Skin Cancer

Introduction

The incidence of skin cancer in India is much lower than in other parts of the world. The researchers found India to have a low incidence of melanoma.

Skin cancer is the abnormal growth of skin cells and is the most common type of cancer around the world. While skin cancer usually forms on sections of the skin exposed to direct sunlight, it can also grow on other parts of the body that don't often see the sun's harmful ultraviolet rays.

Types of Skin Cancer

There are three main types of skin cancer-

Basal cell carcinoma (BCC) :Basal cell carcinoma, or BCC, is a cancer of the basal cells at the bottom of the epidermis. Basal Cell Carcinomas are the most common type of skin cancer and mostly develop in areas of skin exposed to the sun such as the head, face, ears, and neck.
Squamous cell carcinoma (SCC) : Squamous cell carcinoma, or SCC, is a cancer of the cells in the outer layer of the skin and is the second most common type of skin cancer. Usually, SCCs develop slowly and they only spread to other parts of the body if they are left untreated for a long time. Sometimes, they can behave more aggressively and spread at an earlier stage.
Malignant melanomas : Malignant melanomas are less common but very serious. They behave differently from Basal Cell Carcinomas or Squamous Cell Carcinomas. Malignant melanomas can grow quickly so need to be treated early. Melanoma develops when cells called melanocytes to grow and divide at a quicker rate than usual.

There are four main types of skin melanoma:

I. Superficial spreading melanoma
II. Nodular melanoma

III. Lentigo maligna melanoma
IV. Acral lentiginous melanoma.

Causes

The majority of skin cancer is caused by overexposure to ultraviolet (UV) radiation from the sun and artificial sources such as solariums. UV radiation is strong enough to damage skin cells and cause skin cancer.

Risk factor

Factors that may increase the risk of skin cancer include:

Fair skin— anyone, regardless of skin color, can get skin cancer
A history of sunburns
Excessive sun exposure
Sunny or high-altitude climates
Moles
Precancerous skin lesions
A family history of skin cancer
A personal history of skin cancer
Weakened immune system
Exposure to radiation

Signs & Symptoms

A change in skin is the most common sign of skin cancer. This could be new growth, a sore that doesn't heal, or a change in a mole. Not all skin cancers look the same.

For melanoma specifically, a simple way to remember the warning signs is to remember the A-B-C-D-Es of melanoma—

“A” stands for asymmetrical. Does the mole or spot have an irregular shape with two parts that look very different?
“B” stands for border. Is the border irregular or jagged?
“C” is for color. Is the color uneven?
“D” is for diameter. Is the mole or spot larger than the size of a pea?
“E” is for evolving. Has the mole or spot changed during the past few weeks or months?

Diagnosis

If a doctor finds an abnormality on skin that might be skin cancer, the doctor may perform one or more of the following tests:

Physical Exam : The doctor will first do a careful skin examination of your suspicious finding, as well as a general skin exam. This is important, as other skin findings, such as the presence of many moles, may increase the chance that your skin lesion is skin cancer.
Biopsy : There are several different biopsy methods, but an excisional biopsy in which the doctor removes the entire growth is often sufficient to treat skin cancer. Other types of biopsies include a shave biopsy, in which your doctor shaves off the top layers of the lesion, and a punch biopsy, in which the doctor uses a special tool to cut a tiny round piece of the tumor, including deeper layers of the skin.Your doctor may also take a biopsy of any suspicious lymph nodes to see if they contain cancer cells.

Imaging tests : Most skin cancers—especially basal cell carcinoma, the most common form of skin cancer—remain local and do not spread to distant organs. Melanoma is more prone to spread. In those cases, one of several medical imaging procedures may be used to determine whether cancer cells have metastasized to internal organs and bones. Imaging procedures include:
- CT scan
- X-ray
- MRI
- These imaging procedures are non-invasive and painless. If they reveal suspicious spots or metastases, a more invasive biopsy may be required.
Gene Mutation Testing: Testing for gene mutations (done on a sample of the tissue removed via biopsy or excision) has been a major advancement, allowing doctors to address these cancers with "targeted therapies," drugs that target specific pathways in the growth of a cancer cell.

A few of the gene mutations that may be present in melanoma and that can be detected in a blood sample, include:

BRAF

CDKN2A

MC1R

BAP1

Management

A recommended treatment plan will depend on different factors, like the size, location, type, and stage of your skin cancer. After considering these factors, your healthcare team may recommend one or more of the following treatments:

Cryotherapy : The growth is frozen using liquid nitrogen and the tissue is destroyed as it thaws.
Excisional surgery : The growth and some of the healthy skin surrounding it are cut out.
Mohs surgery : The growth is removed layer by layer, and each layer is examined under a microscope until no abnormal cells are visible.
Curettage and electrodesiccation : A long spoon-shaped blade is used to scrape away the cancer cells, and the remaining cancer cells are burned using an electric needle.
Chemotherapy : Drugs are taken orally, applied topically, or injected with a needle or IV line to kill the cancer cells.
Photodynamic therapy : A laser light and drugs are used to destroy the cancer cells.
Radiation : High-powered energy beams are used to kill cancer cells.
Biological therapy : Biological treatments are used to stimulate your immune system to fight cancer cells.
Immunotherapy : A cream is applied to your skin to stimulate your immune system to kill the cancer cells.

Follow-Up

Follow-up visits for melanoma skin cancer are usually scheduled every 3 to 12 months. It depends on the stage and risk that cancer will come back. If you were treated for an advanced stage of melanoma skin cancer or have a high risk of recurrence, follow-up is usually done more often for the first 2 to 3 years.

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