SKIN CANCER

There are three main types of skin cancer: basal-cell skin cancer (basal-cell carcinoma) (BCC), squamous-
cell skin cancer (squamous-cell carcinoma) (SCC) and malignant melanoma

Cancer Description Illustration

Note the pearly translucency to fleshy color, tiny blood

Basal-cell
vessels on the surface, and sometime ulceration which can
carcinoma
be characteristics. The key term is translucency.

Squamous-cell Commonly presents as a red, crusted, or scaly patch or

carcinoma bump. Often a very rapid growing tumor.

The common appearance is an asymmetrical area, with an

Malignant
irregular border, color variation, and often greater than 6 mm
melanoma
diameter.[17]

asal-cell carcinomas are present on sun-exposed areas of the skin, especially the face. They rarely
metastasize and rarely cause death. They are easily treated with surgery or radiation.
Squamous-cell skin cancer are common, but much less common than basal-cell cancers. They
metastasize more frequently than BCCs. Even then, the metastasis rate is quite low, with the exception of
SCC of the lip, ear, and in people who are immunosuppressed.
Melanoma are the least frequent of the 3 common skin cancers. They frequently metastasize, and could
potentially cause death once they spread.
Less common skin cancers include: dermatofibrosarcoma protuberans, Merkel cell carcinoma, Kaposi's
sarcoma, keratoacanthoma, spindle cell tumors, sebaceous carcinomas, microcystic adnexal
carcinoma, Paget's disease of the breast, atypical fibroxanthoma, leiomyosarcoma, and angiosarcoma.
SYMPTOM

Basal-cell skin cancer[edit]

Basal-cell skin cancer (BCC) usually presents as a raised, smooth, pearly bump on the sun-exposed skin of
the head, neck or shoulders. Sometimes small blood vessels (called telangiectasia) can be seen within the
tumor. Crusting and bleeding in the center of the tumor frequently develops. It is often mistaken for a sore
that does not heal. This form of skin cancer is the least deadly and with proper treatment can be completely
eliminated, often without scarring.
Squamous-cell skin cancer[edit]
Squamous-cell skin cancer (SCC) is commonly a red, scaling, thickened patch on sun-exposed skin. Some
are firm hard nodules and dome shaped like keratoacanthomas. Ulceration and bleeding may occur. When
SCC is not treated, it may develop into a large mass. Squamous-cell is the second most common skin
cancer. It is dangerous, but not nearly as dangerous as a melanoma.
Melanoma[edit]
Most melanoma consist of various colours from shades of brown to black. A small number of melanoma are
pink, red or fleshy in colour; these are called amelanotic melanoma and tend to be more aggressive.
Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole.
Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around
the site, or bleeding at the site. An often-used mnemonic is "ABCDE", where A is for "asymmetrical", B for
"borders" (irregular: "Coast of Maine sign"), C for "color" (variegated), D for "diameter" (larger than 6 mm—
the size of a pencil eraser) and E for "evolving."[19][20]
Other[edit]
Merkel cell carcinomas are most often rapidly growing, non-tender red, purple or skin colored bumps that
are not painful or itchy. They may be mistaken for a cyst or another type of cancer

SYMPTOM

 Smoking tobacco[23]
 HPV infections increase the risk of squamous-cell carcinoma.[23]
 Some genetic syndromes[23] including congenital melanocytic nevi syndrome .
 Chronic non-healing wounds.[23] These are called Marjolin's ulcers based on their appearance, and can
develop into squamous-cell carcinoma.
 Ionizing radiation such as X-rays, environmental carcinogens, artificial UV radiation (e.g. tanning beds),
aging, and light skin color.[23] It is believed that tanning beds are the cause of hundreds of thousands of
basal and squamous-cell carcinomas.
 The use of many immunosuppressive medications increases the risk of skin cancer. Cyclosporin A,
a calcineurin inhibitor for example increases the risk approximately 200 times, and azathioprine about
60 times.[28]

The following procedures may be used:

 Skin exam: A doctor or nurse checks the skin for bumps or spots that look abnormal in color, size, shape, or
texture.
 Skin biopsy : All or part of the abnormal-looking growth is cut from the skin and viewed under a microscope by
a pathologist to check for signs of cancer. There are four main types of skin biopsies:
o Shave biopsy : A sterile razor blade is used to “shave-off” the abnormal-looking growth.
o Punch biopsy : A special instrument called a punch or a trephine is used to remove a circle of tissue from
the abnormal-looking growth.
o Incisional biopsy : A scalpel is used to remove part of a growth.
o Excisional biopsy : A scalpel is used to remove the entire growth.
TX
Surgery
The surgeon removes the cancerous growth and includes some normal tissue surrounding it. This reduces
the chance that cancer cells will be left behind after surgery. The surgical method depends on the type of
cancer, its size and location. Some of the types of surgery include excisional skin surgery, moh’s surgery,
cryosurgery etc.

Excisional skin surgery

Excisional skin surgery is a common treatment to remove any type of skin cancer. Local anesthesia is used
to numb the area before operation. The tumor is then removed with a scalpel. The margin of skin is also
removed and is examined under the microscope for spread of the cancer. Affected lymph nodes around the
cancer are also removed to detect spread of the cancer.

Mohs micrographic surgery

Mohs micrographic surgery is often used for basal cell and squamous cell skin cancers. This is also
performed under local anesthesia. The surgeon shaves off thin layers of the tumor. Every layer is examined
under a microscope. The operation continues until no cancer cells are seen under the microscope.
Radiation therapy may be prescribed after this surgery to kill off the remaining cancer cells.
Electrodesiccation and curettage
Electrodesiccation and curettage is used to remove a small basal cell or squamous cell skin cancer. After
locally anesthetising the area the cancer is removed with a sharp tool shaped like a spoon (called
a curette). Then a needle like electrode is used to send an electric current into the treated area to control
bleeding and kill any cancer cells that may be left. This is a faster and simpler technique. It may be
performed up to three times to remove all the cancer cells.

Cryosurgery
Cryosurgery can be used in early-stage or a very thin basal cell or squamous cell skin cancer. The cancer
cells are killed using liquid nitrogen directly to the skin growth to freeze and kill the cancer cells.

Skin reconstruction
If a large area of skin is removed a skin reconstruction is used. Skin from another part of the body may be
used to replace the skin that was removed. Usually skin from over the belly or thighs is used for
reconstruction.

Chemotherapy
This therapy uses anti-cancer drugs to kill off the cancer cells. It is usually used after surgery. Some of the
anti-cancer agents may be applied directly over the skin. These are used in very thin, early-stage basal cell
or squamous cell skin cancer. This may also be used if there are several small skin cancers.

The creams are to be applied one or two times a day for several weeks. Some of the drugs used in the
creams include Fluorouracil or 5-FU. This is used to treat early-stage basal cell and squamous cell cancers.
Imiquimod is another agent that is used to treat early-stage basal cell cancer.

Chemotherapy agents may also be given as pills or as injections. People with melanoma may receive
chemotherapy in this manner. Chemotherapy is associated with several side effects like:

 loss of appetite  diarrhea

 nausea  anemia
 vomiting  bleeding tendencies
 loss of hair  propensity to get infections etc.

Radiation therapy
This uses high energy beams of radiation to kill the residual cancer cells after surgery. Radiation therapy is
not a common treatment for skin cancer. It is used after surgery for squamous cell carcinoma when the
cancer has spread to other organs.

Photodynamic therapy
Photodynamic therapy is a method of treatment that uses a drug along with a special light source, such as
a laser light, to kill cancer cells. PDT is helpful in very thin, early-stage basal cell or squamous cell skin
cancer. The chemotherapeutic agent is either rubbed into the skin or injected intravenously before light is
applied. The drug becomes active and destroys the cancer cells as the light is focussed on the lesion.

Biological therapy
This is useful in some patients with advanced melanoma. Biological therapy for melanoma may improve the
immune response of the body against the cancer cells. Drugs used for biological therapy include Interferon.
Interferon can slow the growth of melanoma cells. Another drug is called Interleukin-2. It can help the body
destroy cancer cells.