SKIN CANCER

What is skin cancer?

Skin cancers are cancers that arise from the skin. There is a high cure rate for these cancers. It is important that you check your skin regularly. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. Most of the cases are caused by exposure to ultraviolet radiation from the Sun. Also due to thinning of ozone layer risk of exposure to UV rays has increased.

Signs and Symptoms

Non-melanoma skin cancer

Non- melanoma skin cancers tend to develop most often on skin that’s exposed to the sun. To spot skin cancers early, it helps to know how your skin normally looks. That way, you’ll notice any changes more easily. To check your back or other areas you can’t see easily, get your partner or a trusted friend to check. This is very important if you are regularly outside in the sun for work or leisure.

1. A spot or sore

Spots and sores are common. But if you have one that doesn’t heal within 4 weeks, it needs to be examined as it can be the very first sign of skin cancer.
Also, look out for a spot or sore that hurts, is itchy, crusty, scabs over or bleeds for more than 4 weeks.
The colour of the spot could be red or dark, but this isn’t always the case.

2. Ulcer

Skin that’s broken down (an ulcer) and doesn’t heal within 4 weeks, and one can’t think of a reason for this change.

3. A lump

This might be small, slow growing, shiny and pink or red.

4. Red patches on your skin

These red patches could also be itchy. This could be due to other non- cancerous skin conditions. But get it checked to make sure.

Types

There are two main types of non-melanoma skin cancers:

  • Basal-cell skin cancer (BCC)
  • Squamous-cell skin cancer (SCC) Cancerous skin cancer

Basal-cell skin cancer (BCC)

  • Basal-cell carcinoma (BCC), also known as basal-cell cancer, is the most common type of skin cancer.
  • It often appears as a painless raised area of skin, that may be shiny with small blood vessels running over it or it may present as a raised area with ulceration.
  • Basal cell cancer accounts for at least 32% of all cancers globally.
  • Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death.
  • It’s very rare for basal cell skin cancer to spread to another part of the body to form a secondary cancer. It’s possible to have more than one basal cell cancer at any one time and having had one does increase your risk of getting another.

Risk factors

Risk factors include exposure to ultraviolet light, having lighter skin, radiation therapy, long term exposure to arsenic, and poor immune system function.

UV light exposure during childhood is particularly harmful.

Sign and Symptoms

  • Shiny, pearly skin nodule
  • Waxy, hard skin growth.
  • Basal cell carcinomas are also fragile and can bleed easily.

Diagnosis

To diagnose basal cell carcinomas, a skin biopsy is performed. The most common method is a shave biopsy under local anaesthesia. Most nodular basal cell cancers can be diagnosed clinically.

Treatment

The following methods are employed in the treatment of basal-cell carcinoma (BCC): Radiotherapy, chemotherapy, PDT (Photo dynamic therapy) and Surgery.

Surgery

Standard Surgical Excision
Many small non melanoma skin cancers can be removed by Head and neck cancer specialists by a small surgery.

Excisional biopsy

What it is?
An excisional biopsy is when your doctor removes the affected area of skin and a small amount of the surrounding healthy tissue. You might have an excisional biopsy to diagnose and treat a skin cancer at the same time.

Process
It is given under local anaesthetic. Dr. Mudit Aggarwal (surgical oncologist) gives you an injection to numb the area and then removes the cancer. As well as the cancer tissue, He removes an area of healthy tissue from around it. This is the healthy margin. A healthy margin is to make sure that all the cancer is removed.
One may need further surgery to make sure enough all the cancer is removed with a large enough healthy margins.

Wide local excision

What it is?
Cancer patient can have wide local excision to remove more tissue if all the skin cancer has not been removed. This helps reduce the chance of the cancer coming back.

Process

You might have this treatment under either local or general anaesthetic. The amount of tissue you have removed depends on:

  • the size and type of the cancer
  • where it is on the body
  • how much tissue was taken away if you had an excision biopsy

You might have stitches where the cancer was removed. This might feel a little tight at first. As it heals, the surrounding skin will stretch and the tightness should ease.

Sometimes the doctor removes a large area of skin. You might need a skin graft or skin flap to repair the area if this is the case.

Skin graft and skin flaps

You need to have the area of skin replaced (repaired) if you have a large area of skin removed. This can be done with a skin graft or skin flap.

After both skin grafting and skin flap repair, doctors will keep a close eye on your wound site. This is to make sure the site is getting a good supply of blood, which brings oxygen and food to the healing tissues.

Skin Graft

What it is?
A skin graft is a thin sheet of skin that your surgeon removes from another part of your body (donor site). They use it to cover the area of skin they remove. The donor site usually comes from somewhere not too obvious, such as your inner thigh.

How it’s done?
You have a skin graft during the operation to remove your cancer. A plastic surgeon usually does the operation. The surgeon shaves off the sheet of skin (using a special instrument), or cuts out the donor site. You have a dressing on the donor site. You don’t usually need stitches if your surgeon shaves the donor site. It will heal on it’s on. You have stitches to repair a donor site that has been cut away.
The skin graft is very delicate while it heals. It’s very important that it is not damaged or knocked while healing. Dr. Mudit Aggarwal always remains very careful that your wound doesn’t become infected. You may have antibiotics to prevent this.

One disadvantage of skin grafting is sometimes the skin looks different from the surrounding area. It may be a slightly different colour and appear as a dent compared to the surrounding skin.

Skin Flap

What it is?

A skin flap is another way to repair a large wound. It uses a flap of skin and the tissue from underneath it (subcutaneous tissue).

How it’s done?

Surgeon takes the flap from close to your wound. The cut (incision) is usually deeper than that of a skin graft, but is left partly connected to its original site. This means the skin flap is still connected to your blood supply so is likely to heal well. The flap is then positioned over your wound and stitched in place.

The area that the skin flap was taken from is stitched closed.

Only specially trained dermatologists (a skin specialist) or plastic surgeons do skin flaps.

Advantages

Skin flaps often look better than a skin graft. So it tends to be used where the appearance of the skin is most important, such as on your face.

Squamous cell skin cancer (SCC)

SCC is generally faster growing than basal cell cancers. About 20 out of every 100 cases (20%) of skin cancers are SCC. They begin in cells called keratinocytes, found in the epidermis layer of the skin.

Most SCCs develop in areas that have been exposed to the sun. These areas include parts of the head, neck, and on the back of your hands and forearms. They can also develop in scars, areas of skin that have been burnt in the past, or that have been ulcerated for a long time.

SCCs don’t often spread. If they do, it’s most often to the deeper layers of the skin. They can spread to nearby lymph nodes and other organs causing secondary cancers, but this is unusual.

Signs and Symptoms

  •  SCC usually begins as a dome-shaped bump or a red, scaly patch of skin.
  •  It’s usually rough and crusty, and can bleed easily when scraped.
  •  Large growths may itch or hurt.
  •  It may also pop through scars or chronic skin sores.
  •  SCC often occurs in areas exposed to UV radiation, such as the face, ear, and hands. However, it can also appear in the mouth, in the anal area, and on the genitals.
  •  In some cases, you’ll notice a new growth on a pre-existing scar, mole, or birthmark. Any existing lesions or sores that aren’t healing can also indicate SCC.

Risk Factors for SCC Includes

  • having fair skin
  • having light-coloured hair and blue, green, or grey eyes
  • having long-term exposure to UV radiation
  • living in sunny regions or at a high altitude
  • having a history of multiple severe sunburns, especially if they occurred early in life
  • having a history of being exposed to chemicals, such as arsenic

Diagnosis

Doctor first perform a physical exam and inspect any abnormal areas for signs of SCC. He may also ask you about your medical history. If SCC is suspected, your doctor may decide to take a biopsy to confirm the diagnosis.

A biopsy usually involves removing a very small portion of the affected skin. The skin sample is then sent to a laboratory for testing. In some cases, your doctor may need to remove a larger part or all of the abnormal growth for testing. Talk to your doctor about any potential scarring or biopsy concerns.

Treatment

The treatment methodology is same as BCC treatment. Surgeon decides treatment type considering factors like-

  • the extent and severity of your cancer
  • Patient’s age
  • Patient’s overall health
  • the location of the cancer

Prevention of Squamous Cell Cancer (SCC)

To help reduce your risk for SCC, following tips are given by the doctor:

  • Limit your sun exposure.
  • Avoid the sun during the hottest part of the day, which is between 10 a.m. and 4 p.m.
  • Wear sunscreen that has an SPF of at least 15 whenever you go out in the sun.
  • Wear sunglasses with UV ray protection.
  • Wear a hat and cover your skin when working outside.
  • Avoid using tanning beds and lamps.
  • Protect your skin during winter as well because winter rays can be especially dangerous.
  • Check your skin each month for any new or abnormal growths.
  • See a dermatologist once per year for a full-body skin check.