Most people cringe upon hearing the word cancer. But most skin cancer, if diagnosed early, can be treated without a deadly consequence. Our skin protects us from the heat, injury, and infection. It also protects our body from damage by ultraviolet radiation while manufacturing vitamin D. Our skin also stores water and fat while regulating body heat.
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the skin and other body organs. Normal cells grow and divide, forming new cells needed by the body. When normal cells grow old or get damaged, they usually die, and new cells take their place. But sometimes, this process goes awry. New cells form when the body does not need them while old or damaged cells just do not die. This buildup of extra cells often forms a mass of tissue called a growth or tumor.
Growths on the skin can be benign or malignant. Benign growths are not as harmful as malignant growths, they are rarely a threat to life. They can generally be removed and usually do not grow back. Benign growths do not invade tissues around them and do not spread to other parts of the body. Malignant growths, on the other hand, may be a threat to life, often can be removed but sometimes grow back. Malignant growths may invade and damage nearby organs and tissues because they spread.
Skin cancers are named for the type of cells that become malignant.
• Melanoma can occur on any skin surface: head, neck, between shoulders, hips. In women, it is often found on the skin on the lower legs or between the shoulders and the hips. It is rare in people with dark skin, but if seen, usually they are found under the toenails or fingernails, on the palms or soles.
• Basal Cell Carcinoma (BCC) is the most common type of skin cancer in fair-skinned individuals.
• Squamous Cell Carcinoma (SCC) begins in the squamous cells of the skin and is the most common type of skin cancer in dark-skinned individuals. It is usually located in places that are not exposed to the sun, such as the legs or feet. If it does occur in fair-skinned people they are usually seen in the head, face, ears, and neck (sun-exposed areas). Well-known risk factors for BCC, SCC, and melanoma include severe blistering sunburns, lifetime sun exposure (accumulated UV exposures), immunosuppression, exposure to ionizing radiation or chemical carcinogens, family history and personal history of skin cancer, skin that burns easily, presence of infection such as HPV infection, chronic deep fungal infection, lupus vulgaris (skin tuberculosis), burnt scar or thermal injury, venous ulcer or any non-healing ulcerations, etc.
• Merkel Cell Carcinoma (MCC) is a neuroendocrine carcinoma of the skin. Although 40 times less common than melanoma, it has a higher mortality (33%) than melanoma (15%). Affects the elderly, whites, and the immunosuppressed.
Unlike birthmarks, skin cancer can invade normal tissues nearby and spread throughout the body. MCC and melanoma are more likely than other skin cancers to spread. SCC sometimes metastasizes to other parts of the body, but BCC rarely does. When skin cancer cells spread, they break away from the original growth and enter the blood vessels or lymph vessels. Cancer cells may also spread to other tissues and attach there to form new tumors that may damage those tissues. Treatment will depend on the type, stage, size, and location of the tumor and the patient’s general health and medical history.
Most skin cancers, if found and treated early, can be cured so the general goal is to remove or destroy the cancer completely. Excisional skin surgery uses a scalpel to remove the tumor while MOH’s surgery shaves away tissue until no cancer cells can be seen under the microscope — in this way, cancer cells are completely removed together with only a small bit of healthy tissue. Radiation therapy is not a common treatment for skin cancer, but it may be useful for those located in areas where surgery could be difficult or leave a bad scar like those on the eyelid, ear or nose. It can also be indicated for SCC that cannot be completely removed or those SCC that spread to the lymph nodes or melanoma that has spread to the brain, bones, lymph nodes or other parts of the body.
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