Skin Cancer

In the beginning, skin cell cancer can be painful, and they may appear as a pain that bleeds and oozes or otherwise something that does not heals. Even a minor trauma may result in bleeding of that bump. The skin bump has a central ulceration along with raised edges. The skin cancer symptoms include:

• Red, pink or translucent bump(s) on the skin
• Growth of raised border around the lesion
• Reddish skin patch with a crust or itch which may be painful
• A scar resembled by white or yellow waxy area with imperfectly determined border
• An open lesion present for weeks
• Wart-like development on the skin

We often see that moles develop on the skin, but they are mostly harmless. Rarely a mole turns into skin cancer. If a mole does turn cancerous then it is melanoma. Individuals should take care and look out for any signs of differences in the mole’s color, symmetry or any other evolving changes. Therefore, it is obligatory to visit a physician or a dermatologist and get the abnormality examined.

Most of the skin cancers are naturally modulated by the immune system or by mutational repair mechanisms. When the immune system is compromised or there is a faulty mutation repair gene, it results in the development of malignant cells that eventually grow into a tumor. Some of the most common risk factors involved in skin cancer are:

• Exposure to UV light through sun or even tanning beds
• Persistently suppressed immune system
• Exposure to X-rays or chemicals such as arsenic which is a known precursor to cancer
• Elderly individuals are at higher risk of developing skin cancer

Predominantly, there are three types of skin cancer – basal cell carcinoma, squamous cell carcinoma, and melanoma.

1. Basal cell carcinoma: Basal cell carcinoma arises when skin’s basal cells grow in an abnormal and uncontrolled manner. Basal cells are those that line the outermost layer of the skin.
2. Squamous cell carcinoma: Uncontrolled growth of abnormal squamous cells (composing most of the epidermis) result in squamous cell carcinoma.
3. Melanoma: Termed as one of the deadliest skin cancers, melanoma is where the malignant tumor growth occurs because of an unrepaired DNA damage to skin cells triggering mutation.
4. Merkel cell carcinoma: It is one of the rarest and an aggressive type of skin cancer with a high recurrence and metastasizing rate. Individuals above 50 years of age are more prone to Merkel cell carcinoma.

Actinic keratosis is also called as precancer because if left untreated may develop into a skin cancer. It is often a crusty and scaly growth which occurs due to prolonged UV exposure. Atypical moles or dysplastic nevi are benign moles which resemble like melanoma. Individuals with higher number of moles are at risk of developing melanoma in the future.

Many productive measures are present for treating skin cancer, but the choice of treatment chiefly depends on the size and location of the tumor. Treatment options can be broadly divided into medications and procedures. Medication includes several topical therapies and drugs which are injected or taken orally. Procedures comprise surgeries, radiation therapy, and laser and light-based treatments.

Medication:

Few gels and creams are now used in superficial basal cell carcinomas which include imiquimod that works by invigorating the immune system through the production of interferon which eventually attacks the cancerous cells. Drugs are also used in combination of topical solutions.

Targeted therapies are a kind of novel drug combination where drugs such as cobimetinib and vemurafenib are taken orally along with advanced immunotherapies. Such therapies are currently gaining much attention in the treatment of advanced melanoma.

• Chemical peel: Trichloroacetic acid is applied to repair superficial skin damage which peels the top skin layer. In general, normal skin regrows in a few weeks.
• Cryosurgery: Liquid nitrogen is topically applied to the tumor growth causing the lesions to freeze. Later the lesion falls off naturally causing a temporary swelling and redness.
• Curettage and Electrodesiccation: Curette, a small sharp ring-shaped instrument is used to scrape off the lesion and then cauterized using electrodesiccation. The applied heat destroys any residual lesion.
• Excisional surgery: In this surgery, the physician removes the entire tumor along with some surrounding healthy tissue. Only after the lab confirms whether the tumor is present or not in the tissue beyond the safety margin, the physician declares the patient fit.
• Laser surgery: Ablative lasers are used to remove the tissue without causing it to bleed. The laser gives the physician a better control in tissue removal.
• Mohs Micrographic surgery: This technique is chiefly employed when preservation of unaffected tissue is vital. It is also employed when the tumor is poorly defined or after a recurrence of previously treated lesions. The very first layer of the tumor is removed and immediately assessed. The region demonstrating any residual microscopic tumor is then re-excised and re-evaluated. This procedure is further repeated till no tumor is seen.
• Photodynamic therapy: A light-sensitizing agent is applied to the tumor and allowed to get absorbed in the skin. Then the physician uses a strong red or blue laser which selectively destroys the lesions by activating the medicated region.
• Radiation therapy: Tumors are directly subjected to X-ray beams to treat cancerous lesions. It is employed when the tumors are hard to be removed or with immunosuppressed patients.

After a successful skin cancer treatment, a patient is full of hope and happiness. But all are never the same. Few patients are concerned with cancer recurrence. This brings worries and fear which at times may be quite intense for some survivors. Each patient tries to manage these emotions. Some proportion of depression or worry is quite normal among patients and hence it is essential for patients to receive emotional support. It could be a professional counselor, support groups, religious groups and friends or family.