mutations that result in uncontrolled cell growth, eventually leading to skin cancer.

Risk Factors
Skin cancer is a threat that everyone should aware seriously, but individuals with the following characteristics generally have a higher risk of developing the disease:

Many moles on the body.
Family history of melanoma.
Prolonged sun exposure.
Fair skin that burns quickly but doesn't tan.
Red or blond hair.
Blue or green eyes.
Weakened immune system, such as a history of organ transplantation or testing positive for HIV.
Occupational exposure to chemicals like arsenic, coal tar, or asphalt.
Previous history of skin cancer or radiation therapy.

The most effective way to prevent skin cancer is to avoid prolonged exposure to UV radiation. Self-examination is also a practical method. Start by taking photos of your entire body and periodically compare them to the initial images. Check areas like the soles of your feet, spaces between toes, and toenails. If you notice new skin spots that don't resemble nearby spots, or if existing freckles or spots change in size, shape, or colour, or if wounds do not heal, document them and note the date. If they persist for a month or longer, seek medical attention promptly.

Diagnosis

The diagnostic methods for skin cancer can vary depending on the type. Melanoma, which is often darker in colour and typically grows in the outermost layer of the skin (epidermis), can usually be preliminarily assessed with the naked eye observation. However, a biopsy is needed when it's impossible to distinguish benign from malignant cells based solely on appearance. In these cases, doctors perform a local anaesthetic at the suspected site of cancer cell growth and then use a small surgical blade to remove a small piece of tissue. The specimen will sent to a laboratory for examination under a microscope to determine whether the cells are benign or malignant.

Since most skin cancers are visible on the skin's surface and grow relatively slowly with minimal spread to other body parts, more in-depth testing and staging are generally not required. However, if a patient experiences skin cancer recurrence after successful treatment, it is more likely to spread. In such cases, the doctor may gently examine nearby lymph nodes by touch to check for swelling and perform additional biopsy tests.

Staging of Skin Cancer:

Stage	Extent
Stage I	IA: Tumour thickness ≤1mm, confined to the dermis. IB: Tumour thickness ≤1mm with ulceration or confined to the subcutaneous fat layer.
Stage II	Tumour has not penetrated beyond the skin, thickness >2mm.
Stage III	Melanoma has spread to lymph nodes.
Stage IV	Tumour has metastasized to other organs, such as lungs, liver, brain, or there are distant metastases to skin and lymph nodes.

Treatment

The treatment method choice depends on factors such as the tumour's type, location, size, and extent. For example, non-melanoma skin cancers can often be cured, and the most common treatment methods include surgical removal of the tumour or radiation therapy to enhance the effect.

Surgery	If the doctor, during the biopsy process, hasn't removed the entire tumour or if the cancer has spread from the epidermis into the body, surgery is required to remove more tissue. The extent of surgery depends on the size of the skin cancer. Local anaesthesia may be sufficient for smaller tumours, and the patient can usually return home the same day. However, larger tumours may require general anaesthesia and skin grafting to repair the wound.
Mohs Surgery	Also known as "Mohs Micrographic Surgery," this is a minimally invasive procedure using local anaesthesia to treat more significant skin cancers, recurrent basal cell carcinomas, or cancers that tend to spread. In Mohs surgery, the doctor removes tissue and examines the margins under a microscope to ensure complete removal of cancer cells. Due to the larger wound size, some patients may require skin grafts.
Cryotherapy	Used for small surface skin cancers, liquid nitrogen or liquid carbon dioxide is applied to the cancer site to freeze and kill cancer tissue. The patient may experience stinging during the procedure, and there may be pain and blistering afterwards. Healing generally occurs within two weeks, but scarring is possible. Some patients may need multiple cryotherapy treatments.
Curettage and Electrodessication	Typically used for superficial cancers like basal cell carcinoma, this procedure involves local anaesthesia, scraping out the tumour, and electrodessication to stop bleeding and destroy any remaining cancer cells. Wounds typically heal within a few weeks, with scarring varying from person to person.
Laser Surgery	Laser beams replace traditional surgical blades during tissue removal, reducing the risk of bleeding.
Photodynamic Therapy	Suitable for skin cancers attached to bones. A photosensitizing drug is administered via injection or applied topically to the affected area. Afterwards, the site is exposed to light, activating the drug to attack cancer cells.
Radiation Therapy	Used for skin cancers attached to bones. Radiation therapy combines a drug, administered via injection or topical application, with light exposure to target cancer cells.
Chemotherapy	Topical chemotherapy for skin cancer involves applying a cream to the affected area. Patients can administer the treatment at home daily for several weeks. After applying the chemotherapy, patients should cover the treated area and avoid sunlight. If any pain or oozing occurs, they should discontinue use.
Topical Immunotherapy	Some superficial basal cell carcinomas can be treated with a cream called Imiquimod, which stimulates the immune system to attack cancer cells. This treatment is often suitable for areas where surgery is challenging or for patients with multiple skin cancers. Patients using topical immunotherapy can apply the cream at home once daily for several weeks. Side effects may include redness, pain, crusting, and peeling, but permanent scarring is less likely.
Retinoid Therapy	A medication related to vitamin A, sometimes used to treat squamous cell carcinoma.