Skin Cancer Symptoms, Treatment And Prevention Methods

Skin cancer is among the most common cancers within all cancers. Melanoma, one of the skin cancer types in our country, has increased by 237% over the last 30 years. Melanoma is the most dangerous skin cancer type, although it is the least common (less than 2%) among skin cancers. Melanoma, which spreads to other organs, constitutes the majority of all skin cancer deaths. Among basal and flat cancers in the non-melanoma skin cancer group, the basal cell cancers are more common. While 1 million new cases are observed every year in USA, this rate is 1.9 for every 100 thousand men and 1.3 for every 100 thousand women in our country. The rate of mortality in skin cancer is estimated to be 1 per 100 patients.   Memorial Antalya Hospital Dermatology Department Specialist Lütfiye Çoban, MD provided information about skin cancer and treatment.

What is Skin Cancer? How Does It Develop?

The greatest organ in the body has many tasks. The skin that is covering the internal organs protects the body against possible injuries, prevents excess water and fluid loss, and helps the body maintain Vitamin D. It also protects against microbes such as bacteria as well as harmful ultraviolet (UV) rays and helps control body temperature. Skin cancer is a malignant growth on the skin that occurs due to many reasons.  The skin consists of 3 layers, these being the epidermis, dermis and subcutis.

Epidermis: The outermost layer is the epidermis. The epidermis is very thin and has a thickness of about 0.05-0.1 mm. It protects deep sub-layers and organs against external factors. Keratinocytes are the main cell types of the epidermis. These cells produce an important protein called keratin, which helps the skin in order to protect the body. The outermost part of the epidermis is called the stratum corneum. In this part, dead keratinocytes are replaced by new ones. The cells in this layer are called squamous cells due to their smooth shape. Living squamous cells reside under the stratum corneum. These cells move from the outer part of the body to the bottom of the epidermis. The cells in the base layer are called base cells. Their task cell division in order to create new keratin. Thus, older keratinocytes that decline over time on the skin surface are replaced by new ones.

Melanocytes are cells found in the epidermis that cant transform into melanoma (skin cancer). These skin cells produce brown pigments called melanin, which gives the a skin bronze or brunette color. Melanin protects the lower layers of the deep from several harmful effects of the sun. In many people, when the skin is exposed to the sun, melanocytes produce more of these pigments and cause skin tanning. The epidermis is separated from the lower layers of skin by a basal membrane. This is an important structure. Because when skin cancer progresses, it develops into this barrier and lower layers.

Dermis: This is the intermediary skin layer which is a much thicker layer compared to the epidermis. It contains hair follicles, sweat glands, veins and nerves that are retained by the protein called collagen, which provides strength and elasticity to the skin.

Subcutis: The deepest layer is called subcutis. The lower part of the subcutis and dermis form the collagen and fat cell network. The subcutis helps to maintain body heat. This layer also has a shock absorbing effect that helps protect the body's organs from injury.

Types of Skin Cancer

Melanoma Skin Cancer

Melanoma is a skin cancer that starts in cells called melanocytes, which are cells that provide the skin with color. It is called malignant melanoma or cutaneous (skin induced) melanoma. Since most melanoma skin cancer cells continue to produce melanin, the tumor is usually brown or black in color. However, some melanomas do not produce melanin.

In this case, the cancer can be observed as pink, yellowish brown or even white. The melanoma skin cancer may develop on congenital or later on appearing nevi (beauty spots) and can be observed anywhere on the body, including the scalp and the soles.

Melanoma skin cancer, is commonly observed in the neck and back regions in men and in the legs, the neck and the face in women. However, the cancer can also develop on the palms, soles and nails. In addition to all these, it may also rarely develop in the eye, oral, genital or anal region. Melanoma, a form of cancer that can be treated when diagnosed early, can transform into a cancer that reduces the chance of treatment if it shows rapid spread.

Other Types of Skin Cancer

Basal cell and squamous cell carcinomas are most commonly seen in areas exposed to the sun, such as the head, neck and arms. However, it is also found in other parts of the body.

Basal Cell Carcinoma: This is the most common type of skin cancer. It is a flat, hard, cancerous an pale appearing area with small, mucus containing, pink or red, transparent, bright, pearly swellings that can easily bleed even a small accident. The center area is dark blue, brown or black. Large basal cell carcinomas have a crusted or spreading area.

Squamous Cell Carcinoma: This is the second most common skin cancer. It may appear like a growing lump. Mostly it has a hard, flaky or crusty surface. It may also have a slowly developing, red, smudged appearance. Both of these skin cancers may develop in a flat area and display very little change if compared to normal skin.

Acneic keratosis is also known as solar keratosis. Sometimes it can be a pre-cancerous condition and it may develop as consequence of overexposure to the sun. Acneic keratosis are small, hard or flaky points, usually pink-red or skin color. It usually starts in the face, the ears and on the hands. However, it can also be observed in other parts of the body which are exposed to the sun. Acneic keratosis is usually very numerous. Some may develop within squamous cell carcinomas. Others remain the same or develop on their own.

Factors Causing Skin Cancer

• Exposure to ultraviolet (UV) radiation: UV rays are one of the major risk factors for melanoma skin cancer. It damages the DNA of skin cells and starts skin cancer. Sunlight is the main source of ultraviolet rays. It can also be said that solariums are another source of UV radiation. Exposure to UV radiation from these sources will increase the risk of many skin cancers, including melanoma. The main skin cancer risk factors can be listed as follows;
• UVA Radiation:It can cause cell senescence and damage cell DNA. It is considered to play a role in the development of causing long-term damage to the skin such as wrinkles and some skin cancers skin cancers as well.
• UVB Radiation:This is the main source of sunburn that can directly damage cell DNA. This is considered to cause the majority of skin cancers.
• UVC Radiation:This radiation cannot penetrate the atmosphere. Therefore, it is not present in the sunlight. For this reason, it does not cause skin cancer.
• Solarium:Surveys show that people who frequently visit a solarium for tanning have a greater risk of developing melanoma skin cancer. UV lamps used for tanning in solariums need to be "ultraviolet lamps" and there must be labels on them that are indicate the following "exposure to UV rays, can cause premature aging of the skin and skin cancer". It is also believed that placing a label that says "regular doctor check for skin cancer is necessary" may be a warning for users who are constantly exposed to these rays. Thus, it is aimed to reduce the tendency towards the use of ultraviolet products (Black light lamp, mercury vapor lamp, high pressure xenon and xenon bulb arc lamp, plasma lanterns and arc sources etc.) for people younger than 18, children and people with skin cancer history in their family, thus especially those at risk of skin cancer.
• Nevi (Beauty Spots):Nevi in our bodies are benign tumors and occur not only at birth (are congenital) but also during childhood and adolescence. Most of them never cause problems. However, the risk of developing melanoma in people with a large number of nevi is greater.
• Dysplastic Nevus: Dysplastic nevus or nevi (nevi being the plural form of nevus) usually appear, at least a few, normal nevi but display some features of the melanoma. They are usually bigger than other nevi and the shape or color is out of the ordinary and most of them do not turn into cancer.
• Congenital Melanocytic Nevus: Congenital melanocytic nevi that are present at birth are called congenital melanocytic nevi. In this nevi that are present at birth, it is estimated that the risk of melanoma development is 0 to 10%, depending on the size of the nevus. People with a large congenital melanocytic nevus have a greater risk of developing melanoma. For example; If the congenital nevi aresmaller than the palm, the risk of melanoma is lower. Conversely, the risk of melanoma is significantly increased in congenital nevi, which are large in size and located in the back, hip or the wrists.
• Light Skin, Freckles and Light Hair:For white-skinned, light-haired people, the risk of melanoma is 10 times higher than for black-skinned people. For white-skinned, light-haired blue or green eyed people, the risk of melanoma is 10 times higher than for black-skinned people.
• Age: Melanoma is most commonly observed in the 25-29 age group (especially in young females), although it is also quit often observed in young people aged 15-29. However, it may be observe at older ages as well.
• Gender:Considering the frequency of appearance and biological differences, skin cancers are divided into malignant melanoma and non-melanoma skin cancers. It is the fourth most common cancer type among young adults, ie, males aged 25-34, while it is the most common type of cancer among females after breast and gynecological cancers.
• Welding and Metalworking Related Occupation:It has been shown to increase melanoma risk in the eyes
• Phototherapy (Light Therapy):Treatment related UV ray exposure applied to people with certain skin diseases such as psoriasis increase the risk of squamous cell skin cancer.

Genetic Factors in Skin Cancer

People with one or more relatives of the first-degree (parents, siblings or children) that have a melanoma skin cancer history are facing a higher risk. About 10% of people with melanoma have the same disease in their family.

One reason for the increased risk is being raised in the same environment within the family and exposure to the sun as a result of similar lifestyles or the fact that light skinned family members are consisting the majority of the family; both factors may be present as well. In addition, gene mutation in the genes of the family as a result of changes in the familial genes may be a factor in the risk of melanoma. Approximately 10-40% of people with high melanoma incidences in the family have gene mutations in their family.

Xeroderma pigmentosum (XP): This is a rare hereditary condition that develops in enzymes which are normally tasked with the repair of the DNA. People with XP may develop many skin cancers, including melanoma, in sun-exposed areas of their skin because the ability to repair DNA is impaired due to sunlight.

Unusual wounds, swellings, spots, scratches, or changes in the appearance of the area of interest may indicate a melanoma or other skin cancer sign or may be a warning indication of cancer.

Normal Nevi: These are present on the skin and are usually brown, skin colored or in the form of black dots. They can be flat or high and puffy, round or oval, and are usually less than 6 mm in size. Nevi can develop congenitally or during childhood and adolescence. Nevi that newly develop in adulthood should be checked by a physician due to risk of skin cancer.

When a nevus develops on the body, it will stay in the same size, shape and color for years. However some nevi will disappear spontaneously over time. Many people have nevi and many of those are harmless. However, it is important to recognize a change in shape, size or color in order to detect potential skin cancer development.

Skin (Skin) Cancer Symptoms

The most important symptom of skin cancer is a new spot on the skin or change in the size, shape or color of a spot on the skin. Another important sign is that the skin mark looks different from the other mark on your skin. This is also called ugly duck sign. If you observe any of these warning signs, you should visit your physician without wasting time.

Other Warning signs:

• Non-healing wounds
• Pigments spreading out to the outer skin beyond the border of the mark
• A redness o a new swelling beyond the borders
• Increased sensitivity - itching, tenderness or pain
• Surface changes on the nevus, meniscal appearance, hemorrhage, nodule or tuber appearance

Sometimes it can be difficult to tell the difference between a normal nevus and a melanoma. The right thing to do in this case is to apply to visit an expert dermatologist as soon as possible.

Skin Cancer Diagnosis

The most important symptoms of skin cancer is a new spot on the skin or change in the size, shape or color of a spot on the skin. Unusual and non-healing injuries, swelling, spots, scratches or changes in the appearance of the skin alteration of the surface of the nevus (meniscal appearance, hemorrhage, nodule or tuber appearance) itching, tenderness and pain may be a warning for melanoma or other skin cancer types or a sign that cancer may develop. When such symptoms are encountered, consulting a qualified physician without delay will provide a quick solution to the early identified health problem.

Self Examination of the Skin Against Skin Cancer: It is very important to check the skin twice a month. It is important that you know the characteristics of nevi, spots and freckles and that you know your body enough so that you can recognize a new nevus or a spot. The skin examination on oneself should be performed in a well-lit room in front of a mirror where the whole body can be observed. By using a portable mirror, it is easier to see the blind spots of the body, such as the back, the hips. In men, 3 in 1 melanomas are observed in the back. All areas of the body should be checked, such as the back, palms, soles, head skin, eyes, nails.

Medical history and physical examination: Physical examination for skin cancer should first be performed by a specialist dermatologist. By using a technique called dermatoscopy (also known as epiluminescence microscopy or surface microscopy), the stains or nevi on the skin are closely examined and can be imaged if desired and the possible spreading of the underlying lymph nodes near the suspicious site can be observed. Some skin cancers spread to the lymph glands. When this happens, the affected lymph nodes may grow and become stiffer than normal. This can be very effective for the early detection of skin cancer. It is important that people with a disability nevus syndrome, who previously had cases of melanoma in their family undergo a regular skin examination.

Dermatoscopy in Skin Cancer Diagnosis

Dermatoscopy is microscopy of the skin surface which used in the diagnosis of nevi and other pigmented lesions. In this method, the surface of the greased skin is examined by a dermatoscope which provides a magnification under light. The dermatoscope is similar to the otoscope used in an ear examination and has been widely used for more than 10 years. Until a few years ago, nevi were followed by taking photographs of dermatoscopic images. Then digital dermatoscopy was developed by adding  computer technology to this method. With this method, a map of the nevi in the body is created and the locations are pinpointed. Then a dermatoscopic image is taken and recorded for each individual nevus. This gives provides the chance to compare the image with the image obtained in next follow-up.

The Digital Dermatoscope also creates an index showing the malignant melanoma risk by mathematically calculating the suspicious changes that are observed on the nevus. This index is helpful for diagnostics and planning of the treatment. With the naked eye, the chance of early-stage melanoma diagnosis is 60%, but with digital dermatoscopy this probability reaches 90%.

Skin Biopsy: If the suspect region is considered to be skin cancer, a sample is taken from this area and examined in a laboratory environment. This is called skin biopsy. Skin biopsy can be done in many different ways. The biopsy will be decided according to the location of the suspected area in the body, the size and the suspected type of skin cancer. If the suspected nevus is diagnosed as pre-cancerous or as cancer, your doctor may want to perform more tests or treatments. If the suspect nevus or spot is small and regional, a larger biopsy (to receive more tissue) or some sort of surgical intervention may be performed. In the case of skin cancers that display no spreading, imaging tests, immunotherapy, targeted therapy, chemotherapy and radiotherapy will be required for treatment.

Early Diagnosis in Skin Cancer Saves Lives

Skin cancers are cancer that can be visually observed with the naked eye. Skin cancers, if detected early can also be treated before spreading, as is the case in other types of cancer.

In addition, side effects due to treatment in skin cancer treated at an early stage are minimal.

Skin Cancer Treatment

In the treatment of skin cancer, it is aimed to remove all of the cancerous tissue without leaving any residue. Surgical treatment can achieve a quite high success rate. With the cancerous tissue removed at a sufficient depth and width, the spreading of the cancer is prevented.  In the treatment of skin cancer, it is emphasized that in addition to destroying the cancerous cell, the treatment does not cause any aesthetic trauma and loss of function. For the area where skin cancer is most frequently seen, the general condition of the patient, the age, tumor size, skin characteristics and the possibility of spreading to the lymph glands become important.

In skin cancer, a wide range of special treatment options are offered instead of single type of treatment. In the treatment of small tumors in terms of surgery and radiotherapy, there is usually no problem. Another important point is that a team experienced in the treatment of skin cancer performs the tumor removal.

Radiotherapy may be preferred as the primary treatment modality if there will be many marks left after surgery and the tumor can be controlled by radiation without serious side effects. Non-melanoma skin cancer observed on the cheek, forehead, or nose is treated very successfully with radiotherapy, especially if it is basal cell. Cryotherapy can be preferred for the treatment of small tumors. Abnormal cells die when the tumor is treated with liquid nitrogen. After thawing of the ice, the dead tissue seperates from the body. In the treatment method called curettage, the cancerous region is scraped with a spoon-shaped curette, the electric current from a special device stops the bleeding and the cancer cells are killed. At the end of the process, a flat, white scar is left on the skin. In topical skin cancers, an option of treatment with a cream or lotion in the form of local chemotherapy is present.

Methods for Skin Cancer Protection

Protection may be possible by reducing risk factors that cause skin cancer as well as by reducing UV exposure. So, what kind of precautions can be taken for protection against the sun?

• Cover yourself. If you are not sunbathing, wear something, wear a wide-brimmed hat and protect your skin as much as possible. You can protect your eyes by wearing sunglasses that block UV rays by at least 99%.
• Sit in shadows. Do not sunbathe between 10:00 and 16:00, when the sunrays are the most intense. Limit exposure to direct sunlight to the times specified by the experts.
• Do not tan in solariums. It can contribute to the formation of skin cancer and can cause long-term damage to your skin.
• Pay attention to the expiration date of cosmetic products.
• Use broad spectrum sunscreen with a sun protection factor of at least 30. Make sure you keep your sun cream applied every 2 hours, after swimming and sweating.

The US Food and Drug Administration (FDA) has put into effect the production of sunscreens that protect not only from sunburn, but also from UVA rays that trigger skin cancer and premature aging. In addition, the labeling of moisturizers, lipsticks and make-up materials requires that the degree of protection factor be specified, as is the case in sunscreens.

What To Look For When Using Sunscreen?

Supported with test and "Wide Spectrum": The new rules will ensure that the consumer purchases a "broad spectrum" of sunscreen, which protects both from UVB and UVA rays. All sunscreen products are protective against UVB rays that cause sunburn. From now on, these products will provide protection against UVA radiation, which is a common cause of skin cancer and premature aging of the skin. Only products that pass the tests can be labeled with the "broad spectrum" tag.

Skin Cancer / Warning for Early Skin Aging:

Staying in sunlight for longer durations increases the risk of skin cancer and premature skin aging. Products should also be labeled with the following; “This product helps to prevent skin cancer or premature aging and not just sunburn." The same warning should be present on sunscreens that are not "broad spectrum".

Products with a low Sun Protection Factor should be marked with a warning. Sunscreens with a Sun Protection Factor lower than 15 should be marked with a warning. "Water resistant" does not mean "waterproof." No sun cream is waterproof or "durable". The producers will no longer be able to claim this. If the product is labeled as waterproof in the front of the product, it should be stated that the effect lasts for 40 minutes or 80 minutes while swimming or sweating. The products shall not promise more than they can deliver. Sun creams can not offer more than 2 hours of protection without instant protection or re-application. The shall not use the label “Sun Protection”. It is possible to prevent premature aging and skin cancer by protecting the damage caused by the sun to the skin.

Early Diagnosis Screening Recommended Age Range;

There is no recommended specific age range. The skin of men, women, young or old people or anyone can be examined for early detection of skin cancer.

What to Do for Early Detection of Skin Cancer;

Everyone must examine their whole body by themselves (especially in front of the mirror for areas of the body that are not readily visible, especially the back).

Nevi present on our bodies should be followed up regularly via regular checkups or we should consult a specialist for bleeding skin sores that do not heal.

It is recommended that suspicious lesions or skin cancers that are diagnosed beforehand should be examined via Dermatoscopy (surface microscope).

Prepared by Memorial Medical Editorial Board.