Skin Cancer

WHAT IS SKIN CANCER ?

Skin is the largest organ in the body. It covers internal organs and protects the body from UV rays. It acts against the germs and keeps the body warm. Skin can be affected by cancer. Skin cancer is the uncontrolled growth of abnormal skin cells. It occurs when there is DNA damage to skin cells (most often caused by ultraviolet radiation from sunshine or tanning beds), triggering mutations, or genetic defects, which lead the skin cells to multiply rapidly and form malignant tumours.

WHAT ARE THE DIFFERENT KINDS OF SKIN CANCERS ?

There are different kinds of cancers that affect the skin, based on which cells they impact. The most common cancer is squamous cell skin cancers, while the most dangerous and life threatening is Melanoma. Some other types of skin cancers include :

• Basal and Squamous Cell Skin Cancers: They originate in the squamous cells or the basal cells of the skin. They are present in the top most layer of your skin. They are predominantly found in exposed areas of the skin such as face, ears, neck, and lips. Basal cells can also grow in the deeper layers of your skin and spread but this is a rare occurrence. Both the basal and the squamous cell skin cancers can be treated and cured if you know what they are and get them diagnosed at an early stage.
• Melanoma Skin Cancer: Melanocytes produce the brown skin pigment called melanin. It gives the skin the brown colour. Melanin protects the skin from sun’s harmful rays.

Melanoma starts in melanocytes and can cause pigment change anywhere in the eyes, the mouth, anal or in the genitals etc. Its treatable and curable if diagnosed at an early stage but the fact that it can grow and spread fast makes it one of the dangerous types of cancer. The other less common skin cancers include merkel cell carcinoma, skin lymphoma, Kaposi sarcoma, skin adnexal tumours, and sarcomas.

 What are the Risk Factors ?

Everyone is at some risk for skin cancer, but certain factors increase this risk. Most risk factors apply to all three of the major skin cancers, but there are certain factors associated with only non- melanoma skin cancers and others that pertain to only melanoma. Some of the observed risk factors include :

• Too many or strange moles on the body
• Weak immune system
• Severe sun burns
• Old age
• Hereditary risk
• Exposure to arsenic, coal, paraffin
• Pale skin that is rarely tanned
• Exposure to ultraviolet radiation

WHAT ARE THE SIGNS AND SYMPTOMS OF SKIN CANCER ?

Early detection of cancer is possible in most types of cancer as these have evident lumps, bumps, or aberration in the body; however, with skin cancer early detection is difficult as the symptoms may not be obvious. Some of the early warning signs that one needs to be aware are :

• A sore that is refuses to heal
• A dark pigmentation that spreads past the mole or a spot
• A change or a deformation in the area of the skin such as the outgrowth of something similar to scales, bleeding, rough patchy skin
• Any change in the colour and size of the mole, growth or a spot for that matter
• Pain, itchiness or a change in the sensation

WHAT ARE THE TESTS AVAILABLE FOR THE DIAGNOSIS OF SKIN CANCERS ?

The best way to determine the skin cancers are through a skin biopsy. Incisional, excisional, punch or a shave biopsy is done with the help of a local anaesthesia. All the three involve cutting of the skin and examining them under a microscope. The cut area will be sewed and will heal like any wound. If doctors diagnose skin cancer, additional tests may be prescribed to determine the extent of the skin cancer.

If you have a large squamous cell carcinoma, Merkel cell carcinoma, or melanoma, your doctor may recommend further tests to determine the extent of the cancer. Additional tests might include imaging tests to examine the nearby lymph nodes for signs of cancer or a procedure to remove a nearby lymph node and test it for signs of cancer (sentinel lymph node biopsy).

WHAT ARE THE TREATMENT OPTIONS FOR SKIN CANCERS ?

There are several effective ways to eradicate squamous cell carcinoma. The choice of treatment is based on the tumour’s type, size, location, and depth of penetration, as well as the patient's age and general health. A local anaesthetic is used during most surgical procedures. Pain or discomfort is usually minimal, and there is rarely much pain afterwards. Some of the available treatment options are :

• Mohs Micrographic Surgery : Using a scalpel or curette (a sharp, ring-shaped instrument), the doctor removes the visible tumour with a very thin layer of tissue around it. While the patient waits, this layer is sectioned, frozen, stained, and mapped in detail. The skin is then checked under a microscope thoroughly. If cancer is still present in the depths or peripheries of this excised surrounding tissue, the procedure is repeated on the corresponding area of the body still containing tumour cells until the last layer viewed under the microscope is cancer-free.
• Excisional Surgery : The doctor uses a scalpel to remove the entire growth, along with a surrounding border of apparently normal skin as a safety margin. The wound around the surgical site is then closed with sutures (stitches).
• Cutterage and Electrodessication (Electrosurgery) : This technique is usually reserved for small lesions. The growth is scraped off with a curette (an instrument with a sharp, ring- shaped tip), and burning heat produced by an electrocautery needle destroys residual tumour and controls bleeding.
• Cryosurgery : The doctor destroys the tumour tissue by freezing it with liquid nitrogen, using a cotton-tipped applicator or spray device. There is no cutting or bleeding, and no anaesthesia is required. The growth becomes crusted and scabbed, and usually falls off within weeks.
• Radiation : X-ray beams are directed at the tumour, with no need for cutting or anaesthesia. Destruction of the tumour usually requires a series of treatments, administered several times a week for one to four weeks, or sometimes daily for one month.
• Photodynamic Therapy : PDT can be especially useful for growths on the face and scalp. A chemical agent that reacts to light, such as topical 5-aminolevulinic acid (5-ALA) or methyl aminolevulinate (MAL), is applied to the growths at the physician's office; it is taken up by the abnormal cells. Hours later, those medicated areas are activated by a strong light. The treatment selectively destroys squamous cell carcinomas while causing minimal damage to surrounding normal tissue.
• Laser Surgery : The skin's outer layer and variable amounts of deeper skin are removed using a carbon dioxide or erbium YAG laser. This method is bloodless, and gives the physician good control over the depth of tissue removed.
• Topical Medication : Medications like 5-fluorouracil (5-FU) and imiquimod are topical treatments that have successfully been used to cure skin cancer. Imiquimod stimulates the immune system to produce interferon, a chemical that attacks cancerous and precancerous cells, while 5-FU is a topical form of chemotherapy that has a direct toxic effect on cancerous cells.

Because most treatment options involve cutting, some scarring from the tumour removal should be expected. This is most often cosmetically acceptable with small cancers, but removal of a larger tumour often requires reconstructive surgery, involving a skin graft or flap to cover the defect.

HOW CAN SKIN CANCER BE PREVENTED ?

The most important way to prevent skin cancer is to protect your skin from the harmful effects of the sun's rays. Here are a few ways to prevent excessive exposure to sun :

• Teach your kids about the shadow and help them assess the dangers of exposure to sun’s harmful rays. When your shadow is smaller than you the sun is at the highest. At such times, protection of your skin is very important. So tell them to stay and play in the shade.
• Wear clothes that covers your body as much as possible and let the clothes be a little skin hugging so that the sun doesn’t peek in any free space.
• Choose a sun screen lotion with SPF 30 or even more. Apply a generous amount of it on all the exposed parts of your body. Repeat after every two hours.
• Use a wide cover hat that covers your eyes, ears, face, and neck.
• Wear sun glasses that are 100 percent UVA and UVB absorption to protect your eyes and skin.
• These safety measures are supposed to be practiced for your own good health and it becomes a must after knowing that the sun can damage the skin to an extent of endangering a loved one’s life.

Why KIMS ?

KIMS has an expert team of oncologists that are adept at recognizing the early signs of skin cancer, when they are easily treated. We believe in highly personalized care that involves carefully monitoring patients with early biopsies and frequent appointments. Our experts use a team approach for patient assessment, treatment and management, all occurring in a state-of- the-art facility. Team members work closely with referring doctors to create a plan of care and follow-up for individual patients.

Our robust research program in our multi-super- speciality hospital in Hyderabad and Secunderabad offers you access to clinical trials for melanoma, squamous cell carcinoma, and basal cell carcinoma.