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Skin Cancer: The Story Of Yasir Ibn Mohammed From Kuwait

Updated on July 24, 2013

Squamous Cell Carcinoma

Birthmarks

Birth marks or moles are major predisposing factors or even causes to skin cancers
Birth marks or moles are major predisposing factors or even causes to skin cancers

Mr. Yasir Ibn Mohammed's story

Mr. Yasir Ibn Mohammed is from Kuwait and has been working in a petrochemical company for the past 6 years. The fair-skinned Yasir has some birthmarks at the topmost part of his back. They are about 3 of which two are larger than 22 mm in size. One day he came back from work and was about to freshen up when his wife discovered something interesting when he took off his shirt. The birthmarks all seemed to have increased in size, but his wife's observation led to an argument and it was carelessly ignored.

After about eight days all the birthmarks doubled in size forming large brownish spots with dark speckles and small lesions with irregular borders having portions which appear red. This time around, his wife persisted and they went to the hospital. After some medical procedures such as scraping some parts of the spots and taken for histological analysis, radioisotopic scanning and other procedures, the Doctors came up with this diagnosis:

Skin Cancer: Malignant Melanoma, Stage IIB. Is Yasir safe? What is this?

The Skin

Beautiful Skin
Beautiful Skin

THE SKIN

The largest Organ of the Body is the Skin. It is of great physiological importance as it rids the body of waste products via the sweat glands, helps control fluid loss, helps regulate body temperature and most importantly, it is the first line of protection to the body against injury and infection.
The skin is divided into two major layers. The outer layer known as the epidermis and the inner layer known as the dermis. The outer layer has different layers of cells and they are as follows:

  • The Squamous cells (The Keratocytes) which lie just below the outer surface of the skin.
  • Basal cells which produce new cells as old ones are shed. These cells lie underneath the Squamous cells, and finally,
  • Melanocytes: These are Melanin secreting cells. Melanin is responsible for the skin normal coloration.

The dermis, being the inner layer houses inner tissues such as fats, connective tissues and blood vessels.

Squamous Cell Carcinoma

Malignant Melanoma on Chest

SKIN CANCER

Cancer or a cancerous growth is the pathological or abnormal mitotic proliferation of cells (multiplication of cells through fast growth). If this is the case in the Skin, then this abnormal mitotic growth could occur in Squamous cells (Squamous Cell Carcinoma- SCC), Basal Cells (Basal cell Carcinoma- BCC) or in the Melanocytes (Melanoma). These three types of Skin Cancer are the major and most common skin cancers.
As for the cells of the Dermis, cancerous growth can occur in fatty cells (Liposarcoma), Muscle tissue (Miosarcoma), Blood and lymphatic vessels (Angiosarcoma, angioendotelioma, Kaposi's sarcoma, lymphangiosarcoma etc.) and even on undifferentiated cells (undifferentiated sarcoma, mixosarcoma).Our major focus will be on the cancer of the epidermic cells, since they have a more than 85% occurrence of skin cancers globally.

Causes

The following can cause skin cancers:

  • Ultra-violet radiation from Sunlight especially (As in the case of Yasir, since Kuwait is a temperate and very hot region). Other sources could be commercial tanning lamps and tanning beds.
  • The human Papillomavirus (HPV)
  • Birthmarks, especially when its as large as 20 mm, also in Yasir's situation.
  • Immunosuppressive syndrome or drugs suppressing the human body immunity such as cyclosporin, Azathiopine etc.

Predisposing Factors

There are some factors which can aid or compliment the occurrence of Skin cancer. This in other words means people with such factors have a high risk of getting skin cancers. Such factors are as follows:

  1. Fair skin (Yasir's case)
  2. History of sunburns
  3. Excessive sun exposure, especially those living in the tropics.
  4. Presence of Moles, or birthmarks on the skin (also in Yasir's case)
  5. Precancerous skin lesions
  6. Cases of skin cancer in Family (Positive family history)
  7. Weakened immunity
  8. Biological factors such as high level of daily protein and adipose consumption and medical products such as exogenous oestrogens.
  9. Certain rare hereditary conditions such as Gorlin syndrome or Xeroderma pigmentosum (XP).
  10. Exposure to toxic substances such as Arsenic, Coaltar, soot, pitch, Asphalt, Creosotes, Paraffin, waxes, petroleum derivatives, cutting oils, petrochemicals, chemicals such as Nitric acids, rubber-producing plants (production of polyvinyl chloride, plastic benzol, pesticides).

Red ulcerated Lesion On the skin

WHAT ARE THE SIGNS AND SYMPTOMS?

1. In Basal Cell Carcinoma, what is observed is a pearly waxy bump or/and a flat flesh-coloured or brown scar-like lesion. These lesions grow slowly and almost never spread to other parts of the body. If detected early, it can be treated and cured. Other signs are: lesions sometimes bleed, crusts are usually formed, there is this characteristic deceiving healing signs but healing never occurs, itching and development of painless ulcers are additional symptoms. This is the most common of all cancers and occurs in 75% of skin cancer cases.


2. In Squamous cell carcinoma, most common anatomical locations affected are: face, ears, hands, and individuals with darker skins are more likely to develop SCC on their legs and feet. A red firm Nodule is usually the clinical presentation and in almost all cases with a flat lesion with a scaly crusted surface. Like the B.C.C, it also has a slow growth rate and only spreads to other body parts if left untreated for a very long time. Skin area which is affected is raised in comparison to the neighbouring areas and lesions can be very tender to touch.


3. Malignant Melanoma is the most severe and dangerous of the three. Growth and spread are very fast and that is why it is clinically identified as malignant. Presentation of this type can be on any part of the body, but mostly on the head, trunk and Neck for men and lower legs for women. Other clinical presentations are: a large brownish spot with darker speckles; small lesions with irregular borders with portions that appear red, white, blue or blue-black and dark lesions on Palms, soles, finger tips and toes, or on mucous membrane lining the mouth, Nose, vagina or Anus.The characteristic feature of Malignant Melanoma is its production of sharply circumscribed and chronic lesions of the skin called Nevus, popularly known as Moles or birthmarks. These Nevi presentation come with some certain clinical features which are as follows:

  1. disappearance of skin pattern from the nervus surface
  2. appearance of shiny, glossy nervus surface
  3. appearance of a symmetry or contours of the nevus, i.e. changes of its shape
  4. Horizontal nevus growth (Can also be vertical).
  5. Feeling of subjective sensation of heat, itching or pain in the nevus area.
  6. appearance of single nodules (satellites) around the nevus.
  7. Peeling of the nevus surface with formation of withered "Scabs".
  8. Absence or shedding of hair on the nervus surface.
  9. Partial (irregular) or complete colour change of the nevus-melanoma-appearance of areas of the so-called bound depigmentation.
  10. Vertical growth of the nevus melanoma.
  11. Change in the nevus-melanoma consistency- becomes soft (observed through palpation).
  12. Ulceration of the epidermis just above the nevus-melanoma.
  13. Inflammation of the area of nevus-melanoma and surrounding tissues.
  14. Bleeding.

Dermatoscopy

DIAGNOSIS AND TREATMENT

Diagnostics

Diagnostic procedures slightly differ due to the type of cancer. As for the Basal cell carcinoma and Squamous cell carcinoma procedures like normal palpation, the use of Dermatoscopy, cytological analysis of the scrap or smear, incisional biopsy, Ultrasound diagnosis and thoracic cavity radiography (to check for metastasis in lymph nodes and distant metastases). As for Melanoma, additional procedures such as Echography, tumor thermography and Radioisotope scanning with the help of radio-active 32 P (300%) are needed.

Differential Diagnosis

The carcinomas should be differentiated from Red Lupus, Tuberculosis, Syphilitic gumma, Actinomycosis, Melanoma and Non-malignant skin growths. On the other hand, Malignant melanoma of the skin should be adequately differentiated with Youth melanoma (spits Nevus), Blue Nevus, Galo-nevus, Displatic nevus, Cavernous thrombotic gemangioma, Non-malignant skin tumors, Malignant skin tumors, underungual and under-epidermal hematoma, Onichomycosis, Extragenital chancre and Metastasis of tumors of other histogenesis into the skin.
TreatmentBefore we begin discussing the treatment, we need to know the different stages of skin cancer because this is of great relevance to how Skin cancers should be treated. And as the trend is, the staging differ with the type of cancer. The Carcinomas have the following.Primary Tumor

  • T0- Not identified
  • Tis- Carcinoma in situ
  • T1- The tumour is 2cm in the greatest dimension
  • T2- The Tumour is >2cm but <5cm in the greatest dimension.
  • T3- the tumour is >5cm in the greatest dimension
  • T4- the tumour grows into the lower Organs (Cartilages, muscles and bones).

Regional lymph node involvement

  • N0- no evidence of regional lymph nodes affection
  • N1- the regional lymph nodes are affected

Metastatic InvolvementM0- distant metastasis has not occurred.M1- there is distant metastasis.

Staging of the Carcinoma Types of Skin Cancer

Stage
Tumor
Lymph Involvment
Metastasis
Stage 0
Tis
N0
M0
Stage I
T1
N0
M0
Stage II
T2
N0
M0
 
T3
N0
M0
Stage III
T4
N0
M0
 
Any T
N1
M0
Stage IV
Any T
Any N
M1

Radiotherapy

DIAGNOSIS AND TREATMENT: Continuation

For Basal Cell Carcinoma;

  • Electroexcision (recovery takes place in 95% cases)
  • closely-focused radiotherapy (recovery takes place in 90% cases).
  • Excision (recovery takes place in 95% cases).
  • Cryotherapy
  • Relapse is treated by wide excision.

For Squamous Cell Carcinoma;

  • Surgery is indicated for Stages I and II. Wide ablation of the tumour with the healthy skin area around it (not less than 2cm) together with the hypodermic cellular tissue and fascia.
  • Radiotherapy is indicated also for Stages I and II. Closely focused radiotherapy, total dose is 30-60 Gr.
  • Combined Medical therapy for Stages III and IV (chemotherapy).

Prognosis

Early diagnosis of the disease has an excellent prognosis of 80-100% complete recovery with no relapse. In case of absence of regional lymph node metastases, a 5 year survival is guaranteed in 75-85% cases, but if present with metastases of adjacent tissues and organs, the 5 year survival is only about 24% probable.
Melanoma

Primary Tumour

  • Tis- Melanoma in situ
  • T1- the tumour is less than 1 mm thick and (a) without ulceration; (b) with ulceration.
  • T2- the tumour is 1.01-2.0 mm thick and (a) without ulceration; (b) with ulceration.
  • T3- the tumour is 2.01-4.0 mm thick and (a) without ulceration; (b) with ulceration.
  • T4- the tumour is more than 4 mm thick and (a) without ulceration; (b) with ulceration.

Regional lymph node involvement

  • N1- Metastases in 1 gland; (a) micrometastases 1; (b) macrometastases 2.
  • N2- Metastases in 2-3 lymph nodes: (a) micrometastases 1; (b) macrometastases 2; (c) transitional metastases/satellites without metastatic lymph nodes.
  • N3-4 and more metastatic lymph nodes are a conglomeration of lymph nodes or transitional metastases/satellites with metastatic lymph nodes.

Note: Micrometastases 1 are diagnosed after observation or selective lymphodenectomia. Macrometastases 2 are clinically found in lymph nodes, confirmed by therapeutical lymphodenectomia or extracapsular spread of metastases in the lymph nodes.
Metastatic involvement

  • M1a- there are distant metastases on the skin, hypoderma or in the lymph nodes.
  • M1b- metastases in the lungs
  • M1c- other visceral or any distant metastases.

Skin Melanoma staging

Stages
Tumor
Lymph Involvment
Metastasis
Stage 0
Tis
N0
M0
Stage IA
T1a
N0
M0
Stage IB
T1b
N0
M0
 
T2a
N0
M0
Stage IIA
T2b
N0
M0
 
T3a
N0
M0
Stage IIB
T3b
N0
M0
 
T4a
N0
M0
Stage IIC
T4b
N0
M0
Stage III
Any T
N1
M0
 
 
N1-N3
M0
Stage IV
Any T
Any N
M0-M1
From the Doctor's Diagnosis, we can say Mr. Yasir Ibn Mohammed has Melanoma which is more than 4mm thick but without ulceration; no lymph node involvment and metastasis is yet to occur

Squamous Cell Carcinoma

TREATMENT: Continuation

stage Of treatment of Melanoma

The standard treatment in case of IA and IB stages is wide excision of the rumour at the distance of 2cm from the tumour borders.
In stage II treatment, the standard excision carried out should be at the distance of 3 cm from the tumour borders. Besides tumour excision, it is possible to perform immunotherapy using interferon alpha-2b 3ml ME/m2 of hypodermic injection 3 times per week during 3 years or until a relapse and melanoma metastases.
In stage III treatment, the medical standard is wide excision of the primary tumour within 3 cm and more combined with regional lymphodenectomy. Chemotherapy, immunotherapy (interferon Alpha-2b, BCG), polychemotherapy should be performed in usual or modified (hyperthermia, hyperglycemia, etc) are also ideal. Another method of treatment is polychemotherapy (decarbazine combined with platinum medications-Cisplatin, periwinkle alkaloids- Vinblastine, and medications of Urea nitromesil group-lomustin.
The standard for stage IV treatment is simply systemic chemotherapy. Surgical procedure can be performed in the presence of single metastases in the lungs, gastrointestinal tract, bones or brain. Palliative radiotherapy can relieve the patient's state. Sometimes, in addition to these procedures, anti-oestrogens (tamoksifen) are used.
Prognosis

In case of localized process, a 5-year survival is possible in 75-86% cases, 10 years-47%. In case of regional metastases- 33-52% and 13% accordingly. In case of distant metastases, a 5-year survival does not exceed 5-12%.
Skin cancers are gradually increasing in occurrence and therefore, should be taken into great consideration.

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    • Healthyannie profile image

      Healthyannie 4 years ago from Spain

      This is a very good hub on skin cancer but medical advise is vital

    • D.Virtual.Doctor profile image

      Funom Theophilus Makama 4 years ago from Europe

      Well done Funom Makama 3... I think the medical advise here is simple. For those with moles or birthmarks, they should ensure they go for screening once yearly to be able to detect any form of skin cancer in its early stages...

      If its occurrence is in the family, then screening is also vital and as well avoidance of other predisposing factors such as much exposure to sun, exposure to chemicals and other harmful materials and a good diet and maintenance of good immunity. And if detected, meet an oncologist as soon as possible for treatment and management..

    • shiningirisheyes profile image

      Shining Irish Eyes 4 years ago from Upstate, New York

      Important informative hub. As someone who was diagnosed with melanoma, I understand the importance of informing people what to look for. Mine started out very small and everyone told me they thought it was just a pimple. I let it go and ended up having extensive surgery. I now see a physician regularly and receive regular exams. In total, I have had three re-occurrences in different areas. I am fair skinned and love the outdoors.

      Voting up.

    • Funom Makama 3 profile image
      Author

      Funom Theophilus Makama 4 years ago from Europe

      Oh! I am so sorry to know this... It's nice you appreciate this hub and even share your experience. People need to be informed so that we all take precaution. Thanks a lot shiningirisheyes and I wish you good health and long life....

      Thanks so much for your contribution.

    • always exploring profile image

      Ruby Jean Fuller 4 years ago from Southern Illinois

      This is a very good, in depth article. Written well. I have fair skin so i avoid the direct sun. Thank you..

    • agusfanani profile image

      agusfanani 4 years ago from Indonesia

      A useful information about skin cancer. I have an active mole on my left hand which looks pitch black, uneven surface and felt tichy then a friend of mine suggest to drink various fruit juice to ease it and I think it's got better and not as active as before.

    • Funom Makama 3 profile image
      Author

      Funom Theophilus Makama 4 years ago from Europe

      Thanks a lot always exploring... Yeah, ensure you keep off from all predisposing factors to skin cancer.....

      @agustanani..... It's niece you shared your experience, nevertheless, I still suggest you go for screening at least once yearly to ensure total precautions.

    • agusfanani profile image

      agusfanani 4 years ago from Indonesia

      Yes, thank you for your advice. I'd better do that for precautions.

    • teaches12345 profile image

      Dianna Mendez 4 years ago

      Your article is well written and detailed. This is very interesting to read and I learned so much from your post. I think it is so dangerous to ignore any skin changes that appear; it's better to be safe than sorry -- have it checked. Voted up+++

    • profile image

      What is skin cancer? 4 years ago

      Skin cancer is the most common type of cancer among white or Caucasian populations, in the UK and worldwide. Most are easy to treat and pose only a small threat to life, but one type, malignant melanoma, is difficult to treat unless detected early. Over the past 25 years, rates of melanoma in the UK have risen faster than any other common cancer, and numbers have quadrupled since 1982, probably reflecting the fashion in recent decades for a suntan.

    • profile image

      Skin cancer symptoms 4 years ago

      There are three principal types of skin cancer, which can have different symptoms and appearances. Basal cell carcinoma (BCC) is the most common type of skin cancer, accounting for 75 per cent of non-melanoma skin cancers. It affects a type of cell within the top layer of skin (epidermis), and is a slow-growing cancer that doesn't usually spread to other parts of the body.

      BCC affects all sun-exposed areas of the body, especially parts of the face such as the nose, forehead, cheeks and ear lobes. The main symptom is a small, painless, pink/brownish-grey lump, with a smooth surface, blood vessels and a waxy or pearl-like border. The lump grows, developing a central depression (or ulcer) with rolled edges. They are often symptomless but may be itchy and bleed. BCC's usually develop in mid to late life.

      Squamous cell carcinoma (SCC) involves another type of cell in the top layer of skin or epidermis. It usually affects the head, neck or back of the hands and the main symptom is an area of thickened, scaly skin that develops into a painless, hard lump, reddish brown in colour with an irregular edge. The lump becomes a recurring ulcer and doesn't heal. Occasionally SCCs form on the vulva or around the anus.

      These two types (BCC and SCC) are known as non-melanoma skin cancer (along with a few other much more rare types of skin cancer). They are usually slow growing, occur on sun-exposed areas of the skin and rarely spread.

      Malignant melanoma skin cancer can occur anywhere on the body and is more dangerous. It's related to the common mole and changes in the appearance of moles on your body should be checked by your GP.

      Malignant melanoma develops from the pigmented cells that produce the skin's colouring, in the outer layer of the skin (the epidermis) usually within a mole. It tends to spread much more rapidly down through the layers of skin and then through the bloodstream than the other two types of skin cancer and is much more resistant to treatment. If not caught early or treated successfully it can spread to the liver, lungs or brain.

    • profile image

      BBC 4 years ago

      The main symptom is a quick-growing, irregular, dark-coloured spot on previously normal skin or in an existing mole that changes size, colour, develops irregular edges, bleeds, itches, crusts or reddens. If an adult has a growing, changing, brown or black mark which cannot be covered by the blunt end of a pencil, this should be shown to the doctor straight away. People with darker skin are less likely to get a melanoma but it may still occur, usually on the palms of the hands, soles of the feet or under a nail.

      Occasionally, melanoma may present with swollen lymph glands or rarely in unusual places including inside the mouth or eye. If melanoma is diagnosed, then further tests will be done to see if the cancer has spread beyond the skin to other parts of the body. This may involve taking x-rays and scans to look at the liver, brain and lungs.

    • profile image

      Skin cancer causes 4 years ago

      The main cause of skin cancer is over-exposure to the sun's harmful UV rays. A suntan isn't healthy - it's a sign of skin damage. It's thought the UV radiation in sunlight causes subtle cell damage which can lead to cancerous changes. Scientists have found that those with lighter skin are far more vulnerable to skin cancers, because they produce less pigment which protects against the sun. Rates of skin cancer of all sorts are extremely low among dark-skinned people.

      Non-melanoma skin cancer results from prolonged sunlight exposure over many years, which is why they mostly occur in later life. The main cause of malignant melanoma is exposure to short periods of intense sunlight. Episodes of sunburn, especially in childhood, are particularly linked to an increased risk of malignant melanoma. Men are more likely to develop cancers on their neck, shoulders and back, whereas in women they're more likely to appear on the legs and arms.

    • profile image

      Diagnosing skin cancer 4 years ago

      Diagnosis of skin cancer can usually be made by your GP or hospital specialist by simple skin examination. Sometimes, the skin cancer will need to be removed by a small operation or biopsy; both for treatment and lab testing. Other routine tests, including X-rays and scans aren't usually required.

    • profile image

      Skin cancer treatments 4 years ago

      Non-melanoma skin cancers are usually treated by an operation to cut out the affected area under local anaesthetic (larger tumours in difficult areas or needing a skin graft may need a general anaesthetic). Another method used on smaller cancers is cryosurgery, in which liquid nitrogen is applied to the tumour to freeze it and kill the cells, which simply shrivel and drop off. Some cases of basal cell carcinoma may be suitable for photodynamic therapy, which uses a cream to sensitise the tumour and then exposes it to high intensities of light to destroy it.

      Radiotherapy may also be used for both BCCs and SCCs especially in certain cases such as when the cancer covers a large area, is in an area of skin that is difficult to cut out or in the frail elderly. Chemotherapy or drug treatments may be used in some cases too. A newer type of treatment, called immunotherapy, stimulates the cells of the immune system to attack and kill the skin cancer cells. This may be useful for SCCs in the nose or mouth, for example or a BCC in the top layer of the skin. It is also used for a condition called Actinic Keratosis which is a very early stage of skin cancer.

    • profile image

      BBC 4 years ago

      Because melanoma is such an aggressive cancer, people with it are usually looked after by a team of specialists called a multidisciplinary team. In very early and superficial melanoma surgery alone, with careful surveillance follow-up afterwards may be all that is needed. But the larger the melanoma, the wider the piece of skin that must be removed from where it started in order to ensure that no cancerous cells were left behind and further operations may be needed. If there is a suspicion that the cancer may have spread beyond the skin layer, nearby lymph glands may need to be removed and examined under the microscope for spread of cancer cells.

      Chemotherapy or biological treatment such as interferon may be given to attempt to eradicate microscopic spread of skin cancer cells to other parts of the body, especially in melanoma. These are known as adjuvant therapy but it is not yet clear how effective they are at preventing recurrence of a melanoma, so you would only be offered these treatments as part of a research trial.

      If a melanoma has already spread, further surgery or laser treatment may be used to remove or destroy the cancerous cells. Chemotherapy and radiotherapy are sometimes used too. Biological therapies, which use chemical substances naturally made by the body such as antibodies, may be used in advanced melanoma while other research is looking at vaccines against the cancer.

    • profile image

      BBC 4 years ago

      In non-melanoma skin cancer, cure rates are very high and deaths uncommon - about 500 people died from these sorts of cancers each year (out of 100,000 diagnosed). In 2010 about 2,200 people died from melanoma skin cancer in the UK. Even so, more than 80 per cent of men and about 90 per cent of women are alive at five years following diagnosis and treatment.

    • profile image

      Preventing skin cancer 4 years ago

      The best way to prevent skin cancer is to avoid too much time in the sun. You don't have to be sunbathing to get burned. You can get too much sun while walking to the shops, driving a car with the windows down, even under light cloud cover. Time of day and location are important too. The intensity of UV radiation increases during the middle of the day, between April to September, nearer the equator and at higher altitudes.

      How to protect yourself and your children:

      Stick to the shade between 11am and 3pm

      Cover up with clothes, a wide brimmed hat and sunglasses

      Apply a high-factor sunscreen (minimum SPF15 and three stars) regularly

      Drink plenty of water to avoid overheating

      Avoid using sun lamps or sunbeds

    • profile image

      Watch those moles 4 years ago

      Many moles aren't cancerous, but it's vital to keep an eye on any you have. Watch out for moles that change shape or colour, become bigger, itchy or inflamed, or that weep or bleed. If you notice any changes or are worried, get them checked by a doctor.

      A stands for Asymmetry (i.e if the mole become irregular and asymmetrical in its shape)

      B is for Border - if the edges of the mole become irregular or jagged (smooth edged moles are less likely to be abnormal)

      C stands for Colour - particularly if the mole becomes uneven in its colour and develops several shades of pigment

      D is for Diameter - a mole that grows larger than the eraser on the end of a pencil (more than 6mm diameter) should be checked by a doctor

      E is for Evolution, which means change - be wary of any persistent change in a patch of skin, lump or mole

    • profile image

      MedicinePlus 4 years ago

      Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer, melanoma, is more dangerous but less common.

      Anyone can get skin cancer, but it is more common in people who

      Spend a lot of time in the sun or have been sunburned

      Have light-colored skin, hair and eyes

      Have a family member with skin cancer

      Are over age 50

      You should have your doctor check any suspicious skin markings and any changes in the way your skin looks. Treatment is more likely to work well when cancer is found early. If not treated, some types of skin cancer cells can spread to other tissues and organs.

    • profile image

      Definition 4 years ago

      Skin cancer — the abnormal growth of skin cells — most often develops on skin exposed to the sun. But this common form of cancer can also occur on areas of your skin not ordinarily exposed to sunlight.

      There are three major types of skin cancer — basal cell carcinoma, squamous cell carcinoma and melanoma.

      You can reduce your risk of skin cancer by limiting or avoiding exposure to ultraviolet (UV) radiation. Checking your skin for suspicious changes can help detect skin cancer at its earliest stages. Early detection of skin cancer gives you the greatest chance for successful skin cancer treatment.

    • profile image

      SYMPTOMS 4 years ago

      Where skin cancer develops

      Skin cancer develops primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it can also form on areas that rarely see the light of day — your palms, beneath your fingernails or toenails, and your genital area.

      Skin cancer affects people of all skin tones, including those with darker complexions. When melanoma occurs in people with dark skin tones, it's more likely to occur in areas not normally exposed to the sun.

      Basal cell carcinoma signs and symptoms

      Basal cell carcinoma usually occurs in sun-exposed areas of your body, such as your neck or face.

      Basal cell carcinoma may appear as:

      A pearly or waxy bump

      A flat, flesh-colored or brown scar-like lesion

      Squamous cell carcinoma signs and symptoms

      Most often, squamous cell carcinoma occurs on sun-exposed areas of your body, such as your face, ears and hands. People with darker skin are more likely to develop squamous cell carcinoma on areas that aren't often exposed to sun, such as the legs and feet.

      Squamous cell carcinoma may appear as:

      A firm, red nodule

      A flat lesion with a scaly, crusted surface

    • profile image

      Melanoma signs and symptoms 4 years ago

      Melanoma can develop anywhere on your body, in otherwise normal skin or in an existing mole that becomes cancerous. Melanoma most often appears on the trunk, head or neck of affected men. In women, this type of cancer most often develops on the lower legs. In both men and women, melanoma can occur on skin that hasn't been exposed to the sun.

      Melanoma can affect people of any skin tone. In people with darker skin tones, melanoma tends to occur on the palms or soles, or under the fingernails or toenails.

      Melanoma signs include:

      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

      Signs and symptoms of less common skin cancers

      Other, less common types of skin cancer include:

      Kaposi sarcoma. This rare form of skin cancer develops in the skin's blood vessels and causes red or purple patches on the skin or mucous membranes. Kaposi sarcoma mainly occurs in people with weakened immune systems, such as people with AIDS, and in people taking medications that suppress their natural immunity, such as people who've undergone organ transplants. Kaposi sarcoma can also occur in young men living in Africa or older men of Italian or eastern Jewish heritage.

      Merkel cell carcinoma. Merkel cell carcinoma causes firm, shiny nodules that occur on or just beneath the skin and in hair follicles. Merkel cell carcinoma is usually found on sun-exposed areas on the head, neck, arms and legs.

      Sebaceous gland carcinoma. This uncommon and aggressive cancer originates in the oil glands in the skin. Sebaceous gland carcinomas — which usually appear as hard, painless nodules — can develop anywhere, but most occur on the eyelid, where they're frequently mistaken for other eyelid problems.

    • profile image

      Causes 4 years ago

      Skin cancer occurs when errors (mutations) occur in the DNA of skin cells. The mutations cause the cells to grow out of control and form a mass of cancer cells.

      Cells involved in skin cancer

      Skin cancer begins in your skin's top layer &madash; the epidermis. The epidermis is a thin layer that provides a protective cover of skin cells that your body continually sheds. The epidermis contains three main types of cells:

      Squamous cells lie just below the outer surface and function as the skin's inner lining.

      Basal cells, which produce new skin cells, sit beneath the squamous cells.

      Melanocytes &madash; which produce melanin, the pigment that gives skin its normal color &madash; are located in the lower part of your epidermis. Melanocytes produce more melanin when you're in the sun to help protect the deeper layers of your skin.

      Where your skin cancer begins determines its type and your treatment options.

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      Ultraviolet light and other potential causes 4 years ago

      Much of the damage to DNA in skin cells results from ultraviolet (UV) radiation found in sunlight and in commercial tanning lamps and tanning beds. But sun exposure doesn't explain skin cancers that develop on skin not ordinarily exposed to sunlight. This indicates that other factors may contribute to your risk of skin cancer, such as being exposed to toxic substances or having a condition that weakens your immune system.

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      Risk Factors 4 years ago

      Factors that may increase your risk of skin cancer include:

      Fair skin. Anyone, regardless of skin color, can get skin cancer. However, having less pigment (melanin) in your skin provides less protection from damaging UV radiation. If you have blond or red hair and light-colored eyes, and you freckle or sunburn easily, you're much more likely to develop skin cancer than is a person with darker skin.

      A history of sunburns. Having had one or more blistering sunburns as a child or teenager increases your risk of developing skin cancer as an adult. Sunburns in adulthood also are a risk factor.

      Excessive sun exposure. Anyone who spends considerable time in the sun may develop skin cancer, especially if the skin isn't protected by sunscreen or clothing. Tanning, including exposure to tanning lamps and beds, also puts you at risk. A tan is your skin's injury response to excessive UV radiation.

      Sunny or high-altitude climates. People who live in sunny, warm climates are exposed to more sunlight than are people who live in colder climates. Living at higher elevations, where the sunlight is strongest, also exposes you to more radiation.

      Moles. People who have many moles or abnormal moles called dysplastic nevi are at increased risk of skin cancer. These abnormal moles — which look irregular and are generally larger than normal moles — are more likely than others to become cancerous. If you have a history of abnormal moles, watch them regularly for changes.

      Precancerous skin lesions. Having skin lesions known as actinic keratoses can increase your risk of developing skin cancer. These precancerous skin growths typically appear as rough, scaly patches that range in color from brown to dark pink. They're most common on the face, head and hands of fair-skinned people whose skin has been sun damaged.

      A family history of skin cancer. If one of your parents or a sibling has had skin cancer, you may have an increased risk of the disease.

      A personal history of skin cancer. If you developed skin cancer once, you're at risk of developing it again. Even basal cell and squamous cell carcinomas that have been successfully removed can recur.

      A weakened immune system. People with weakened immune systems have a greater risk of developing skin cancer. This includes people living with HIV/AIDS or leukemia and those taking immunosuppressant drugs after an organ transplant.

      Exposure to radiation. People who received radiation treatment for skin conditions such as eczema and acne may have an increased risk of skin cancer, particularly basal cell carcinoma.

      Exposure to certain substances. Exposure to certain substances, such as arsenic, may increase your risk of skin cancer.

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      Diagnosis 4 years ago

      Diagnosing skin cancer

      To diagnose skin cancer, your doctor may:

      Examine your skin. Your doctor may look at your skin to determine whether your skin changes are likely to be skin cancer. Further testing may be needed to confirm that diagnosis.

      Remove a sample of suspicious skin for testing (skin biopsy). Your doctor may remove a small sample of suspicious-looking skin for laboratory testing. A biopsy can determine whether you have skin cancer and, if so, what type of skin cancer you have.

      Determining the extent of the skin cancer

      If your doctor determines you have skin cancer, you may have additional tests to determine the extent (stage) of the skin cancer. Because superficial skin cancers such as basal cell carcinoma rarely spread, a biopsy which removes the entire growth often is the only test needed to determine the cancer stage. But if you have a large squamous cell carcinoma, Merkel cell carcinoma or melanoma, your doctor may recommend further tests to determine the extent of the cancer.

      Doctors use the Roman numerals I through IV to indicate a cancer's stage. Stage I cancers are small and limited to the area where they began. Stage IV indicates advanced cancer that has spread to other areas of the body.

      The skin cancer's stage helps determine which treatment options will be most effective.

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      Treatment & Drugs 4 years ago

      Treatment for skin cancer and the precancerous skin lesions known as actinic keratoses varies, depending on the size, type, depth and location of the lesions. Small skin cancers limited to the surface of the skin may not require treatment beyond an initial skin biopsy that removes the entire growth.

      If additional treatment is needed, options may include:

      Freezing. Your doctor may destroy actinic keratoses and some small, early skin cancers by freezing them with liquid nitrogen (cryosurgery). The dead tissue sloughs off when it thaws.

      Excisional surgery. This type of treatment may be appropriate for any type of skin cancer. Your doctor cuts out (excises) the cancerous tissue and a surrounding margin of healthy skin. A wide excision — removing extra normal skin around the tumor — may be recommended in some cases.

      Laser therapy. A precise, intense beam of light vaporizes growths, generally with little damage to surrounding tissue. A doctor may use this therapy to treat superficial skin cancers.

      Mohs surgery. This procedure is for larger, recurring or difficult-to-treat skin cancers, which may include both basal and squamous cell carcinomas. Your doctor removes the skin growth layer by layer, examining each layer under the microscope, until no abnormal cells remain. This procedure allows cancerous cells to be removed without taking an excessive amount of surrounding healthy skin.

      Curettage and electrodesiccation. After removing most of a growth, your doctor scrapes away layers of cancer cells using a circular blade (curet). An electric needle destroys any remaining cancer cells. This simple, quick procedure may be used to treat small or thin basal cell cancers or squamous cell cancers.

      Radiation therapy. Radiation may be used in situations when surgery isn't an option.

      Chemotherapy. In chemotherapy, drugs are used to kill cancer cells. For cancers limited to the top layer of skin, creams or lotions containing anti-cancer agents may be applied directly to the skin. Systemic chemotherapy can be used to treat skin cancers that have spread to other parts of the body.

      Photodynamic therapy (PDT). This treatment destroys skin cancer cells with a combination of laser light and drugs that makes cancer cells sensitive to light. PDT makes your skin sensitive to light, so you will need to avoid direct sunlight for at least six weeks after treatment.

      Biological therapy. Biological treatments stimulate your immune system in order to kill cancer cells. Biological therapy medications used to treat certain skin cancer include interferon and interleukin-2

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      Prevention 4 years ago

      Most skin cancers are preventable. To protect yourself, follow these skin cancer prevention tips:

      Avoid the sun during the middle of the day. For many people in North America, the sun's rays are strongest between about 10 a.m. and 4 p.m. Schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy. You absorb UV radiation year-round, and clouds offer little protection from damaging rays. Avoiding the sun at its strongest helps you avoid the sunburns and suntans that cause skin damage and increase your risk of developing skin cancer. Sun exposure accumulated over time also may cause skin cancer.

      Wear sunscreen year-round. Sunscreens don't filter out all harmful UV radiation, especially the radiation that can lead to melanoma. But they play a major role in an overall sun protection program. Use a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen generously, and reapply every two hours — or more often if you're swimming or perspiring. Use a generous amount of sunscreen on all exposed skin, including your lips, the tips of your ears, and the backs of your hands and neck.

      Wear protective clothing. Sunscreens don't provide complete protection from UV rays. So cover your skin with dark, tightly woven clothing that covers your arms and legs, and a broad-brimmed hat, which provides more protection than a baseball cap or visor does. Some companies also sell photoprotective clothing. A dermatologist can recommend an appropriate brand. Don't forget sunglasses. Look for those that block both types of UV radiation — UVA and UVB rays.

      Avoid tanning beds. Tanning beds emit UV rays and can increase your risk of skin cancer.

      Be aware of sun-sensitizing medications. Some common prescription and over-the-counter drugs, including antibiotics, can make your skin more sensitive to sunlight. Ask your doctor or pharmacist about the side effects of any medications you take. If they increase your sensitivity to sunlight, take extra precautions to stay out of the sun in order to protect your skin.

      Check your skin regularly and report changes to your doctor. Examine your skin often for new skin growths or changes in existing moles, freckles, bumps and birthmarks. With the help of mirrors, check your face, neck, ears and scalp. Examine your chest and trunk, and the tops and undersides of your arms and hands. Examine both the front and back of your legs, and your feet, including the soles and the spaces between your toes. Also check your genital area and between your buttocks.

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      Cancer Institute 4 years ago

      Definition of skin cancer: Cancer that forms in the tissues of the skin. There are several types of skin cancer. Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) is called basal cell carcinoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called neuroendocrine carcinoma of the skin. Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems.

      Estimated new cases and deaths from skin (nonmelanoma) cancer in the United States in 2012:

      New cases: more than 2,000,000

      Deaths: less than 1,000

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      Cancer Institute 4 years ago

      Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.

      The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of three kinds of cells:

      Squamous cells: Thin, flat cells that form the top layer of the epidermis.

      Basal cells: Round cells under the squamous cells.

      Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to darken.

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      Cancer Institute 4 years ago

      Skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, neck, hands, and arms.

      There are different types of cancer that start in the skin.

      The most common types are basal cell carcinoma and squamous cell carcinoma, which are nonmelanoma skin cancers. Nonmelanoma skin cancers rarely spread to other parts of the body. Melanoma is the rarest form of skin cancer. It is more likely to invade nearby tissues and spread to other parts of the body. Actinic keratosis is a skin condition that sometimes becomes squamous cell carcinoma.

      This summary is about nonmelanoma skin cancer and actinic keratosis. See the following PDQ summaries for information on melanoma and other kinds of cancer that affect the skin:

      Melanoma Treatment

      Mycosis Fungoides and the Sézary Syndrome Treatment

      Kaposi Sarcoma Treatment

      Merkel Cell Carcinoma Treatment

      Unusual Cancers of Childhood

      Genetics of Skin Cancer

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      Cancer Institute 4 years ago

      Skin color and being exposed to sunlight can increase the risk of nonmelanoma skin cancer and actinic keratosis.

      Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for basal cell carcinoma and squamous cell carcinoma include the following:

      Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.

      Having a fair complexion, which includes the following:

      Fair skin that freckles and burns easily, does not tan, or tans poorly.

      Blue or green or other light-colored eyes.

      Red or blond hair.

      Having actinic keratosis.

      Past treatment with radiation.

      Having a weakened immune system.

      Having certain changes in the genes that are linked to skin cancer.

      Being exposed to arsenic.

      Risk factors for actinic keratosis include the following:

      Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.

      Having a fair complexion, which includes the following:

      Fair skin that freckles and burns easily, does not tan, or tans poorly.

      Blue or green or other light-colored eyes.

      Red or blond hair.

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      Cancer Institute 4 years ago

      Nonmelanoma skin cancer and actinic keratosis often appear as a change in the skin.

      Not all changes in the skin are a sign of nonmelanoma skin cancer or actinic keratosis. Check with your doctor if you notice any changes in your skin.

      Possible signs of nonmelanoma skin cancer include the following:

      A sore that does not heal.

      Areas of the skin that are:

      Raised, smooth, shiny, and look pearly.

      Firm and look like a scar, and may be white, yellow, or waxy.

      Raised, and red or reddish-brown.

      Scaly, bleeding or crusty.

      Possible signs of actinic keratosis include the following:

      A rough, red, pink, or brown, raised, scaly patch on the skin that may be flat or raised.

      Cracking or peeling of the lower lip that is not helped by lip balm or petroleum jelly.

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      Cancer Institute 4 years ago

      There are three main types of skin cancer:

      Basal cell carcinoma (BCC).

      Squamous cell carcinoma (SCC).

      Melanoma.

      BCC and SCC are the most common forms of skin cancer and are collectively referred to as nonmelanoma skin cancers. This summary only covers the treatment of nonmelanoma skin cancers. (Refer to the PDQ summary on Melanoma Treatment for more information.)

      Incidence and Mortality

      Nonmelanoma skin cancer is the most commonly occurring cancer in the United States. BCC is the more common type of the two nonmelanoma types, accounting for about three-quarters of nonmelanoma skin cancers.[1] The incidence of nonmelanoma skin cancer appears to be increasing in some,[2] but not all [3] areas of the United States. Overall U.S. incidence rates have likely been increasing for a number of years.[4] At least some of this increase may be attributable to increasing skin cancer awareness and resulting increasing investigation and biopsy of skin lesions.

      Precise estimation of the total numbers and incidence rate of nonmelanoma skin cancer is not possible because reporting to cancer registries is not required. However, based on Medicare fee-for-service data, which were then extrapolated to the U.S. population, an estimated 2,152,500 persons were treated for nonmelanoma skin cancers in 2006.[4] That number would exceed all other cases of cancer estimated by the American Cancer Society for that year, which was about 1.4 million.[5] Although the two types of nonmelanoma skin cancer are the most common of all malignancies, they account for less than 0.1% of patient deaths caused by cancer.

      Risk Factors

      Epidemiologic evidence suggests that exposure to ultraviolet (UV) radiation and the sensitivity of an individual’s skin to UV radiation are risk factors for skin cancer, though the type of exposure (i.e., high-intensity exposure and short-duration exposure vs. chronic exposure) and pattern of exposure (i.e., continuous pattern vs. intermittent pattern) may differ among the three main skin cancer types.[6-8] All three types of skin cancer are more likely to occur in individuals of light complexion who have had substantial exposure to sunlight, and skin cancers are more common in the southern latitudes of the Northern hemisphere. In addition, the immune system may play a role in pathogenesis of skin cancers.

      Organ transplant recipients receiving immunosuppressive drugs are at an elevated risk of skin cancers, particularly SCC. Arsenic exposure also increases the risk of cutaneous SCC.[1] Serologic evidence from a population-based case-control study has shown a possible association between infection with the human papilloma virus (HPV) genus beta-species 1 and SCC.

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      Merkel Cell Carcinoma 4 years ago

      Merkel cell carcinoma is a very rare disease in which malignant (cancer) cells form in the skin.

      Merkel cells are found in the top layer of the skin. These cells are very close to the nerve endings that receive the sensation of touch. Merkel cell carcinoma, also called neuroendocrine carcinoma of the skin or trabecular cancer, is a very rare type of skin cancer that forms when Merkel cells grow out of control. Merkel cell carcinoma starts most often in areas of skin exposed to the sun, especially the head and neck, as well as the arms, legs, and trunk.

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      Merkel Cell Carcinoma 4 years ago

      Merkel cell carcinoma tends to grow quickly and to metastasize (spread) at an early stage. It usually spreads first to nearby lymph nodes and then may spread to lymph nodes or skin in distant parts of the body, lungs, brain, bones, or other organs.

      Sun exposure and having a weak immune system can affect the risk of Merkel cell carcinoma.

      Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for Merkel cell carcinoma include the following:

      Being exposed to a lot of natural sunlight.

      Being exposed to artificial sunlight, such as from tanning beds or psoralen and ultraviolet A (PUVA) therapy for psoriasis.

      Having an immune system weakened by disease, such as chronic lymphocytic leukemia or HIV infection.

      Taking drugs that make the immune system less active, such as after an organ transplant.

      Having a history of other types of cancer.

      Being older than 50 years, male, or white.

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      Merkel Cell Carcinoma 4 years ago

      Merkel cell carcinoma usually appears as a single painless lump on sun-exposed skin.

      This and other changes in the skin may be caused by Merkel cell carcinoma. Other conditions may cause the same symptoms. Check with your doctor if you see changes in your skin.

      Merkel cell carcinoma usually appears on sun-exposed skin as a single lump that is:

      Fast-growing.

      Painless.

      Firm and dome-shaped or raised.

      Red or violet in color.

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      Merkel Cell Carcinoma 4 years ago

      Tests and procedures that examine the skin are used to detect (find) and diagnose Merkel cell carcinoma.

      The following tests and procedures may be used:

      Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

      Full-body skin exam: A doctor or nurse checks the skin for bumps or spots that look abnormal in color, size, shape, or texture. The size, shape, and texture of the lymph nodes will also be checked.

      Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

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      Merkel Cell Carcinoma 4 years ago

      Certain factors affect prognosis (chance of recovery) and treatment options.

      The prognosis (chance of recovery) and treatment options depend on the following:

      The stage of the cancer (the size of the tumor and whether it has spread to the lymph nodes or other parts of the body).

      Where the cancer is in the body.

      Whether the cancer has just been diagnosed or has recurred (come back).

      The patient's age and general health.

      Prognosis also depends on how deeply the tumor has grown into the skin.

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      Merkel Cell Carcinoma 4 years ago

      Merkel cell carcinoma (MCC) was originally described by Toker in 1972 as trabecular carcinoma of the skin.[1] Other names include Toker tumor, primary small cell carcinoma of the skin, primary cutaneous neuroendocrine tumor, and malignant trichodiscoma.[2]

      MCC is an aggressive neuroendocrine carcinoma arising in the dermoepidermal junction. (See Figure 1.) Although the exact origin and function of the Merkel cell remains under investigation, it is thought to have features of both epithelial and neuroendocrine origin and arise in cells with touch-sensitivity function (mechanoreceptors)

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      Merkel Cell Carcinoma 4 years ago

      In Surveillance, Epidemiology and End Results (SEER) Program data from 1986 to 2001, the age-adjusted U.S. annual incidence of MCC tripled from 0.15 to 0.44 per 100,000, an increase of 8.08% per year. Although this rate of increase is faster than any other skin cancer including melanoma, the absolute number of U.S. cases per year is small. About 1,500 new cases of MCC were expected in the United States in 2007.

      MCC incidence increases progressively with age. There are few cases in patients younger than 50 years, and the median age at diagnosis is about 65 years (see Figure 2).[11] Incidence is considerably greater in whites than blacks and slightly greater in males than females.

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      Merkel Cell Carcinoma 4 years ago

      The apparent increase in incidence may reflect an actual increase and/or more accurate diagnostic pathology tools, improved clinical awareness of MCC, an aging population, increased sun exposure in susceptible populations, and improved registry tools.

      MCC occurs most frequently in sun-exposed areas of skin, particularly the head and neck, followed by the extremities, and then the trunk.[3,13,16] Incidence has been reported to be greater in geographic regions with higher levels of ultraviolet B sunlight.[13]

      A 2009 review of 3,804 MCC cases from the SEER Program database from 1973–2000 tabulated the ten most common sites of MCC

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      Merkel Cell Carcinoma 4 years ago

      In various cases series, up to 97% of MCCs arise in skin. Primaries in other sites were very rare, as are MCCs from unknown primary sites.[15]

      SEER registry data have shown excess risk of MCC as a first or second cancer in patients with several primary cancers.[17] National cancer registries from three Scandinavian countries have identified a variety of second cancers diagnosed after MCC.[18]

      Increased incidence of MCC has also been seen in people treated heavily with methoxsalen (psoralen) and ultraviolet A (PUVA) for psoriasis (3 of 1,380 patients, 0.2%), and those with chronic immune suppression, especially from chronic lymphocytic leukemia, human immunodeficiency virus, and prior solid organ transplant.[13,19]

      In 2008, a novel polyomavirus (Merkel cell polyoma virus, MCPyV) was first reported in MCC tumor specimens [20], a finding subsequently confirmed in other laboratories.[21-23] High levels of viral DNA and clonal integration of the virus in MCC tumors have also been reported [24] along with expression of certain viral antigens in MCC cells and the presence of antiviral antibodies. Not all cases of MCC appear to be associated with Merkel cell polyomavirus infection.[25]

      MCPyV has been detected at very low levels in normal skin distant from the MCC primary, in a significant percentage of patients with non-MCC cutaneous disorders, in normal appearing skin in healthy individuals, and in nonmelanoma skin cancers in immune-suppressed individuals.[8,26-28] Various methods have been used to identify and quantify the presence of MCPyV in MCC tumor specimens, other non-MCC tumors, blood, urine, and other tissues.[29,30]

      The significance of the new MCPyV findings remains uncertain. The prognostic significance of viral load, antibody titer levels, and the role of underlying immunosuppression in hosts (from disease and medications) are under investigation.

      Prevalence of MCPyV appears to differ between MCC patients in the the United States and Europe versus Australia. It has been suggested that there may be two independent pathways for the development of MCC: one driven by the presence of MCPyV, and the other driven primarily by sun damage, especially as noted in patient series from Australia.

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      Cancer Institute 4 years ago

      Clinical Presentation

      MCC usually presents as a painless, indurated, solitary dermal nodule with a slightly erythematous to deeply violaceous color, and rarely, an ulcer. MCC can infiltrate locally via dermal lymphatics, resulting in multiple satellite lesions. Because of its nonspecific clinical appearance, MCC is rarely suspected prior to biopsy.[3] Photographs of MCC skin lesions illustrate its clinical variability.[32]

      A mnemonic [16] summarizing typical clinical characteristics of MCC has been proposed:

      AEIOU

      A=Asymptomatic.

      E=Expanding rapidly.

      I=Immune suppressed.

      O=Older than 50 years.

      U=UV-exposed skin.

      Not all patients have every element in this mnemonic; however, in this study, 89% of patients met three or more criteria, 52% met four or more criteria, and 7% met all five criteria.[16]

      Initial Clinical Evaluation

      Because local-regional spread is common, newly diagnosed MCC patients require a careful clinical examination that includes looking for satellite lesions and regional nodal involvement.

      An imaging work-up should be tailored to the clinical presentation as well as any relevant signs and symptoms. There has been no systematic study of the optimal imaging work-up for newly diagnosed patients, and it is not clear if all newly diagnosed patients, especially those with the smallest primaries, benefit from a detailed imaging work-up.

      If an imaging work-up is performed, it may include a computed tomography (CT) scan of the chest and abdomen to rule out primary small cell lung cancer as well as distant and regional metastases. Imaging studies designed to evaluate suspicious signs and symptoms may also be recommended. In one series, CT scans had an 80% false-negative rate for regional metastases.[33] Head and neck presentations may require additional imaging. Magnetic resonance imaging has been used to evaluate MCC but has not been studied systematically.[34] Fluorodeoxyglucose-positron emission tomography results have been reported only in selected cases.[35,36] Routine blood work as a baseline has been recommended but has not been studied systematically. There are no known circulating tumor markers specifically for MCC.

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      Cancer Institute 4 years ago

      Initial Staging Results

      The results of initial clinical staging of MCC vary widely in the literature, based on retrospective case series reported over decades. In 2009, 3,870 MCC cases were reported from the SEER Program registry. For invasive cancers, 48.6% were localized, 31.1% were regional, and 8.2% were distant.[15]

      MCC that presents in regional nodes without an identifiable primary lesion is found in a minority of patients, with the percent of these cases varying among the reported series. Tumors without an identifiable primary lesion have been attributed to either spontaneous regression of the primary or metastatic neuroendocrine carcinoma from a clinically occult site.

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      Cancer Institute 4 years ago

      Clinical Progression

      In a review of patients from 18 case series, 279 of 926 patients (30.1%) developed local recurrence during follow-up, excluding those presenting with distant metastatic disease. These events have been typically attributed to inadequate surgical margins and/or a lack of adjuvant radiation therapy. In addition, 545 of 982 patients (55.5%) had lymph node metastases at diagnosis or during follow-up.[6]

      In the same review of 18 case series, the most common sites of distant metastases were distant lymph nodes (60.1%), distant skin (30.3%), lung (23.4%), central nervous system (18.4%), and bone (15.2%).[6] Many other sites of disease have also been reported, and the distribution of metastatic sites varies among case series.

      In one series of 237 patients presenting with local or regional disease, the median time-to-recurrence was 9 months (range, 2–70 months). Ninety-one percent of recurrences occurred within 2 years of diagnosis.[

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      Cancer Institute 4 years ago

      Potential Prognostic Factors

      The extent of disease at presentation appears to provide the most useful estimate of prognosis.[5]

      Diagnostic procedures, such as sentinel lymph node biopsy, may help distinguish between local and regional disease at presentation. One-third of patients who lack clinically palpable or radiologically visible nodes will have microscopically evident regional disease.[33] The likelihood is that nodal positivity may be substantially lower among patients with small tumors (e.g., ≤1.0 cm).[40]

      Many retrospective studies have evaluated the relationship of a wide variety of biological and histological factors to survival and local-regional control.[5,6,15,33,39,41-52][Level of evidence: 3iiiDiii] Many of these reports are confounded by small numbers, potential selection bias, referral bias, short follow-up, no uniform clinical protocol for both staging and treatment, and are underpowered to detect modest differences.

      A large, single-institution, retrospective study of 156 MCC patients, with a median follow-up of 51 months (range 2–224 months), evaluated histologic factors potentially associated with prognosis.[50][Level of evidence: 3iiiB] Although this report is subject to potential selection and referral bias, both univariate and multivariate analyses demonstrated a relationship between improved cause-specific survival and circumscribed growth pattern versus infiltrative pattern, shallow-tumor depth versus deep-tumor depth, and absence of lymphovascular invasion versus presence of lymphovascular invasion. Adoption of these findings into a global prognostic algorithm awaits independent confirmation by adequately powered studies.

      A 2009 study investigated whether the presence of newly identified MCPyV in MCC tumor specimens influenced clinical outcome among 114 Finnish patients with MCC. In this small study, patients whose tumors were MCPyV+ appeared to have better survival than patients whose tumors were MCPyV-.Level of evidence: Standardization of procedures to identify and quantify MCPyV and relevant antibodies is needed to improve understanding of both prognostic and epidemiologic questions.

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      Cancer Institute 4 years ago

      Prognosis

      The bulk of MCC literature is from small case series, which are subject to many confounding factors (refer to the Prognostic Factors section of this summary). For this reason, the relapse and survival rates reported by stage vary widely in the literature. In general, lower-stage disease is associated with better overall survival.[54]

      Outcomes from patients presenting with small volume local disease and pathologically confirmed cancer-negative lymph nodes report a cause-specific 5-year survival exceeding 90% in one report.[39,50][Level of evidence: 3iiiDiii]

      A tabular summary of treatment results of MCC from 12 series illustrates the difficulty in comparing outcome data among series.[5]

      Using the SEER Program registry MCC staging system adopted in 1973, MCC survival data (1973–2006) by stage is summarized below:

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      Cryosurgery in Cancer Treatment: Questions and Answers 4 years ago

      Cryosurgery is a technique for freezing and killing abnormal cells. It is used to treat some kinds of cancer and some precancerous or noncancerous conditions, and can be used inside the body and on the skin (see Question 1).

      Cryosurgery is an alternative to surgery for liver cancer that has not spread, for cancer that has spread to the liver from another site, for prostate cancer confined to the prostate gland, for a precancerous condition of the cervix, and for cancerous and noncancerous tumors of the bone (see Questions 2, 3, and 4).

      Cryosurgery may have fewer side effects than other types of treatments, and is less expensive and requires shorter recovery times (see Questions 5 and 6).

      The technique is still under study, and its long-term effectiveness is not known (see Questions 7 and 8).

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      What is cryosurgery? 4 years ago

      Cryosurgery (also called cryotherapy) is the use of extreme cold produced by liquid nitrogen (or argon gas) to destroy abnormal tissue. Cryosurgery is used to treat external tumors, such as those on the skin. For external tumors, liquid nitrogen is applied directly to the cancer cells with a cotton swab or spraying device.

      Cryosurgery is also used to treat tumors inside the body (internal tumors and tumors in the bone). For internal tumors, liquid nitrogen or argon gas is circulated through a hollow instrument called a cryoprobe, which is placed in contact with the tumor. The doctor uses ultrasound or MRI to guide the cryoprobe and monitor the freezing of the cells, thus limiting damage to nearby healthy tissue. (In ultrasound, sound waves are bounced off organs and other tissues to create a picture called a sonogram.) A ball of ice crystals forms around the probe, freezing nearby cells. Sometimes more than one probe is used to deliver the liquid nitrogen to various parts of the tumor. The probes may be put into the tumor during surgery or through the skin (percutaneously). After cryosurgery, the frozen tissue thaws and is either naturally absorbed by the body (for internal tumors), or it dissolves and forms a scab (for external tumors).

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      What types of cancer can be treated with cryosurgery? 4 years ago

      Cryosurgery is used to treat several types of cancer, and some precancerous or noncancerous conditions. In addition to prostate and liver tumors, cryosurgery can be an effective treatment for the following:

      Retinoblastoma (a childhood cancer that affects the retina of the eye). Doctors have found that cryosurgery is most effective when the tumor is small and only in certain parts of the retina.

      Early-stage skin cancers (both basal cell and squamous cell carcinomas).

      Precancerous skin growths known as actinic keratosis.

      Precancerous conditions of the cervix known as cervical intraepithelial neoplasia (abnormal cell changes in the cervix that can develop into cervical cancer).

      Cryosurgery is also used to treat some types of low-grade cancerous and noncancerous tumors of the bone. It may reduce the risk of joint damage when compared with more extensive surgery, and help lessen the need for amputation. The treatment is also used to treat AIDS-related Kaposi sarcoma when the skin lesions are small and localized.

      Researchers are evaluating cryosurgery as a treatment for a number of cancers, including breast, colon, and kidney cancer. They are also exploring cryotherapy in combination with other cancer treatments, such as hormone therapy, chemotherapy, radiation therapy, or surgery.

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      In what situations can cryosurgery be used to treat prostate cancer? What are the side effects? 4 years ago

      Cryosurgery can be used to treat men who have early-stage prostate cancer that is confined to the prostate gland. It is less well established than standard prostatectomy and various types of radiation therapy. Long-term outcomes are not known. Because it is effective only in small areas, cryosurgery is not used to treat prostate cancer that has spread outside the gland, or to distant parts of the body.

      Some advantages of cryosurgery are that the procedure can be repeated, and it can be used to treat men who cannot have surgery or radiation therapy because of their age or other medical problems.

      Cryosurgery for the prostate gland can cause side effects. These side effects may occur more often in men who have had radiation to the prostate.

      Cryosurgery may obstruct urine flow or cause incontinence (lack of control over urine flow); often, these side effects are temporary.

      Many men become impotent (loss of sexual function).

      In some cases, the surgery has caused injury to the rectum.

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      cryosurgery 4 years ago

      In what situations can cryosurgery be used to treat primary liver cancer or liver metastases (cancer that has spread to the liver from another part of the body)? What are the side effects?

      Cryosurgery may be used to treat primary liver cancer that has not spread. It is used especially if surgery is not possible due to factors such as other medical conditions. The treatment also may be used for cancer that has spread to the liver from another site (such as the colon or rectum). In some cases, chemotherapy and/or radiation therapy may be given before or after cryosurgery. Cryosurgery in the liver may cause damage to the bile ducts and/or major blood vessels, which can lead to hemorrhage (heavy bleeding) or infection.

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      cryosurgery 4 years ago

      Does cryosurgery have any complications or side effects?

      Cryosurgery does have side effects, although they may be less severe than those associated with surgery or radiation therapy. The effects depend on the location of the tumor. Cryosurgery for cervical intraepithelial neoplasia has not been shown to affect a woman's fertility, but it can cause cramping, pain, or bleeding. When used to treat skin cancer (including Kaposi sarcoma), cryosurgery may cause scarring and swelling; if nerves are damaged, loss of sensation may occur, and, rarely, it may cause a loss of pigmentation and loss of hair in the treated area. When used to treat tumors of the bone, cryosurgery may lead to the destruction of nearby bone tissue and result in fractures, but these effects may not be seen for some time after the initial treatment and can often be delayed with other treatments. In rare cases, cryosurgery may interact badly with certain types of chemotherapy. Although the side effects of surgery may be less severe than those associated with conventional surgery or radiation, more studies are needed to determine the long-term effects.

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      cryosurgery 4 years ago

      What are the advantages of cryosurgery?

      Cryosurgery offers advantages over other methods of cancer treatment. It is less invasive than surgery, involving only a small incision or insertion of the cryoprobe through the skin. Consequently, pain, bleeding, and other complications of surgery are minimized. Cryosurgery is less expensive than other treatments and requires shorter recovery time and a shorter hospital stay, or no hospital stay at all. Sometimes cryosurgery can be done using only local anesthesia.

      Because physicians can focus cryosurgical treatment on a limited area, they can avoid the destruction of nearby healthy tissue. The treatment can be safely repeated and may be used along with standard treatments such as surgery, chemotherapy, hormone therapy, and radiation. Cryosurgery may offer an option for treating cancers that are considered inoperable or that do not respond to standard treatments. Furthermore, it can be used for patients who are not good candidates for conventional surgery because of their age or other medical conditions.

      What are the disadvantages of cryosurgery?

      The major disadvantage of cryosurgery is the uncertainty surrounding its long-term effectiveness. While cryosurgery may be effective in treating tumors the physician can see by using imaging tests (tests that produce pictures of areas inside the body), it can miss microscopic cancer spread. Furthermore, because the effectiveness of the technique is still being assessed, insurance coverage issues may arise.

      What does the future hold for cryosurgery?

      Additional studies are needed to determine the effectiveness of cryosurgery in controlling cancer and improving survival. Data from these studies will allow physicians to compare cryosurgery with standard treatment options such as surgery, chemotherapy, and radiation. Moreover, physicians continue to examine the possibility of using cryosurgery in combination with other treatments.

      Where is cryosurgery currently available?

      Cryosurgery is widely available in gynecologists' offices for the treatment of cervical neoplasias. A limited number of hospitals and cancer centers throughout the country currently have skilled doctors and the necessary technology to perform cryosurgery for other noncancerous, precancerous, and cancerous conditions. Individuals can consult with their doctors or contact hospitals and cancer centers in their area to find out where cryosurgery is being used.

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      Skin cancer facts 4 years ago

      There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.

      Skin cancer is the most common form of cancer in humans.

      Ultraviolet light, which is in sunlight, is the main cause of skin cancer.

      The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal. Unexplained changes in the appearance of the skin lasting longer than two weeks should be evaluated by a doctor.

      Nonmelanoma skin cancer is generally curable. The cure rate for nonmelanoma skin cancer could be 100% if these lesions were brought to a doctor's attention before they had a chance to spread.

      Treatment of nonmelanoma skin cancer depends on the type and location of the skin cancer, the risk of scarring, as well as the age and health of the patient. Methods used include curettage and desiccation, surgical excision, cryosurgery, radiation, and Mohs micrographic surgery.

      Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.

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      Introduction 4 years ago

      Skin cancer is the most common form of human cancer. It is estimated that over 1 million new cases occur annually. The annual rates of all forms of skin cancer are increasing each year, representing a growing public concern. It has also been estimated that nearly half of all Americans who live to age 65 will develop skin cancer at least once.

      The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal.

      The term "skin cancer" refers to three different conditions. From the least to the most dangerous, they are:

      basal cell carcinoma (or basal cell carcinoma epithelioma)

      squamous cell carcinoma (the first stage of which is called actinic keratosis)

      melanoma

      The two most common forms of skin cancer are basal cell carcinoma and squamous cell carcinoma. Together, these two are also referred to as nonmelanoma skin cancer. Melanoma is generally the most serious form of skin cancer because it tends to spread (metastasize) throughout the body quickly. Skin cancer is also known as skin neoplasia.

      This article will discuss the two kinds of nonmelanoma skin cancer.

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      Basal cell carcinoma 4 years ago

      What is basal cell carcinoma?

      Basal cell carcinoma is the most common form of skin cancer and accounts for more than 90% of all skin cancer in the U.S. These cancers almost never spread (metastasize) to other parts of the body. They can, however, cause damage by growing and invading surrounding tissue.

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      MedicineNet 4 years ago

      What are risk factors for developing basal cell carcinoma?

      Light-colored skin, sun exposure, and age are all important factors in the development of basal cell carcinomas. People who have fair skin and are older have higher rates of basal cell carcinoma. About 20% of these skin cancers, however, occur in areas that are not sun-exposed, such as the chest, back, arms, legs, and scalp. The face, however, remains the most common location for basal cell lesions. Weakening of the immune system, whether by disease or medication, can also promote the risk of developing basal cell carcinoma. Other risk factors include

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      MedicineNet 4 years ago

      exposure to sun. There is evidence that, in contrast to squamous cell carcinoma, basal cell carcinoma is promoted not by accumulated sun exposure but by intermittent sun exposure like that received during vacations, especially early in life. According to the U.S. National Institutes of Health, ultraviolet (UV) radiation from the sun is the main cause of skin cancer. The risk of developing skin cancer is also affected by where a person lives. People who live in areas that receive high levels of UV radiation from the sun are more likely to develop skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, which are areas that receive high amounts of UV radiation.

      age. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age. Therefore, protection should start in childhood in order to prevent skin cancer later in life.

      exposure to ultraviolet radiation in tanning booths. Tanning booths are very popular, especially among adolescents, and they even let people who live in cold climates radiate their skin year-round.

      therapeutic radiation, such as that given for treating other forms of cancer.

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      What does basal cell carcinoma look like? 4 years ago

      A basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by small, superficial blood vessels called telangiectases. The texture of such a spot is often shiny and translucent, sometimes referred to as "pearly." It is often hard to tell a basal cell carcinoma from a benign growth like a flesh-colored mole without performing a biopsy. Some basal cell carcinomas contain melanin pigment, making them look dark rather than shiny.

      Superficial basal cell carcinomas often appear on the chest or back and look more like patches of raw, dry skin. They grow slowly over the course of months or years.

      Basal cell carcinomas grow slowly, taking months or even years to become sizable. Although spread to other parts of the body (metastasis) is very rare, a basal cell carcinoma can damage and disfigure the eye, ear, or nose if it grows nearby.

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      How is basal cell carcinoma diagnosed? 4 years ago

      To make a proper diagnosis, doctors usually remove all or part of the growth by performing a biopsy. This usually involves taking a sample by injecting a local anesthesia and scraping a small piece of skin. This method is referred to as a shave biopsy. The skin that is removed is then examined under a microscope to check for cancer cells.

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      How is basal cell carcinoma treated? 4 years ago

      There are many ways to successfully treat a basal cell carcinoma with a good chance of success of 90% or more. The doctor's main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history.

      Methods used to treat basal cell carcinomas include:

      Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.

      Surgical excision: The tumor is cut out and stitched up.

      Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions, perhaps 25 to 30.

      Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.

      Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed "microscopically controlled excision." The surgeon meticulously removes a small piece of the tumor and examines it under the microscope during surgery. This sequence of cutting and microscopic examination is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. Cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, forehead, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible postsurgical appearance.

      Medical therapy using creams that attack cancer cells (5-Fluorouracil--5-FU, Efudex, Fluoroplex) or stimulate the immune system (imiquimod [Aldara]). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.

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      How is squamous cell carcinoma prevented? 4 years ago

      Even more so than is the case with basal cell carcinoma, the key principles of prevention are minimizing sun exposure and getting regular checkups.

      Common-sense preventive techniques are the same as for basal cell carcinoma and include

      limiting recreational sun exposure;

      avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);

      wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun;

      regularly using a waterproof or water-resistant sunscreen with UVA protection and SPF 30 or higher;

      undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of a doctor; and

      avoiding the use of tanning beds and using a sunscreen with an SPF 30 and protection against UVA (long waves of ultraviolet light). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a "base coat" to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every two to three hours, especially after swimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as "waterproof."

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      follow-up care for skin cancer? 4 years ago

      Skin cancer has a better prognosis, or outcome, than most other types of cancer. It is generally curable. Even though most skin cancers are cured, people who have been treated for skin cancer have a higher-than-average risk of developing a new cancer of the skin. This is the reason why it is so important for patients to continue to examine themselves regularly, visit their doctor for regular checkups, and follow their doctor's instructions on how to reduce their risk of developing skin cancer again.

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      How about vitamin D and cancer? 4 years ago

      Some recent reports suggest that getting vitamin D from sun exposure may prevent the occurrence and spread of cancers, both of internal organs and of the skin. In spite of the occasional controversy surrounding these studies, their common-sense implications are simple enough. Even those doctors who recommend sun for vitamin D only suggest 15 minutes a few times a week. For most people, especially those who have day jobs or live in cooler climates, following this advice is not likely to result in markedly higher risk of skin cancer. No responsible authority suggests that to help with vitamin D, people ought to sunbathe or visit tanning salo

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      The skin 4 years ago

      The skin has many purposes.

      The skin:

      protects the body from injury and infection

      helps to regulate body temperature

      helps to control fluid loss

      gets rid of waste substances through the sweat glands.

      The skin is divided into two main layers: the outer layer known as the epidermis and a layer underneath called the dermis.

      Underneath these is a deeper layer made up of fatty tissue. The epidermis contains three types of cells. Most of the epidermis is filled with cells known as squamous cells. At the base of the squamous cells are rounder cells called basal cells. In between the basal cells are other cells called melanocytes. Melanocytes produce the pigment melanin. It’s this pigment that gives skin its colour.

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      What is cancer? 4 years ago

      There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

      Basal cell carcinoma

      Squamous cell carcinoma

      Malignant melanoma

      Rarer types of non-melanoma skin cancer

      Bowen's disease

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      Basal cell carcinoma 4 years ago

      Basal cell carcinoma, or BCC, is a cancer of the basal cells at the bottom of the epidermis. It’s very common and accounts for more than 75% of all skin cancers in the UK. Most BCCs are very slow-growing and almost never spread to other parts of the body. They often start as a small, red, shiny spot or nodule that may bleed occasionally.

      In many BCCs, the skin over the top can remain intact for many months. Eventually they may develop into an ulcer that doesn’t heal. When BCCs are treated at an early stage, most of the time they are completely cured. However, some BCCs are aggressive, and if left to grow they may spread into the deeper layers of the skin and sometimes to the bones, making treatment difficult.

      A small number of BCCs may also come back in the same area of skin after treatment. This is known as a local recurrence.

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      Squamous cell carcinoma 4 years ago

      Squamous cell carcinoma, or SCC, is a cancer of the cells (called keratinocytes) found in the outermost layer of the skin (the epidermis). It’s the second most common type of skin cancer in the UK. One in five skin cancers (20%) are this type. Usually squamous cell carcinomas are slow-growing and only spread to other parts of the body if they are left untreated for a long time. Occasionally though, they can behave more aggressively and spread at a relatively early stage. However, most people treated for SCC are completely cured with simple treatment.

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      Malignant melanoma 4 years ago

      This is a less common type of skin cancer than the two other types mentioned in this section. About 11,000 people in the UK are diagnosed with malignant melanoma each year. Melanoma behaves differently to basal cell and squamous cell cancers. It can grow quickly and needs to be treated early.

      We have separate information on malignant melanoma.

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      Rarer types of non-melanoma skin cancer 4 years ago

      There are a number of other rare types of cancer that can occur in the skin:

      Merkel cell carcinoma

      Kaposi's sarcoma

      cutaneous T-cell lymphoma of the skin

      sarcoma.

      These make up less than 1 in 100 (1%) of all skin cancers in the UK.

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      Bowen's disease 4 years ago

      Bowen’s disease is a precancerous skin condition caused by abnormal cells growing in the epidermis. These cells are not invasive or malignant (cancerous). If left untreated, Bowen’s disease may develop into squamous cell carcinoma.

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      Sun exposure 4 years ago

      UV light damages skin cells and can cause skin cancer. Episodes of overexposure to the sun or sunburn in childhood are important risk factors in the development of basal cell cancers. It’s likely that skin damage from UV light that occurs in childhood doesn’t show up until many years later. Sun exposure over a lifetime is more significant for squamous cell cancers.

      Skin cancer is more common than it used to be and there are several possible reasons for this. People are living longer so their lifetime sun exposure is greater. They often spend more time enjoying outdoor activities and holidays in sunny climates, and many people still consider suntans to be healthy and attractive. There’s also been an increase in skin cancer awareness in recent years.

      People who work outdoors for a living, such as farm workers, builders and gardeners, are at an increased risk of developing skin cancer because of prolonged exposure to the sun. This is relevant for both squamous cell and basal cell cancers.

      A fair-skinned person who tends to go red or freckle in the sun will be most at risk. Children and young adults who have been overexposed to the sun have an increased risk of developing some form of skin cancer, especially if they have fair skin. This will not show up until later on in life – usually after the age of 40, and often not until the age of 60 or 70. Black- or brown-skinned people have an extremely low risk of developing skin cancer because the pigment melanin in their skin gives them protection.

      The regular use of sunlamps and sunbeds can increase the risk of developing some skin cancers. This is seen mainly in people who have used them excessively for many years.

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      Previous skin cancer 4 years ago

      If you’ve previously had a skin cancer, you’re at risk of developing another one, either in the same place as before or somewhere else on your body.

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      Previous radiotherapy treatment 4 years ago

      Previous radiotherapy treatment for other conditions can sometimes cause skin cancer (particularly basal cell carcinoma) in the treatment area later in life.

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      Lowered immunity 4 years ago

      People who have to take drugs that lower their immunity (immunosuppressants) – for example, after a kidney transplant – are at an increased risk of getting skin cancer. Squamous cell cancers are the most frequent, but basal cell cancers and melanomas are also more common in these people than in the general population.

      However, the reason for taking the immunosuppressants outweighs the potential risk of skin cancer. If you’ve had a transplant it’s important that you see your doctor regularly to check for early signs of skin cancer.

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      Exposure to chemicals 4 years ago

      Another rare possible cause for non-melanoma skin cancer is overexposure to certain chemicals at work. These include:

      coal tar

      soot

      pitch

      asphalt

      creosotes

      paraffin waxes

      petroleum derivatives

      cutting oils

      arsenic.

      You should wear protective clothing if you frequently handle these substances. Very small amounts of these chemicals used in the home are unlikely to cause skin cancer, but you should always follow the manufacturer’s instructions when using them.

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      Genetic conditions 4 years ago

      Most skin cancers are not caused by an inherited faulty gene that can be passed on to other family members. However, families are likely to have the same skin type, which may increase their risk of developing a skin cancer.

      People with certain rare hereditary conditions, such as Gorlin syndrome or xeroderma pigmentosum (XP), have a higher risk of developing skin cancer.

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      Symptoms of basal cell carcinoma 4 years ago

      Basal cell cancers may:

      be smooth and pearly

      look waxy

      appear as a firm, red lump

      bleed sometimes

      develop a crust or scab

      begin to show signs of healing and yet never quite heal

      be itchy

      look like a flat, red spot which is scaly and crusty

      develop into a painless ulcer.

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      Symptoms of squamous cell carcinoma 4 years ago

      Squamous cell cancers most often develop in areas that have been damaged by exposure to the sun. They are mainly found on the face, neck, bald scalps, arms, backs of hands and lower legs.

      Squamous cell cancers may:

      look scaly

      have a hard, horny cap

      make the skin raised in the area of the cancer

      feel tender to touch.

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      Changes in your skin 4 years ago

      If you notice anything unusual on your skin that doesn’t go away within a month, show it to your doctor. It might be helpful to take a photograph of anything unusual so you can monitor any changes over time.

      It’s important to remember that there are many other conditions that may appear in the skin that are not cancer, especially in older people. You may still want to have these treated for cosmetic reasons.

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      How skin cancers are diagnosed 4 years ago

      In certain situations, a specially trained GP may be able to remove the affected area. However, most people with suspected skin cancer are referred to a specialist at their local hospital for advice and treatment.

      A doctor who specialises in treating skin diseases is called a dermatologist. Depending on the area of the body affected and the type of treatment needed, you may also be referred to a:

      plastic surgeon

      general surgeon.

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      Biopsy 4 years ago

      The dermatologist will be able to tell a great deal from a simple examination of the affected area of skin, possibly using an instrument called a dermatoscope. However, it’s not always possible to tell the difference between skin cancers and benign (non-cancerous) conditions by examination alone, so you may be advised to have a tissue sample (biopsy) done.

      This is a quick and simple procedure, which can usually be done in the outpatient department using a local anaesthetic. The doctor will remove all or part of the affected area and send it to the laboratory where it will be examined under a microscope by a pathologist.

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      Further tests 4 years ago

      If you have a basal cell carcinoma, you probably won’t need any further tests as long as the cancer has been completely removed. This is because basal cell carcinomas almost never spread.

      If you have a squamous cell carcinoma, your doctor may want to examine you all over as well as taking a biopsy. This is to make sure that you don’t need any further treatment, as squamous cell carcinomas can occasionally spread.

      Further tests are particularly important if you’ve had treatment for skin cancer before and it has come back (recurred). During the physical examination, your doctor will probably feel the lymph nodes close to the cancer to see if any of them are enlarged.

      Rarely, your doctor may recommend that you have an operation to sample some of the nearby lymph nodes if they think there’s a risk that the cancer has spread to them. Very occasionally, ultrasound, CT or MRI scans are done if your doctor thinks there’s a possibility that the cancer has begun to spread. These scans are not usually needed when you are first diagnosed. Your doctor will explain these tests to you if necessary.

      It may take 1-2 weeks for the results of your tests to be ready. Waiting for your results can be a difficult time. It may help to talk things over with a relative or close friend. You may want to call our cancer support specialists, or contact other support organisations.

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      Staging of skin cancers 4 years ago

      Knowing the extent of the cancer helps the doctors to decide on the most appropriate treatment. Most people with basal cell cancers do not need to have tests to find the stage of the cancer, as it is very rare for them to spread beyond the initial area of skin. Tests will only be done if the cancer is very large.

      Although it is rare for squamous cell cancers to spread, tests to find the stage may be done because in some people they may spread.

      A commonly used staging system is outlined below:

      Stage 0 is also called carcinoma in situ. Carcinoma in situ means that cancer cells are present, but they are all contained in a small area in the top layer of skin (the epidermis). They have not started to spread or grow into deeper layers of skin. Squamous cell stage 0 is also called Bowen's disease. If it is not treated, it can develop into a squamous cell skin cancer.

      Stage 1 The cancer is less than 2cm across and has not spread

      Stage 2 The cancer is more than 2cm across and has not spread

      Stage 3 The cancer has spread into the tissues under the skin and possibly to nearby lymph nodes

      Stage 4 The cancer has spread to another part of the body. This very rarely occurs with either squamous or basal cell cancers of the skin.

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      TNM staging system 4 years ago

      Another staging system known as the TNM system is commonly used. This can give more precise information about the extent of the cancer.

      T describes the size of the tumour.

      N describes whether the cancer has spread to the lymph nodes.

      M describes whether the cancer has spread to another part of the body (secondary or metastatic cancer).

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      Treatment for skin cancer 4 years ago

      There is a variety of treatments for skin cancer – the options offered to you will depend on several factors including the size of the skin cancer, where it is on your body and your biopsy results.

      Monitoring Your specialist may want to keep an eye on the changes to your skin rather than give treatment immediately.

      Surgery This is an important treatment for many skin cancers. It can be done in a variety of ways.

      Cryotherapy This destroys cancer cells by using liquid nitrogen to freeze them. It’s a very quick way of treating small, low-risk skin cancers such as superficial basal cell carcinomas.

      Radiotherapy This may be used instead of surgery. It can be a very effective treatment for basal and squamous cell carcinomas. Radiotherapy may be given after surgery if there’s a risk that some cancer cells may still be present. Sometimes it’s used for tumours that have grown into the deeper layers of the skin.

      Photodynamic therapy (PDT) PDT uses light sources, combined with a light-sensitive drug (sometimes called a photosensitising agent), to destroy cancer cells.

      Topical chemotherapy A chemotherapy cream containing a drug called 5FU (Efudix®) can be used to treat some early squamous cell carcinomas and superficial basal cell carcinomas.

      Topical immunotherapy A cream called imiquimod (Aldara®) can be used to treat some basal cell carcinomas and squamous cell carcinomas.

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      How treatment is planned 4 years ago

      In most hospitals a team of specialists will talk to you about the treatment they feel is best for your situation. This multidisciplinary team (MDT) will include:

      oncologists (chemotherapy, immunotherapy and radiotherapy specialists)

      plastic surgeons

      dermatologists (skin disease specialists)

      pathologists (who advise on the type and extent of the skin cancer by examining tissue under a microscope)

      skin cancer specialist nurses

      counsellors and psychologists.

      The MDT will take a number of factors into account when advising you on the best course of action, including your age, general health, any medication you are taking, the type and size of the cancer, where it is on your body and what the cells look like under a microscope.

      You may be asked if you’d like to take part in a clinical trial.

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      Skin grafts 4 years ago

      Surgery for all types of skin cancer involves removing the affected area and some of the surrounding, healthy-looking skin.

      If the area is fairly small, it will be possible to close the wound by bringing the edges of skin together. Larger wounds may need a skin graft to cover the area. Skin grafts are layers of skin taken from another part of the body (the donor site) and placed over the area where the cancer has been removed.

      A partial thickness (or 'split') thickness skin graft is where the epidermis and a part of the dermis layer are used. The skin is usually taken from the thigh, buttock or upper arm. Skin will grow back in these areas.

      A full thickness skin graft is where the epidermis and the full dermis layers are used. In this case, only a small area is taken from the donor site and the skin edges of the donor site are then stitched together to heal. Skin may be taken from the neck, the area behind the ears and the inner side of the upper arm.

      Nowadays, skin grafts are less commonly needed as part of skin cancer treatment. This is because skin cancers are generally picked up and removed at an earlier stage when they are still small. This means the wound is also small so skin grafting isn’t needed. Another reason is that surgeons now use more skin flaps. This is where a portion of nearby skin, its underlying tissue and blood supply is moved to close the area where the cancer was removed. Skin flaps can give a better cosmetic result and heal more quickly.

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      How a skin graft is done 4 years ago

      You may have either a general or a local anaesthetic depending on the area being grafted. Your doctors will advise you which is best for you.

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      The grafted area 4 years ago

      Once the skin layer has been removed from the donor site, it is laid over the area where the cancer has been removed. It may be secured in place with stitches. You will have a dressing over the grafted area and this is left in place while the graft heals. The skin graft will connect with the blood supply in the area, which allows it to ‘take’ and survive. This usually takes 5-7 days.

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      The donor site 4 years ago

      You will also have a dressing on the donor site to protect it from infection. For a partial thickness skin graft, healing will take about two weeks, but the area may remain red for some time after this. With a full thickness graft, the donor area will take about five days to heal.

      The donor area can often feel more uncomfortable than the grafted area, and you may need to take regular painkillers.

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      After the skin graft 4 years ago

      You can usually go home the same day or you may need a short stay in hospital. This depends on where the graft is and how big it is.

      If the grafted area is on your hand, you may have a sling to help keep your arm raised as much as possible. If the graft is on your leg, it's important to keep your leg up when possible. This helps prevent swelling and reduces pain.

      You will need to take things gently for the first two weeks to allow the graft to heal properly. The grafted area will be quite fragile, so it's important not to rub or brush against the graft or the dressing, or to put any pressure on the area.

      Avoid any kind of exercise that might stretch or injure the graft for a few weeks. Start with some gentle exercise and build it up. You might need to take some time off work, depending on where the graft is and the kind of work you do. Your specialist will give you more advice on this.

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      Complications and side effects of skin grafts 4 years ago

      Sometimes the grafted area may bleed or get infected. This can cause the graft to fail. It's important to contact your doctors if the area becomes painful, red and swollen. You are more likely to have problems with the graft if you smoke.

      Both the grafted and donor areas will develop scars. These should gradually fade. They usually heal well with time, especially if they are on the face. Using a moisturising cream can help keep the skin supple.

      There will be some difference between the grafted skin and the skin surrounding it. This should lessen over time. If you are concerned about the appearance of the area, you could try camouflage make-up. Some hospitals have specialist nurses who can show you the best way to apply this.

      We also have a section on coping with body changes.

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      Your feelings 4 years ago

      You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.

      How you feel about the way you look is an important part of self-esteem, so if your skin graft has affected your appearance even slightly, this can also have an effect on your feelings.

      Everyone has their own way of coping with difficult situations. Adjusting to the news that you have a long-term condition can take time and it’s important that you get the support that you need. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. Our cancer support specialists can give you information about counselling in your area.

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      Cryotherapy for skin cancer 4 years ago

      If the cancer is very small and only affecting the surface layers of the skin, it may be possible to remove it by freezing it. This is called cryotherapy or cryosurgery. This treatment is only occasionally used.

      Liquid nitrogen is sprayed on to the cancer to freeze it. It can be a bit painful when the liquid nitrogen is applied - some patients describe the feeling as like a bee sting.

      After the treatment you may feel an aching or throbbing sensation in the area for a minute or two. Within an hour or so the area may blister. This is to be expected and the blister may contain blood. Fluid may need to be drained from the blister using a sterile needle, but the top of the blister should be left intact.

      The treated area needs to be covered with a dressing until a scab forms. About two weeks after the treatment, the scab drops off and the cancer cells should have cleared. You may have a white scar in the area. Occasionally, you may need more than one cryotherapy treatment to get rid of the tumour completely.

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      Radiotherapy for skin cancer 4 years ago

      Radiotherapy treats cancer by using x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells.

      Radiotherapy works well for skin cancers and is particularly useful in areas where surgery might be difficult or disfiguring (such as the face), and for tumours that have penetrated deeply into the skin. However, its use isn’t recommended for young people as it can cause skin changes, which become more visible over the years.

      The treatment is given in the hospital radiotherapy department. It can be given as a single treatment, but usually several doses are necessary and these are given each day over a period of one or more weeks. Your doctor will discuss your individual treatment plan with you.

      Radiotherapy treatment affects only a small area of skin and will not make you feel unwell. For up to a month after treatment, the treated skin will be red and inflamed. During this time, it will look as though the treatment has made things worse rather than better. This is normal. After a further few weeks the area will dry up and form a crust or scab.

      In time the scab will peel away, leaving healed skin underneath. At first, this new skin will look pinker than the skin around it. This will gradually fade and the treated area will start to look like the skin around it, although it may be slightly paler.

      Radiotherapy to areas that produce hair, such as the head, can make the hair fall out in the treated area. Your hair usually grows back within 6-12 months, depending on the dose of radiotherapy and how many sessions you’ve had. Some people find that the hair loss is permanent. Your clinical oncologist can discuss with you whether your hair is likely to grow back after treatment.

      Radiotherapy doesn’t make you radioactive and it’s perfectly safe for you to be around other people, including children, throughout your treatment.

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      Photodynamic therapy for skin cancer 4 years ago

      PDT uses light sources combined with a light-sensitive drug (sometimes called a photosensitising agent) to destroy cancer cells. PDT is particularly useful in areas where the skin cancer develops directly over bone, such as in Bowen’s disease on the shins and hands.

      Before your treatment, the doctor may remove any scabs from the area. A photosensitising cream (for example Metvix®, which contains methyl aminolevulinate) will then be applied to your skin. It will be left on for a specific time period, usually between 3-6 hours, depending on the type of cream that’s used. This is so it can penetrate into the skin.

      After the cream is removed, the doctor shines a special light onto the treatment area. The light treatment usually lasts 8-45 minutes depending on the light source used.

      Afterwards, a dressing is put on to cover the area and protect it from light. You may need to keep the dressing on the treated area for up to 36 hours after your treatment. You will be given instructions about this before you leave hospital.

      Usually only one treatment of PDT is needed, but occasionally two or three further treatments may be given if your skin cancer is thick.

      Your doctor or nurse will be able to give you more detailed information about your specific PDT treatment.

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      Side effects of PDT for skin cancer 4 years ago

      Pain

      Before your PDT treatment, your doctor or specialist nurse may advise you to take a couple of paracetamol tablets to prevent any pain. For many people this is all they need, but occasionally a local anaesthetic is given before treatment.

      You may feel a bit of discomfort, like a burning sensation, when you’re having the treatment. A cooling fan can sometimes be used to relieve this.

      At the end of treatment, a steroid cream may be applied to the treated area to stop it becoming painful. You may be given a steroid cream to use when you get home in case the area becomes painful later on.

      Sensitivity to light

      The treated area of skin will be sensitive to daylight and bright, indoor lighting. This effect will probably last for about 24 hours. You will need to keep the treated area of skin covered during this time so that your skin doesn’t burn.

      After that you can wash, bathe or shower as usual, but you’ll still need to treat your skin gently and not rub the area until it’s healed.

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      Healing 4 years ago

      After PDT, a crust may form over the treated area. The crust will fall off naturally in a few weeks, leaving the healed, new skin underneath. Usually there’s no scarring and the appearance of the healed skin is very good

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      Topical chemotherapy for skin cancer 4 years ago

      If chemotherapy is given, it’s normally applied directly to the skin cancer as a cream or lotion. This is called topical chemotherapy.

      Usually a drug called 5-fluorouracil (Efudix®), which is commonly known as 5FU, is used. You will be asked to put the cream on at home. Your doctor or specialist nurse will explain how to do this.

      The chemotherapy cream is applied once or twice a day for a number of weeks. If possible, a waterproof dressing should be put over the cream once applied, although it can sometimes be difficult to put a dressing on some areas of the body.

      The treatment should make the skin red and inflamed. Once the area becomes sore and weepy, the treatment will need to be stopped. Your doctor can prescribe a steroid cream to reduce the inflammation if it’s very sore. The skin will take a week or two to heal after treatment finishes.

      Exposure to the sun can make the inflammation worse, so you should protect the area until it has healed. Usually there are no other side effects with this type of chemotherapy.

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      Topical immunotherapy for skin cancer 4 years ago

      Immunotherapy is the name given to cancer treatments that use the body's immune system to attack cancer cells.

      An immunotherapy cream called imiquimod (Aldara®) stimulates the immune system and may be used to treat some small, superficial basal cell cancers or Bowen's disease. It’s usually used in areas where surgery may be difficult or for people who have more than one tumour.

      You’ll be given the cream to take home and asked to apply it once a day for a number of weeks. Some redness or crusting of the skin occurs during the treatment, but there should be no permanent scarring. If the skin reaction is very strong, your doctor may give you a steroid cream to use as well.

      Occasionally, the cream may cause shivers and other flu-like symptoms. If this is the case, let your doctor or specialist nurse know as they may advise you to stop using it.

      Your hospital team can give you more detailed instructions on how to use your immunotherapy cream and how to manage any side effects.

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      Research - clinical trials for skin cancer 4 years ago

      Cancer research trials are carried out to try to find new and better treatments for cancer. Trials that are carried out on patients are called clinical trials.

      Clinical trials may be carried out to:

      test new treatments, such as new chemotherapy drugs, gene therapy or cancer vaccines

      look at new combinations of existing treatments, or change the way they are given, to make them more effective or reduce side effects

      compare the effectiveness of drugs used to control symptoms

      find out how cancer treatments work

      find out which treatments are the most cost-effective.

      Trials are the only reliable way to find out if a different type of surgery, chemotherapy, radiotherapy, or other treatment is better than what is already available.

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      Bowen’s disease 4 years ago

      Bowen’s disease looks like a red, scaly patch on the skin. It is caused by the abnormal growth of cells called keratinocytes in the outer layer of the skin (epidermis). These cells don’t spread into the deeper layers of the skin. Bowen’s disease is sometimes called squamous cell carcinoma in-situ.

      Untreated cases of Bowen’s disease may develop into squamous cell cancer in a small number of people (about 3-5 out of every 100 who have it). This is a common, curable type of skin cancer which affects the outermost cells of the skin but can spread to deeper layers of skin.

      If left untreated for a long time, squamous cell cancer can spread to other parts of the body. Bowen’s disease is more common in women and it usually affects people in their 60s and 70s.

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      Bowen's disease- causes 4 years ago

      Long-term overexposure to the sun is probably the most important risk factor for Bowen’s disease. But it can occur in areas that haven’t been exposed to the sun so this isn’t the only cause.

      Previous radiotherapy in the affected area is another risk factor, as is exposure to a chemical called arsenic, although this is rare.

      People who have to take drugs that lower their immunity (for example, after a kidney transplant) are more at risk of getting Bowen’s disease.

      Occasionally, Bowen’s disease can affect the genital area. This is usually linked with a common type of virus called the human papilloma virus (HPV). There are different types of this virus and some are linked with cancers, such as cervical cancer.

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      Signs and symptoms of Bowen’s disease 4 years ago

      Bowen’s disease can occur anywhere on the body but it's usually found on the lower legs. To begin with, it often looks like a red, scaly patch, or sometimes like raised spots or warts. The affected skin may become itchy, sore and may bleed. As Bowen’s disease can look like other skin conditions such as eczema or psoriasis, it’s important to get any skin problems checked out by a doctor.

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      How Bowen’s disease is diagnosed 4 years ago

      Bowen’s disease is diagnosed by taking a sample of skin (biopsy). You will usually be referred to a dermatologist (specialist in skin diseases) to have this done.

      A local anaesthetic is given to numb the area and a small part of the affected skin is removed. The sample is then sent to the laboratory to be looked at under a microscope.

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      Treatment for Bowen’s disease 4 years ago

      There are a number of different treatments available for Bowen’s disease. Your treatment will depend on where it is on your body, the size, thickness and the number of patches.

      How well the skin is likely to heal afterwards is an important factor when making decisions about treatment. The skin on the lower legs tends to be more fragile (especially in older people) and, as a result, there may be problems with it healing.

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      Bowen's disease- Observation 4 years ago

      Bowen’s disease often grows very slowly, over a period of months or years. So, if you have a thin patch of affected skin which isn't changing, then keeping a close eye on it (observation) may be all that your dermatologist advises. You may have regular check-ups to monitor it carefully.

      This can sometimes be a good option for people who are more likely to have problems with skin healing after treatment.

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      Cryotherapy 4 years ago

      It may be possible to treat the area by freezing it. This is called cryotherapy or cryosurgery. Liquid nitrogen is sprayed on to the affected area to freeze it. At the time, this feels very cold and a bit uncomfortable. Afterwards, you will have a scab, which usually falls off within a few weeks. This removes the affected skin.

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      Creams (topical therapy) 4 years ago

      A chemotherapy (anti-cancer treatment) cream called 5-fluorouracil (Efudix®), also known as 5FU, may be used. The cream is applied to the skin regularly over a period of time. It can make the skin in the area red and inflamed before the Bowen’s disease gets better. Usually there are no other side effects.

      A cream called Imiquimod (Aldara®), which works by using the immune system to attack the abnormal cells, can also be used. You will be asked to apply it regularly over a period of time. It will cause some redness and skin irritation before the Bowen’s disease improves.

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      Curettage and electrocautery 4 years ago

      Scraping away the affected area (curettage) and using heat or electricity to stop any bleeding (electrocautery) are suitable for small patches of Bowen’s disease. A local anaesthetic is given before the doctor scrapes away the area using a spoon-shaped instrument called a curette.

      An electrically heated loop or needle is then applied to stop the bleeding from the wound (cauterise it) and destroy any remaining abnormal cells. After this treatment a scar may develop.

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      Photodynamic therapy (PDT) 4 years ago

      Photodynamic therapy is a newer treatment that is used for different conditions. It can be a useful option for people with large areas of Bowen’s disease. It uses laser, or other light sources, combined with a light-sensitive drug (sometimes called a photosensitising agent) to destroy abnormal cells. A photosensitising cream is applied to the affected area. This is usually done 4-6 hours before treatment with the light, which lasts about 20-45 minutes. Afterwards a dressing is put on to cover the area and protect it from light. Usually more than one treatment is needed.

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      Surgery 4 years ago

      Surgery may be used for small areas of Bowen’s disease that can be removed under local anaesthetic. But it’s not always the best option for large patches of Bowen’s disease.

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      Laser treatment 4 years ago

      Laser treatment uses intense light energy to remove tissue. It's sometimes used as a treatment for Bowen's disease of the finger or the genitals. Doctors are carrying out research trials to find out how effective this treatment is in the long term.

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      Follow-up after treatment for Bowen’s disease 4 years ago

      You may have regular check-ups after treatment. At follow-up appointments, the doctors will check for any further changes that may need to be treated. However, if you notice changes in a patch, or a new patch developing in between appointments, contact your doctor or nurse for advice.

      If you aren’t being seen regularly by a skin specialist, it’s important to keep a close eye on your own skin. Let your GP know if you develop new patches or have any other skin symptoms. Many people with Bowen’s disease are looked after by their GPs when their treatment is over.

      Protecting yourself from the sun is even more important when you’ve had Bowen’s disease. This means wearing clothing that protects you from the sun and using a high-factor sunscreen (SPF 30 or above).

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      Your feelings 4 years ago

      You may have many different emotions including anger, resentment, guilt, anxiety and fear. These are all normal reactions, and are part of the process many people go through in trying to come to terms with their condition.

      Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. Our cancer support specialists can give you information about counselling in your area.

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      Melanoma 4 years ago

      What is melanoma?

      Melanoma is a kind of skin cancer. It is not as common as other types of skincancer, but it is the most serious.

      Melanoma can affect your skin only, or it may spread to your organs and bones. As with other cancers, treatment for melanoma works best when the cancer is found early.

      This topic is about melanoma that occurs in the skin. It does not cover melanoma that occurs in the eye or in any other part of the body besides the skin.

      What causes melanoma?

      You can get melanoma by spending too much time in the sun. Too much sun exposure causes normal skin cells to become abnormal. These abnormal cells quickly grow out of control and attack the tissues around them.

      Melanoma tends to run in families. Other things in your family background can increase your chances of getting the disease. For example, you may have abnormal, or atypical, moles. Atypical moles may fade into the skin and have a flat part that is level with the skin. They may be smooth or slightly scaly, or they may look rough and "pebbly." Having many atypical moles increases your risk of melanoma. Also, it may be a sign that melanoma runs in your family.

      What are the symptoms?

      The main sign of melanoma is a change in a mole or other skin growth, such as a birthmark. Any change in the shape, size, or color of a mole may be a sign of melanoma.

      Melanoma may grow in a mole or birthmark that you already have. But melanomas may grow in unmarked skin. They can be found anywhere on your body. Most of the time, they are on the upper back in men and women and on the legs of women.

      Melanoma may look like a flat, brown or black mole that has uneven edges. Melanomas usually have an irregular or asymmetrical shape. This means that one half of the mole doesn't match the other half. Melanoma moles or marks may be any size, but they are usually 6 mm (0.25 in.) or larger.

      Unlike a normal mole or mark, a melanoma can:

      Change color, size, or the shape of its border.

      Be lumpy or rounded.

      Become crusty, ooze, or bleed.

      How is melanoma diagnosed?

      Your doctor will check your skin to look for melanoma. If your doctor thinks you have melanoma, he or she will remove a sample of tissue from the area around the melanoma (biopsy). Another doctor, called a pathologist, will look at the tissue to check for cancer cells.

      If your biopsy shows melanoma, you may need to have more tests to find out if it has spread to your lymph nodes.

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      Melanoma 4 years ago

      There are many risk factors for developing melanoma. The risk factor you can best control to reduce your risk of melanoma is exposure to ultraviolet (UV) radiation from the sun.

      To help prevent skin cancer:

      Protect your skin.

      Stay out of the sun during the midday hours (10 a.m. to 4 p.m.).

      Wear protective clothing. This includes a hat with a brim to shade your ears and neck, a shirt with sleeves to cover your shoulders, and pants. The best fabric for skin protection has a tight weave to keep sunlight out.

      Use a sunscreen every day with an SPF of at least 15. Look for a sunscreen that protects against both types of ultraviolet radiation in the sun's rays-UVA and UVB.

      Use a higher SPF when you are at higher elevations.

      Set a good example for your children by protecting your skin from too much sun.

      Avoid sunbathing and tanning salons. Studies suggest that your risk of melanoma increases by 75% if you start using artificial tanning before you are 30 years old.3

      Examine your skin regularly, and have your doctor check your skin during all other health exams, or at least once a year.

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      Early symptoms 4 years ago

      Early signs

      The most important warning sign for melanoma is any change in size, shape, or color of a mole or other skin growth, such as a birthmark. Watch for changes that occur over a period of weeks to a month. Use the ABCDE rule to evaluate skin changes, and call your health professional if you have any of the following changes.

      A is for asymmetry. One half of the mole or skin growth doesn't match the other half.

      B is for border irregularity. The edges are ragged, notched, or blurred.

      C is for color. The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance. Changes in color distribution, especially the spread of color from the edge of a mole into the surrounding skin, also are an early sign of melanoma.

      D is for diameter. The mole or skin growth is larger than 6 mm (0.25 in.) or about the size of a pencil eraser. Any growth of a mole should be of concern.

      E is for evolution. There is a change in the size, shape, symptoms (such as itching or tenderness), surface (especially bleeding), or color of a mole.

      Signs of melanoma in an existing mole include changes in:

      Elevation, such as thickening or raising of a previously flat mole.

      Surface, such as scaling, erosion, oozing, bleeding, or crusting.

      Surrounding skin, such as redness, swelling, or small new patches of color around a larger lesion (satellite pigmentations).

      Sensation, such as itching, tingling, or burning.

      Consistency, such as softening or small pieces that break off easily (friability).

      Melanoma can develop in an existing mole or other mark on the skin, but it often develops in unmarked skin. Although melanoma can grow anywhere on the body, it often occurs on the upper back of men and women and on the legs in women. Less often, it can grow on the soles, palms, nail beds, or mucous membranes that line body cavities such as the mouth, the rectum, and the vagina. On older people, the face is the most common place for melanoma to grow. And in older men, the most common sites are the neck, scalp, and ears.1

      Many other skin conditions (such as seborrheic keratosis, warts, and basal cell cancer) have features similar to those of melanoma.

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      Later symptoms 4 years ago

      Later signs of melanoma include:

      A break in the skin or bleeding from a mole or other colored skin lesion.

      Pain in a mole or lesion.

      Symptoms of metastatic melanoma may be vague and include:

      Swollen lymph nodes, especially in the armpit or groin.

      A colorless lump or thickening under the skin.

      Unexplained weight loss.

      Gray skin (melanosis).

      Ongoing (chronic) cough.

      Headaches.

      Seizures.

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      Evualation of a skin lesion 4 years ago

      A physical exam of the skin is used to evaluate the skin for melanoma. If melanoma is suspected, a skin biopsy will be done. For this, your doctor will remove a sample of skin tissue and send it to a pathologist to be looked at under a microscope. If the biopsy shows melanoma, the pathologist will measure the thickness of the melanoma to find out how advanced the cancer is.

      Other techniques may include total-body photography to monitor for changes in any mole and to watch for new moles appearing in normal skin. A series of photos of the suspicious lesions may be taken. Then the photos can be used as a baseline to compare with follow-up photos.

      Evaluation of lymph nodes

      Your doctor will do a physical exam that includes checking the lymph nodes to see whether they are larger than normal. This may be followed by a sentinel lymph node biopsy to see whether the melanoma has spread to the lymph system.

      Evaluation for possible metastases (spread of cancer)

      A complete medical history and a physical exam are needed to find out whether the cancer has spread (metastasized) to other parts of the body. Imaging tests, including positron emission tomography (PET scan), computed tomography (CT scan), or magnetic resonance imaging (MRI), may be used to identify metastases in other parts of the body, such as the lungs, brain, liver, or other organs.

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      Early detection 4 years ago

      Skin self-exam is a good way to detect early skin changes that may point to melanoma. A skin self-exam is used to find suspicious growths that may be cancer or growths that may develop into skin cancer (precancers). Adults should examine their skin once every month. Look for any abnormal skin growth or any change in the color, shape, size, or appearance of a skin growth. Check for any area of injured skin (lesion) that does not heal. Have your spouse or someone such as a close friend help you monitor your skin, especially places that are hard to see such as your scalp and back.

      There are other steps you can take to prevent skin cancer or detect it at an early stage.

      Be aware of the risk of skin cancer and the steps you can take to prevent it, including staying out of the midday sun, wearing protective clothing, and using sunscreen on exposed skin.

      Have your doctor examine any suspicious skin changes. He or she may check your skin once a year. Or your doctor may suggest a skin exam more often, especially if you have:

      Familial atypical mole and melanoma (FAM-M) syndrome, which is an inherited tendency to develop melanoma. Examine your skin every month and be examined by a doctor every 4 to 6 months, preferably by the same doctor each time.

      Increased exposure to ultraviolet (UV) radiation because of your job, hobbies, or outdoor activities.

      Abnormal moles called atypical moles (dysplastic nevi). These moles are not cancerous. But their presence is a warning of an inherited tendency to develop melanoma.

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      Treatment overview 4 years ago

      Surgical removal (excision) of the affected skin is the most effective treatment for melanoma. Excision involves removing the entire melanoma along with a border (margin) of normal-appearing skin. More treatment may be needed based on the stage of the melanoma.

      Initial treatment

      Melanoma may be cured if caught and treated in its early stages when it affects only the skin. If melanoma is confined to the skin (primary melanoma), you will have surgery to remove the affected skin. If the melanoma is thin and has not invaded surrounding tissues, excision may cure the melanoma. In more advanced stages, melanoma may spread, or metastasize, to other organs and bones, requiring additional treatment such as radiation, chemotherapy, or immunotherapy.

      Treatments used for melanoma include:

      Surgery. Your doctor may use one of these surgeries:

      Local excision. This surgery takes out the melanoma and a little of the tissue around it.

      Wide local excision. This surgery removes more of the tissue around the melanoma. Lymph nodes may also be removed during this surgery.

      Lymph node dissection (lymphadenectomy). This is surgery to remove lymph nodes to see if they have cancer cells. Or this may be done to remove lymph nodes that are cancerous.

      Sentinel lymph node biopsy. This surgery removes the first lymph node that the cancer may have spread to from the tumor. If this lymph node does not have any cancer cells, then you may not need to have more lymph nodes removed.

      Chemotherapy.

      Radiation therapy.

      Immunotherapy.

      Side effects of treatment

      The side effects of treatment for melanoma will depend on the type of treatment you have and your age and overall health. The side effects of surgery, chemotherapy, or radiation may be mild enough that you can do things at home to manage them. See the Home Treatment section of this topic for more information.

      Some of the treatment side effects can be avoided. For example, your doctor may prescribe medicines to control nausea and vomiting caused by chemotherapy. Be sure to talk to your doctor about all the side effects that you have.

      Ongoing treatment

      Regular follow-up appointments are important after you have been diagnosed with melanoma. Your doctor will set up a regular schedule of checkups that will happen less often as time goes on.

      Learn to do a skin self-exam and to check for swelling in your lymph nodes, and report any changes to your doctor. It's a good idea to get in the habit of doing this skin and lymph-node check at the same time every month.

      Treatment if the condition gets worse

      Metastatic melanoma

      Swollen or tender lymph nodes may be a sign that the melanoma has spread (metastatic melanoma). Any enlarged regional lymph nodes should be removed and checked for melanoma.

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      Melanoma Treatment 4 years ago

      When melanoma has spread to only one tumor in another location, metastatic melanoma sometimes can be successfully treated with surgery. But metastatic melanoma usually responds poorly to most forms of treatment.

      When successful treatment is not possible, the goal of treatment for metastatic melanoma is to control symptoms, reduce complications, and increase comfort (palliative care).

      Your doctor may recommend that you join a clinical trial if one is available in your area. Clinical trials study other treatments, such as combinations of chemotherapy, vaccines, and immunotherapies. They are also studying targeted therapy with agents such as PLX4032 and ipilimumab.

      Recurrent melanoma

      Melanoma can come back after treatment. This called recurrent melanoma. This kind of melanoma, like metastatic melanoma, usually cannot be cured with treatment. But your medical team will keep you comfortable and help you live as long as possible. Treatments that may help include:

      Surgery to remove any tumors.

      Hyperthermic isolated limb perfusion. If the melanoma is on your arm or leg, chemotherapy medicine may be added to a warm solution and injected into the bloodstream of that limb. The flow of blood to and from that limb is stopped for a short time so the medicine can go right to the tumor.

      Radiation or immunotherapy to relieve symptoms (palliative therapy).

      Medicines injected directly into tumors.

      Lasers to destroy tumors.

      Palliative care may be an important part of your treatment plan.

      What To Think About

      When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It is normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with their family and friends.

      If your emotional reaction to cancer interferes with your ability to make decisions about your health, it is important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. You may also contact your local chapter of the American Cancer Society to help you find a support group.

      Palliative care

      Cancer treatment has two main goals: to cure the cancer and to make your quality of life as good as possible. Your quality of life may be improved by having palliative care to manage your symptoms.

      For some people with advanced-stage cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.

      It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. For more information, see the topics:

      Palliative Care.

      Hospice Care.

      Care at the End of Life.

      For more information about specific treatments, see the following topic

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      Home Treatment 4 years ago

      Home treatment can help you manage the side effects that may occur from your treatment. Some treatments for melanoma, such as taking interferon or having chemotherapy, can have serious side effects. If your doctor gives you instructions or medicines to treat these side effects, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.

      Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as having a dry mouth or feeling lightheaded when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.

      Home treatment for diarrhea includes resting your stomach and watching for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea.

      Home treatment for constipation includes gentle exercise along with adequate intake of fluids and a diet that is high in fruits, vegetables, and fiber. Check with your doctor before using a laxative for your constipation.

      Home treatment for fatigue includes making sure you get extra rest if you are receiving chemotherapy or radiation therapy. Let your symptoms be your guide. You may be able to stay with your usual routine and just get some extra sleep. Fatigue is often worse at the end of treatment or just after treatment is completed.

      Other issues may include:

      Recommended Related to Melanoma/Skin Cancer

      Overview

      Note: Separate PDQ summaries on Skin Cancer Prevention, Skin Cancer Treatment, and Levels of Evidence for Cancer Screening and Prevention Studies are also available. Interventions The only widely proposed screening procedure for skin cancer is visual examination of the skin, including both self-examination and clinical examination. Benefits In asymptomatic populations, the effect of visual skin examination on mortality from nonmelanomatous skin cancers is unknown. Further, the evidence...

      Read the Overview article

      Hair loss. This can be emotionally distressing. Not all chemotherapy medicines cause hair loss, and some people have only mild thinning that is noticeable only to them. Talk to your doctor about whether hair loss is an expected side effect with the medicines you will receive.

      Sleep problems. If you find you have trouble sleeping, you may sleep more easily if you have a regular bedtime, get some exercise during the day, avoid caffeine late in the day, and try other methods to relieve sleep problems.

      Not all forms of cancer or cancer treatment cause pain. If pain occurs, many treatments are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment may help to reduce pain and improve your physical and mental well-being. Be sure to talk with your doctor about any home treatment you use for pain.

      The diagnosis of melanoma and the need for treatment can be very stressful. You may be able to reduce your stress by expressing your feelings to others. Learning relaxation techniques may also help you reduce your stress.

      Your feelings about your body may change following a diagnosis of melanoma and the need for treatment. Adapting to your body image changes may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to groups that can offer additional support and information.

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      Medications for melanoma 4 years ago

      Medicines for melanoma include chemotherapy with a single medicine or several medicines. Medicines for treatment may include immunotherapy or even a combination of chemotherapy and immunotherapy.

      Medication Choices

      Medicine for melanoma that has metastasized may include:

      Recommended Related to Melanoma/Skin Cancer

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      Note: Separate PDQ summaries on Skin Cancer Prevention, Skin Cancer Treatment, and Levels of Evidence for Cancer Screening and Prevention Studies are also available. Interventions The only widely proposed screening procedure for skin cancer is visual examination of the skin, including both self-examination and clinical examination. Benefits In asymptomatic populations, the effect of visual skin examination on mortality from nonmelanomatous skin cancers is unknown. Further, the evidence...

      Read the Overview article

      Chemotherapy with medicines such as dacarbazine or temozolomide.

      Immunotherapy with interferon or interleukin-2.

      What To Think About

      Chemotherapy used to treat melanoma may be given as an outpatient treatment, but sometimes people need a short hospital stay.

      Medicines used for chemotherapy may be taken by mouth or injected into your bloodstream so they can travel throughout your body. If the melanoma is on an arm or leg, chemotherapy medicines may added to a warm solution that is injected into the bloodstream of that limb. The flow of blood to and from that limb is stopped for a short time so the medicine can go right to the tumor. This is called hyperthermic isolated limb perfusion.

      Medicines being studied in clinical trials include combinations of chemotherapy, vaccines, and immunotherapies. Clinical trials are also looking at targeted therapy with the monoclonal antibody ipilimumab and a medicine called PLX4032.

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      Surgery 4 years ago

      Surgery is the most common treatment for melanoma and is done to remove the primary melanoma. Sometimes lymph nodes may be removed at the same time to check them for cancer. Surgery also may be done to remove lymph nodes that have cancer or to remove tumors that may have spread to other parts of the body.

      Surgery Choices

      The most common types of surgery used to treat melanoma include:

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      Background Incidence and mortality There are three main types of skin cancer: Basal cell carcinoma. Squamous cell carcinoma (together with basal cell carcinoma referred to as nonmelanoma skin cancer). Melanoma. Basal cell carcinoma and squamous cell carcinoma are the most common forms of skin cancer but have substantially better prognoses than the less common, generally more aggressive melanoma. Nonmelanoma skin cancer is the most commonly occurring cancer in the United...

      Read the Description of the Evidence article

      Local excision. This surgery takes out the melanoma and a little of the tissue around it.

      Wide local excision. This surgery removes more of the tissue around the melanoma. Lymph nodes may also be removed during this surgery.

      Lymph node dissection (lymphadenectomy). This is surgery to remove lymph nodes to see if they have cancer cells. Or this may be done to remove lymph nodes that are cancerous.

      Sentinel lymph node biopsy. This surgery removes the first lymph node that the cancer may have spread to from the tumor. If this lymph node does not have any cancer cells, then you may not need to have more lymph nodes removed.

      What To Think About

      After removal of a primary melanoma, you may need a skingraft or other reconstructive surgery for cosmetic reasons or to restore function. This is most likely if the melanoma was large or was a late-stage tumor.

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      Other Treatments 4 years ago

      Clinical trials are currently studying many other treatments. These include new forms of chemotherapy and immunotherapy, such as monoclonal antibodies and vaccines. Your doctor may recommend that you join a clinical trial if one is available in your area.

      Complementary therapies

      People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

      Recommended Related to Melanoma/Skin Cancer

      Basal Cell Carcinoma of the Skin Treatment

      Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.) There is a wide range of treatment approaches, including excision, radiation therapy, cryosurgery, electrodesiccation and curettage, photodynamic or laser-beam light exposure, and...

      Read the Basal Cell Carcinoma of the Skin Treatment article

      Acupuncture, to relieve pain.

      Meditation or yoga, to relieve stress.

      Massage and biofeedback, to reduce pain and ease tension.

      Breathing exercises for relaxation.

      Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

      Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

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      Cancer: Controlling Nausea and Vomiting From Chemotherapy 4 years ago

      Of all the side effects of chemotherapy, nausea and vomiting are two of the most distressing. But in many cases, nausea and vomiting can be controlled and even prevented.

      Key points

      Nausea and vomiting can be controlled and even prevented. The best treatment plan is one set up by you and your health care team, based on your particular needs and feelings. You are the authority on how well you feel and how much nausea you have.

      Today’s antinausea drugs are very good at preventing and controlling nausea and vomiting. Your doctor should be able to find one that works for you.

      Prevent nausea. When you or your doctor foresee that a treatment will make you very sick, it's best that you take antinausea medicine beforehand.

      There are several other ways to get relief and make yourself feel better before and after your chemotherapy treatments.

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      What causes Nausea And vomiting? 4 years ago

      Researchers do not know exactly why some chemotherapy drugs cause nausea and vomiting. They believe there are several ways that this can happen. Some drugs may affect the parts of your spinal cord or nervous system that trigger nausea and vomiting. Some drugs may cause nausea and vomiting by irritating the lining of your digestive system. Sometimes, if you had nausea when you had chemotherapy before, your brain remembers this and expects nausea when you have chemotherapy again.

      Chemotherapy drugs are ranked according to how often they cause nausea and vomiting. Some cause very little of those side effects. Also, some people are more likely than others to get sick. Your doctor will consider many things about you, your treatment, and your cancer to decide if you are likely to feel sick.

      Whether you have nausea and vomiting may depend on:

      What types of chemotherapy drugs you get. Some of these drugs are more likely to cause nausea and vomiting than others.

      How large a dose you get. Higher doses are more likely to cause nausea and vomiting.

      When and how often you get chemotherapy. If the time between treatments is short, your body has less time to recover from the nausea and vomiting before you get your next dose.

      How the drugs are given. A drug that is given through your vein (IV) may cause nausea and vomiting sooner than a pill that is swallowed, because your body will absorb the IV drug faster.

      Individual differences. Not every person reacts the same to the same medicine.

      The antinausea medicine you are taking. If it isn't working for you, you may need to try a different one.

      You may feel sick shortly after your chemotherapy treatment begins. Or you may not feel sick until a day or two later. You may not feel sick at all. As soon as you start to feel sick, tell your doctor.

      Many people start feeling sick before a treatment session even begins. This is called anticipatory nausea and vomiting. Any little thing-the smell of an alcohol swab, the sight of a nurse's uniform, the sounds of the treatment room-may trigger nausea. This usually doesn't happen until after the third or fourth treatment session. Learning how to control anticipatory nausea and vomiting is important, because it can make nausea and vomiting more severe when the chemotherapy actually starts.

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      Importance of controlling Nausea and vomiting 4 years ago

      People who feel good are better able to fight their cancer and have happier lives. Your body needs to be able to rest, to refuel, and to cope with the stresses of cancer and its treatment.

      If untreated, nausea and vomiting can make you feel:

      Depressed.

      Unable to cope.

      Tired.

      Stressed.

      Unable to sleep.

      Worried.

      Angry.

      Uninterested in food.

      Dehydrated.

      Controlling your nausea and vomiting can help you to:

      Be active.

      Sleep.

      Cope better with your cancer and its treatment.

      Enjoy family and friends.

      Eat with pleasure

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      How can I control Nausea And Vomiting 4 years ago

      The best way to control nausea and vomiting is to begin treatment for it before you start chemotherapy. Talk to your doctor about your treatment plan. Find out if the cancer drug you'll receive is likely to make you sick. Ask your doctor what medicines are available to prevent nausea and vomiting. Talk about your concerns, no matter how small. The more you know about your treatment, the more you will feel in control and the easier it will be to talk about it with your doctors and nurses.

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      Antinausea drugs 4 years ago

      Antinausea drugs are usually taken on a regular daily schedule for as long as chemotherapy lasts. Sometimes you may be asked to take the antinausea drug "only as needed." You may be given more than one kind of antinausea drug. Drugs to relieve your nausea include ondansetron (Zofran) and lorazepam (Ativan).

      Antinausea drugs can be given as pills you swallow, as an IV, or as shots. Some drugs are available as suppositories, as capsules that melt in your mouth, or as a patch that is taped to your skin.

      Be sure to follow your doctor's instructions for taking your antinausea medicines and to report back about how well they are working.

      If you have nausea and vomiting after chemotherapy in spite of taking antinausea drugs, tell your doctor immediately. A different antinausea drug may be the answer. Or your chemotherapy drug may need to be changed.

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      Medical marijuana 4 years ago

      Marijuana, either in its natural form or as a synthetic drug, has been shown to ease the nausea and vomiting caused by chemotherapy. Although it worked better than many of the antinausea drugs available in the past, it doesn't seem to work as well as other medicines available today. And marijuana can cause unpleasant side effects including dry mouth, low blood pressure, and dizziness, especially in older people or people who haven't used it before. Also, the legality of marijuana for medical use is still a question in many countries.

      Some doctors still use the synthetic form of marijuana to treat nausea and vomiting. These drugs have not been shown to work as well as other drugs now available, but they may be helpful for certain people

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      Complementary therapy 4 years ago

      Although drugs are the main way to treat nausea and vomiting, there are other treatments that have been shown to work well.1 They involve the help of a qualified therapist who can teach you to use your mind and body to control nausea and vomiting. These techniques help stop anticipatory nausea and vomiting. They work by relaxing you, distracting your attention, helping you feel in control, and making you feel less helpless. These treatments include:

      Biofeedback . Biofeedback uses the mind to control a body function that the body normally regulates on its own, such as skin temperature, muscle tension, or heart rate.

      Guided imagery . This is a series of thoughts and suggestions that direct your imagination toward a relaxed, focused state. This technique can help you mentally block the nausea and vomiting.

      Distraction . For example, kids getting chemotherapy may use a video game to help keep their mind off what is happening. This may also help mentally block the nausea and vomiting.

      Progressive muscle relaxation . This is a technique in which you learn to relax by tensing and then releasing different groups of muscles, one at a time.

      Self-hypnosis . A therapist can teach you to hypnotize yourself. Some people are able to learn from books.

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      Acupuncture 4 years ago

      Some studies have shown that acupuncture is an effective treatment for nausea and vomiting caused by chemotherapy.2 Your doctor may refer you to a qualified acupuncturist.

      You can also try acupressure. Constant pressure on the P6 point is used to prevent or reduce nausea. The P6 point is on the inner side of your arm, in line with your middle finger. It is close to your wrist, one-sixth of the distance between your wrist and elbow. You can press on your arm with a thumb or finger or try wearing wristbands (such as Sea-Bands) that press a plastic disc on the P6 point on each arm.

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      Nutrition 4 years ago

      Eating well may seem to be an odd way to treat nausea and vomiting, but it’s very important. As a cancer patient, you need nutritious foods to help you feel better, keep up your strength and energy, keep up your weight, and keep up your ability to fight infection and recover as quickly as possible.

      Here are some tips for eating well during chemotherapy:

      Eat small, frequent meals or snacks. Treat yourself by choosing the foods you like best.

      Make the most of the days when your appetite is good.

      Ask friends and family for help with shopping and preparing meals. Consider having meals delivered to your home or have lunch at a community or senior center.

      Nutritional supplements are convenient and can help you get the extra calories and protein you need. Try a variety to find out which ones work best. Your doctor, nurse, or dietitian can help and may have samples for you to try.

      Is there a time of day when you are able to eat more? Many people find that breakfast time is best. Try eating more during that time of day when you can.

      Don't force yourself to eat when you are nauseated.

      Eat food cold or at room temperature.

      Keep your mouth clean, and brush your teeth after vomiting.

      Have fresh air with a fan or an open window.

      Limit sounds, sights, and smells that make you feel sick.

      When you don't feel like eating your normal foods, try apple or grape juice, weak teas, clear broths, dry toast, cooked cereal, and gelatin desserts. Avoid citrus juices and lemonade.

      Try ginger, such as candied ginger or ginger tea. Real ginger-not ginger flavoring-helps to reduce nausea.

      Eat a light meal or snack before your chemotherapy appointment so that you have something in your stomach.

      If your chemotherapy is the kind that takes several hours rather than a few minutes, bring a light meal or snacks with you. Your treatment center should have a refrigerator and microwave available for your use.

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      WebMD 4 years ago

      It's important to tell your doctors or nurses when you feel any nausea. Sometimes people worry about bothering the doctor or nurse. Sometimes they think there is nothing that can be done, so it is not worth bringing up. Speak up about your fears and about any nausea you are feeling, no matter how slight. You may need a different medicine for nausea a few days after chemotherapy than the one you used right afterward.

      To help you and your health care team deal with any nausea and vomiting, you may want to keep track of how you feel. You can use this symptoms diary or one like it to write down how you are feeling. Take your diary with you whenever you visit your doctor.

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      Protecting Your skin 4 years ago

      Excessive exposure to the sun and its ultraviolet (UV) rays can cause skin cancer. You can reduce your risk for skin cancer by:

      Protecting your skin, and that of your family members, from UV radiation.

      Performing frequent skin self-examinations.

      Finding out whether you have an increased risk of developing melanoma and other skin cancers.

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      UV And My Skin 4 years ago

      The sunlight that reaches the earth has ultraviolet A and B (UVA and UVB) rays. These ultraviolet (UV) rays are the main causes of damage to the skin from the sun. Some people are more susceptible than others to skin damage. Certain factors may mean that you have an increased risk of developing skin cancer:

      A personal history of skin cancer

      A family member with skin cancer

      More than 50 moles

      Abnormal moles (atypical moles), or moles larger than 6 mm (0.2 in.), about the size of a pencil eraser

      A weakened immune system

      Severe sunburns-even one-as a child, or sunburns as an adult

      Living in a sunny or high-altitude climate or near the equator

      Fair skin that burns or freckles easily and does not tan

      Sunburns in childhood are the most damaging to the skin. The earlier in life that you are burned by the sun, the greater the risk of developing skin cancer later in life.

      Some people believe that tanning protects against a sunburn. But the amount of sun exposure needed to get a tan can by itself cause excessive skin damage and outweigh any possible benefit.

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      Skin Protection 4 years ago

      You can stop skin cancer before it starts.

      Exposure to the sun is the most common cause of skin cancer. Sunburns do the most damage, but sustained time in the sun increases the risk of skin damage and mole growth.

      Most early skin cancers are easily seen on the skin and may be curable if treated early.

      Some people have a higher risk of developing skin cancer. If you are aware that you have a higher risk, have regular skin exams and take steps to protect your skin.

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      Skin Protection 4 years ago

      Avoiding skin cancer can be as simple as protecting your skin and taking a good look at it regularly. While sunscreen plays a vital role in protecting your skin from UV radiation, it can't prevent skin damage if you are exposed to the sun's rays for long periods of time. Experts recommend that you use multiple methods to fully protect your skin.

      Protect your skin

      Stay out of the sun during the peak hours of UV radiation, from 10 a.m. to 4 p.m.

      Wear protective clothing:

      Wide-brimmed hats that protect the face and neck

      Tightly-woven clothing made of thick material, such as unbleached cotton, polyester, wool, or silk

      Dark clothing with dyes added that help absorb UV radiation

      Loose-fitting long-sleeved clothing that covers as much of the skin as possible

      Clothing that has sun protection factor (SPF) in the fabric that does not wash out

      Wear sunscreen with an SPF of 15 or higher, summer and winter, on both cloudy and clear days:

      SPF of 11 offers minimal protection.

      SPF of 12 to 29 offers moderate protection.

      SPF of 30 and above offers high protection.

      Apply sunscreen that blocks both UVA and UVB radiation to all exposed skin, including lips, ears, back of the hands, and neck. Apply sunscreen 30 minutes before going in the sun, and reapply it every 2 hours and after swimming, exercising, or sweating.

      Wear wraparound sunglasses that block at least 99% of UVA and UVB radiation.

      Be careful when you are on sand, snow, or water, because these surfaces can reflect 85% of the sun's rays.

      Avoid artificial sources of UVA radiation, including sunlamps and tanning booths. Like the sun, they can cause skin damage and increase the risk of skin cancer.

      A child's skin is more sensitive to the sun than an adult's skin and is more easily burned. Babies younger than 6 months should always be completely shielded from the sun. Children 6 months and older should have their skin protected from too much sun exposure.

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      Know the ABCDEs of early detection 4 years ago

      Skin cancer can be cured if found and treated early. If it is not discovered or treated until too late, it can spread throughout the body and may be fatal. Skin cancer often appears on the trunk of men and on the legs of women. Learn your ABCDEs, the changes in a mole or skin growth that are warning signs of melanoma:

      Asymmetry : One half doesn't match the other half.

      Border irregularity : The edges are ragged, notched, or blurred.

      Color : The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance. Color may spread from the edge of a mole into the surrounding skin.

      Diameter : The size of the mole is greater than 6 mm (0.2 in.), or about the size of a pencil eraser.

      Evolution : There is a change in the size, shape, symptoms (such as itching or tenderness), surface (especially bleeding), or color of a mole.

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      Get to know your skin 4 years ago

      Skin cancer, including melanoma, is curable if spotted early. A careful skin exam may identify suspicious growths that may be cancer or growths that may develop into skin cancer (precancers).

      Examine your skin once every month. Get to know your moles and birthmarks, and look for any abnormal skin growth and any change in the color, shape, size, or appearance of a skin growth.

      Check for any area of skin that does not heal after an injury.

      Have your doctor check your skin during any other health exams. Most experts recommend having your skin examined regularly.

      Bring any suspicious skin growths or changes in a mole to the attention of your doctor.

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      10 Questions to Ask Your Doctor About Melanoma 4 years ago

      Since you’ve recently been diagnosed with melanoma, ask your doctor these questions at your next visit.

      How far has my melanoma spread? How did you determine that?

      Can you remove all of the cancer through surgery alone?

      If I need any treatments besides surgery, what do you recommend, and why?

      How successful have these treatments been in cases like mine?

      What side effects can I expect from my treatments? What steps can I take to manage them?

      How long will I need these treatments?

      Will my surgery leave a noticeable scar? Is there a way to minimize scarring?

      Am I at high risk for a return of melanoma? What should I do to prevent a recurrence?

      Am I at higher risk for other types of cancer?

      How often should I see you for follow-up? Are there any symptoms I should look for in between visits?

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      Reality T.V. Star Becomes Melanoma Patient 4 years ago

      On The Real Housewives of Orange County, you faced a serious health threat. What happened?

      My doctor found a malignant mole -- a shallow melanoma in early stages -- on my thigh, a few inches above my knee. I've faced skin cancer before, but I never intended to share this "reality" on the show. Now, I'm glad I did. Since the show has aired, several people have told me they've gotten their skin checked because of me -- and it thrills me to hear it.

      Recommended Related to Melanoma/Skin Cancer

      Overview

      Note: Separate PDQ summaries on Skin Cancer Prevention, Skin Cancer Treatment, and Levels of Evidence for Cancer Screening and Prevention Studies are also available. Interventions The only widely proposed screening procedure for skin cancer is visual examination of the skin, including both self-examination and clinical examination. Benefits In asymptomatic populations, the effect of visual skin examination on mortality from nonmelanomatous skin cancers is unknown. Further, the evidence...

      Read the Overview article

      When were you first diagnosed with skin cancer?

      At age 27 -- 17 years ago. I went in for acne treatments and my doctor gasped. He removed 22 moles from my body. He tested them all, and one came back malignant.

      Were you a sun worshipper when you were young?

      I got a tremendous amount of sun exposure as a child. All the damage was done before I was 25.

      You write on your Bravo blog that you had an eye sewn shut for two months after half of your lower eyelid was removed due to skin cancer. Tell us about this experience.

      I had a tiny tumor near my tear duct. It was not malignant, but I still tell everyone: Wear sunglasses! Make sure your children wear sunglasses! Protect your eyes!

      How much has changed in the last two decades, in terms of prevention and treatment of skin cancers?

      Not enough. It will take someone like Brad Pitt getting melanoma to get the kind of funding needed to get the research done that this cancer needs.

      Any advice for other mothers trying to keep their families safe from UV rays?

      When my kids were little, it wasn't hard keeping them covered up. Now they want to be at the beach with their friends -- and not look dorky in long sleeves. But there are companies that make cute clothes that have sunscreen built into the fabrics. Also, be creative. Don't tell your teenager she can't go to the beach. Instead, plan an indoor activity for her and her friends -- like going to a cool sushi bar or a museum -- then take them to the beach after 4 p.m. Watch the sunset together.

      Since facing cancer, do you view your life or relationships differently?

      Completely. Yes, plan for the future. But enjoy the moment. Share your feelings for someone right now. Take more risks. Have a sense of adventure.

      How do you feel about aging?

      I like it. I am more confident in my 40s than I was in my 20s. I've got a great husband, great kids; I'm more direct. And physically? Well, I do look at my skin and wish I didn't get so much sun.

      As a society, are we are growing more obsessed with appearance? Or is it a matter of wanting to look and feel great to be healthy?

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      Reality T.V. Star Becomes Melanoma Patient 4 years ago

      Sure, it's vanity. But healthy looks good. Clear eyes, shiny hair -- we all want that.

      You've been forward about getting breast implants. Any regrets?

      I researched the procedure; spoke with my doctor; weighed the risks. I felt solid in my appearance, but I did it for my husband. He got a vasectomy for me, so we traded surgeries.

      You are a fitness fanatic who regularly hikes, surfs, and takes Pilates. Have you always been so active?

      My parents were active, so I have always been. But with any cancer, you need to exercise, eat right, and sleep to keep your immune system strong. So I am doubly motivated.

      What about nutrition? Do you follow a special regimen, diet, or simply try to eat well?

      Tons of water, veggies, green tea ... the works.

      How would you react if your teenaged daughter asked for breast implants?

      This was a major issue for me. I have never wanted her to have a false or bad body image. And I didn't want to contradict all the things I've told her, her whole life. I sat her down, explained that I had made this decision well into my 40s. I told her that once she is settled, has her children, and chooses whether or not to nurse, then if she decides to have implants, I'll even pay for them. I'll take care of her while she's recovering. But if she wants implants to help define herself or nab the right guy, then I'll fight her tooth and nail!

      What is your health philosophy?

      Eat right. Exercise. Have fun. Stay active -- but active out of the sun!

      What's better: real life or what we see on "reality" TV?

      Real life! But reality TV is a kick in the pants.

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      Skin cancer 4 years ago

      Skin cancers (neoplasms) are named after the type of skin cell from which they arise. Basal cell cancer originates from the lowest layer of the epidermis, and is the most common but least dangerous skin cancer. Squamous cell cancer originates from the middle layer, and is less common but more likely to spread and, if untreated, become fatal. Melanoma, which originates in the pigment-producing cells (melanocytes), is the least common, but most aggressive, most likely to spread and, if untreated, become fatal. Still, melanoma has one of the higher survival rates among major cancer, with over 75% of patients surviving 10 years in the UK during 2005-2007.

      In the UK in 2010, 12,818 people were diagnosed with malignant melanoma, and about 100,000 people were diagnosed with non-melanoma skin cancer. There were 2,746 deaths from skin cancer, 2,203 from malignant melanoma and 546 from non-malignant melanoma. In the US in 2008, 59,695 people were diagnosed with melanoma, and 8,623 people died from it.

      Most cases are caused by over-exposure to UV rays from the sun or sunbeds.

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      Classification 4 years ago

      There are three main types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma.

      Basal cell carcinomas are present on sun-exposed areas of the skin, especially the face. They rarely metastasize and rarely cause death. They are easily treated with surgery or radiation. Squamous cell carcinomas (SCC) are common, but much less common than basal cell cancers. They metastasize more frequently than BCCs. Even then, the metastasis rate is quite low, with the exception of SCC of the lip, ear, and in immunosuppressed patients. Melanomas are the least frequent of the 3 common skin cancers. They frequently metastasize, and could potentially cause death once they spread.

      Less common skin cancers include: Dermatofibrosarcoma protuberans, Merkel cell carcinoma, Kaposi's sarcoma, keratoacanthoma, spindle cell tumors, sebaceous carcinomas, microcystic adnexal carcinoma, Pagets's disease of the breast, atypical fibroxanthoma, leimyosarcoma, and angiosarcoma.

      The BCC and the SCCs often carry a UV-signature mutation indicating that these cancers are caused by UV-B radiation via the direct DNA damage. However the malignant melanoma is predominantly caused by UV-A radiation via the indirect DNA damage.The indirect DNA damage is caused by free radicals and reactive oxygen species. Research indicates that the absorption of three sunscreen ingredients into the skin, combined with a 60-minute exposure to UV, leads to an increase of free radicals in the skin, if applied in too little quantities and too infrequently. However, the researchers add that newer creams often do not contain these specific compounds, and that the combination of other ingredients tends to retain the compounds on the surface of the skin. They also add the frequent re-application reduces the risk of radical formation.

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      Signs & Symptoms 4 years ago

      There are a variety of different skin cancer symptoms. These include changes in the skin that do not heal, ulcering in the skin, discolored skin, and changes in existing moles, such as jagged edges to the mole and enlargement of the mole.

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      Basal Cell Carcinoma 4 years ago

      Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders. Sometimes small blood vessels can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring.

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      Squamous cell carcinoma 4 years ago

      Squamous cell carcinoma is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped like keratoacanthomas. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous cell is the second most common skin cancer. It is dangerous, but not nearly as dangerous as a melanoma.

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      Melanoma 4 years ago

      Most melanomas are brown to black looking lesions. Unfortunately, a few melanomas are pink, red or fleshy in color; these are called amelanotic melanomas. These tend to be more aggressive. Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or new pain, itching, ulceration or bleeding. An often-used mnemonic is "ABCDE", where A= asymmetrical, B= "borders" (irregular= "Coast of Maine sign"), C= "color" (variegated), D= "diameter" (larger than 6 mm—the size of a pencil eraser) and E= "evolving."

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      Others 4 years ago

      Merkel cell carcinomas are most often rapidly growing, non-tender red, purple or skin colored bumps that are not painful or itchy. They may be mistaken for a cyst or other type of cancer

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      Causes 4 years ago

      Ultraviolet radiation from sun exposure is the primary cause of skin cancer. Other factors that play a role include:

      Smoking tobacco

      HPV infections increase the risk of squamous cell carcinoma.

      Some genetic syndromes including congenital melanocytic nevi syndrome which is characterized by the presence of nevi (birthmarks or moles) of varying size which are either present at birth, or appear within 6 months of birth. Nevi larger than 20 mm (3/4") in size are at higher risk for becoming cancerous.

      Chronic non-healing wounds. These are called Marjolin's ulcers based on their appearance, and can develop into squamous cell carcinoma.

      Ionizing radiation, environmental carcinogens, artificial UV radiation (e.g. tanning beds), aging, and light skin color. It is believed that tanning beds are the cause of hundreds of thousands of basal and squamous cell carcinomas.

      The use of many immunosuppressive medication increase the risk of skin cancer. Cyclosporin A, a calcineurin inhibitor for example increases the risk approximately 200 times, and azathioprine about 60 times.

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      Pathophysiology 4 years ago

      Squamous cell carcinoma is a malignant epithelial tumor which originates in epidermis, squamous mucosa or areas of squamous metaplasia.

      Macroscopically, the tumor is often elevated, fungating, or may be ulcerated with irregular borders. Microscopically, tumor cells destroy the basement membrane and form sheets or compact masses which invade the subjacent connective tissue (dermis). In well differentiated carcinomas, tumor cells are pleomorphic/atypical, but resembling normal keratinocytes from prickle layer (large, polygonal, with abundant eosinophilic (pink) cytoplasm and central nucleus).

      Their disposal tends to be similar to that of normal epidermis: immature/basal cells at the periphery, becoming more mature to the centre of the tumor masses. Tumor cells transform into keratinized squamous cells and form round nodules with concentric, laminated layers, called "cell nests" or "epithelial/keratinous pearls". The surrounding stroma is reduced and contains inflammatory infiltrate (lymphocytes). Poorly differentiated squamous carcinomas contain more pleomorphic cells and no keratinization.

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      Prevention 4 years ago

      Sunscreen is effective and thus recommended to prevent melanoma and squamous cell carcinoma. There is little evidence that it is effective in preventing basal cell carcinoma. Other advice to reduce rates of skin cancer includes: avoiding sunburning, wearing protective clothing, sunglasses and hats, and attempting to avoid periods of peak sun exposure. The U.S. Preventive Services Task Force recommends that people aged between 9 and 25 years of age are advised to avoid ultraviolet light.

      The risk of developing skin cancer can be reduced through a number of measures including: decreasing indoor tanning and mid day sun exposure, increasing the use of sunscreen, and avoiding the use of tobacco products.

      There is insufficient evidence either for or against screening for skin cancers. Vitamin supplements and antioxidant supplements have not been found to have an effect in prevention. Evidence for a benefit from dietary measures is tentative.

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      Management 4 years ago

      Treatment is dependent on type of cancer, location of the cancer, age of the patient, and whether the cancer is primary or a recurrence. Treatment is also determined by the specific type of cancer. For a small basal cell cancer in a young person, the treatment with the best cure rate (Mohs surgery or CCPDMA) might be indicated. In the case of an elderly frail man with multiple complicating medical problems, a difficult to excise basal cell cancer of the nose might warrant radiation therapy (slightly lower cure rate) or no treatment at all. Topical chemotherapy might be indicated for large superficial basal cell carcinoma for good cosmetic outcome, whereas it might be inadequate for invasive nodular basal cell carcinoma or invasive squamous cell carcinoma. In general, melanoma is poorly responsive to radiation or chemotherapy.

      For low-risk disease, radiation therapy (external beam radiotherapy or brachytherapy), topical chemotherapy (imiquimod or 5-fluorouracil) and cryotherapy (freezing the cancer off) can provide adequate control of the disease; both, however, may have lower overall cure rates than certain type of surgery. Other modalities of treatment such as photodynamic therapy, topical chemotherapy, electrodesiccation and curettage can be found in the discussions of basal cell carcinoma and squamous cell carcinoma.

      Mohs' micrographic surgery (Mohs surgery) is a technique used to remove the cancer with the least amount of surrounding tissue and the edges are checked immediately to see if tumor is found. This provides the opportunity to remove the least amount of tissue and provide the best cosmetically favorable results. This is especially important for areas where excess skin is limited, such as the face. Cure rates are equivalent to wide excision. Special training is required to perform this technique. An alternative method is CCPDMA and can be performed by a pathologist not familiar with Mohs surgery.

      In the case of disease that has spread (metastasized), further surgical procedures or chemotherapy may be required.

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      Reconstruction 4 years ago

      Currently, surgical excision is the most common form of treatment for skin cancers. The goal of reconstructive surgery is restoration of normal appearance and function. The choice of technique in reconstruction is dictated by the size and location of the defect. Excision and reconstruction of facial skin cancers is generally more challenging due to presence of highly visible and functional anatomic structures in the face.

      When skin defects are small in size, most can be repaired with simple repair where skin edges are approximated and closed with sutures. This will result in a linear scar. If the repair is made along a natural skin fold or wrinkle line, the scar will be hardly visible. Larger defects may require repair with a skin graft, local skin flap, pedicled skin flap, or a microvascular free flap. Skin grafts and local skin flaps are by far more common than the other listed choices.

      Skin grafting is patching of a defect with skin that is removed from another site in the body. The skin graft is sutured to the edges of the defect, and a bolster dressing is placed atop the graft for seven to ten days, to immobilize the graft as it heals in place. There are two forms of skin grafting: split thickness and full thickness. In a split thickness skin graft, a shaver is used to shave a layer of skin from the abdomen or thigh. The donor site, regenerates skin and heals over a period of two weeks. In a full thickness skin graft, a segment of skin is totally removed and the donor site needs to be sutured closed.

      Split thickness grafts can be used to repair larger defects, but the grafts are inferior in their cosmetic appearance. Full thickness skin grafts are more acceptable cosmetically. However, full thickness grafts can only be used for small or moderate sized defects.

      Local skin flaps are a method of closing defects with tissue that closely matches the defect in color and quality. Skin from the periphery of the defect site is mobilized and repositioned to fill the deficit. Various forms of local flaps can be designed to minimize disruption to surrounding tissues and maximize cosmetic outcome of the reconstruction. Pedicled skin flaps are a method of transferring skin with an intact blood supply from a nearby region of the body. An example of such reconstruction is a pedicled forehead flap for repair of a large nasal skin defect. Once the flap develops a source of blood supply form its new bed, the vascular pedicle can be detached.

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      Prognosis 4 years ago

      The mortality rate of basal cell and squamous cell carcinoma are around 0.3% causing 2000 deaths per year in the US. In comparison the mortality rate of melanoma is 15-20% and it causes 6500 deaths per year.:29,31 Even though it is much less common, malignant melanoma is responsible for 75% of all skin cancer-related deaths.

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      Epidemiology 4 years ago

      A study of the incidence of non-melanoma skin cancer from 1992 to 2006 in the United States was performed by the dermatologist Howard Rogers, MD, PhD, and his colleagues based on the evaluation of Medicare databases. The results of their research showed that cases of non-melanoma skin cancer rose an average of 4.2% a year.

      More than 3.5 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in that country. According to the Skin Cancer Foundation, one in five Americans will develop skin cancer at some point of their lives. The first most common form of skin cancer is basal cell carcinoma, followed by the squamous cell carcinoma. Although the incidence of many cancers in the United States is falling, the incidence of melanoma keeps growing, with approximately 68,729 melanomas diagnosed in 2004 according to reports of the National Cancer Institute.

      The survival rate for patients with melanoma depends upon when they start treatment. The cure rate is very high when melanoma is detected in early stages, when it can easily be removed surgically. The prognosis is less favorable if the melanoma has spread to other parts of the body.

      In the UK, 84,500 non-melanoma skin cancers were registered in 2007 although a study estimated that at least 100,000 cases are diagnosed each year. Most NMSCs were basal cell carcinomas or squamous cell carcinomas. In 2007, 10,672 cases of malignant melanoma were diagnosed.

      Australia and New Zealand exhibits one of the highest rates of skin cancer incidence in the world, almost four times the rates registered in the United States, the UK and Canada. Around 434,000 people receive treatment for non-melanoma skin cancers and 10,300 are treated for melanoma. Melanoma is the common type of cancer in people between 15–44 years in both countries. This is largely due to the ozone hole located over the Tasman Sea, making prolonged unprotected outdoor sun exposure very dangerous. The risk of skin cancer in Australia is predicted to increase. The reason given for the increase is that ozone levels are not expected to recover to pre-depletion levels until the middle of this century, UV levels are expected to continue to rise. Combined with Australians favoring an outdoor life-style, when temperatures are warmer, under high levels of UV, the associated risk of skin cancer will increase.

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      Facts about Tanning 4 years ago

      No one should go to tanning salons, let alone a child. A recent study showed that children of women who tan indoors are more likely to be indoor tanners themselves. The study found that young women whose first indoor ultraviolet (UV) tanning experience is with their mothers are more than 4.6 times more likely to become heavy tanners.

      Here are the facts on indoor tanning:

      Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors.1

      People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.2

      Ten minutes in a sunbed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun.3

      Nearly 30 million people tan indoors in the U.S. every year4; 2.3 million of them are teens.

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      Prevention Guidelines 4 years ago

      Since its inception in 1979, The Skin Cancer Foundation has always recommended using a sunscreen with an SPF 15 or higher as one important part of a complete sun protection regimen. Sunscreen alone is not enough, however. Read our full list of skin cancer prevention tips.

      Seek the shade, especially between 10 AM and 4 PM.

      Do not burn.

      Avoid tanning and UV tanning booths.

      Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.

      Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.

      Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside.

      Reapply every two hours or immediately after swimming or excessive sweating.

      Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.

      Examine your skin head-to-toe every month.

      See your physician every year for a professional skin exam.

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      Make Vitamin D not UV a priority 4 years ago

      Sometimes the cure can be worse than the condition. For thousands of vitamin D-deficient people in the U.S., can obtaining this so-called "sunshine vitamin" actually endanger health?

      Vitamin D has been a mainstay in the news recently, with stories claiming it protects against everything from high blood pressure to cancer. Though its ability to prevent these conditions remains unproven, vitamin D is essential for bone health, immune system functioning, and more.

      An organic compound, Vitamin D is fat-soluble (meaning some dietary fat is necessary for its absorption). A lack of the vitamin puts us at risk for painful, weak muscles, inadequate bone mineralization, and skeletal deformities in children (rickets), as well as mineral loss and soft bones in adults (osteomalacia).

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      UV exposure is not the answer 4 years ago

      Our bodies manufacture vitamin D when the sun's ultraviolet B (UVB) rays interact with 7-dehydrocholesterol (7-DHC) present in the skin. "However, we can produce only a limited amount of vitamin D from UVB. A few minutes at midday are sufficient for many Caucasians," says Roy Geronemus, MD, clinical professor of dermatology at New York University Medical Center and director of the Skin/Laser Division at the New York Eye & Ear Infirmary. "After reaching the production limit, further exposure actually destroys the vitamin, decreasing vitamin D levels."

      Furthermore, UV exposure is unlikely to produce enough vitamin D in darker skin, so African-Americans and dark-skinned Hispanics relying on UV alone are especially at risk for deficiency. The National Institutes of Health's Office of Dietary Supplements also warns that the elderly have a reduced ability to synthesize vitamin D from sunlight; and between November and February, UV radiation (UVR) is insufficient to produce vitamin D in people living above 42 north latitude, which includes Boston, northern California, and other areas north.

      Finally, prolonged exposure to UVR is linked to skin cancer, immune system suppression, photoaging (sun-induced skin aging), cataracts, and other eye damage. Therefore, The Skin Cancer Foundation recommends obtaining vitamin D largely from food or supplements while continuing to follow the Foundation's skin cancer Prevention Guidelines.

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      How much Vitamin D do we need? 4 years ago

      The Skin Cancer Foundation supports The Institute of Medicine of the National Academies’ Recommended Dietary Allowance (RDA) for vitamin D, which is 600 IU (International Units) a day for people between the ages of 1 and 70, and 800 IU a day for people ages 70 and older. For children under 1 year, adequate intake (AI) is 400 IU a day.

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      vitamin D sources 4 years ago

      While oily fish are the best food source of Vitamin D (See "Oily Fish: Your Route to Vitamin D"), several other foods supply significant amounts, including the choices below.

      Look for products labeled "for bone health" or "with calcium"; these usually contain vitamin D to aid in calcium absorption.

      So maximize your health by getting enough vitamin D the safe way your body will thank you!

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      Vitamin D sources 4 years ago

      Cod liver oil 1 tbsp. 1,360

      Vitamin D-fortified

      soy milk 8 oz. Up to 120

      Vitamin D-fortified orange juice 8 oz. 98

      Vitamin D-fortified milk 8 oz. 98

      Vitamin D-fortified yogurt 6 oz. Up to 80

      Vitamin D-fortified margarine 1 tbsp. 60

      Vitamin D-fortified

      cereal 6-8 oz. 40

      Egg yolk 1 yolk 0

      Beef liver, cooked 3.5 oz. 15

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      Anderson Cooper, temporarily blinded 4 years ago

      Anderson Cooper is used to reporting the news, but in early December the CNN anchor was the subject of a story himself after a boat trip in Portugal left him temporarily blind. While out on the water reporting for CBS’s 60 Minutes, Cooper was not wearing sunglasses. The sunlight both from above and reflected off the water burnt his eyes.

      Cooper explained, “I wake up in the middle of the night and it feels like my eyes are on fire…I think, oh maybe I have sand in my eyes or something…It turns out I have sunburned my eyeballs...I went blind for 36 hours.”

      The condition experienced by Cooper is known as keratitis, which occurs when the outermost layer of the eye becomes inflamed. The outer layer on the front of the eyeball, known as the cornea, is similar to the outer layer of our skin. When it gets burned by the sun’s rays, it can lead to intense pain and temporary blindness. There is a higher risk of burning for individuals like Anderson Cooper, who have lighter-colored eyes.

      “We have sunscreen we can put on our skin, but we don’t have eye drops that offer a protective film for the cornea, so it is really important that everyone, and especially people with fair or light eyes, wear sunglasses that protect against both UVA and UVB rays,” said Deborah S. Sarnoff, MD, Senior Vice President of The Skin Cancer Foundation.

      To lower your risk for future eye conditions such as cataracts, macular degeneration, or skin cancer around the eyes, be sure to wear sun protection every day. “To keep your eyes safe, wear sunglasses and a hat with a three-inch brim. If you do get a burn, see your ophthalmologist right away,” advises Dr. Sarnoff.

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      Sunscreen 4 years ago

      Since its inception in 1979, The Skin Cancer Foundation has always recommended using a sunscreen with an SPF of 15 or higher as one important part of a complete sun protection regimen which includes seeking shade, covering up with clothing including a wide-brimmed hat and UV-blocking sunglasses and avoiding tanning and UV tanning booths. Recent attacks on sunscreens in the media point to imperfections and potential risks, but miss the point that sunscreen continues to be one of the safest and most effective sun protection methods available.

      We are concerned that the criticisms will raise unnecessary fears and cause people to stop using sunscreen, doing their skin serious harm.

      In general, the criticisms have not been based on hard science. In fact, The Chair of the Skin Cancer Foundation’s Photobiology Committee, an independent panel of top experts on sun damage and sun protection, reviewed the same studies cited in the media, and found that their determination of what made a sunscreen bad or good was based on “junk science.”

      Below, the Photobiology Committee responds to the criticisms and explains why sunscreen remains an essential part of anyone’s daily sun safety program.

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      General skin cancer facts 4 years ago

      Skin cancer is the most common form of cancer in the United States. More than 3.5 million skin cancers in over two million people are diagnosed annually.1

      Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.2

      Treatment of nonmelanoma skin cancers increased by nearly 77 percent between 1992 and 2006.1

      Over the past three decades, more people have had skin cancer than all other cancers combined.3

      One in five Americans will develop skin cancer in the course of a lifetime.5

      13 million white non-Hispanics living in the US at the beginning of 2007 had at least one nonmelanoma skin cancer, typically diagnosed as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).3

      Basal cell carcinoma is the most common form of skin cancer; an estimated 2.8 million are diagnosed annually in the US. BCCs are rarely fatal, but can be highly disfiguring if allowed to grow.6

      Squamous cell carcinoma is the second most common form of skin cancer. An estimated 700,000 cases of SCC are diagnosed each year in the US.6,7

      An estimated 3,010 deaths from nonmelanoma skin cancers will occur in the US in 2012.2

      Between 40 and 50 percent of Americans who live to age 65 will have either BCC or SCC at least once.4

      Actinic keratosis is the most common precancer; it affects more than 58 million Americans.8

      Approximately 65 percent of all squamous cell carcinomas and 36 percent of all basal cell carcinomas arise in lesions that previously were diagnosed as actinic keratoses.9

      About 90 percent of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun

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      Melanoma facts 4 years ago

      From 1970 to 2009, the incidence of melanoma increased by 800 percent among young women and 400 percent among young men.45

      One person dies of melanoma every hour (every 57 minutes).2

      Melanoma accounts for less than five percent of skin cancer cases, but the vast majority of skin cancer deaths.2

      An estimated 76,250 new cases of invasive melanoma will be diagnosed in the US in 2012, with 9,180 estimated to result in death.2

      Of the seven most common cancers in the US, melanoma is the only one whose incidence is increasing. Between 2000 and 2009, incidence climbed 1.9 percent annually.11

      1 in 50 men and women will be diagnosed with melanoma of the skin during their lifetime.11

      In 2009, there were approximately 876,344 men and women alive in the U.S. with a history of melanoma.11

      Survival with melanoma increased from 49 percent (1950 – 1954) to 92 percent (1996 – 2003).12

      About 86 percent of melanomas can be attributed to exposure to ultraviolet (UV) radiation from the sun.13

      Melanoma is one of only three cancers with an increasing mortality rate for men, along with liver cancer and esophageal cancer.14

      Survivors of melanoma are about nine times as likely as the general population to develop a new melanoma.15

      The vast majority of mutations found in melanoma are caused by ultraviolet radiation.16

      Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.17

      The overall 5-year survival rate for patients whose melanoma is detected early, before the tumor has spread to regional lymph nodes or other organs, is about 98 percent in the US. The survival rate falls to 62 percent when the disease reaches the lymph nodes, and 15 percent when the disease metastasizes to distant organs.2

      A person’s risk for melanoma doubles if he or she has had more than five sunburns at any age.19

      One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.

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      Skin Cancer In relation to men and women 4 years ago

      An estimated 44,250 new cases of invasive melanoma in men and 32,000 in women will be diagnosed in the US in 2012.2

      An estimated 6,060 men and 3,120 women in the US will die from melanoma in 2012.2

      Melanoma is the fifth most common cancer for males and sixth most common for females.2

      Five percent of all cancers in men are melanomas; four percent of all cancers in women are melanomas.2

      One in 36 men and one in 55 women will develop melanoma in their lifetimes.2

      Up until age 40, significantly more women develop melanoma than men (1 in 377 women vs. 1 in 677 men). After age 40, significantly more men develop melanoma than women (1 in 36 vs. 1 in 55).2

      Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.2

      The majority of people diagnosed with melanoma are white men over age 50.11

      Caucasian men over age 65 have had an 5.1 percent annual increase in melanoma incidence since 1975, the highest annual increase of any gender or age group.21

      The number of women under age 40 diagnosed with basal cell carcinoma has more than doubled in the last 30 years; the incidence of squamous cell carcinoma among women under age 40 has increased almost 700 percent.22

      Adults over age 40, especially men, have the highest annual exposure to UV.

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      Indoor Tanning Facts 4 years ago

      Ultraviolet radiation (UVR) is a proven human carcinogen.24

      The International Agency for Research on Cancer, an affiliate of the World Health Organization, includes ultraviolet (UV) tanning devices in its Group 1, a list of the most dangerous cancer-causing substances. Group 1 also includes agents such as plutonium, cigarettes, and solar UV radiation.25

      Currently tanning beds are regulated by the FDA as Class I medical devices18, the same designation given elastic bandages and tongue depressors.26

      Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.24

      Just one indoor tanning session increases users’ chances of developing melanoma by 20 percent, and each additional session during the same year boosts the risk almost another two percent.46

      People who tan indoors just four times per year increase their risk of basal cell carcinoma and squamous cell carcinoma by 15 percent.27

      Just one indoor tanning session per year in high school or college boosts the risk of basal cell carcinoma by 10 percent. That risk is increased to 73 percent if one tans six times per year.27

      Indoor tanners have a 69 percent increased risk of early-onset basal cell carcinoma.28

      Approximately 25 percent of early-onset basal cell carcinomas could be avoided if an individual never tanned indoors.28

      Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors.29 Those who begin tanning before the age of 35 increase their melanoma risk by 87 percent.46

      Ten minutes in a sunbed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun.30

      Nearly 30 million people tan indoors in the U.S. every year.31 Two to three million of them are teens.32

      The indoor tanning industry has annual estimated revenue of $5 billion.32

      People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.33

      Seventy-one percent of tanning salon patrons are females.34

      On an average day, more than one million Americans use tanning salons.

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      Ethnicity Facts 4 years ago

      The overall 5-year melanoma survival rate for African Americans is only 77 percent, versus 91 percent for Caucasians.14

      Skin cancer represents approximately two to four percent of all cancers in Asians.36

      Skin cancer comprises one to two percent of all cancers in African Americans and Asian Indians. 36

      Melanomas in African Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.36

      Basal cell carcinoma (BCC) is the most common cancer in Caucasians, Hispanics, Chinese Asian and the Japanese.36

      Squamous cell carcinoma (SCC) is the most common skin cancer among African Americans and Asian Indians.36

      Squamous cell carcinomas in African Americans tend to be more aggressive and are associated with a 20-40 percent risk of metastasis (spreading).36

      Late-stage melanoma diagnoses are more prevalent among minority patients than Caucasian patients; 52 percent of non-Hispanic black patients and 26 percent of Hispanic patients receive an initial diagnosis of advanced stage melanoma, versus 16 percent of non-Hispanic white patients.37

      Asian American and African American melanoma patients have a greater tendency than Caucasians to present with advanced disease at time of diagnosis.38

      While melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.

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      Aging/Sun Damage facts 4 years ago

      More than 90 percent of the visible changes commonly attributed to skin aging are caused by the sun.42

      Contrary to popular belief, 80 percent of a person’s lifetime sun exposure is not acquired before age 18; only about 23 percent of lifetime exposure occurs by age 18.

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      Facts about skin cancer treatment 4 years ago

      In adults 65 or older, melanoma treatment costs total about $249 million annually. About 40 percent of the annual cost for melanoma goes to treating stage IV (advanced) cancers, though they account for only three percent of melanomas.43

      The number of nonmelanoma skin cancers in the Medicare population went up an average of 4.2 percent every year between 1992 and 2006.1

      In 2004, the total direct cost associated with the treatment for nonmelanoma skin cancer was $1.4 billion.

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      Devika Primić 4 years ago from Dubrovnik, Croatia

      I have a mole and got to have it checked it has been for a while and has grown since 2002, and fails to go away no matter what I do. thanks for this information

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      Author

      Funom Theophilus Makama 4 years ago from Europe

      Pls DDE, do regular examination on it and consult a professional.

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      Robert Morgan 2 years ago from Hutchinson Island, FL - Myrtle Beach, SC - Scottsdale AZ

      This is an excellent article. I hope you are doing well in your medical en-devours. I am a Naturopath and I work with many people who have been turned away by medical doctors. I wish you well. Blessings

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      Dr. Dave Gray 15 months ago

      We are urgently in need of kidney donors

      in Appolo Hospitals India for the sum of $290,000.00 USD,

      Contact Dr.Dave Gray now on email for more details.

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