What is Skin Cancer?
Skin cancer is the most common type of cancer in the U.S. It’s generally split into two main groups: nonmelanoma skin cancer (NMSC) and melanoma. It’s hard to know the exact number of people with skin cancer because it’s often underreported and there isn’t a standard method for identifying it. Nonetheless, numerous studies have shown a rising number of NMSC and melanoma cases over the past few decades.
Identifying and treating these types of cancer pose a significant health problem, affecting people’s welfare and causing considerable healthcare costs. Skin cancers often show up in areas exposed to the sun, like the head and neck. These locations can lead to significant health issues during diagnosis and treatment.
Several treatment options exist such as surgery to remove the cancer, cryotherapy (cold therapy), chemotherapy (drug treatment), immunotherapy (stimulating the immune system to fight cancer), and radiation (using high-energy waves to kill cancer cells).
One of the best ways to prevent skin cancer is through proper sun safety, like using sunscreen, which shouldn’t be underestimated in its importance.
What Causes Skin Cancer?
Exposure to the sun’s ultraviolet (UV) rays is the main cause of skin cancers. In fact, the majority of non-melanoma skin cancers (NMSC) and melanomas are linked to UV exposure. These harmful rays cause cancer by doing two things: they create damage in our DNA which can lead to mutations, and they weaken our immune system’s ability to spot and get rid of cancerous cells.
The most common types of NMSC, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are both caused by mutations in the skin cells (more specifically, the epidermal keratinocytes). The more you’re exposed to UV rays over your lifetime, the higher your risk of developing BCC and SCC.
Melanoma is the most dangerous type of skin cancer and it’s caused by mutations in the melanocytes, which are the cells that give our skin color. Unlike BCC and SCC, your risk of getting melanoma is directly linked to sun exposure during your teenage years, particularly the number of sunburns you got between the ages of 15 to 20.
Other things that can increase your risk of skin cancer include having a family history of the disease, being exposed to certain chemicals, using tanning beds, having a certain type of human papillomavirus (HPV), having fair skin (known as a Fitzpatrick skin type), having many moles (or melanocytic nevi), and having a weakened immune system.
Risk Factors and Frequency for Skin Cancer
Skin cancer is the most common type of cancer in the United States, making it a major healthcare problem in terms of patient comfort and treatment costs. This disease impacts people of all races, but it’s more common in white individuals because they have less protective melanin in their skin. People with light skin color usually account for 75% to 80% of non-melanoma skin cancers being basal cell carcinomas, and up to 25% being squamous cell carcinomas. Furthermore, people with certain genetic issues causing inadequate DNA repair mechanisms, like in conditions known as xeroderma pigmentosum and Muir-Torre Syndrome, are at a higher risk of developing skin cancer.
Signs and Symptoms of Skin Cancer
Examining your skin thoroughly can help detect early signs of skin cancer. It’s important to pay attention to certain characteristics of any unusual skin changes. Aspects like the location, feel, size, color, shape, and the edges of any suspicious skin changes require close attention. A recent change in a spot or freckle can also indicate issues.
Precancerous changes known as actinic keratoses often feel rough like sandpaper and look red. Basal cell carcinomas, a type of skin cancer, typically appear as pink shiny bumps with tiny visible blood vessels. Squamous cell carcinomas can look like pink, rough bumps, patches, or plaques. Melanomas are usually brown or black and uneven in shape, color, and size, often larger than 6mm. Any new or changing skin alteration or one that appears different from other moles or freckles on your body (also known as the “ugly duckling sign”), should be seen as suspicious.
Basal cell and squamous cell carcinomas are frequently found on areas of the head and neck that have been most exposed to the sun during a person’s life. These include the nose, ear, and upper lip. Melanomas, on the other hand, can show up anywhere on the body, but are often found on men’s backs and shoulders and on women’s lower legs. However, research comparing different areas of the skin has found that the face carries the highest risk for melanoma.
Testing for Skin Cancer
If you’re at risk of developing skin cancer, the normal check-up includes a full-body skin scan. This can be done by your usual doctor or by a skin specialist, who has completed three extra years of skin-related medical training. Most of the time, if they see a spot that looks worrying, a skin biopsy will be performed. This involves taking a small sample of skin from the spot under local anaesthesia, which means the area is numbed so you won’t feel it. This procedure is usually done at the doctor’s office and doesn’t require a hospital visit. The sample is then sent to a lab to be examined under a microscope by a pathologist with special training in examining skin samples.
If the lab specialist confirms that the skin sample is cancerous, further treatment will likely be required. The exact type of treatment depends on the specific type of skin cancer diagnosed and how it interacts with your overall health situation.
Treatment Options for Skin Cancer
The best treatment for precancerous skin lesions and skin cancer relies on the patient’s specific condition and what will lead to the best results. For single precancerous lesions, commonly referred to as actinic keratoses, a treatment like cryotherapy, which uses extreme cold to destroy abnormal tissues, can be used. However, if a patient has numerous skin lesions or widespread skin damage, a more comprehensive approach is necessary. This could include topical medications (5-fluorouracil, imiquimod, and ingenol mebutate) or a treatment called photodynamic therapy, which involves a special type of light combined with a light-sensitive drug to destroy cancer cells. An important upfront step is to minimize the patient’s risk of developing skin cancer. Such steps could include reducing the doses of drugs that suppress the immune system in transplant patients, regular check-ups for patients on immune-regulating therapies, and proper treatment of precancerous skin lesions.
As for treating basal cell carcinomas and squamous cell carcinomas, which are types of skin cancer, the standard method is usually surgery. This might involve methods like electrodesiccation and curettage (using heat to destroy the cancer and a curette to scrape away the treated area) or surgical removal of the lesion. For larger skin cancers or those located in sensitive areas like the face, hands, feet, and genitalia, a specialized surgical procedure known as Mohs micrographic surgery is usually required. This procedure involves removing skin in layers until no cancer cells are found. Some patients with aggressive, recurrent forms of skin cancer may not be suitable for surgery and may need radiation therapy or specific medications instead.
Melanoma, the most dangerous type of skin cancer, is typically treated with surgical removal. If diagnosed early, surgery can often be curative. However, in advanced stages, the prognosis is usually worse and additional treatments like chemotherapy or immunotherapy may be required.
What else can Skin Cancer be?
When evaluating skin conditions, there are several possibilities that should be considered:
- Psoriasis
- Seborrheic keratoses
- Sebaceous hyperplasia
- Nevus
- Cherry angioma
- Benign melanocytic lesions
- Dysplastic nevus
- Metastatic tumors to the skin
- Epithelioid tumor
All of these present with different appearances and symptoms on the skin, and knowing the difference can assist in getting the appropriate treatment.