DEFINITION
Skin Neoplasm is the type of cancers that arise from the skin cells. Skin cancer commonly occurs in the areas of the skin exposed to the sun.
The primary areas to develop skin cancers are the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs and rarely skin cancer can occur in the palms, beneath the fingernails or toenails, and in the genital area.
TYPES OF SKIN CANCERS
Basal cell carcinoma: Basal cell carcinoma originates from the basal cells in the lowest layer of the epidermis. These cancers appear as a transparent bump on the skin
Squamous cell carcinoma: This originates from the squamous cells which is the middle and outer layer of the skin. This is a less common type but has the ability to spread aggressively, if left untreated and can cause serious complications.
Malignant melanoma: This originates from the pigment producing cells (Melonocytes) and is the most aggressive type of cancer more likely to spread to other parts of the body.
ETIOLOGY/ RISK FACTORS
- Ultraviolet radiation from sun exposure
- Smoking, tobacco use can cause chemical mutations and predisposes to skin cancer
- HIV infections increases the risk of squamous cell carcinoma
- Some genetic syndrome like congenital melanocytic nevi syndrome (presence of birth marks or moles) of varying size are at higher risk for becoming cancerous
- Chronic Non-healing wounds can develop into squamous cell carcinoma
- Ionizing radiation, environmental carcinogens, artificial UV radiation (Eg. Tanning beds)
- Ageing and light skin color has the risk of developing basal and squamous cell carcinoma
- Exposure to chemical substances such as Arsenic
- Use of immuno suppressive medications like cyclosporine A calcinerium inhibitor, azathioprine, increases the risk of cancer about 200 times as these drugs modulates the Immune System leading to impaired body defenses and abnormal growth of unwanted cells in the skin
PATHOPHYSIOLOGY
Due to factors that cause gene Mutation or chemical alterations in the skin from Ultraviolet radiation exposure
↓
Tanning of the skin causes Repair of the DNA
↓
Impaired Immune Surveillance to identify the newly formed Tumor cells
↓
Formation of epithelial tumor that originates from the epidermis
↓
Metaplasia of the cells into cancerous cells
↓
The tumor cells become elevated and may be ulcerated with irregular borders
↓
The tumor cells destroy the basement membrane and form as sheets or compact masses
↓
Tumors cells then invade the adjacent connective tissue (dermis)
↓
Tumor cells multiply atypically with abundant cytoplasm and nucleus
↓
Tumor cells transform into keratinized squamous cells and form round nodules with concentric laminated layers called keratinous pearls
↓
The cells then infiltrate into surrounding structures and metastasize to all parts of body
CLINICAL MANIFESTATIONS
- Changes in skin that do not heal
- Ulceration of skin, discolored skin
- Changes in the existing moles like jagged edges to the mole and enlargement of the mole
- Crusting and bleeding in the Centre of tumor
- Appearance of new mole with pain, itching, ulceration, redness around the site with bleeding
| S.No | TYPES OF SKIN CARCINOMA | CLINICAL CHARACTERISTICS |
| 1. | Basal Cell Carcinoma | · Smooth, pearly bump on the sun exposed skin of the head, neck and shoulders
· A flat, skin-colored or brown scar-like lesion · A bleeding or scabbing sore does not heals
|
| 2. | Squamous Cell Carcinoma | · Red scaling, thickened patch on skin exposed skin
· Presence of Firm red Nodule · Lesion with Crusted Surface |
| 3. | Malignant Melanoma | · A pink, red, fleshy color melanoma varying in size, shape, color and elevation of mole (malignant melanoma)
· A brownish spot with speckles · Painful lesion with itching and burns · Dark lesions on the palms, soles, fingertips or toes
|
Diagnostic Evaluation
Skin Examination
- A- Asymmetrical
- B- borders (irregular coast or maine sign)
- C- Color (variegated)
- D-Diameter (larger than 6 mm in size of a pencil eraser
- E- Evolving
Skin Biopsy: To differentiate the type of cancer
MANAGEMENT OF SKIN CANCERS
MOH’s surgery: It is also known as chemo surgery. It is obtaining complete margin control during the removal of a skin cancer and complete circumferential peripheral and deep margin assessment using frozen section histology
Excisional Surgery: In this surgery the cancerous tissue including the surrounding margin of healthy skin is removed. A wide Excision can be done by removing the extra normal skin around the tumor
Radiation Therapy: External beam radiation therapy and brachytherapy to prevent recurrence after surgery
Chemotherapy: Topical imiquimod or 5-flurouracil to treat cancer tissue after surgery
Cryotherapy: It is therapy where the cancer tissue is freezes off using freezing ice
Photodynamic Therapy: Where heat energy is applied on the cancer tissue to cause scarring off cancer
Electro desiccation and curettage: Here a curette is used to scrape of cancer down to the dermis. The scraping is then paused which an electro surgical device like hyfrecator and electro coagulation is performed over the raw surgical ulcer to denature the layer of epidermis and again curette is done to remove the denatured dermis tissue.
Reconstruction treatment
Excision and Reconstruction of facial skin: The skin defects that are small in size can be repaired where skin edges are approximated and closed with sutures. Large defects may require repair with a skin graft, local skin flap or a micro-vascular free flap. Skin grafts are used for patching of a defect with skin that is removed from another site of the body.
PREVENTION
- Apply Sunscreen when going outdoor in sun as it is effective in preventing melanoma
- Wear Protective clothing that covers the arms, leg and neck. Use broad-brimmed caps when walking in the sun to prevent Ultraviolet radiation exposure to the face
- Avoid sun burns by wearing sunglasses, hats and avoid sun exposure at peak periods
- Decrease indoor tanning and mid day sun exposure
- Avoid use of tobacco products
- Vitamin supplements and anti oxidant supplements is dietary measures to benefit in preventing skin cancer.
- Examine the Skin regularly for any newly originated freckles, bumps or changes in the moles and birthmarks and any color changes in the skin with the help of Mirrors and notify the dermatologist Immediately
- Avoid Over the counter drugs and any skin sensitive Medications