Skin Cancer

skin is the outer covering of our body, and is the largest organ of the body with a surface area around 20 square feet.
The skin is composed of three main layers:

1. The epidermis is the outermost layer of the skin. This layer serves as a barrier for infections forming a waterproof protective wrapping around the body surface.
2. Underneath the epidermis another layer is “Dermis” that contains connective tissue providing cushions to the body, nerve endings that provide the sense of touch and heat, blood vessels, hair follicles and sweat glands.
3. The hypodermis is the innermost layer which is also known as subcutaneous tissue. It is made of fat serving as padding and insulation for the body and connective tissue to attach the skin to bones and muscles.

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WHAT IS SKIN CANCER?

Skin cancers are cancers that start in the skin cells.
it is developed when the abnormal growth of skin cells develops on skin which is exposed to the sun. However, it can also occur on those areas of skin which are not exposed to sunlight.

TYPES :

The outermost layer i.e, epidermis is made up of three types of cells- basal cells, squamous cells and melanocytes. Most common type of skin cancer develops in these tissues. These are as follows:

• Basal cell carcinoma: Basal cell carcinoma is rarely staged as these are almost always cured before they spread to other parts of the body.
• Squamous cell carcinoma: Squamous cell carcinoma usually occurs in the head and the neck regions and is more likely to recur and also spread to other parts of the body.
• Melanoma Skin Cancer: Melanoma is the cancer that starts in the melanocytes. These are skin cells that make a deep brown pigment called melanin which is responsible to give the skin its colour. It protects the deep layers of the skin from the effects of the sun and exposure to sun increases the production of melanin making people get tan or get darker.

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SYMPTOMS :

Skin cancer develops primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it can also develop on palms, beneath fingernails or toenails, and genital area, that hardly see the sunlight.
The symptoms of the skin cancer can depend on the type of skin cancer too. The following are the symptoms of the common types of skin cancer:

• Sores or moles that appear smooth and pearly, look waxy or appear as a firm, red lump
• These may bleed sometimes
• They begin to heal but recurs
• These can be itchy too
• It may develop into a painless ulcer.
• A flat, flesh-coloured or brown scar-like lesion
• Red and scaly patches of the skin that bleed
• Bleeding sores
• A wart-like growth that bleed
• Itching, burning sensation and tenderness in the affected areas
• Changes in size, colour or feel of common (normal) moles
• Bleeding moles
• Brownish spot with dark speckles.

CAUSES

Skin cancer occurs when DNA of skin cells change, termed as mutation. This process cause the cells to grow abnormally forming a mass of cancer cells.

ULTRAVIOLET RAYS

Much of the damage to DNA in skin cells results from ultraviolet (UV) radiation found in sunlight and in the lights used in tanning beds. Ultraviolet (UV) radiation emitted by the sun can damage skin cells and genes, which makes it a major risk factor for skin cancer.
But sun exposure doesn't explain skin cancers that develop on skin not ordinarily exposed to sunlight. This indicates that other factors may contribute to the risk of skin cancer, such as being exposed to toxic substances or having a condition that weakens our immune system.

RISK FACTORS

Factors that may increase the risk of skin cancer include:

• Excessive sun exposure: People who spend more time in the sun might develop skin cancer. Excessive skin tanning is skin's injury response to excessive UV radiation.
• Sunny or high-altitude climates: People who live in sunny, warm climates are exposed to more sunlight are also at risk of developing skin cancer.
• Moles: People who have many moles or abnormal moles which look irregular and are generally larger than normal moles are at increased risk of skin cancer.
• Precancerous skin lesions: Having rough, scaly patches that range in colour from brown to dark pink skin lesions can increase the risk of developing skin cancer.
• A family history of skin cancer: If anyone in family once had skin cancer, one may be at increased risk of the skin cancer.
• A personal history of skin cancer: Patients with history of skin cancer can develop it again.
• A weak immune system: People with weakened immune systems tend to grow quickly and are more likely to cause death.
• Exposure to certain substances: Risk of skin cancer is more when exposed to certain substances, such as arsenic.
• HPV-Human papillomavirus can be related with a considerable amount of skin cancers.

Diagnosis:

1. Physical examination: The Dermatologist examines the patient’s skin to determine whether the skin changes are likely to cause skin cancer. Further tests and investigations are required to confirm the diagnosis.
2. Imaging Tests:
   • Chest X ray
   • CT scan
   • PET scan
   • MRI
   • CT-PET scan
3. Blood tests: Blood tests are done to check overall health of patient including marrow, liver, and kidney functions.
4. Biopsy: “Dermatologist” removes the suspicious-looking skin for lab testing to determine whether you have skin cancer and, if so, what type of skin cancer it is.

STAGES :

Once it has been diagnosed, staging is done to determine the extent of the skin cancer in the body. Staging helps the “Oncologist or Cancer Specialist” to define the plan how to cure the cancer.

• Stage I: The cancer is around 2 cm or lesser in size and has no high-risk features.
• Stage II: The cancer is around 2 cm in size and has a few high-risk features.
• Stage III: The cancer spread into the bones of face like the jaw bone or the bone around the eye or it may grow to a nearby lymph node and size is less than 3 cm.
• Stage IV: The cancer has spread into the spine, lower part of the skull or the ribs or it has spread to a lymph node more than 3 cm in size or to an internal organ such as the lungs.

TREATMENT OPTIONS:

The following are the major treatment options available at Oncoplus Hospital, Delhi for treating skin cancers:

Skin Cancer Surgery

Surgery is the most common and preferred treatment method to cure skin cancer. There are different types of surgeries available to treat skin cancers, the exact type is chosen based on the severity of the condition and the location of the cancer.

• Mohs surgery: This procedure is for larger, recurring or difficult-to-treat skin cancers. This procedure allows cancerous cells to be removed without taking an excessive amount of surrounding healthy skin.
  In this surgery, doctor removes the skin growth layer by layer, examining each layer under the microscope, until no abnormal cells remain.
• Curettage and electrodessication: After removing most of a growth, the doctor scrapes away layers of cancer cells using a device with a circular blade (curet). An electric needle destroys any remaining cancer cells.
• Cryosurgery: Early it can be destroyed by freezing them with liquid nitrogen.
• Laser surgery:
• Excisional surgery: In this type of surgery doctor cuts out (excises) the cancerous tissue and a surrounding margin of healthy skin. A wide excision — removing extra normal skin around the tumor — may be recommended in some cases.

Targeted therapy

This treatment uses drugs that target the cancerous cells. They avoid causing extreme damage to the remaining healthy cells which can occur in chemotherapy. As a part of targeted therapy in treating recurrent basal cell carcinoma, a signal transduction inhibitor is used. These inhibitors block the signals that pass between molecules in the cells, which leads to death of those cells.

Immunotherapy

Immunotherapy aims in making the patient’s immune system stronger by using artificial substances to restore the body’s defence against cancer. This procedure is also known as biotherapy or biologic therapy.

Photodynamic therapy (PDT)

This treatment destroys skin cancer cells with a combination of laser light and drugs that makes cancer cells sensitive to light.

Chemotherapy for Skin Cancer

Chemotherapy drugs to kill cancer cells throughout the body and is used if the skin cancer has metastasized and spread to other organs. It is not the standard treatment for this cancer type though unless the cancer has advanced. The treatment is given in cycles of medication and rest to allow the body to recover and reduce the intensity of side effects.

Radiation therapy

Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy may be an option when cancer can't be completely removed during surgery.

Consult the cancer specialist at Oncoplus Hospital, Delhi.