Skin Cancer

Skin Cancer

All skin cancers originate in the outer layer of skin known as the epidermis. In the normal course of skin rejuvenation, basal cells located at the base of the epidermis move upward to replace dead cells constantly being shed from the skin's surface. Along the way, the round basal cells are transformed into flat syuamous cells. Throughout the epidermis are melanocytes, cells that produce a protective pigment called melanin.

Skin cancers fall into two major categories: melanoma and nonmelanoma. Melanoma is cancer of melanocytes, affecting about 1 in 10 skin cancer patients. It can start in heavily pigmented tissue, such as a mole or birthmark, as well as in normally pigmented skin. Melanoma usually appears first on the torso, although it can arise on the palm of the hand; on the sole of the foot; under a fingernail or toenail; in the mucous linings of the mouth, vagina, or anus; and even in the eye. Melanoma is an extremely virulent, life-threatening cancer. It is readily detectable and always curable if treated early, but it progresses faster than other types of skin cancer and tends to spread beyond the skin. Once this occurs, melanoma becomes very difficult to treat and cure.

The two most common skin cancers, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are nonmelanomas, which are rarely life threatening. They progress slowly, seldom spread beyond the skin, are detected easily, and usually are curable. BCC, which accounts for nearly 3 out of 4 skin cancers, is the slowest growing; SCC is somewhat more aggressive and more inclined to spread. In addition, there are a few rare non-melanomas, such as Kaposi's sarcoma, a potential-ly life-threatening disease characterized by purple growths and often associated with AIDS.

Some technically noncancerous skin growths have the potential to become cancerous. The most common are actinic keratoses—crusty red dish lesions that may scratch off but grow back on sun-exposed skin. Another precancerous skin growth, cutaneous horns, appears as funnel-shaped growths that extend from a red base on the skin.

Every malignant skin tumor in time becomes visible on the skin's surface, making skin cancer the only type of cancer that is almost always detect able in its early, curable stages. Prompt detection and treatment of skin cancer is equivalent to cure. Skin cancer is by far the most common cancer in the world. Most cases are cured, but the disease is a major health concern because it affects so many people. Over 700,000 cases of non-melanoma skin cancer are diagnosed annually in the United States alone, and about 32,000 cases of melanoma. Of the 9,000 or so deaths from skin cancer in the U.S. each year, about 7,000 are from melanoma. Skin cancer tends to strike people of light skin color; dark-skinned people are rarely affected, and then only on light areas of the body such as the soles of the feet or under fingernails or toenails. An estimated 40 to 50 per-cent of fair-skinned people who live to be 65 will develop at least one skin cancer. The incidence of skin cancer is predictably higher in places with intense sunshine, such as Arizona and Hawaii; it is most common in Australia, settled largely by fair-skinned people of Irish and English descent.

Causes
Excessive exposure to sunlight is the main cause of skin cancer. Sunlight contains ultraviolet (UV) rays that can alter the genetic material in skin cells, causing mutations. Sunlamps, tanning booths, and x-rays also generate UV rays that can damage skin and cause malignant cell mutations. BCC and SCC have been linked to chronic sun ex-posure, typically in fair-skinned people who work outside. Melanoma is associated with infrequent but excessive sunbathing that causes scorching sunburn. One blistering sunburn during child-hood appears to double a person's risk for developing melanoma later in life.

Fair-skinned people are most susceptible be-cause they are born with the least amount of protective melanin. Redheads, blue-eyed blonds, and people with pigment disorders such as albinism bear the greatest risk. But people with many freckles or moles, particularly abnormal-looking ones, may also be vulnerable to melanol7ia. Workers regularly exposed to coal tar, radium, inorganic arsenic compounds in insecticides, and certain oth-er carcinogens are at slightly higher than normal risk for nonmelanoma skin cancer.

The incidence of skin cancer is rising, even though most cases could be prevented by limiting skin's exposure to ultraviolet radiation. Skin cancer is about three times more common in men than in women, and the risk increases with age. Most people diagnosed with skin cancer are between ages 40 and 60, although all forms of the disease are appearing more often in younger people. If you or any close relatives have had skin cancer, you are more likely to get the disease.

Diagnostic and Test Procedures
If you are in a high-risk group for skin cancer or have ever been treated for some form of the disease, you should familiarize yourself with how skin cancers look. Examine your skin from head to toe every few months, using a full-length mirror and hand mirror to check your mouth, nose, scalp, palms, soles, backs of ears, genital area, and between the buttocks. Cover every inch of skin and pay special attention to moles and sites of previous skin cancer. If you find a suspicious growth, have it examined by your doctor or dermatologist.

All potentially cancerous skin growths must be biopsied to confirm a cancer diagnosis. Depending on the suspected type of skin cancer, the biopsy techniques vary slightly but crucially. Any potential melanoma requires a surgical biopsy, in which the entire growth is removed with a scalpel. A pathologist then studies the sample under a microscope to determine whether cancer cells are present. If cancer exists and it is melanoma, grains of melanin will be visible in the cancer cells. Skin growths that may be melanoma tumors should never be removed by shaving, burning, or freezing because those techniques do not allow pathologic examination of the growth. Eye melanomas usually are not biopsied because they are virtually unmistakable to an experienced ophthalmologist. If melanoma is diagnosed, other tests may be ordered to assess the degree of can-cer spread. Skin growths that are most likely BCC, SCC, or other forms of nonmelanoma can be biopsied in various ways. Part or all of the growth can be taken with a scalpel, or a thin layer can be shaved off for examination under a microscope.

Treatment
Most skin cancers are detected and cured before they spread. Melanoma that has spread to other organs presents the greatest treatment challenge.

Conventional Medicine
Standard treatments for localized basal cell and squamous cell carcinomas are safe and effective and cause few side effects. Small tumors can be removed with electric current, frozen with liquid nitrogen, or killed with low-dose radiation. Applying an ointment containing a chemotherapeutic agent called 5-fluorouracil to a superficial tumor for several weeks may also work. Larger localized tumors are removed surgically.

In rare cases where BCC or SCC has begun to spread beyond the skin, tumors are removed surgically and patients are treated with chemotherapy, radiation, or immunotherapy. Some patients with advanced SCC respond well to a combination of retinoic acid (a derivative of vitamin A) and in terferon (a type of disease-fighting protein produced in laboratories for cancer immunotherapy). Retinoic acid also seems to inhibit cancer recurrence in patients who have had tumors removed.

Melanoma tumors must be removed surgical-ly, preferably before they spread beyond the skin into other organs or glands. The surgeon excises the tumor fully, along with a safe margin of sur-rounding tissue and possibly nearby lymph nodes. Neither radiation nor chemotherapy will cure ad-vanced melanoma, but either treatment may slow the disease and relieve symptoms. Chemotherapy, sometimes in combination with immunother-apy-using interferon-is generally preferred. If melanoma spreads to the brain, radiation is used to slow the growth and control symptoms.

Immunotherapy is a relatively new field of cancer treatment that attempts to target and kill cancer cells by manipulating the body's immune system. Some of the most promising developments in the field of immunotherapy have sprung from efforts to cure advanced melanoma. Some re-searchers are treating advanced cases with vac-cines, while others are using drugs such as inter-feron and interleukin 2 in an effort to stimulate immune cells into attacking melanoma cells more aggressively. Genetic manipulation of melanoma tumors may make them more vulnerable to attack by the immune system. Each of these experimen-tal treatment approaches aims to immunize a pa-tient's body against its own cancer-something the body cannot do naturally.

People who have had skin cancer once are at risk for getting it again. Anyone who has been treated for skin cancer of any kind should have a checkup at least once a year. About 20 percent of skin cancer patients experience recurrence, usu-ally within the first two years after diagnosis.

Complementary Therapies
Once skin cancer is diagnosed, the only accept-able treatment is medical care. Alternative ap-proaches may be useful in cancer prevention and in combating nausea, vomiting, fatigue, and headaches from chemotherapy, radiation, or im-munotherapy used to treat advanced skin cancer.

Nutrition and Diet
Skin experts know that the mineral zinc and the antioxidant vitamins A (beta carotene), C, and E can help repair damaged body tissue and promote healthy skin. Now researchers are trying to determine whether these and other nutrients might protect skin from the harmful effects of sunlight. To test the theory, selected skin cancer patients are given experimental supplements of these vita-mins in the hope of preventing cancer recurrence.

Herbal Therapies
Following the advice of a local herbalist, some light-skinned Zimbabweans have used a crude ointment from the root and bark of the African sausage tree (Kigelia pinnata) to treat skin cancer. While initial research indicates that kigelia extract can kill melanoma cells, further study is needed to determine whether or not a kigelia-based drug will effectively treat melanoma in humans.

Prevention
If you are susceptible to skin cancer, take the following precautions whenever possible:

Additional Resources:

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