Let’s Talk Skin Cancer
Written by: Michael Asbury, PA-C
What is skin cancer?
Skin cancers are malignant growths. Malignant growths are a collection of diseased cells. The diseased skin cells copy themselves uncontrollably due to damage to the cell, or imbalance in the normal process of cell creation.
The skin is made of different types of cells. These cells are sandwiched into layers, much like a peanut butter and jelly sandwich.
There are different types of skin cancer. Each type of skin cancer is related to the layer that it comes from and/or the cells that are growing uncontrollably.
Example: A disease of the jelly layer would probably be called a “jelly cell carcinoma”
The most common forms of skin cancer are:
Basal cell carcinoma (BCC)
Squamous cell carcinoma (SCC) (cutaneous)
Melanoma
Basal Cell Carcinoma
Squamous Cell Carcinoma
Melanoma
Image source: dermnetnz.org
The term non-melanoma skin cancer (NMSC) refers to all types of skin cancer except Melanoma.
Basal cell skin cancer is a malignant disease of the Basal layer of our skin. The Basal layer is where cells called Keratinocytes are born and begin their journey upward toward the surface. This layer is also responsible for our water barrier because it makes and secretes fatty cells called lipids.
Squamous cell skin cancer is uncontrolled copy and pasting of diseased cells that happens in the Squamous layer of our skin. Squamous cell layers can be found in different parts of the body, including the outer layers of skin and the inner mucosal surfaces like the mouth and esophagus.
Example: consider both pieces of bread in that peanut butter and jelly sandwich, being the inside AND outside of the sandwich.
Because of the multiple locations of squamous cell layers, we have recently began to specify “Cutaneous” Squamous Cell Carcinoma (SCC) when discussing skin cancer.
Setting up shop both inside and outside of the body, makes the squamous layer the gate keeper. It is made of mature Keratinocytes. Keratinocytes produce Keratin, which is a tough protective protein that makes up most of the skin, hair, and nails. It’s no wonder why the Squamous layer is responsible for protection and involved in transporting certain things into and out of the body.
Melanoma is a skin cancer that has uncontrolled growth of cells called melanocytes. Melanocytes are cells that give the skin its tan or brown color, they are also responsible for some immune responses. Melanoma happens when damaged melanocytes start to grow out of control. Melanoma can then spread to other areas of the body. This is most likely because the melanocytes are a found throughout the ENTIRE body.
Example: Consider the calories from the peanut butter and jelly sandwich. There are calories in the bread, there are calories in the peanut butter, and there are calories in the jelly.
Who gets skin cancer?
Skin cancer most commonly affects older adults, but it can also affect younger adults, and rarely, children.
Skin cancer tends to affect individuals with fair skin (Fitzpatrick skin phototype I, II and III), although people with darker skin can also develop skin cancer.
People who have had skin cancer have an increased risk of developing other skin cancers.
A family history of skin cancer also increases risk as certain genes have been identified as carrying an increased risk of skin cancer.
What causes skin cancer?
The common forms of skin cancer listed above are related to exposure to ultraviolet radiation (from sunlight or tanning beds) and the effects of ageing. Other risks include:
Smoking (especially for SCC)
Human papillomavirus infection (genital warts), particularly for mucosal sites such as oral mucosa, lips, and genitals
Immune suppression (for example in patients who have received an organ transplant, HIV, etc.)
Exposure to ionizing radiation
Exposure to certain chemicals, such as arsenic and coal tar
What are the clinical features of skin cancer?
Skin cancers generally appear as a progressive lump or nodule, an ulcer, or a color changing lesion.
Consider your skin as a room full of polka-dots. If ALL the polka-dots on the wall are blue, and you have 1 red polka-dot on the wall, the question is “Why is there 1 red polka dot on the wall?”.
We are looking for the “ugly ducklings”.
Source: https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/
What are the complications of skin cancer?
Skin cancer can usually be treated and cured before complications occur. Signs of advanced, aggressive, or neglected skin cancer may include:
Bleeding
Local invasion and destruction of adjacent tissues and structures
Distant spread of a tumor to lymph glands and other organs such as liver and brain (metastasis).
Patients with skin cancer may be at increased risk of developing other skin cancers.
How is skin cancer diagnosed?
Skin cancers are generally diagnosed clinically by a dermatologist or family doctor, when learning of an enlarging, crusting, or bleeding lesion. The lesion will be inspected carefully, and ideally, a full skin examination will also be conducted to rule out other findings.
A skin biopsy may be taken in cases of suspected skin cancer to confirm the diagnosis. A skin biopsy is getting a sample of the suspicious spot, it helps determine the subtype of the skin cancer, which may influence treatment. The sample is sent for diagnosis and confirmation in the laboratory by a histopathologist. This process can take a few days for the report to be issued, or longer if special tests are required. Further investigations may be required if there is a suspicion spread has occurred.
How is skin cancer treated?
Early treatment of skin cancer usually cures it. Most skin cancers are treated surgically, using a local anesthetic to numb the skin. Surgical techniques include:
Excision biopsy
Wide local excision
Mohs micrographic surgery.
cautery and electrosurgery
Cryotherapy
Topical therapy such as fluorouracil or imiquimod creams)
Photodynamic therapy (photosensitizing cream plus light)
Radiotherapy (x-ray treatment)
Lasers
Systemic immunotherapy
Topical and intralesional immunotherapy
How do we avoid skin cancers?
Careful sun protection, including the regular application of sunscreens
Learn and practice self-skin examination
Regular skin checks by a dermatologist or dermatology Physician Associate
Seek medical attention if you notice any changing or enlarging skin lesions
Come in and see us at Charlotte Dermatology to better understand that skin you’re in!!!!