Cancer Treatment
Skin Cancer
Our skin consists of three layers the epidermis, the top layer of the skin protects our body and is thin in some regions and thicker in other places. The second layer called the dermis is thicker than the epidermis, consisting of the sweat glands (which cools our body), nerve endings (enabling a sense of touch, temperature, and pressure), hair roots & oil glands (keep the skin moist) and blood vessels (to supply nutrition to the skin). The third and lowermost layer of the skin is the subcutaneous fat layer, which attaches the skin to the body, helping control body temperature and acting as a fat reserve.
The abnormal and uncontrolled growth of cells usually happens in the epidermis, the outermost layer of our skin. Mutations are triggered due to the deterioration of the DNA, often due to high exposure of skin to sunrays and in some cases on areas of skin not ordinarily exposed to sunlight and lead to the formation of cancer cells on the skin.
Symptoms of Skin Cancer:
Different types of skin cancers may exhibit different symptoms.
Basal cell carcinoma: A translucent, skin-coloured or pink growth or bleeding or scabbing sore, which usually appears near the face or ears.
Squamous cell carcinoma: A firm, red bump or a flat sore with a scaly crust or a non-healing ulcer.
Melanoma: A change in the existing mole (increase in size with irregular borders, bleeds on scratching, irregular surface, change of colour) or a new pigmented or abnormal growth on your skin
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Causes of Skin Cancer
- Exposure to UV Radiation: The ultraviolet radiation found in the sun or tanning beds can be harmful to the skin, resulting in DNA damage. Going out in the sun for long periods without a protective cover (clothes or sunscreens) can increase the risk. Having sunburns mean that your skin is not able to protect itself from the sun, which puts you at a higher risk of cancer than others.
- Fair Skin: Melanin (the pigment responsible for skin colour) protects the skin from UV rays; skin cancer can occur in any individual irrespective of skin colour, and lighter skin increases the risk of skin cancer.
- Moles:If you have moles of irregular shape and an unusual number of moles, you may be at a higher risk for cancer.
- Precancerous skin lesions: Skin lesions known as actinic keratoses can increase your risk of developing skin cancer. These precancerous skin growths typically appear as rough, scaly patches varying in colour from brown to dark pink and are typically found on the face, head and hands of fair-skinned people whose skin has been damaged by UV rays from sunlight.
- Family History:Having a positive family history of skin cancer, can increase your risk of getting skin cancer.
- Weak immune system: People with weakened immune systems have a greater risk of developing skin cancer, which includes individuals with HIV/AIDS or taking immunosuppressant drugs after an organ transplant.
- Radiation exposure: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.
Understanding skin cancer and adopting effective preventive measures is your best defence against skin cancer.
Types of Skin Cancer
There are the following types of cancer:
- Basal cell carcinoma: This cancer develops in the lowermost layer of the epidermis and usually occurs in skin regions exposed to UV rays. These cancers grow slowly and are less likely to metastasize to other parts of the body with higher chances of making a recurrence.
- Squamous cell carcinoma: These account for almost 20% of non-melanoma cancers of the skin. Squamous cells are the flat cells on the outermost layer of the skin and are more likely to be found in areas exposed to the sun like the head, neck or arms. They usually metastasize to surrounding lymph nodes and if left untreated spread to distant organs as well.
- Melanoma: Malignant transformation of melanocytes gives rise to melanoma and is aggressive. Melanocytes are the skin cells responsible for producing melanin; a pigment accountable for skin colour, which protects us from the UV rays. These cells darken (as they release more melanin) on exposure to the sun as a response to protect the skin from the harmful effects of UV rays.
- Merkel cell carcinoma: This is an aggressive form of cancer that originates in the Merkel cells, which are responsible for touch sensation. They are typically common in areas like the head, scalp or face, with the tendency to metastasize to the brain, bones, liver and/or lungs
- Rare skin cancers:These include Kaposi’s sarcoma, sebaceous gland carcinoma, cutaneous lymphoma etc.
Prevention of Skin Cancer
Most skin cancers can be prevented by employing the following preventive measures:
Avoid going out in the sun for longer periods of time when the sun is at its peak.
If you have to go in the sun, make sure to wear protective clothing.
Use sunscreens. You may want to use broad-spectrum sunscreen (with SPF above 30) on exposed skin when going out in the sun.
Avoid tanning beds as they emit UV radiation.
Do not use ‘sun-sensitizing’ medications without doctor approval.
If you are at a higher risk than others, get yourself tested and screened periodically. A self-examination by standing in front of the mirror and checking for any changes to your skin or pre-existing moles is recommended.
Tests for Skin Cancer:
Physical examination: A thorough physical examination will be carried out after obtaining a detailed history of your symptoms.
Biopsy: A biopsy is performed to determine the exact type of skin cancer. Depending on the size of the growth or suspicious area, the biopsy can be:
- Incisional biopsy:a small sample is taken after administering local anaesthesia and sent for histopathological reporting.
- Excisional biopsy: for smaller growths or suspicious areas, the entire area is removed under local anaesthesia.
CT scan: In advanced cases of squamous cell carcinoma, a CT scan of the chest, abdomen and pelvis may be done to determine the spread of cancer into lymph nodes (pelvic, abdominal or mediastinal) or to other organs, which helps determine the stage the disease and in turn decide on the best treatment approaches for the patient.
PET CECT scan: A PET CT scan is usually advised to determine the stage of disease in patients with melanoma.
Treatment includes
Surgery
This process involves the removal of the primary skin tumour with a margin of normal tissue. This can be achieved with various procedures depending on the size of the skin cancer.
Excisional surgery: This procedure is apt for any type of skin cancer wherein the cancerous tissue along with a margin of healthy skin tissues is removed.
Mohs micrographic surgery: involves the removal of the tumour layer by layer to preserve the maximum area of skin as possible, which is a preferred treatment approach in areas where skin preservation is necessary.
Amputation: In some cases, amputation of the affected part may be needed to completely remove the cancerous growth.
Lymph node dissection: Is usually carried out in cases of squamous cell carcinomas and melanomas, to remove the draining lymph nodes.
Non-surgical options include:
Excisional surgery: This procedure is apt for any type of skin cancer wherein the cancerous tissue along with a margin of healthy skin tissues is removed.
Cryotherapy: This process utilizes liquid nitrogen to freeze the cancerous cells until the tissues are destroyed.
Curettage and Electrodesiccation or Cryotherapy: After removing the cancerous growth this procedure is employed wherein layers of cancer cells are scraped off using a circular blade and the remaining cancer cells are destroyed using electric needles.
Anti-cancer creams: Cancers that are limited to the upper layers of the skin can be treated using creams that contain anti-cancer agents.
Photodynamic therapy: It uses a combination of laser light and drugs to treat superficial skin cancers
Radiation therapy: This procedure makes use of high-energy rays to target and destroy cancer cells. Radiation treatment may be suggested after surgery as adjuvant treatment with or without chemotherapy in cases of squamous cell carcinoma.
Chemotherapy: Chemotherapy in the form of injections may be suggested depending on the stage of disease in cases of squamous cell carcinoma which is done in 2 -3 weekly cycles, for a total of 6 cycles. In some cases, chemo is given along with radiation treatment and is called concurrent chemo-radiotherapy.
Biological therapy or immunotherapy: In advanced cases of melanoma, biological therapy or immunotherapy is recommended. Immunotherapy targets the cells, which affect the body’s immune response and helps the body eliminate cancer cells.
Targeted therapy: Targeted therapy uses drugs to target specific proteins within the cancer cells, to eliminate them. For example, Vemurafenib, and Dabrafenib targeting BRAF protein in melanoma cells is recommended for the treatment of advanced cases of melanoma.
Doctors
Plastic Surgery
Dr. Sachin Chavre
DNB, GS
Surgical Oncology
Dr. Aruna Prabhu
MS, MCh
Radiation oncology
Dr. Karthick Rajamanickam
MD
Surgical Oncology
Dr. Deepti Mishra
MS, MCh