Skin

Multi-purpose skin is made up of three layers and is the largest organ of the body. The layer at the surface is the outer epidermis; the layer beneath that is known as the dermis, and the deepest layer, made up fat and loose tissues, is known as the subcutaneous layer.

Skin performs many functions; it protects the internal organs from injury and infection, and communicates with the brain about temperature, touch, and pain sensations. It also expels waste products, excess water, and salt through the sweat glands.

Skin Cancer

Cancerous cells are healthy cells that have mutated. The abnormal cells multiply rapidly and their uncontrolled growth creates a build up of tissue. If this tissue mass is malignant (cancerous), it is able to spread (metastasize) to nearby and/or distant organs. If the tissue mass is benign (non-cancerous), it is not a life-threatening or serious condition but will usually be removed anyway.

Malignant melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) are the three main types of malignant skin cancer. Malignant melanoma is commonly known as simply “melanoma,” while the basal cell and squamous cell carcinomas are lumped together as non-melanoma.

Melanoma

Most melanomas begin in pigment-producing cells called melanocytes. Pigment determines the color of your skin. People with dark pigmentation have dark skin and are at less risk for skin cancer than people with fair skin.

Melanoma accounts for the majority of skin cancer deaths, but makes up only a small percentage of all skin cancer cases. According the American Cancer Society, the year 2005 will see an estimated 59,600 cases of melanoma. Furthermore, of the estimated 10,600 deaths that will be attributed to skin cancer this year, around 7,800 will be melanoma cases.

Symptoms of Melanoma

Melanomas have a resemblance to moles, but a close-up look reveals that there are several differences. The round outline of a mole tends to be smoothly defined, while the melanoma has a jagged edge. Melanoma is usually an irregularly shaped lesion, bigger than 6mm across (about the same size as an eraser on a pencil) and variegated in color (sometimes black).

Melanoma can spread quickly, but if it is detected in its early stages, it is very curable. Any spot on your skin that itches, bleeds, oozes, or changes in shape, size, or color, should be reported to your doctor. Other skin conditions may cause similar symptoms, but let your physician assess the situation.

Non-melanoma

Most skin cancers are non-melanomas, meaning they begin in skin cells other than the melanocytes. According to the American Cancer Society, every year more than one million people in the United States are diagnosed with sun-related non-melanoma skin cancers.

Basal cell carcinoma is the most commonly diagnosed malignant skin cancer. Basal cell is not usually life-threatening because it tends to stay in small areas and grow slowly. Left unchecked, it will expand beyond its home base in the epidermis level of the skin and move into deeper layers. This malignant non-melanoma is also known as a “rodent ulcer.”

Squamous cell carcinoma is the second most commonly diagnosed skin cancer. Squamous cells can occur in old scars and are sometimes caused by skin-affecting viruses. These cancerous cells originate in the epidermis skin level and then spread to the surrounding area. In rare cases, this cancer becomes life-threatening by moving into lymph nodes, important pockets of cells in various locations along the body’s blood system.

Symptoms of Non-melanoma

In general, non-melanomas most often appear on the neck, face, ears, or any other area that receives a lot of sun exposure. The basal cell cancers usually begin as either a smooth, pearly-looking lump that sometimes bleeds or itches, or a scaly, crusty, flat, red spot. It is possible for it to appear as a firm, red lump.

Squamous cell carcinomas often show up as tender spots beneath a hard, looking cap with a scaly appearance. In addition to the other over-exposed areas, they are also found on the arms, the backs of hands, the lower legs, a bald scalp, or the face.

Benign skin growths

Some skin conditions are not cancerous, but cause changes on the skin’s surface nonetheless. These benign growths include moles, warts, and corns. Many people have benign growths removed, not for health purposes, but for cosmetic reasons.

There are also less common benign growths with the potential to become malignant. The two most commonly recognized are Bowen’s disease and actinic keratosis.

Bowen’s Disease--There are some professionals in the medical field who consider this slow-growing, reddish-brown patch on the skin to be precancerous. Others consider it to be the earliest stage of skin cancer, known as carcinoma in situ (cancer that involves only the cells that it originated in, and has not spread). Either way, it appears as a scaly or crusty patch and resembles dermatitis or psoriasis.

Actinic Keratosis--Actinic keratosis, also known as solar keratosis, appears as patches that are usually less than one inch across. These raised, scaly patches on the skin can be flesh-colored, or fall somewhere in the range of pink to red to brown. Like Bowen’s disease, they appear mostly on areas exposed to the sun, such as the face, ears, forearms, lips, backs of the hands, and the neck. Left untreated, 1 in 10 cases develop into squamous cell carcinoma.

Risk Factors for Skin Cancer

Anything that increases your chance of developing a disease or health condition is considered a risk factor. Risk factors for skin cancer include:

• Exposure/overexposure to the ultraviolet light of the sun
• 40 years of age or older
• Bowen’s disease
• Actinic keratosis
• A fair skin and blue eyes combination
• Freckles
• Skin cancer in the family history
• Regular exposure to sunlamps or sunbeds
• Skin that burns easily
• Severe or excessive number of sunburns in childhood
• Over exposure to certain workplace chemicals including (but not limited to) radium, coal tar, arsenic compounds, soot, asphalt, paraffin waxes, hair dyes, and petroleum derivatives.
• Use of pharmaceutical drugs that lower the immune system
• Previous radiation treatments for other conditions

Prevention

• Exposure to the sun is the number one risk factor for any type of skin cancer. Many things on the risk factor list cannot be controlled, such as age, family history, eye color, etc., but you can take steps to protect your skin from the sun. Also remember that UV rays travel through clouds, so skin needs to be protected on cloudy and overcast days as well.
• Always use sunscreen and lots of it (15 SPF or higher is recommended, talk to your dermatologist or doctor about what is right for you)
• As much as possible, avoid direct sunlight between 10:00 a.m. and 4:00 p.m.
• Wear wide sunglasses with 99%-100% UV absorption to protect the skin around your eyes as well as your eyeballs
• Do not use sunbeds for tanning
• Wear a hat to shade that provides shade for your face, neck, and ears (but do not neglect to use sunscreen on those areas as well)
• Hang out in the shade as much as possible
• Cover up with protective clothing when you are in the sun

Staging

When doctors know the extent of a disease, how big it is and how far it has spread, it helps them to know which treatment will be most appropriate (effective) for that particular case. To simplify this, the cancers are classified into the following 5 stages:

Stage 0—This stage is also known as carcinoma in situ. At this point, the cancerous cells are contained in the top layer of skin in a small area.

Stage 1—At this stage, the cancer has not spread and is less than 2 cm across.

Stage 2—The cancerous lesion is now wider than 2 cm, but has not spread out.

Stage 3—The cancer has invaded other tissues beneath the epidermis and has possibly moved into the lymph nodes.

Stage 4—The non-melanoma cancers rarely reach this stage, where the cancer has spread to another part of the body.

Treatments

Surgery is the most common treatment for all skin cancers. The cutting out of the cancerous tissue (and often the surrounding area to be sure it hasn’t spread) is known as excision. Excision is the process that comes to mind when most people hear the word “surgery.”

The surgical removal of lymph nodes is called lymphadenectomy. Sometimes this is done to see if the lymph nodes (important pockets of cells located at various places along the body’s blood network) are carrying cancerous cells. If cancerous cells are found in the lymph, removal is the best way of preventing their spread.

Another surgical procedure used to remove skin cancer is called curettage and electrocautery. The doctor will use a spoon-shaped instrument known as a curette to scrape away the cancer, and then an electrically heated needle is used to cauterize (stop the bleeding) the wound.

Cryotherapy, also known as cryosurgery, is often used when the cancerous tumor is small and only affecting the surface layer of skin. A spray of liquid nitrogen is used to freeze the area, and sometimes more than one treatment may be necessary.

Chemotherapy is the use of anti-cancer drugs. While the chemotherapy treatments for most cancers are given through the spine, through a vein, through the mouth, or through an injection, treatment for skin cancer may include a topical (applied to the skin) chemotherapy called fluorouracil.

Photodynamic therapy (PDT) is also known as photoradiation therapy, phototherapy, or photochemotherapy. The procedure includes a drug referred to as a photosensitizing agent. The drug, applied to the skin or injected into the bloodstream, reacts with oxygen when exposed to light and forms a cancer-killing chemical.

Radiation therapy, also known as radiotherapy, is the use of high-energy rays to kill the cancerous cells while doing as little damage to the surrounding healthy tissue as possible. Radiation is very useful in many cases where the cancer is in a location that would be difficult to treat with surgery or cryotherapy, and also in cases where surgery might leave disfigurement, such as the face, the ears, etc.

Survival

As with any other cancer, the stage of diagnosis affects the most likely outcome for survival. Basal and squamous cell cancers, if found and treated early, have a very high chance of being cured.

Melanoma is also highly treatable if detected early. For melanoma that has not spread out to other areas, the 5-year survival rate is 98%. For melanoma that has spread to its nearby regions, the survival rate is 60%. Melanoma that has spread to distant areas of the body has a survival rate of 16%. Fortunately, according to the American Cancer Society, 83% of all melanomas are diagnosed at a localized stage.

I bet those people are thankful that they went to their doctors when they did. Especially the ones who really thought it was no big deal but finally caved in to the pressure of their loved ones to “just have it looked it at.” If you’ve noticed some changes on your skin that you aren’t too worried about, go see your doctor and let him or her reinforce your theory. Self-diagnosis can be a very bad thing, especially if you don’t have a medical degree. And besides, it’s always better to be a hypochondriac than a corpse. Best wishes to you for a happy and healthy life.