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Skin Cancer

There are two main types of skin cancers; non melanoma skin cancer and melanoma.  The incidence of skin cancer, and of melanoma in particular, has increased substantially over the last few decades. Knowledge about early detection and skin cancer symptoms are essential. Actinic keratosis (AK) is the most common warning signal of skin cancer in fair-skinned people. Actinic Keratosis can progress to some types of non-melanoma skin cancer.  Both Basal cell carcinoma (BCC) and Squamous cell carcinoma (SCC) are two of the most common non-melanoma skin cancers found throughout the world. Skin cancer mainly affects areas of the skin that have been exposed to the sun.  

Disease overview

Description

Skin cancer is a general term for diseases in which skin cells lose control over how they grow and proliferate. There are several different types of skin cancer, depending on which skin cells are involved.
These skin cells include keratinocytes present throughout the epidermis, and melanocytes present in the basal layer between keratinocytes.

When melanocytes become cancerous, and this leads to melanoma. Melanoma is relatively rare, but is the most serious type of skin cancer.

Other types of skin cells may also transform into cancerous cells. The transformation of basal cells originating from hair follicles leads to basal cell carcinoma (BCC), and the transformation of squamous cells  originating from the uppermost layer of the skin – the epidermis leads to squamous cell carcinoma (SCC). These two types of skin cancer are collectively referred to as non-melanoma skin cancer. BCC is the most common form of skin cancer, but very rarely leads to serious disease. SCC is less common, but it may progress and invade other parts of the body, making it potentially very serious.

Diagnosis

Each type of skin cancer has a different appearance. A dermatologist may be able to make a diagnosis simply by examining the skin. Dermoscopy, a technique involving a hand-held instrument that magnifies the skin surface, can help to differentiate skin cancer from other skin disorders; in some cases, a healthcare professional will take a histological section of the skin to confirm the diagnosis. When caught early, skin cancer is often treated with a very high success rate—so early diagnosis is very important for both melanoma and non-melanoma skin cancers.

Non-Melanoma Skin Cancers (NMSC)

Actinic Keratoses (AK's) - Appear as small pink or red spots with a rough surface.  They may be more easily felt than seen.  Usually appear on UV exposed areas such as the face, ears, scalp, neck, décolletage, backs of hands, forearms and lips.

Basel Cell Carcinomas (BCC's) - Usually appear as small pink or reddish bumps, nodules, patches, spots or scars.  Again, usually found in UV exposed areas of the skin but may also be present on other skin areas such as the trunk.

Squamous Cell Carcinomas (SCC's) - Similar in look to BCC's, but are usually more scaly and stand out further from the skin.  Usually appear on UV exposed areas such as the face, ears, scalp, neck, décolletage, backs of hands, forearms and lips.

Melanoma
Melanoma is the most serious form of skin cancer, it is therefore especially important for it to be diagnosed accurately. Many patients at risk for melanoma will have moles on their body that are not dangerous, but may look like melanoma to the untrained eye. Healthcare professionals have several tools at their disposal to correctly diagnose a case of melanoma, but it may help to be aware of new and suspicious-looking moles in order to let your doctor know at the earliest possible time. The ‘ABCDEs’ of melanoma describe the key features in an easy-to-remember list:

A

Asymmetry

B

Border irregularity

C

Colour variation

D

Diameter > 6 mm

E

Evolving characteristics

Moles that may potentially be melanoma are asymmetric, have an irregular border, have varied colors, are relatively large (>6 mm), or have changed in their appearance. If you notice one or more suspicious moles, talk to your doctor about whether these may be melanoma.

For non-melanoma skin cancer, key warnings signs are: 

  • New growths
  • Spots that get larger
  • Visible sores that do not heal after 3 months

KEY MESSAGES:

IMPORTANT FACTS ABOUT Skin Cancer :

  • Being aware of suspicious lesions can help you to seek medical advice when it is appropriate
  • Not all types of skin cancer are the same! Some are relatively common but do not pose serious risks, while others are relatively uncommon but are dangerous if left untreated
  • Limiting exposure of unprotected skin to the sun can help reduce your chances of developing skin cancer
  • If skin cancer does occur, early detection is the best defense. Skin cancer can be treated successfully in most instances—even very serious types of skin cancer such as melanoma

Risk Factors

Exposure to UV rays from the sun increases your risk of developing skin cancer. In the case of melanoma, childhood exposure seems to be especially important. High sun exposure before the age of 10 increases the risk of developing melanoma later in life. Some types of nonmelanoma skin cancer occur mostly in areas that receive the most sunlight, showing the importance of sun exposure in these types of cancer as well.

For melanoma, other risk factors include:

Family History

· People with a family history of melanoma are more likely to develop it themselves, which in some cases may imply a genetic predisposition

Exposure

· People who have had severe blistering sunburns or have used sunbeds (especially before age 30) are more likely to develop melanoma

· People with exposure to some pesticides are potentially at increased risk

Complexion

· People with fair or Caucasian skin, especially those with red or blond hair, are more susceptible to developing melanoma

· Number of nevi/ dysplasic nevi

Number of lesions

· People with greater numbers of lesions on their skin, especially abnormal ones, are at a greater risk of melanoma

 For non-melanoma skin cancer, other risk factors include:

Complexion

· As with melanoma, people with fair skin are more likely to develop non-melanoma skin cancer

Family History

· Non-melanoma skin cancer also shows a genetic predisposition and family history may increase one’s risk

Age

· Older people are much more likely to develop non-melanoma skin cancers

Male Gender

· Men are more likely to develop non-melanoma skin cancer than women

Precancerous skin lesions

· People who have had skin lesions that were not cancerous, but had the potential to progress to cancer, are more likely to develop non-melanoma skin cancer

Chronic inflammation

· People who have conditions that result in chronic inflammation of their skin are at an increased risk of non-melanoma skin cancer

Immunosuppression

· People who have a weakened immune system (for example, transplant patients who are taking immunosuppressive drugs to prevent rejection of transplanted organs) are more likely to develop non-melanoma skin cancers.

Ionizing radiation

· People with increased exposure to ionizing radiation (like X-rays) are more likely to develop non-melanoma skin cancers


Treatment & Practical Tips

There are several different types of skin cancers with various treatments available. Your healthcare professional will be able to advise the most suitable treatment for your individual circumstances.  Any treatment will depend on the particular type of skin cancer as well as the severity, consult with your healthcare professional for what may be suitable for you.

The incidence of skin cancer, and of melanoma in particular, has increased substantially over the last few decades. Actinic keratosis (AK) is the most common warning signal of skin cancer in fair-skinned people. Basal cell carcinoma (BCC) is the most common non melanoma skin cancer. Skin cancer mainly affects areas of the skin which have been exposed to the sun.

Aktinic keratosis

The incidence of AK increases with age. Its prevalence in adults varies from approximately 10% in Europe to 46% in Australia. The lesions appear as rough, scaly patches on sun-exposed areas of the body, such as on the face, bald scalp or the back of the hands. If left untreated, they can develop into a form of skin cancer called squamous cell carcinoma. Actinic keratosis is treated with cryotherapy (liquid nitrogen), topical treatments and photodynamic therapy (combining a photosensitizing medication with a red light).

Basal cell carcinoma

BCC represents roughly 75% of all skin cancers. Its incidence varies from approximately 0.1% per year in Europe to approximately 2% per year in Australia. BCCs are not life-threatening but enlarge slowly, are locally invasive and can ulcerate. They will not regress spontaneously. The standard treatment is surgical excision. In some cases a healthcare professional will choose cryotherapy, curettage (scooping the lesion away with a curette) and electrocautery, with topical treatment or photodynamic therapy.

Squamous cell carcinoma

SCC can look similar to Basal cell carcinoma (BCC), but are usually more scaly and stand out further from the surface of the skin.  SCC's often occurs on the head and neck, or other areas that have been open to UV exposure including ears, lips, backs of the hands or arms.  Although curable, it is vitally important to take measures to stop SCC's from forming.  Left untreated, the tumour can invade deeply and spread throughout the body.

Melanoma

Melanoma is cancer of the melanocyte, the cell that produces the natural skin pigment. Melanoma is most often caused by over- exposure to the sun or ultraviolet radiation, especially in people with fair skin or who tend to suffer from sunburn. Although the incidence is very low (from 0.02% in the USA to twice as many in Australia), it is the most life-threatening skin cancer. Whereas in early diagnosed melanoma treated by surgical removal, the prognosis is excellent, delayed treatment exposes the patients to the risk of the melanoma spreading to other parts of the body (metastatic melanoma). Patients with metastatic melanoma have less chance of making a complete recovery. In its early stages, a melanoma can be mistaken for a mole. There is a simple approach to identifying moles which should be shown to a healthcare professional, called the ABCD approach:

  • A= asymmetry; the melanoma lesions are irregularly shaped
  • B= border; uneven, irregular borders
  • C= color; many shades from brown to black
  • D= diameter: more than 6 millimeters in diameter

The best way to reduce the risk of melanoma is to protect oneself and especially children from the sun by staying in the shade, wearing protective clothes, wide-brimmed hats and applying sunscreen with a sun protection factor (SPF) of 15 or higher, on all exposed skin. For those diagnosed with melanoma, the most common treatment begins by surgical removal of the cancer. Patients with thick melanomas or metastatic melanoma are usually offered repeated injections of interferon or chemotherapy.

Treatment

How it works

Surgery

 

For all types of skin cancer, the primary treatment option is surgery. Surgery also allows for microscopic examination that helps make a definitive diagnosis and may achieve the complete removal of the lesion. In surgery, doctors will attempt to physically remove skin tissue that has transformed into cancer. If all the cancer is removed, and hasn’t spread to other parts of the body, this approach will cure the cancer. When treating melanoma, surgeons will afterwards remove tissue surrounding the primary lesion in order to reduce the risk of relapse.

Chemotherapy, Radiotherapy, or Immunotherapy 

In some cases, it isn’t possible to treat skin cancer by surgical removal. For instance, if cancer has already moved to other parts of the body when it has been detected and diagnosed, surgery may no longer be an option. In these cases chemotherapy, radiotherapy or immunotherapy may be used. These treatments are toxic to cancer cells and may cause skin cancer to disappear or delay it from returning for many years. These treatments may have side effects that make them unpleasant to take and are therefore typically reserved for more serious cases of skin cancer.

Immunotherapy and targeted therapy

The last years have been marked by real improvements in the treatment of melanoma and NMSC, especially with immunotherapy and targeted therapies. In melanoma two treatments (immunotherapy and targeted therapy) have shown a benefit in overall survival in comparison to conventional chemotherapy in patients with metastatic melanoma. In basal cell carcinoma, a novel pathway has been discovered (sonic hedgehog pathway) leading to promising therapies for the future.

Topical Treatments or Photodynamic Therapy (PDT)

In cases of non-melanoma skin cancer in which surgery is not considered appropriate, topical treatments such as imiquimod cream or photodynamic therapy (PDT) may be used. PDT involves applying a special light-reactive cream to precancerous skin lesions in the treatment of non-melanoma skin cancer. Afterwards, the area is exposed to a particular type of light for a short amount of time. This activates the topical treatment which damages cancerous cells. Afterwards the area heals over, and may resume a normal appearance. One important benefit of topical therapy is that, unlike surgery, there is no scarring.

Cryotherapy

Cryotherapy is the primary treatment for precancerous skin lesions. It involves the use of extreme cold to destroy skin abnormalities and is most often used to remove moles and warts in addition to precancerous lesions. This approach is generally effective and has few side effects.

 

Your doctor will help you to decide which treatment is best for you. In addition, you may want to consider the following factors when selecting a skin cancer treatment that is right for you:

  • Consider your lifestyle, available time and cost to help you decide among the options.
  • The treatment may need to be used for prolonged periods of time or continuously in order to keep your skin cancer under control and stop it from progressing into something more serious.
  • Keep in mind: treatment adherence strongly influences treatment effectiveness (If you don’t use it, it won’t work!)

Preventing skin cancer involves reducing exposure to the sun’s harmful UV rays. These lifestyle measures may help reduce your UV exposure and reduce your risk of developing skin cancer: 

Avoid midday sun exposure

The sun’s rays are most powerful between 10AM and 4PM; if possible, avoid exposure to the sun during this time

Sunscreen

Wearing sunscreen year round can help ensure you are always protected

Sunscreens with ingredients such as titanium dioxide mexoryl are more effective at blocking the UV rays responsible for melanoma

Broad-spectrum sunscreens with a sun protection factor (SPF) of at least 15 provide the best protection

Sunscreen should be applied on any exposed skin, including lips, the tops of your ears and the back or your hands and neck

Sunscreen should be applied 20 to 30 minutes before sun exposure, and reapplied every 2 or 3 hours (and immediately after activities such as exercise or swimming)

Protective clothing

Sunscreens do not provide complete protection against the sun; dark, tightly woven clothing can help protect you from harmful UV rays

Avoid tanning beds

Tanning beds emit UV rays, which may be just as dangerous as those that come from the sun

Be aware of sun-sensitizing medications

Certain medications make your skin more susceptible to sun damage, increasing the risk of sunburn and skin cancer. Ask your doctor about whether any prescribed medication will make your skin more sensitive to the sun

Check your skin regularly

Regular self exams can help ensure the earliest possible detection of skin cancer and can allow you to seek medical advice sooner

galderma.co.uk is focused on educating the public and patients about skin conditions and the different types of treatments that are available to treat and manage these diseases. This site is not intended as a substitute for medical advice from your doctor, dermatologist, or other healthcare professional and may include discussions about therapies or treatment options that are not suitable for your individual needs. We encourage you to use the information contained in this site to educate yourself about your disease and allow better communication between you and your healthcare professional.  Always consult a dermatologist or a healthcare professional for more information about your condition and the appropriate treatment / product that is right for your individual needs.

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