Skin Cancer

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Skin Cancer

Skin cancer is a malignant tumor that develops from skin cells.

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.

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.

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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.

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.

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.

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