Skin Cancer

Skin cancer is the abnormal growth of skin cells on areas of the skin. They are major of three types - melanoma, nonmelanoma, squamous cell carcinoma, and basal cell carcinoma. The risks of this disease can be reduced by minimizing exposure to UV rays.

Associated Anatomy

Skin cancer generally develops from the epidermis layer cells of the skin.

Stages of Skin Cancer

The different stages of cancer tell us about the severity of the disease and help a doctor decide the kind of treatment the stage requires. There are several systems used to stage cancer, the most common being used is the TNM system (Tumor, Node, Metastases). The stages are

Stage 0 or Carcinoma -  in situ is the stage where the cancer cells have just started developing but have not spread further to the dermis.

Stage 1 - basal cell carcinoma is the stage where the cancer cells are smaller than 2cm across.

Stage 2 - basal cell carcinoma means the cancer cells have become larger than 2cm across

Stage 3 - basal cell carcinoma is the stage where the skin cancer grows larger than 4cm across. At this stage, the cancer cells either spread to the bones, around a nerve (perineural invasion) or have started growing under the skin (subcutaneous tissue).

Stage 4 - basal cell carcinoma means when the cancer cells have grown and spread (metastasized) to one or more lymph nodes and bones or organs of the body.

Types of Skin Cancer

Melanoma

Our body has cells called Melanocytes that produce the dark pigment that gives skin its color called melanin. Melanoma is a type of cancer that starts in Melanocytes. This is considered the most dangerous type of skin cancer which grows quickly and is likely to spread to an organ. Early detection and early treatment of this disease can help cure it.

Melanoma Skin Cancer Causes:

The major cause of Melanoma is the increased levels of exposure to UV radiation from sunlight. It can be caused in any area of the body like the legs, upper back, eyes, or internal organs.

Melanoma Skin Cancer Symptoms:

They occur as open sores, raised bumps, moles, or scaly patches. The American Academy of Dermatology has created an ABCDE memory device to learn the signs and symptoms that could be due to Melanoma.

• Asymmetry - the shape is not uniform,
• Border - irregular and rough borders,
• Colour - occur in uneven colours or shade,
• Diameter - the size of the lesion is more than 6mm in diameter (equal to the diameter of a pencil),
• Evolving - shape, size, and colour of melanoma changes.

If you observe any such symptoms, it is advised to visit a doctor.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is another common type of skin cancer that grows slowly in the flat cells of the epidermis called squamous cells or keratinocytes. This cancer starts developing when these cells continue to grow out of control and start spreading to the tissues, bones, mouth, lungs, digestive tract, or lymph nodes causing other complications.

Squamous Cell Carcinoma Skin Cancer Causes:

This occurs due to the damage caused to the squamous cells by exposure to UV radiation. Other causes of SCC are genetics, smoking, chemical exposure, radiation exposure, severe burns or scars, and immunosuppression.

Squamous Cell Carcinoma Skin Cancer Symptoms:

• An open flat sore with raised borders and a scaly crust
• Reddish and raised patch of skin
• A brown spot looking like an age spot
• Wart-like growth
• A firm dome-shaped bump
• An SCC can be red, pink, brown, black, yellowish, or white

Basal Cell Carcinoma

Basal cell carcinoma develops in the basal cells of the skin. The basal cells found in the lower part of the epidermis are responsible for producing new skin cells and replacing the old dead squamous cells.

Basal Cell Carcinoma Skin Cancer Causes:

Like other types of skin cancer, one of the major causes of basal cell carcinoma is over-exposure to ultraviolet radiation. The UV rays damage the DNA in basal cells. Other than that, exposure to arsenic, and chronic inflammatory conditions are other causes of basal cell carcinoma.

Basal Cell Carcinoma Skin Cancer Symptoms:

There are changes noticed in the skin which are as follows:

• Translucent shiny bump through which tiny blood vessels are visible. These lumps grow bigger with time.
• Lesions with dark spots and a raised border.
• Flat and red scaly patches that look like eczema and grow over time.
• Crusty sores that bleed often.

Treatment for Skin Cancer

The treatment of Squamous cell carcinoma is based on certain factors like age, health, location of cancer, and severity of cancer. The methods of treatment for SCC are:

• Excisional Surgery: This method involves removing the cancer cells and a layer of skin around it to avoid recurrence of cancer. The doctors ensure that the entire cancerous area has been removed from the skin by sending a sample to the laboratory.
• Radiation: This method uses a machine that emits high-intensity X-ray radiation to kill cancerous cells. This procedure is performed several times a week for a long duration.
• Mohs Micrographic Surgery: This surgery is conducted by the doctor where they remove the abnormal skin and the surrounding tissue. They ensure to remove all the cancer cells by repeating the process as many times as required.
• Electrosurgery: In this method, the cancerous area is scraped and then burnt to completely kill and remove the cancerous cells.
• Cryosurgery: This method involves freezing and destroying the cancerous cells by using liquid nitrogen. This process is also repeated until the entire cancerous area is removed.
• Photodynamic Therapy (PDT): This therapy involves applying a photosensitizing substance to the abnormal area followed by exposure to strong light after 3-4 hours. This helps in killing the cancerous cells in the area.
• Systemic Drugs: There are several systemic drugs approved by the FDA that are useful in treating aggressive cancers.
• Immunotherapy: This is a type of biological therapy that uses substances made from living organisms to help the immune system fight cancer. The different types of immunotherapy methods include T-cell transfer therapy, immune checkpoint inhibitors, monoclonal antibodies, treatment vaccines, and immune system modulators.

Other non-FDA-approved methods of treating cancer involve topical medications and laser surgery.

Diagnosis for Skin Cancer

The diagnosis of skin cancer starts by first examining the skin and then performing a biopsy. If cancerous cells are found, skin cancer is diagnosed. The next step is to determine the stage of cancer with the help of other additional tests like imaging tests. This helps the doctors examine the spread of the cancer cells according to which the most effective treatment is suggested to the patient.

How to Prevent Skin Cancer

• Stay in the shade, especially between 10 am - 4 pm when the sun rays are strongest.
• Apply a water-resistant sunscreen with an SPF of 30 or higher that will protect your skin against UVA and UVB rays.
• Refrain from tanning beds as they cause premature skin ageing and skin cancer.
• Be observant of your skin and any changes that take place. Self-examination is important.

Frequently Asked Questions

What are The Best Hospitals for Skin Cancer Treatment in Mumbai?

Nanavati Max Hospital in Mumbai is considered one of the best hospitals for skin cancer treatment in the city, offering a range of advanced treatments and experienced specialists.