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Skin Cancer: Causes, Prevention, Symptoms & Treatment
By Dr Charu Sharma

Dr Charu Sharma, a renowned cosmetic dermatologist, has a wealth of experience from meticulously performing thousands of aesthetic dermatology procedures. Having graduated from Bangalore and Wales (UK) Universities, she also holds diplomas from the USA and Dubai. Her articles have been published in leading newspapers including The Times of India.

I really do think that any deep crisis in one's life is an opportunity change it into something very special. I would like to take this opportunity to help in understanding the disease of skin cancer and also to suggest a few precautions which can help in reducing the risk of contracting the disease.

Skin cancer is one of the most common of all human cancers and living with it can present many new challenges for the patient and for his/her family and friends. Many people feel anxious and depressed; some people feel angry and resentful; others feel helpless and defeated. But it is possible to be happy without having perfect health... Thank goodness our happiness doesn't come from our body, but from our heart. I believe in this and hope faith will help others in believing the same.

Cancer

Cancer occurs when normal cells undergo a transformation during which they grow and multiply without normal controls. As the cells multiply, they form a mass called a tumor. Tumors of the skin are often referred to as lesions. Tumors are cancerous only if they are malignant. This means that they encroach on and invade neighboring tissues because of their uncontrolled growth. Tumors may also travel to remote organs via the bloodstream or lymphatic system. Tumors overwhelm surrounding tissues by invading their space and taking the oxygen and nutrients they need to survive and function.

Skin cancers

Skin cancers are of three major types: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. The vast majority of skin cancers are BCCs or SCCs. While malignant, these are unlikely to spread to other parts of the body. They may be locally disfiguring if not treated early. A small but significant number of skin cancers are malignant melanomas. Malignant melanoma is a highly aggressive cancer that tends to spread to other parts of the body. These cancers may be fatal if not treated early.

Like many cancers, skin cancers start as precancerous lesions. These precancerous lesions are changes in skin that are not cancer but could become cancer over time. Medical professionals often refer to these changes as dysplasia. Some specific dysplastic changes that occur in skin are as follows:

  • Actinic keratosis is a patch of red or brown, scaly, rough skin, which can develop into squamous cell carcinoma.
  • Dysplastic nevi are abnormal moles. These can develop into melanoma over time. Dysplastic nevi are not cancer, but they can become cancer. People with dysplastic nevi often have a lot of them, perhaps as many as 100 or more. They are usually irregular in shape, with notched or fading borders.

Causes of skin cancer

Ultraviolet (UV) light exposure, most commonly from sunlight, is the most frequent cause of skin cancer.

Other important causes of skin cancer include the following:

  • Use of tanning booths (not a common cause in India)
  • Immunosuppression—impairment of the immune system
  • Exposure to unusually high levels of X-rays
  • Contact with certain chemicals: arsenic (miners, sheep shearers, and farmers), hydrocarbons in tar, oils and soot (may cause squamous cell carcinoma)

The following people are at greatest risk

  • People with fair skin, especially types that freckle, sunburn easily
  • People with light (blond or red) hair and blue or green eyes
  • Those with certain genetic disorders that deplete skin pigment such as albinism, xeroderma, pigmentosum
  • People who have already been treated for skin cancer
  • People with numerous moles, unusual moles, or large moles that were present at birth
  • People with close family members who have developed skin cancer
  • People who had at least one severe sunburn early in life

Basal cell carcinomas and squamous cell carcinomas are more common in older people. Melanomas are more common in younger people 25-29 years of age.

Prevention

You can reduce your risk of getting skin cancer.

  • Limit sun exposure. Attempt to avoid the sun's intense rays between 10 a.m. and 3 p.m.
  • Apply sunscreen frequently. Use a sunscreen with sun protection factor (SPF) of at least 15 both before and during sun exposure. Select products that block both UVA and UVB light.
  • If you are likely to sunburn, wear long sleeves and a wide-brimmed hat.
  • Perform regular self examinations of your skin and note any changes.
  • Healthy diet.

Symptoms of skin cancer

 
   
Squamous cell carcinoma
Malignant melanoma
   

A basal cell carcinoma (BCC) usually looks like a raised, smooth, pearly bump on the sun-exposed skin of the head, neck, or shoulders.

A squamous cell carcinoma (SCC) is commonly a well-defined, red, scaling, thickened patch on sun-exposed skin.

The majority of malignant melanomas are brown to black pigmented lesions. Warning signs include change in size, shape, color, or elevation of a mole. The appearance of a new mole during adulthood, or new pain, itching, ulceration, or bleeding of an existing mole should all be checked by a health-care provider.

The following easy-to-remember guideline, "ABCD," is useful for identifying malignant melanoma:

  • Asymmetry. One side of the lesion does not look like the other.
  • Border irregularity. Margins may be notched or irregular.
  • Color. Melanomas are often a mixture of black, tan, brown, blue, red, or white.
  • Diameter. Cancerous lesions are usually larger than 6 mm across (about the size of a pencil eraser), but any change in size may be significant.

Many people, especially those who have fair coloring or have had extensive sun exposure, should periodically check their entire body for suggestive moles and lesions.

Examinations and tests

If you have a worrisome mole or other lesion, a dermatologist will examine the entire skin surface. A sample of skin (biopsy) will be taken so that the suspicious area of skin can be examined under a microscope.

A biopsy can almost always be done in a dermatologist's clinic. If a biopsy shows that you have malignant melanoma, you will probably undergo further blood tests, a chest X-ray and other tests as needed.

Treatment of skin cancer

Treatment for basal cell carcinoma and squamous cell carcinoma is straightforward. Usually, surgical removal of the lesion is adequate. Small lesions may be removed through a variety of techniques, including simple excision (cutting it away), electrodesiccation and curettage (burning the tissue with an electric needle), and cryosurgery (freezing the area with liquid nitrogen). Larger tumors, lesions in high-risk locations, recurrent tumors, and lesions in cosmetically sensitive areas are removed by Mohs micrographic surgery. The surgeon carefully removes tissue, layer by layer, until cancer-free tissue is reached. When treated properly, the cure rate for both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) approaches 95%.

Malignant melanoma, however, may require several treatment methods, including surgery, radiation therapy and chemotherapy. Because of the complexity of treatment decisions, patients with malignant melanoma may benefit from the combined expertise of a dermatologist, a cancer surgeon, and an oncologist.

"Turn your face to the sun and the shadows fall behind you. Turn your worries and pain over to God." - Dr Charu

 
 
 
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