Skin Cancer

Skin cancer is a malignant tumor that develops from skin cells.
Dr. Amalia Tsiatoura
DERMATOLOGIST - VENEREOLOGIST
"Skin Cancer is mainly due to excessive exposure to solar radiation - the most dangerous being UVB - but there is also a hereditary predisposition. It is a fairly common type of cancer, as according to the World Health Organization there are almost 3 million cases per year" says Dermatologist - Venereologist Dr. Amalia Tsiatoura. "Unfortunately, the incidence of skin cancer is increasing, and today it reaches 25% of the population. Despite the fact that in 80% of cases it occurs on the face, hands and neck, it is possible for it to occur in unexposed areas such as the palms, soles and perineum."
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Skin Cancer

What is Skin Cancer

Skin cancer can start in the form of precancerous lesions. These precancerous lesions are changes in the skin that are benign, but can potentially turn into an aggressive form of cancer.
How is it treated?

Skin cancer can occur at any age, with a higher incidence in people aged 40-60 years.

However, in recent years there has been an increase in cases in younger people. As the factors that favor its occurrence are skin type and exposure to sunlight, people with fair skin, freckles, moles, a family history of skin cancer and people who are frequently exposed to the sun or have received radiation therapy have an increased risk of developing skin cancer.

The incidence of skin cancer is particularly high in countries with high sunshine, such as Greece. Often, skin cancer occurs in people with a weak immune system, for example, people infected with the human immunodeficiency virus (HIV) or people who have undergone chemotherapy.

Skin Cancer

Basal cell epithelioma BCC

The most common type of skin cancer is basal cell carcinoma (BCC). It is a neoplasm that originates from cells in the basal layer of the epidermis and is the least dangerous form of skin cancer. Basal cell carcinoma accounts for more than 90% of skin cancer cases in the US and Greece. Although it grows slowly and very rarely - if ever - metastasizes, it must be treated immediately because if its removal is delayed, it destroys tissues in great depth, often reaching as far as the bones. An important risk factor for this type of cancer is chronic and prolonged exposure to the sun. According to research, 85% of basal cell carcinomas occur on the face, with the most common area being the nose. The initial appearance of basal cell carcinoma is in the form of a red papule that gradually grows. The most common symptom is an open sore, which does not heal and remains open for more than 3 weeks. Less commonly, itching, bleeding or pain in the area occurs. There are various forms of basal cell carcinoma, such as:
  • nodular (rosacea): appears as a nodular swelling in the color of the skin.
  • ulcerative (like a wound that won't close): a red, flat lesion that looks like eczema or fungal infection.
  • melanchromatous (looks like a dark mole): because of its colour, it is often confused with melanoma.
  • the diagnosed scleroderma type (looks like a white scar): it has the appearance of a yellowish-white plaque and it can take several years before it is visible and diagnosed.
Skin Cancer

Squamous cell carcinoma (SCC)

Squamous cell carcinoma (SCC) of the skin is a malignant tumor that originates from the squamous cells of the epidermis or skin appendages. Unlike basal cell carcinoma (BCC), it carries a higher risk of metastases, but only leads to death in a small percentage of patients. Metastases of squamous cell carcinoma are mainly located in the lymph nodes. It appears as a red hard nodule or ulceration, or as a scaly lesion that may bleed or be covered by an epithelium.

This type of skin cancer metastasizes to the epithelial (local) lymph nodes and, more rarely, in neglected cases, to distant organs. It is mainly found in areas of the skin exposed to sunlight, such as the tip of the nose, forehead, lower lip and hands. It can also occur in areas that have been sunburned in the past, exposed to chemicals or irradiated. It appears as a red hard nodule or ulceration, or as a scaly lesion that may bleed or be covered by an epithelium.

Squamous cell carcinoma can either occur on healthy skin or result from a radial hyperkeratosis that is considered a precancerous condition. Squamous cell carcinoma metastasizes to the epithelial (local) lymph nodes or if left untreated to distant organs such as the lungs and liver.

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Skin Cancer

Diagnosis

For the diagnosis of melanoma, we use the "golden" rule of self-examination, or the "ABCDE" rule. This rule is based on the following characteristics:
A

Αsymmetry

Asymmetry in shape or colour - half of an olive does not match the other half.
B

Border

Irregular or fuzzy borders
C

Color

May display different colors, usually dominated by red, black or brown
D

Diameter

The diameter of the melanoma usually exceeds 6 mm, but may be smaller
E

Evolution/Elevation

Over time the olive mutates and changes shape, size or colour
Keeping in mind the 5 signs of melanoma make it easier to recognize it in time. However, the existence of the above signs is not proof of melanoma.

The diagnosis of skin cancer is made by a qualified medical doctor - dermatologist and is carried out by removing part or all of the skin lesion and examining its cells under a microscope (biopsy). The histological examination is the basis for the diagnosis and treatment of skin cancer. Special immunohistochemistry stains may be used in addition to the classical histological examination for the differential diagnosis of skin cancer and melanoma. The diagnosis is also aided by dermoscopy - mapping in which the specific features of basal cell carcinoma, squamous cell carcinoma and melanoma are visualised on a digital camera.

It is particularly important for the person to do a local self-examination of the skin, especially in areas most exposed to sunlight or where there are moles. Attention should be paid to areas that are not directly visible to the person but are particularly prone to skin cancer such as the scalp, palms, soles, genitals and nails. The best way to self-examine is to review in front of a full-length mirror and identify lesions on the less obvious parts of your body.
Skin Cancer

Melanoma

A less common, but extremely aggressive type of skin cancer is melanoma. Melanoma is caused by melanin cells, the cells that produce melanin, the pigment that gives the skin its characteristic colour. In advanced stages, melanoma can cause metastases and can even lead to death. Although as a type of skin cancer it has the lowest incidence rate, it is responsible for 80% of deaths from skin cancer.

For this reason, a person should be informed and consult a dermatology specialist in case a new nevus (mole) with an irregular shape appears or in case they notice that an existing nevus is altered. Characteristics of the alteration can be a change in size, shape or colour, as well as ulceration or bleeding of the mole. The most common sites of occurrence are mainly the back, arms, legs or face, as well as the genitals.

In men it occurs mainly on the trunk, while in women it occurs on the lower limbs. Melanoma, unlike other forms of skin cancer that usually affect older people, often occurs on the skin of young people.

Skin Cancer

How it is treated

Skin cancer treatment can be done by:
  • Cryotherapy - treatment of small nodular basal cell carcinomas
  • Local treatment with antineoplastic agents - treatment of small lesions
  • Surgical removal & biopsy - treatment of large lumps or carcinomas
  • Skin grafting after Surgical removal
Treatment of skin cancer with medication is almost always combined with one of the above mentioned methods as it alone is not able to provide a definitive cure for skin cancer. Prevention is always the most important treatment.
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Skin Cancer

FAQ

Can I protect myself from skin cancer?

The best precaution, especially for people at risk, is to avoid sun exposure and use appropriate clothing and protective sunscreens. However, you should bear in mind that the use of sun creams is not a proven means of absolute protection against skin cancer.

In addition, one should be examined once a year by a dermatologist who can detect early signs of precancerous lesions and prevent possible progression to skin cancer.

Finally, nevus mapping is an important weapon in the prevention of skin cancer and is recommended for people with dysplastic and numerous nevi, as well as for people with a family history of skin cancer.

What types of people are most commonly affected?

Any person exposed to solar radiation can be affected. However, people with a light phototype, i.e. light skin and light eyes, are considered to be at high risk. In addition, although there are quite a few cases of young people affected by skin cancer, most cases are in older people.

I recently underwent a skin cancer removal. What are the chances of it coming back?

People who have developed skin cancer are particularly prone to developing it again at the same or another site. In particular, those people who have developed basal cell carcinoma have an increased risk of developing the same or other types of skin cancer. Patients diagnosed with basal cell skin carcinoma have a 50% chance of recurrence of the same type in five years. For this reason, regular re-examination is recommended - every 6 months or so.

What are the precursors of skin cancer?

Although skin cancer is sometimes difficult to detect in time, there are some warning signs that should make us suspicious. These worrying signs on the skin can be: a sore that does not heal, local itching or pain, a change in the shape, colour or texture of a pre-existing mole (mole) or the appearance of a new one that is rapidly progressing in shape and size. In all cases, it is important to keep in mind that if skin cancer is detected early, it can be treated.

Is it possible that removing an "innocent" mole could lead to skin cancer?

Although it is a fairly widespread belief, no, olive removal does not cause cancer. People who have developed cancer after having an olive removed means that the olive that was removed was malignant and was not removed properly in the first place.

Can artificial tanning lead to skin cancer?

Although there is no direct link between the use of artificial tanning and the development of cancer, the lamps used in artificial tanning emit UV-A radiation which has the ability to penetrate deep into the skin, reducing the body's defenses. People who frequent tanning centers are more likely to develop skin cancer, especially squamous cell carcinoma and melanoma.

Is skin cancer hereditary?

It has been shown that the occurrence of skin cancer, in addition to external factors, is also due to hereditary causes. More specifically, people whose parents or siblings have developed skin cancer are more likely to develop it themselves. This hereditary association applies to all types of skin cancer, including melanoma. In this case, you should not be alarmed, but be more systematic in self-examination and preventive dermatological screening and rush to the dermatologist if you spot any worrying sign.

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