Skin Cancer

Words by Dr Saroj Poudel

 

Skin cancer is not something that frequently comes up in our talk, but it is a reality that touches us all, regardless of our age, gender, or ethnicity.

Anyone can develop skin cancer, regardless of race or sex.

In a study conducted at the Bir Hospital, researchers delved into the depths of skin biopsies to unravel the prevalence of skin cancer among patients seeking care. This retrospective analysis spanning from Baishakh 1st, 2071 to 30th Poush, 2075 sheds light on the landscape of skin cancer in Nepal. It included all the skin malignancies and pre-invasive lesions received and diagnosed in the Department of Pathology. The results pointed out that the most affected age group was 66 to 75 years with 55% male and 45% females. Head and neck was the most common site occupying 67% of the total cases followed by lower limbs 15%. The study also revealed that 40% of malignant cases were basal cell carcinoma followed by squamous cell carcinoma at 36% and malignant melanoma at 15%. The study is titled “Prevalence of skin cancer based on skin biopsies in Bir hospital, Nepal” and is published in the Journal of Pathology of Nepal. Skin cancer is not something that frequently comes up in our talk, but it is a reality that touches us all, regardless of our age, gender, or ethnicity. Here in Nepal, where agricultural work and outdoor activities are integral parts of our lives, factors such as prolonged exposure to sunlight, frequent sunburns, and a lack of awareness about sun protection contribute significantly to the incidence of skin cancer. Dr. Saroj Poudel sheds light on this pervasive disease, offering insights and guidance crucial for our collective well-being in the Nepali context.

Basal cell carcinoma is the most common malignancy followed by squamous cell carcinoma and malignant melanoma.

What is skin cancer?

Skin cancer is a disease that involves the growth of abnormal cells in your skin tissues. Normally, as skin cells grow old and die, new cells form to replace them. When this process doesn’t work as it should — like following long exposures to ultraviolet (UV) light from the sun — cells grow old more quickly. These cells may be noncancerous (benign), which don’t spread or cause harm or they may turn cancerous.

Skin cancer can spread to nearby tissue or other areas in your body if it’s not caught early. Fortunately, if skin cancer is identified and treated in early stages, most of them can be cured. So, it’s important to talk to  your dermatologist if you think you have any signs of skin cancer.

UV rays from the sun damage your skin, and over time, this may lead to skin cancer.

Types of skin cancer:

There are three main types of skin cancer as seen in the above study: 

• Basal cell carcinoma forms in your basal cells in the lower part of your epidermis (the outside layer of your skin).
• Squamous cell carcinoma forms in your squamous cells in the outside layer of your skin.
• Melanoma forms in cells called melanocytes. Melanocytes produce melanin, a brown pigment that gives your skin its color and protects against some of the sun’s damaging UV rays. This is the most serious type of skin cancer because it can spread to other areas of your body.

Other types of skin cancer include:

• Kaposi sarcoma

• Merkel cell carcinoma

• Sebaceous gland carcinoma

 

How common is skin cancer?

If we look into the United States data, skin cancer is the most common cancer diagnosed in the U.S. In fact, about 1 in 5 people develop skin cancer at some point in their life.

What are the signs and symptoms of skin cancer?

The most common warning sign of skin cancer is a change on your skin — typically a new growth or a change in an existing growth or mole. Skin cancer symptoms include:

• A new mole or a mole that changes in size, shape or color, or that bleeds.
• A pearly or waxy bump on your face, ears or neck.
• A flat, pink/red- or brown-colored patch or bump.
• Areas on your skin that look like scars.
• Sores that look crusty, have a depression in the middle or bleed often.
• A wound or sore that won’t heal, or that heals but comes back again.
• A rough, scaly lesion that might itch, bleed and become crusty.

What does skin cancer look like?

Skin cancer looks different depending on what type of skin cancer you have. Thinking of the ABCDE rule tells you what signs to watch for:

• Asymmetry: Irregular shape.
• Border: Blurry or irregularly shaped edges.
• Color: Mole with more than one color.
• Diameter: Larger than a pencil eraser (6 millimeters).
• Evolution: Enlarging, changing in shape, color or size. (This is the most important sign.)

If you’re worried about a mole or another skin lesion, make an appointment and show it to your dermatologist for further evaluation.

What causes the condition?

The main cause of skin cancer is overexposure to sunlight, especially when you have sunburn and blistering. UV rays from the sun damage DNA in your skin, causing abnormal cells to form. These abnormal cells rapidly divide in a disorganized way, forming a mass of cancer cells.

Skin cancer happens when something changes how your skin cells grow, like overexposure to ultraviolet light.

What are the risk factors for skin cancer?

Anyone can get skin cancer, regardless of race or sex. But some groups get it more than others. Before the age of 50, skin cancer is more common in women and people assigned female at birth (AFAB). After 50, though, it’s more common in men and people assigned male at birth (AMAB). And it’s about 30 times more common in non-Hispanic white people than non-Hispanic Black people or people of Asian/Pacific Islander descent. While cancer being less common in people with darker skin tone, it comes with a problem, unfortunately skin cancer is often diagnosed only in later stages for people with darker skin tones. This makes it more difficult to treat.

Although anyone can develop skin cancer, you’re at increased risk if you:

• Spend a considerable amount of time working or playing in the sun.
• Get easily sunburned or have a history of sunburns.
• Live in a sunny or high-altitude climate.
• Tan or use tanning beds.
• Have many moles or irregularly shaped moles.
• Have actinic keratosis (pre-cancerous skin growths that are rough, scaly, dark pink-to-brown patches).
• Have a family history of skin cancer.
• Have had an organ transplant.
• Take medications that suppress or weaken your immune system.
• Have been exposed to UV light therapy for treating skin conditions such as eczema or psoriasis

How is skin cancer diagnosed?

First, a dermatologist may ask you if you’ve noticed changes in any existing moles, freckles or other skin spots, or if you’ve noticed any new skin growths. Next, they’ll examine all of your skin, including your scalp, ears, palms of your hands, soles of your feet, between your toes and around your genitals.

What tests will be done to diagnose skin cancer?

If your dermatologist suspects skin cancer, they may perform a biopsy. In a biopsy, a sample of tissue is removed and sent to a laboratory where a pathologist examines it under a microscope. Your dermatologist will tell you if your skin lesion is skin cancer, what type you have and discuss treatment options.

Skin cancer stages:

To determine a skin cancer’s stage or severity, your doctor will factor in:

• how large the tumor is
• if it has spread to your lymph nodes
• if it has spread to other parts of the body

Treatments for skin cancer:

Your recommended treatment plan will depend on different factors. These include the cancer’s:

• size
• location
• type
• stage

After considering these factors, your doctor may recommend one or more of the following treatments:

• Cryosurgery: The growth is frozen using liquid nitrogen and destroys the tissue as it thaws.
• Excisional surgery: The physician cuts out the growth and some healthy skin surrounding it.
• Mohs surgery: The growth is removed layer by layer during this procedure. Each layer is examined under a microscope until no irregular cells are visible.
• Curettage and electrodesiccation: A long spoon-shaped blade scrapes away the cancer cells, and the remaining cells burn by an electric needle.
• Chemotherapy: This treatment can be taken orally, applied topically, or injected with a needle or intravenous (IV) line to kill the cancer cells.
• Photodynamic therapy: Laser light and drugs destroy the cancer cells.
• Radiation: High powered energy beams kill the cancer cells.
• Biological therapy: Biological treatments stimulate your immune system to fight cancer cells.
• Immunotherapy: Medications are used to stimulate your immune system to kill the cancer cells.

Can skin cancer be prevented?

In most cases, skin cancer can be prevented. The best way to protect yourself is to avoid too much sunlight and sunburns. UV rays from the sun damage your skin, and over time, this may lead to skin cancer.

How can I lower my risk?

Ways to protect yourself from skin cancer include:

• Use a broad-spectrum sunscreen with a skin protection factor (SPF) of 30 or higher. Broad-spectrum sunscreens protect against both UV-B and UV-A rays. Apply the sunscreen 30 minutes before you go outside. Wear sunscreen every day, even on cloudy days and during the winter months.
• Wear hats with wide brims to protect your face and ears.
• Wear long-sleeved shirts and pants to protect your arms and legs. Look for clothing with an ultraviolet protection factor label for extra protection.
• Wear sunglasses to protect your eyes. Look for glasses that block both UV-B and UV-A rays.
• Use a lip balm with sunscreen.
• Avoid the sun between 10 a.m. and 4 p.m.
• Avoid tanning beds. If you want a tanned look, use a spray-on tanning product.
• Ask your doctor or pharmacist if any of the medications you take make your skin more sensitive to sunlight. Some medications known to make your skin more sensitive to the sun include tetracycline and fluoroquinolone antibiotics, tricyclic antibiotics, the antifungal agent griseofulvin and statin cholesterol-lowering drugs.

Regularly check your skin for any changes in size, shape or color of skin growths or the development of new skin spots. Make an appointment for a full-body skin exam with your dermatologist if you notice any changes in a mole or other skin spot.

Summary:

Skin cancer happens when something changes how your skin cells grow, like over exposure to ultraviolet light. Symptoms include new bumps or patches on your skin, or changes in the size, shape or color of skin growths. Most skin cancer is treatable if it’s caught early. Let’s equip ourselves and our friends and family with knowledge to spot it early on, before it takes its toll.