Skin Cancer Symptoms and Treatment
There are many sun-induced skin sores which are not the nasty cancerous type, but there are also some which can spread rapidly enough to eventually kill the unfortunate owner of the spot. It is often difficult for doctors to be absolutely certain about a spot when examined on the patient, and so if there is any doubt at all, the spot is cut out. This can be done very easily in a general practitioner's surgery. The lesion is then sent to a pathologist, who will examine it further under a microscope to make the exact diagnosis.
Nasty skin spots fall into several different categories. Cancers of the outermost layer of skin are commonly called skin cancers, or squamous cell carcinomas (SCC). Another type of tumor develops if the next layer down in the skin is involved. These growths are called basal cell carcinomas (BCC) and are generally not as serious as the more superficial cancers. Malignant melanomas are the most serious and deadly of them all. Even with the best medical care, a significant proportion of these patients will die, often because they have been seen too late by a doctor. However, complete cures are now possible if the patient presents early in the disease. In the last 10-20 years, the outcome for malignant melanoma sufferers has changed greatly and for the better. Signs to watch for in a spot or sore are:
- any irregularity in color, shape or outline,
- soreness or itchiness,
- bleeding or weeping.
If any of these signs occur, see your doctor immediately! It is far better to find out the truth now, be it good or bad, than to worry for months unnecessarily, or have a far worse outcome because of the delay.
Squamous cell carcinoma (SCC) Cancers of the outermost layer of skin are called squamous cell carcinomas (SCC). They occur most commonly on the exposed parts of the body, such as the rims of the ears, the face, scalp, arms and hands. Men with receding hairlines are at greatest risk, because they lack nature's own sunshade.
The stage before an SCC is called a hyperkeratosis or solar keratosis. These are patches of raised and scaling skin, but they are not red or itchy. These may be treated by acid ointments or surgical procedures to remove them and prevent them from becoming SCCs. In some elderly patients with very large areas affected by keratoses, it may not be practical to remove all the spots, but they should be checked regularly by a doctor so that any which change can be treated immediately.
Another type of skin condition that can progress to an SCC is called Bowen's disease. These are less common than keratoses but are more likely to develop into a skin cancer. They appear as a sharply edged red patch covered with a fine scale. They may be found anywhere on the body and are caused by exposure to sunlight or arsenic compounds. They should be removed or chemically destroyed.
A squamous cell carcinoma looks like a red spot covered in fine white scales. They may be itchy or sore but often attract attention because they are unsightly. They occur on sun-exposed parts of the body, usually in patients who are over 50 years of age. They are caused by prolonged exposure to sunlight or irritant chemicals. Most of them can be very easily removed, and the doctor, if sure of the diagnosis, may burn the cancer off with a diathermy machine or freeze it off with liquid nitrogen. Both methods are very effective in early stages of the disease.
If the skin cancer is larger, or if the diagnosis is not certain, it is necessary to cut out the spot and the surrounding tissue to prevent it from spreading further. SCCs can spread by blood or lymphatics to distant parts of the body. This is why they are more serious than basal cell carcinomas.
Basal cell carcinoma (BCC, rodent ulcer) Cancers of the deeper layers of the skin are called basal cell carcinomas (BCC) and are generally not as serious as the more superficial cancers. They occur at an earlier age than SCCs but rarely before 25 years of age. They are caused by prolonged exposure to sunlight, and so occur most commonly on the face and back, but they are uncommon on the arms and legs.
BCCs may appear as shiny, rounded lumps that often change in size and color, or they may present as an ulcer that fails to heal. The ulcer often has a pearly, rounded edge.
Whenever a BCC is suspected, it should be removed surgically. The specimen is then sent to a pathologist for examination to ensure that the diagnosis is correct, and that all the tumor has been removed. Other forms of treatment include irradiation and diathermy.
If correctly treated, these growths can be completely healed, but if left until large, significant plastic surgery may be necessary to correct the defect left behind after the BCC is removed. Untreated, the cancer will slowly invade deeper tissues, become very obvious and repulsive in appearance, and after many years may cause death. BCCs do not spread to other parts of the body.
Melanomas are the most serious form of skin cancer, and one third of all patients who develop a melanoma will eventually die from this disease. Melanomas may be black, brown, pink or blue, and when found individually or mixed in a skin spot, these colors could be deadly.
The melanocytes are the cells in the skin that create pigment. In Europeans (Caucasians), these cells are relatively inactive, giving a pale color to the skin. In Asians (Mongols) they are moderately active, and in Africans (Negroes) they are very active, giving a steadily darker skin color. Cancer can develop in any type of cell in the body. When the melanocytes start multiplying abnormally, they form melanomas, which appear as irregularly edged, dark (or rarely pink), enlarging spots on the skin. The surface of the melanoma is often uneven and bumpy, and the pigment can be seen advancing into the surrounding skin. They may enlarge very rapidly, and advanced cases will bleed, scab and ulcerate.
Melanomas can occur in unusual situations such as under the nail (where they may be mistaken for a bruise), in the mouth, under the eyelids, on the retina inside the eye, and in the anus, but the sun-exposed parts of the skin are by far the most commonly affected areas.
This type of cancer is rare in children, and slightly more common in women than men. Their greatest incidence is between 30 and 50 years of age, and the most common sites are the legs and back. Fair-skinned people are far more likely to develop this cancer than those with dark complexions.
The actual cause is unknown, but exposure to sunlight, particularly in childhood and the teen years, dramatically increases the risk of developing a melanoma. Ultraviolet radiation, most of which is filtered out of sunlight by the ozone layer in the upper atmosphere, is the part of the spectrum that causes the damage. Any depletion in the ozone layers around the globe will inevitably lead to a dramatic increase in the incidence of melanomas.
When discovered, the melanoma, and a large area of skin around and under it, must be cut out. This usually leaves a hole that must be covered by a skin graft. The lymph nodes around the melanoma may also need to be removed in some patients.
Melanomas have a tendency to grow deep into the body and migrate to other organs. If the melanoma is a particularly virulent one, or there is evidence that it has spread through the bloodstream to other areas, the patient will also be treated with irradiation and injected medications to control its further growth. The liver, lungs and glands in the armpit and groin are the most common areas for secondary melanomas to develop.
It is very difficult to predict the course of the disease in any particular patient. Some cases are completely cured by local excision, others will advance rapidly despite all treatment, and another group
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