Skin cancer

More and more often nowadays there is talk of skin cancer. Medical associations, state bodies, the media and many doctors, have been trying in recent years to inform us about this type of cancer and to give us to understand that vigilance and prevention play a decisive role in limiting it. The following article presents some general information about skin cancer, which aims to raise awareness in terms of prevention and early diagnosis.  

What is skin cancer?

Skin cancer is a type of cancer that develops in the skin and is caused by the proliferation of abnormal skin cells. It is divided into three subtypes: basal cell carcinoma, squamous cell carcinoma and melanoma. In more detail:

1. Basal cell carcinoma

It is the most common form of skin cancer and arises from the basal cells of the epidermis. It occurs most often in white, blonde and older people. It develops mainly in areas of the body exposed to the sun, but its occurrence in other parts of the body cannot be excluded. The initial form is often a small rosy, pearly nodule. It grows slowly and may peel off or even bleed. As a rule, it does not metastasize, but destroys and erodes tissues locally, causing pain and itching.

2. Acanthocytic carcinoma

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It is the second most prevalent type of skin cancer and is developed by the squamous cells of the epidermis. It is most commonly found in older or immunocompromised people. It can occur in various parts of the skin, but it usually occurs in the areas most exposed to the sun, such as the face, lower lip, hands, ear, etc. Other places at increased risk may include burns, scars, ulcers, chronic wounds and areas of the skin that have been exposed to radiation or certain chemicals. Like basal cell carcinoma, squamous cell carcinoma rarely metastasizes. It grows faster than basal cell carcinoma. Clinically it usually appears as a painful thick and rough plaque with scales that bleeds easily or as a sore with irregular borders and superficial crusts that is sometimes dry and sometimes moist.

3. Melanoma

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It is the rarest but most dangerous type of skin cancer and arises from the melanocytes (melanin-producing cells) of the skin. It is the second most common cancer in people aged 15-34 years. It typically affects the skin, but rarely can occur in the mouth, intestines or eye. Usually, it is caused by exposure to sunlight. It tends to metastasize and is treatable only if diagnosed and treated early. It is a cancer rare in children, but exposure to sunlight during childhood predisposes to the development of skin cancer in adulthood.

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It appears as a nevus (mole) or a small black spot on the skin. Moles are not cancers, but they have a good chance of developing into cancer. Compared to moles, melanomas show a) asymmetry, b) irregular margins, c) colour irregularity, d) size larger than a normal mole. Variation in colour, size, shape and the appearance of bleeding or itching raise the suspicion of melanoma. 

Are there any warning signs?

Skin cancer starts with precancerous lesions that appear on the skin and over time can turn into cancer. The most common, which are closely related to the three types of cancer:

1. Radial keratosis

Small scaly marks on the skin, which usually appear after excessive exposure to the sun. It is a very early lesion, for which we cannot say exactly if and when it will develop into skin cancer. Most doctors proactively recommend treatment to prevent a future occurrence of skin cancer.

2. Actinic chilitis

It is a precancerous condition that occurs on the lower lip and is characterized by scaly marks and a rough surface in the area. If untreated, it can develop into squamous cell carcinoma.

3. Dermal horn

It appears as a small lump, which is conical and made of keratin. It varies in size and colour and at its base a squamous cell carcinoma may develop. It occurs in older people with a history of exposure to solar radiation.

4. Dysplastic nevi

Dysplastic moles (moles) are not cancer, but they have a good chance of developing into cancer. They appear all over the body, even in areas that have not been exposed to the sun. Their shape is not symmetrical and their borders may be irregular. Their shade may be pink, brown, red.

What are the causes that lead to skin cancer?

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The factors implicated in the development of skin cancer are:

- Exposure to the sun

- Smoking

- HPV infection

- Existence of a genetic syndrome

- Presence of nevus larger than 20 mm

- Elki Marjolin

- solarium

- Light skin

- Medication (e.g. cyclosporine A)

- Weak immune system

- Advanced age 

How is the diagnosis made?

The diagnosis is made by a qualified doctor, who will proceed to take a comprehensive history and perform a clinical examination. The procedure is completed with a biopsy, which is the basis for the diagnosis and staging of skin cancer. It is particularly important that the person himself carries out a self-examination of his skin, especially where it is exposed to sunlight. If metastasis is suspected, CT, MRI or PET/CT is performed.

What is the treatment?

The method of treatment is determined according to the type of cancer, the age of the patient, the morphology and the general condition of the body. All skin cancers are curable when treated at an early stage. In more detail:

1. Basal cell carcinoma

The treatment of choice is surgical removal in healthy margins, with high rates of complete cure. Other treatment options, depending on the type of patient, include cryopreservation, curettage and electrocautery, photodynamic therapy and the use of topical immunomodulatory agents.

It is possible, after surgical removal, to have a local recurrence. Regular re-examination can prevent and re-treat the skin cancer.

2. Acanthocytic carcinoma

The treatment of choice is surgical removal, while other methods may be used, depending on the type of tumour and the patient's condition.

3. Melanoma

In melanomas, the risk of metastases is high. Therefore, urgent treatment is required in the early stages. Suspicious lesions should be surgically removed and biopsied. If the diagnosis is melanoma, a wider excision is required, as well as checking nearby lymph nodes for possible metastasis to them. In cases of spreading melanoma, newer treatments, such as immunotherapy, biological therapies, sometimes radiotherapy and chemotherapy, improve patient survival.

Are there any preventive measures?

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About 9 out of 10 skin cancers (excluding melanoma) and 6 out of 10 melanomas are caused by excessive sun exposure. We understand, therefore, that for prevention, the main measure to take is to limit exposure to sunlight. More specifically:

Sun protection rules

1. Stay in the shade, especially at midday (from 10.00 a.m. to 4 p.m.).

2. Avoid sunbathing, as well as artificial tanning (solarium).

3. When exposed to the sun, cover your body with long clothing, a wide-brimmed hat and sunglasses.

4. Wear sunglasses with UV-absorbing lenses.

5. Use a broad-spectrum sunscreen with SPF 15 or higher every day.

6. For prolonged outdoor activities, a waterproof sunscreen with a protection index of 30 or higher should be used.

7. Apply sunscreen 30 minutes before exposure to the sun. Repeat the application every 2 hours, after swimming or after excessive sweating.

Also important prevention factors are:

1. Proper nutrition

2. Periodic self-examination of the skin by the patient himself

3. Visiting the dermatologist once a year

Inference

So we understand that skin cancer is a condition that can be significantly reduced through prevention, protection and early diagnosis and intervention. It is primarily a matter of personal responsibility. We have the weapons to defeat skin cancer. It is up to us whether we use them!

References

1. https://www. drsevastiadis.gr/epemvaseis/ogkologiki-xeirourgiki-gia-kakoitheis-ogkous/καρκίνος-του-δέρματος/

2. https://www.aravanisplasticsurgery.gr/services/karkinos-dermatos-therapeia/

3. https://el.wikipedia.org/wiki/Καρκίνος_του_δέρματος

4. https://cgderma.gr/ipiresies/kliniki-dermatologia/karkinos-toy-dermatos/

5. https://www.hygeia.gr/karkinoi-dermatos/

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