Skin is a protective layer that covers our whole body. It shields us against heat, sunlight, injury, and infection.
The uncontrolled growth of mutated cells in the skin is called skin cancer. It occurs when unrepaired DNA damage skin cells triggers mutations, or genetic defects, that lead the skin cells to multiply rapidly and form malignant tumors. These cancer cells can potentially invade the neighbouring cells and tissues and at the later stages can also spread to distant organs. Skin cancer is the most common type of cancer.
- Melanoma: It is a rare and aggressive type of skin cancer. If it isn’t diagnosed early, it is likely to invade nearby tissues and spread to other parts of the body. It accounts for only 2% of skin cancer but causes most deaths from skin cancer
- Nonmelanoma: Squamous cell and basal cell skin cancers are called nonmelanoma skin cancers. These are often found in areas exposed to sun, but may occur elsewhere. They usually respond to treatment and rarely spread to other parts of the body.
Less common types of skin cancer
- Merkel cell carcinoma
- Kaposi sarcoma
- Cutaneous (skin) lymphoma
- Skin adnexal tumors (tumors that start in hair follicles or skin glands)
- Various types of sarcomas
Skin Cancer Occurrence Rate in India
The exact incidence of skin cancer in India is not known. However, skin cancers constitute about 1-2% of all diagnosed cancers. The incidence of skin cancer in India is quite low when compared to western countries. Most of the cases being reported in India are squamous cell carcinoma and basal cell carcinoma while the occurrence of non melanoma skin cancer is quite low among Asians.
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Different types of skin cancer shows different signs. Below mentioned are some of the symptoms that might indicate the presence of the disease but they do not necessarily ascertain the disease. However, if any of the symptoms is spotted then consulting a doctor is highly recommended.
Basal cell carcinoma:
- A pearly or waxy bump
- A flat, flesh-colored or brown scar-like lesion.
Squamous cell carcinoma:
- A firm, red nodule.
- A flat lesion with a scaly, crusted surface.
Melanoma signs and symptoms:
- A large brownish spot with darker speckles
- A mole that changes in color, size or feel or that bleeds
- A small lesion with an irregular border and portions that appear red, white, blue or blue-black
- Dark lesions on your palms, soles, fingertips or toes, or on mucous membranes lining your mouth, nose, vagina or anus
- Red or purple patches on the skin or mucous membranes.
- Firm, shiny nodules that occur on or just beneath the skin and in hair follicles.
- Hard, painless nodules
Skin cancer is associated to a number of causatives. However, many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.
- Ultraviolet (UV) light exposure – One of the major risk factor for most skin cancers is high exposure to the sun. Tanning beds, lamps are another source of UV rays.
- Having fair skin – Less pigment (melanin) in your skin provides less protection from damaging UV radiation.
- Older age – The risk of getting basal and squamous cell skin cancers rises as people get older due to accumulated exposure to UV radiation. However, skin cancers are increasingly being found in younger individuals.
- Male gender – Men are about twice as likely as women to have basal cell cancers
- Exposure to chemicals – Certain chemicals, including Arsenic, coal tar, paraffin, and certain types of oil may also have an increased risk of skin cancer.
- Increased Radiation exposure – Treatment with radiation can increase the risk for developing skin cancers in the exposed area.
- Multiple or unusual moles – People who have many moles or abnormal moles called dysplastic nevi are at increased risk of skin cancer.
- Severe sunburns in the past – Having had one or more blistering sunburns as a child or teenager increases your risk of developing skin cancer as an adult
- Long-term or severe skin inflammation or injury – Skin damaged by some severe inflammatory skin diseases is more likely to develop skin cancers, although this risk is generally small.
- Xeroderma pigmentosum (XP) – This very rare inherited condition reduces the ability of skin cells to repair DNA damage caused by sun exposure.
- Basal cell nevus syndrome (also known as nevoid basal cell carcinoma syndrome or Gorlin syndrome) – In this rare congenital (present at birth) condition, people develop many basal cell cancers over their lifetime.
- Weakened immune system – People with weakened immune systems have a greater risk of developing skin cancer. This includes people living with HIV/AIDS and those taking immunosuppressant drugs after an organ transplant.
- Human papilloma virus (HPV) infection – Infection with certain types of HPV, particularly those that affect the anal or genital area, may increase your skin cancer risks.
- Smoking – People who smoke are more likely to develop squamous cell skin cancer.
- History of skin cancer
The best ways to lower your risk of skin cancer are to avoid long exposure to intense sunlight and practice sun safety, with glares, hats, t-shirts and umbrellas. Wearing a good quality sun screen throughout the year also provides safety. Tanning beds and lamps should be avoided completely.
Regular, thorough skin examinations are also important, especially if there are a large number of moles or other risk factors. While this will not prevent skin cancer from developing, it may help to catch it early, when it can be treated more easily.
Non-melanoma skin cancers rarely spread and may not be staged. The chance that squamous cell carcinomas will spread is slightly higher and may be staged using the TNM System.
- T refers to the spread of cancer cells to tissues next to the testicle.
- N describes the spread of cancer cells to regional lymph nodes.
- M indicates whether the cancer has metastasized.
Like all other cancers skin cancer is also staged into levels depending on the spread, size and severity of the disease.
- Stage 0: The cancer cells are confined to the epidermis
- Stage I: The cancer cells have grown deeper into the skin, but have not spread to the lymph nodes or other parts of the body.
- Stage II: Cancer cells have grown deeper into the skin, or have more high-risk features, but have not spread to the lymph nodes or beyond.
- Stage III: The cancer cells have spread to nearby lymph nodes, but not to distant organs.
- Stage IV: The cancer cells have spread beyond the skin and regional lymph nodes to distant organs such as the liver, lungs or brain or distant lymph nodes and areas of the skin.
Needless to say, if the skin cancer is detected while it is still in Stage I, survival rate is higher. The rate decreases progressively with the increase in stage. Stage III is considered critical, while stage IV is, more often than not, fatal.
Melanoma Staging Survival Rate:
|Stages||5 year Survival Rate|
|Stage I A||97%|
|Stage I B||92%|
Being aware of the signs and symptoms definitely aids in its early detection. Some other methods of diagnosis are discussed below:
- Physical Examination : Skin Cancer can be detected early with screening or even, simply with a self-exam where you take note of the changes on your skin.
- Skin biopsy : Removal of the suspicious-looking skin for lab testing.
Based on the type and stage of the cancer and other factors, treatment options may include:
- Other forms of local therapy
- Radiation therapy
- Systemic chemotherapy
- Targeted therapy
Treatment is based on the type of tumor and other factors, and often more than one type of treatment is used. Discuss all of your treatment options as well as their possible side effects with your treatment team to help make the decision that best fits your needs.
If you have any of the symptoms, please do visit the doctor. Also, a familial history or personal history of the disease commands a regular examination at least once a year for the disease.
If you feel any of the symptoms mentioned in the Symptoms section, you should definitely visit a doctor. Ignoring even a small indication might result in devastation. In early stages Skin cancer is highly curable but it gets complicated with passing time.