This guide provides valuable insights into skin cancer. It’s designed to help you understand the process of diagnosing the disease and the basic principles of its treatment.

The choice of treatment to receive rests entirely with the patient and physician, who make this choice on the basis of the medical history and diagnostic results of the patient.

Cancer Explained

Our body is a magnificent assembly of microscopic units known as cells, which collectively form tissues and organs. Cancer is a disease that disrupts the harmony of these cells. While the cells of different organs may have distinct appearances and functions, their reproduction processes are fundamentally the same. In a healthy body, these cell growth processes are well-regulated.

But when cells in the organ have been altered by environmental exposures, they can turn rogue. Instead of growing in a healthy manner with a feedback mechanism, rogue cells start multiplying without restraint, forming a mass, or a tumor. A tumor can be benign (non-cancerous) or malignant (cancerous).

A benign tumor cell does not breach adjacent tissues, nor does it travel to distant sites and set up colonies in new territories, so according to our definition it is not cancer. Conversely, the growing mass of a benign tumor can exert pressure on surrounding tissues and organs, potentially leading to the development of health issues.

On the other hand, a malignant tumor is a troublesome mass of cancer cells that can invade and grow into nearby tissues and organs, inflicting damage. These cells embody the true nature of cancer, with their harmful and invasive tendencies.

The Destructive Nature of Malignant Cells

Malignant cells have a couple of terrifying traits. First, they can break away from the original tumor and travel via blood or lymph to other organs. Upon reaching a new site, these rogue cells can multiply and form new tumors, known as metastases.

To identify the type of tumor, its cells are closely examined under a microscope by a medical specialist, called a pathologist. The cells for this examination can be collected in various ways. In a procedure called a tumor biopsy, a small portion or sometimes the entire tumor (if it’s small) is excised. Occasionally, cells are collected by scraping the tumor’s surface with a specific instrument, or if the tumor’s surface is moist, a glass slide is gently pressed against it to capture an impression.

After proper preparation, this sample is then examined microscopically. The method of collection is determined by the doctor based on the individual case.

In everyday language, we often refer to all malignant tumors as “cancer”. However, medical professionals understand that “cancer” specifically refers to malignant tumors that originate from epithelial tissue cells. Malignant tumors that arise from non-epithelial cells have different names, such as sarcoma, lymphoma, melanoma, and so on.

Epithelial tissue makes up the outer layer of all our body’s mucous membranes, which line the digestive, respiratory, urinary, and reproductive tracts. The skin’s surface layer is also made of epithelial cells, which is why a malignant tumor originating from these cells is classified as skin cancer.

Another type of skin malignancy is melanoma, which develops from individual cells in the skin, known as melanocytes, or from clusters of melanocytes, like moles. For more details on this malignant skin tumor, refer to the separate guide titled “Understanding skin Melanoma”.

The Role of Skin

The skin is more than just a covering for our bodies; it’s a multifunctional organ with a number of crucial roles. It acts as a protective shield, guarding our internal organs against physical harm, burns, and harmful ultraviolet rays from the sun. Additionally, the skin plays a vital part in maintaining our body’s regular temperature.

Our skin also aids in the elimination of waste materials from the body through sweat. It’s composed of two main layers. The outermost layer, the one we can touch and see, is known as the epidermis. Beneath the epidermis lies the second layer, called the dermis. Together, these layers form the protective and functional unit we refer to as skin.

The epidermis is constructed of layered sheets of a type of tissue known as squamous epithelium. The surface of this layer is constantly shedding and renewing itself, thanks to the basal epithelial cells located deeper within the epidermis.

Nestled among the basal cells in the epidermis is another type of cell, known as the melanocyte. These cells produce melanin, a pigment that gives our skin its unique color and helps protect it from the sun’s rays. A mole, or nevus, is essentially a cluster of these melanocytes in the skin. When a malignant tumor develops from melanocytes, it’s referred to as melanoma.

Types of Skin Cancer

There are primarily two forms of skin cancer. The first is basal cell carcinoma, or basalioma, a malignant tumor that originates from the basal epithelial cells. The second is squamous cell skin cancer, a malignant tumor that arises from the squamous epithelial cells of the epidermis.

Basal cell skin cancer is far more prevalent than squamous cell skin cancer, making up about 80% of all skin cancer cases, while squamous cell skin cancer represents only around 20%.

In some instances, a patient might have multiple skin cancers appearing simultaneously in various parts of the body. It’s also possible for a patient who has previously been treated for and recovered from skin cancer to develop a new skin cancer after some time.

Basalioma is a slow-growing type of cancer that rarely spreads to other organs, and it’s generally quite treatable. However, if left unchecked, basal cell carcinoma can eventually infiltrate deeper into the skin and neighboring tissues.

Squamous cell skin cancer, on the other hand, is more aggressive and relatively uncommon. It has the potential to spread and form metastases in lymph nodes and other organs. It can also recur in the same location, even after treatment.

Skin cancer tends to be more prevalent among the elderly, with two-thirds being women and one-third men. Due to the visible nature of skin tumors, they are typically noticed and examined promptly, leading most patients to seek immediate medical attention. As a result, most skin cancer diagnoses occur at an early stage, with 80% at stage 1 and 16% at stage 2.

This early detection means that the vast majority of skin cancer patients can be effectively treated and entirely cured.

The Root Causes of Skin Cancer 

The primary culprit behind skin cancer is exposure to the sun’s ultraviolet rays. If you have fair skin that reddens quickly in the sun or you’re prone to freckles, your risk of developing skin cancer is higher. Regular use of sunbeds is also believed to escalate the risk of contracting the disease.

In modern times, people have more leisure and resources to spend outdoors or on vacations to sunny locales, where getting a golden tan is often the main goal. A radiant suntan is commonly viewed as a symbol of health and beauty. Unfortunately, children are particularly susceptible to excessive sun exposure. It’s estimated that up to three-quarters of a person’s total lifetime exposure to ultraviolet radiation is received before the age of 20.

This overexposure in early years can increase the likelihood of developing skin cancer later in life.

People with darker skin are significantly less likely to develop skin cancer. The high concentration of melanin, the pigment in the epidermis, provides their skin with a protective shield against excessive sun exposure.

Other Factors Contributing to Skin Cancer

Exposure to certain industrial chemicals also plays a part in the development of skin cancer. These include substances like coal tar, carbon black, tar, asphalt, paraffin, specific liquid fuel mixtures, hair dyes, and arsenic. If you work in environments where such chemicals are present, it’s crucial to wear protective clothing. However, exposure to small amounts of these substances in a household setting should not lead to skin cancer.

Genetics can also contribute to skin cancer, although hereditary cases are relatively rare.

Skin cancer predominantly affects older individuals. The number of skin cancer cases is on the rise, largely due to increasing life expectancies. As a result, there’s a growing number of older people who may have been careless with sun exposure in their younger years, resulting in a higher risk of skin cancer in their later life.

Skin Cancer Prevention

Lowering the risk of skin damage from the sun involves avoiding exposure during the most intense sunlight hours, typically between 11am and 4pm. Wearing long-sleeved clothes can help shield your skin from excessive sun exposure, as can wearing hats and using sun-protective cosmetic products suitable for your skin type, especially before your skin has had a chance to tan. Extra care should be taken to protect children’s skin. For those at an elevated risk of skin cancer, using sun protection products should be as routine as brushing your teeth. In particular, it’s essential to shield the head from the sun’s harmful rays.

Identifying the Symptoms of Skin Cancer

Skin cancer can manifest anywhere on the body, but it’s most common in areas frequently exposed to sunlight, such as the face or neck. Both basal cell carcinoma and squamous cell carcinoma can present in various forms.

They may appear as a small, hard, reddish nodule protruding above the skin, a whitish circular or oval plaque raised 1-2 mm above the skin, a small ulcer, or a small reddened patch of skin with a rough, scaling surface. These lesions may occasionally bleed or develop a crust. They may seem as if they’re healing, but they persist. The lesions are typically painless and tender, but they gradually enlarge. A wart-like, flat, scaly skin cancer can also be found on the outer arms or legs.

If abnormal skin changes persist for more than a month, it’s important to consult a doctor. Of course, many other benign skin conditions can present as nodules or warts for a variety of reasons unrelated to cancer, especially in older individuals. Nonetheless, it’s worth seeking medical advice.

If skin cancer is detected, treatment can start immediately, and any benign skin lesions can be removed for cosmetic reasons.

Skin Cancer Diagnostic Process

If you observe any of the skin changes mentioned above, your first step should be to consult your primary care physician. They will decide if it’s necessary to refer you to a specialist. A skin disease specialist is known as a dermatologist, but you may also be referred to an oncologist, a surgeon, or a plastic surgery specialist.

These professionals will examine your skin lesions to determine if they could be a skin tumor. A tool called a dermatoscope, which significantly magnifies the image of the examined area, is particularly helpful in this assessment.

However, the final confirmation of whether it’s a benign lesion or a type of skin cancer comes from a microscopic examination of the suspected tumor site. This process involves removing parts of the tumor and inspecting them under a microscope in a procedure called a biopsy.

The biopsy procedure is quick, painless, and straightforward. The doctor uses a special tool to scrape the skin tumor slightly, collects the cells onto a slide, and sends it to a laboratory for analysis. The results can often be provided quickly, sometimes even on the same day.

Basal cell carcinoma rarely metastasizes, so further tests are usually unnecessary. Squamous cell carcinoma, on the other hand, can spread, albeit rarely. During your examination, the doctor will check for enlarged lymph nodes near the skin tumor. If the tumor has been present for a few years and covers a significant portion of the skin, the doctor will need to ensure that the disease hasn’t spread beyond what’s visible externally. This may necessitate additional tests to check for metastases in other organs, which will help guide the recommended treatment. The doctor will discuss any needed additional tests with you.

Skin Cancer Treatment Options

The majority of patients diagnosed with basal or squamous cell skin cancer, over 90%, are completely cured. The doctor decides on the most appropriate treatment based on several factors.

While it may appear that patients with skin cancer are treated differently despite having the same diagnosis, it’s important to understand that each tumor is unique in its size, shape, origin, depth of penetration into the skin, and its spread to other areas of the body. Additionally, patients vary in age and general health. These factors greatly influence the chosen course of treatment.

If you have any questions about your treatment, it’s advisable to discuss them with your doctor. To address all your concerns, it could be helpful to prepare a list of questions before your appointment. A close companion or family member could also be involved in the conversation for support.

Surgery

Surgery is one of the primary treatments for skin cancer. During the procedure, the doctor removes the tumor along with a small margin of healthy-looking skin surrounding it to ensure complete removal of cancer cells. The surgical site is then stitched closed. Usually, the procedure is performed under local anesthesia, and you can return home on the same day.

For larger tumors, it might be necessary to remove a more substantial amount of skin. In such cases, the wound may need to be covered with a skin graft taken from another part of your body. After the skin graft is applied, the wound is bandaged and left to heal for a few days before the doctor checks on the healing process. The donor site of the skin graft is treated similarly.

Typically, if both wounds are healing well, the patient can return home about ten days after the operation. Although scars may initially appear prominent, they tend to fade and become less noticeable over time.

Lymph Node Removal

If squamous cell skin cancer has spread to nearby lymph nodes, your doctor may recommend surgical removal of both the tumor and the affected lymph nodes. This procedure, known as a lymphadenectomy, is performed under general anesthesia and can help prevent the disease from spreading further.

After the operation, particularly when lymph nodes in the groin or axilla (armpit) are removed, there is a risk of limb swelling.

This condition, known as lymphedema, should be reported to your doctor if it occurs. Your doctor can recommend therapeutic massage and exercises or prescribe other treatments to manage this condition. The affected limb should be consistently wrapped in elastic bandages for support and to help reduce swelling.

Cryosurgery

Cryosurgery, also known as cryotherapy, is a technique that can be used to treat very small and superficial skin tumors. During this procedure, liquid nitrogen is sprayed onto the tumor, effectively freezing and destroying the cancerous cells.

The procedure can be a bit uncomfortable due to the cold, so it is typically performed under local anesthesia. After the procedure, the treated area is bandaged until a scab forms. After approximately a month, the scab falls off, revealing new, soft, healthy skin underneath.

The tumor should be gone at this point, although a white scar may remain. In some cases, more than one cryotherapy session may be necessary to ensure the complete removal of the tumor.

Laser Treatment

Laser therapy is a relatively common treatment method for skin cancer, especially for small tumors. The procedure is typically carried out under local anesthesia and doesn’t significantly disrupt the patient’s overall health. The laser effectively vaporizes the tumor, which is then replaced by a brownish skin mark. Over time, this mark falls off as the underlying tissue heals and is replaced by new skin.

Photodynamic Therapy (PDT)

Photodynamic therapy is a type of treatment that uses light-sensitive compounds, often a drug like a porphyrin, which are injected into the bloodstream. These compounds tend to accumulate in cancerous tissue. When these light-sensitive compounds have sufficiently accumulated in the skin cancer cells, the tumor is then exposed to a specific wavelength of light, usually laser light.

This exposure triggers photochemical reactions within the cancer cells, causing them to undergo changes that lead to cell death. The light used in PDT is harmless to normal tissue, so the procedure can specifically target cancerous cells without damaging surrounding healthy tissue.

This method can be particularly effective for treating certain types of skin cancer, but it does require that the tumor be located in an area that can be easily reached with light. It’s also worth noting that patients must avoid direct sunlight for a period after treatment, as the light-sensitive compounds can make the skin and eyes extra sensitive to light.

Chemotherapy

Chemotherapy is a type of systemic treatment that uses drugs to kill cancer cells. In cases of skin cancer, topical chemotherapy (applied to the skin) may be used for certain types of the disease, such as superficial basal cell carcinoma or actinic keratosis. A chemotherapy cream or lotion is applied directly to the skin cancer.

In some cases, if the cancer has spread to other parts of the body, systemic chemotherapy (which affects the entire body) may be used. The drugs can be given orally or injected into a vein, and they travel through the bloodstream to reach cancer cells throughout the body.

Immunotherapy

Immunotherapy is a type of treatment that helps the immune system fight cancer. For certain types of skin cancer, topical immunotherapy may be used. This involves applying a cream to the skin that stimulates an immune response to destroy the cancer cells.

For more advanced skin cancers, systemic immunotherapy may be used. This type of treatment involves injecting drugs into the body that stimulate the immune system to recognize and attack cancer cells.

Both chemotherapy and immunotherapy can cause side effects, which can vary widely from person to person. They can include skin irritation, flu-like symptoms, fatigue, and more serious effects such as damage to the heart or other organs. Your doctor will monitor you closely during treatment and can help manage any side effects that occur.

The effectiveness of some immunotherapies might decrease as tumors gain resistance but a number of metabolic modulators and alternative treatments such as DCA or 2DGmay reverse this resistance, and potentially enhance the efficacy of immunotherapy.

Targeted Therapy

Targeted therapy is a type of treatment that uses drugs to target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Targeted therapy can affect the tissue environment that helps a cancer grow and survive or it can target cells related to cancer growth, like blood vessel cells.

For skin cancer, targeted therapy may be used in certain situations, such as for advanced basal cell carcinoma that has spread to other parts of the body or come back after surgery. These drugs are usually taken orally.

Remember, it’s important to discuss all your treatment options with your healthcare team to choose the method that is best for you, considering your personal circumstances and the specific characteristics of your cancer.

Over time, some targeted therapies may lose their effectiveness as tumors develop resistance to treatment. However, certain metabolic modulators and alternative cancer treatments, such as DCA or 2DG, can help overcome this resistance, restoring the effectiveness of targeted therapies.

What to Expect During Your Radiotherapy Session

Imagine your doctor, just a room away, attentively overseeing your procedure. There’s no pain involved in radiotherapy – it’s as simple as lying still. However, this stillness can sometimes lead to a bit of discomfort, simply because you have to remain completely motionless during the session.

The Journey of Radiation Therapy

The delivery of radiation therapy isn’t confined to a hospital bed. It can be provided as an outpatient service or as part of an inpatient stay. Picture a regular routine, much like a weekday job – you’ll receive treatment each day, Monday through Friday, with a weekend break. Each visit, you’re given a specific dose of ionising radiation, the unseen warrior battling your illness.

Think of it as a month-long journey towards better health. Your doctor, your guide in this journey, sits down with you to discuss the roadmap – the course of treatment and its duration. So, while it may sound complex, rest assured, you’re never left in the dark.

Navigating the Side Effects of Radiotherapy

When it comes to skin tumors, radiotherapy is usually a gentle journey with few bumps along the way. Imagine a light blush spreading across the treated area after about a week of radiation, lingering for several weeks. You might feel a subtle warmth, an itch, or a little prickling sensation on the treated patch of skin.

Don’t worry though, your doctor has a soothing balm at the ready – a prescribed ointment that makes you feel much better when applied to the area receiving the radiation. As the journey nears its end, the treated area might feel moist, sore, and cool to the touch.

Upon finishing the radiation treatment, think of the remaining scar as a temporary guest. It stays for about a month until it’s replaced by fresh, healthy, rosy skin that grows from beneath. Then, the scar simply sheds off.

In time, the skin of the treated area usually blends back in with the rest of your body, adopting the same colour. However, in some cases, it might retain a permanent whitish hue.

If the journey of radiotherapy takes us through a hairy part of your body, the hair might retreat temporarily due to the radiation exposure. But it’s a resilient army – it regrows within 6-12 months post-treatment, depending on the doses of radiotherapy given.

Most importantly, radiotherapy doesn’t make you radioactive. You can continue to share your warmth and love with adults and children alike during the treatment without any worries.

Chemotherapy: The Cancer Cell Nemesis

Chemotherapy is a treatment method that uses powerful anticancer drugs designed to annihilate cancer cells. However, in the context of skin cancer, chemotherapy isn’t typically the leading hero. It rises to the challenge when the enemy, skin cancer, spreads and metastasizes to other organs.

The Road to Recovery: Post-treatment Follow-up

Once your treatment is completed, the doctor doesn’t just wave goodbye. You embark on a new journey – a series of follow-up examinations. In the beginning, you’ll meet your doctor more often, then gradually the visits become less frequent: a check-up every 3 months in the first year after treatment, then every 6 months in the second and third years, and from then on, just an annual visit.

During these visits, the doctor carefully inspects the treated area of your skin, keeps an eye out for any new skin lesions in the vicinity, and continually advises you to avoid direct sunlight. These preventive check-ups are perfect opportunities to chat with your doctor about any health issues that have been worrying you.

If you spot any new signs of cancer on your own, don’t hold off until your next scheduled visit – make an appointment to see your doctor as soon as possible.

If your journey goes smoothly, you might reach a landmark moment in five years’ time when the need for these tests might completely fade away.