Skin cancer

Skin cancer is a type of cancer that begins in the cells of the skin. It is the most prevalent cancer worldwide, and its incidence has been rising steadily. The skin, being the largest organ in the body, is susceptible to various forms of damage, and prolonged exposure to ultraviolet (UV) radiation from the sun is the leading cause. Skin cancer can develop in different layers of the skin, and while it is often treatable when detected early, it can be life-threatening if left untreated.

Skin cancer typically falls into three main types: basal cell carcinoma, squamous cell carcinoma, and melanoma. Each type has different characteristics, but they all share common risk factors, including UV exposure and genetic predisposition. Understanding the risk factors, symptoms, and treatment options is crucial for effective prevention and early intervention.

Skin cancer occurs when skin cells begin to grow uncontrollably, forming a tumour. The primary cause of skin cancer is damage to the skin cells' DNA, often resulting from prolonged exposure to ultraviolet (UV) radiation from the sun or artificial sources like tanning beds. The main types of skin cancer include:

• Basal Cell Carcinoma (BCC): The most common form of skin cancer, typically developing in the basal cells of the skin's outermost layer. It grows slowly and rarely spreads to other parts of the body.
• Squamous Cell Carcinoma (SCC): This type forms in the squamous cells and can develop into a more aggressive tumour if left untreated.
• Melanoma: The least common but most dangerous form of skin cancer. It originates in the melanocytes, the cells responsible for producing pigment, and has a higher tendency to spread to other parts of the body.

Each of these cancers presents its own challenges, but understanding them is essential for better prevention and treatment.

Skin cancer is a global health concern, with millions of new cases diagnosed each year. According to the World Health Organization (WHO), skin cancer is the most common type of cancer worldwide. In India, skin cancer is relatively rare compared to Western countries, but the incidence is increasing due to growing exposure to UV radiation and lifestyle changes. Data from the National Cancer Registry Programme of India indicates that non-melanoma skin cancer is among the top 10 cancers in the country, and melanoma is also being detected more frequently.

The prevalence of skin cancer worldwide is alarming, with over 1 million new cases of melanoma and non-melanoma skin cancers reported annually. The rates of diagnosis have increased significantly over the past few decades, with people in fair-skinned populations (e.g., in Europe, North America, and Australia) at higher risk.

1. Basal Cell Carcinoma (BCC)

Basal cell carcinoma is the most common form of skin cancer. It originates in the basal cells at the bottom of the epidermis. BCC typically appears as a small, shiny, or waxy bump or a flat, scaly patch on sun-exposed areas like the face, ears, neck, scalp, shoulders, and back. While BCC rarely spreads to other parts of the body, it can cause significant local damage if untreated.

2. Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma occurs in the squamous cells, which are found in the outer layer of the skin. SCC usually appears as a firm, red nodule or a flat lesion with a scaly, crusted surface. It is more aggressive than BCC and has a greater risk of spreading to other organs, particularly if the tumour is not detected early.

3. Melanoma

Melanoma is the most dangerous type of skin cancer, known for its rapid growth and ability to spread to other organs. It begins in the melanocytes, which are responsible for producing pigment (melanin). Melanomas are often irregularly shaped and coloured, with shades of brown, black, and sometimes even red, blue, or white. The warning signs include changes in an existing mole or the appearance of a new, unusual mole.

The primary cause of skin cancer is the damage to skin cells caused by ultraviolet (UV) radiation from the sun and tanning beds. UV radiation can alter the DNA in skin cells, leading to mutations that cause the cells to grow abnormally.

Other causes include:

• Genetic predisposition: A family history of skin cancer increases the risk.
• Skin type: Fair-skinned individuals with light hair and blue or green eyes are at higher risk.
• Age: Skin cancer risk increases with age.
• Immune system suppression: People with weakened immune systems, such as organ transplant recipients, are more susceptible.
• Exposure to chemicals: Certain chemicals, like arsenic, can increase the risk of skin cancer.
   

The symptoms of skin cancer vary depending on the type, but the following signs are commonly associated with the condition:

• Changes in moles or skin lesions: New growths or changes in the appearance of existing moles (size, colour, shape).
• Bleeding or oozing: Sores that do not heal or moles that bleed or crust over.
• Itching or tenderness: Moles or lesions may itch, become tender, or cause pain.
• Irregular borders or asymmetry: Skin lesions with uneven edges or different colours.
• Skin thickening or lump formation: A bump that feels firm or hard.
   

To diagnose skin cancer, a healthcare professional will perform a thorough physical examination of the skin, looking for any suspicious growths or changes. If a lesion appears concerning, the doctor may recommend a biopsy, where a small sample of skin is removed and examined under a microscope to check for cancer cells.

Other diagnostic tools include:

• Dermatoscopy: A tool used to closely examine skin lesions.
• Imaging tests: If skin cancer has spread, imaging tests such as X-rays, CT scans, or MRIs may be used.
   

Treatment for skin cancer depends on the type, location, and stage of the cancer. Common treatments include:

1. Surgical Excision: The most common treatment, which involves removing the tumour and surrounding healthy tissue.
2. Mohs Surgery: A precise surgical technique often used for BCC and SCC that involves removing thin layers of skin until the cancer is entirely removed.
3. Radiation Therapy: Used when the cancer cannot be removed surgically or has spread to other areas.
4. Chemotherapy: Applied in cases of advanced melanoma, typically using topical or systemic medications to destroy cancer cells.

• Immunotherapy: A treatment that uses the body’s immune system to fight cancer, commonly used for melanoma.
   

While conventional medical treatments are effective, some people seek alternative therapies such as herbal treatments, acupuncture, or dietary supplements. However, it is important to consult a healthcare provider before pursuing these treatments, as they may not have been proven effective or could interfere with medical treatments.

Risk factors for skin cancer include:

• Excessive sun exposure: Especially without proper protection such as sunscreen, hats, or protective clothing.
• Use of tanning beds: Exposure to UV radiation from artificial sources increases the risk.
• Family history: A history of skin cancer in the family increases susceptibility.
• Skin type and complexion: Fair-skinned individuals are at greater risk.
   

If not treated early, skin cancer can lead to:

• Metastasis: The cancer spreading to other organs.
• Infection: Particularly after surgery or radiation treatment.
• Disfigurement: Some forms of skin cancer, especially if they involve the face, can result in permanent scarring.
   

Living with skin cancer requires ongoing care and management. Some tips include:

• Follow-up care: Regular visits to your healthcare provider to monitor for recurrence or new lesions.
• Emotional support: Skin cancer treatment can be mentally and emotionally challenging. Seek support groups or counselling if needed.
• Healthy lifestyle: Maintaining a balanced diet, regular exercise, and avoiding smoking can aid recovery and improve overall health.
   

• Tanning beds are safe if used in moderation: Tanning beds significantly increase the risk of skin cancer.
• Skin cancer is only a concern for older individuals: Skin cancer can occur at any age, especially with early and frequent sun exposure.
• Sunscreen is not necessary on cloudy days: UV radiation can penetrate through clouds, so sunscreen is still essential.
   

You should consult a doctor if you notice any changes in your skin, such as:

• New growths or moles.
• Changes in existing moles (size, colour, texture).
• Bleeding or oozing from a lesion.
• Persistent itching or tenderness.
   

When diagnosed with skin cancer, consider asking your doctor the following questions:

• What type of skin cancer do I have?
• What is the recommended treatment plan?
• Are there any side effects or risks associated with the treatment?
• How can I prevent the cancer from coming back?
  
   

Supporting someone with skin cancer involves emotional support, helping with treatment decisions, and assisting with practical tasks such as transportation to appointments. Encouragement and understanding are key during their journey.

Skin cancer is a serious but treatable condition if detected early. By practising sun safety and seeking regular skin checks, you can reduce your risk. If you notice any changes in your skin, consult a healthcare provider promptly for early diagnosis and intervention.