Skin cancer is the irregular and abnormal growth of skin cells. While most forms of skin cancers are found in areas that are exposed to sunlight, once or twice, they will be found in the area of skin that is often covered.
Based on the cell of origin, skin cancers are grouped into three main classes: squamous cell carcinoma, basal cell carcinoma, and melanoma.
Experts recommend using sunscreen or limiting exposure of the face, hands, and neck to sunlight to reduce the risk of developing skin cancer. Also, it is essential to regularly assess your skin to have a clear-cut line between normal and abnormal skin markings. Such changes on the skin will be the basis of diagnosis, and when a positive confirmation is made, treatment is initiated as soon as possible.
Almost all skin cancers are detected and treated before they metastasize. However, a melanoma that invades nearby and distant tissues carry an immense burden in management.
Where skin cancer develops
Not always do cancers grow in areas that receive sunlight. Sometimes changes occur on palms, soles, nails, and genitals, and cells become cancerous.
A common misconception is that darker complexions don’t get affected by skin cancers. While melanin does offer some protection, skin cancer affects people of all complexions. In fact, in darker complexions, melanoma is more likely to develop in areas not usually exposed to sunlight.
When to see a doctor
Any change that seems abnormal should be reported to your doctor. Only after ordering some investigations and performing a physical examination can a diagnosis be made.
To know the etiology of your symptoms, your doctor will:
- Examine your skin. Your doctor will assess the gross appearance of your skin changes, and after carrying out some tests, will have a definitive answer.
- Take a skin sample for laboratory examination (skin biopsy). A small piece of the suspicious skin will be taken to the lab for further evaluation to detect microscopic cancerous changes and know the type of cancer.
Knowing the stage of the cancer
If you have skin cancer, your doctor may order more tests to determine the stage of the cancer.
The more aggressive skin cancers, such as Merkel cell carcinoma or melanoma, will require serial sampling to know how deep the cancer has grown. However, superficial skin cancer, such as basal cell carcinoma is confined to the same spot. A biopsy that removes the entire growth is usually the only test needed to establish the stage of the cancer.
To evaluate the integrity of nearby lymph nodes, additional imaging evaluations are needed to find any signs of metastasis and to remove a lymph node biopsy to check sings of cancer (sentinel lymph node biopsy).
Doctors use a unified system of staging cancers. Roman numerals I to IV are used – stage I being small benign cancers and stage IV being aggressive cancers with distant metastasis. A unified system ensures the correct, most effective treatment is used.
Typical management of local basal cell and squamous cell carcinomas is safe and effective. Small tumors are surgically sliced off using a scrapping tool (curette) and then obliterated using an electric current or heat (cauterized), frozen with liquid nitrogen, or using low-dose radiation. Topical immune-modulating agents such as imiquimod, or 5-fluorouracil – a chemotherapeutic agent – on a superficial tumor for some weeks also works. Surgery is required to remove more extensive tumors.
In case a basal or squamous cell carcinoma has grown into inner layers of skin and adjacent tissues, these tumors are removed surgically, followed by bouts of chemotherapy and radiation. Severely disfiguring or metastatic basal cell carcinomas cannot be resolved by surgery and concomitant radiation alone, and are treated with oral visodegib (Everidge) or sonidegib (Odomzo).
Early detection of melanomas necessitates immediate surgical removal before they spread underneath the skin and other organs. The surgeon excises the tumor, along with a safe margin surrounding tissue. There is contention whether removing nearby lymph nodes during surgery is of any benefit. And the use of chemo or radiation does not cure advanced melanomas; instead, these modalities alleviate symptoms or makes it less aggressive. Most doctors prefer using chemotherapy alongside immunotherapy (drugs such as interferon-alpha and interleukin-2). A melanoma that metastasizes to the brain requires radiotherapy to inhibit growth and manage symptoms.
Immunotherapy – controlling the response of the immune system towards certain tumors – is a new field of treatment with a promising future. Some positive arose from the management of advanced melanoma. Some scientists are treating advanced cancers with vaccines, T-VEC (Imlygic), a genetically modified herpes virus that targets cancer cells. Other drugs such as interleukin-2, interferon, nivolumab (Opdivo), ipilimumab (Yervoy), or pembrolizumab (Keytruda) increase the response of the immune cells towards a melanoma. Genetic manipulation of melanoma cancers weakens them and makes them easily eliminated by immune cells. A lot of these advances make the patient immune against cancerous cells.
Cancerous cells have genetic markers that are targeted by immune cells. Drugs such as dabrafenib (Tafinlar), vemurafenib (Zelboraf), and trametinib (Mekinist), target unique genes in cancer cells through the process of targeted therapy.
Because cancers can reoccur even after successful treatment, people who have had skin cancer should have an examination at least each year. Cancers can grow back within the first two years of diagnosis in approximately 20% of skin cancer patients.
Alternative and Complementary medicine
The best way to manage skin cancer is through medical care. There are some interventions done to make treatment bearable. This includes alleviation of symptoms including fatigue, vomiting, nausea, headaches, and headaches from radio- and chemotherapy or immunotherapy during the treatment of advanced cancers. Your doctor will advise on the best alternatives before use.
Food and nutrition during therapy
Food is rich in many elements and antioxidants that heal skin and promote the growth of healthy cells. Such include vitamin A (beta carotene), C, and E. Researchers are now trying to prove if these nutrients, among others, can protect skin from UV rays. While this is a fantastic prospect, there’s no scientific evidence to back this claim.