Skin cancer can occur at any age, with a higher frequency during the twenty year interval between the ages of 40 and 60. In recent years there has been an increase on skin cancer cases in younger people. Thus, any unusual nodule or wound on the skin that does not heal and persists for more than 3 months should be considered as skin cancer until proven otherwise.
The most important factors for the development of skin cancer are the skin type and the exposure to sunlight. Those with fair skin color and freckles, who have nevi (moles), are often exposed to the sun, have a family history of skin cancer or have received radiation treatment, are more at risk to be affected by skin cancer.
The best precaution for people at risk is to avoid sun exposure and to use appropriate protective clothing and sunscreen creams.
Diagnosis of skin cancer may be made by the removal of a part or the entire dermal (skin) lesion and the microscopic examination of the cells (biopsy). Histology forms the basis for the diagnosis and treatment of skin cancer.
Moreover, techniques aiding skin cancer diagnosis are dermoscopy – mapping, where the specific characteristics of the basal cell carcinoma or squamous cell carcinoma are illustrated.
It accounts for more than 90% of skin cancers in the USA. This is the least dangerous form of skin cancer. It clinically presents as a nodule, usually pink or pigmented that persists. Some times it forms ulcerations and resembles a wound that does not easily heal or is flat resembling a scar. Basal cell carcinoma develops slowly and metastases are rarely observed. Once diagnosed, however, it must be immediately treated because if its removal is delayed it causes tissue destruction in depth, often reaching the bone. An important risk factor for the occurrence of this type of cancer is the chronic and prolonged sun exposure.
There are various forms of basal cell carcinoma such as the following:nodular (pink nodule) ulcerated (like a wound that does not heal) pigmented (resembles a dark colored mole) resembles localized scleroderma (morpheaform, resembles a white scar)
The squamous cell carcinoma (SCC) of the skin is a malignant tumor derived from the keratinocytes of the epidermis or the hair, glands and nails. Unlike basal cell carcinoma, it carries a greater risk of metastasis, which, however, results in death in only a small proportion of patients. It occurs in skin areas which are exposed to the sun, and more frequently at the tip of the nose, the forehead, the lower lip and the hands. It can also occur in areas of the skin that have been burned, had been exposed to chemical substances or had been irradiated.
It presents as a red hard nodule or ulceration or as a scaly lesion which may bleed or be covered with scab. Squamous cell carcinoma may occur either on healthy skin or be derived from an actinic keratosis which is considered a precancerous condition. Metastases of squamous cell carcinoma are observed at the local lymph nodes and less often in neglected (untreated) cases in distant organs.
Small lesions may respond to local treatment with antineoplastic agents, such as the imiquimod cream (aldara) or 5-fluorouracil cream.
Larger nodules or tumors that have relapsed should always be surgically removed and subjected to microscopic examination. In our clinic we always recommend the application of surgical removal of the nodules including a margin of healthy tissue and its histological examination. Surgical removal is the method that will lead to complete cure and will dramatically reduce the risk of relapse.
In case of larger nodules that occupy a large area, skin graft placement at the area of the excised lesion may be required.