Skin Cancer: Diagnosis, Prevention and Treatment

Skin cancer: what types are there and how they occur?

The most common types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanomas, in that order. Although we do not have good registries, we know that BCC is the most frequent malignant tumor of all, cutaneous or not.

BCC and SCC derive from keratinocytes, which are the cells that make up the epidermis. Melanoma, in turn, derives from melanocytes, which are the cells that manufacture skin pigment.

Other less frequent types are Merkel cell carcinoma, dermatofibrosarcoma protuberans and cutaneous lymphomas. Dr. Vicente Manuel Leis Dosil, Dermatologist expert in Skin Cancer, Melanoma and Dermatologic Surgery, among other skin specialties, deals with the problems related to skin cancer.

Risk factors for skin cancer

The main cause of the three most common types of skin cancer is ultraviolet radiation. But the pattern of exposure is different in each. Squamous cell carcinoma is related to chronic, accumulated and continuous exposure, while basal cell carcinoma and most melanomas are related to intense and occasional exposure.

Consequently, risk factors for possible cases of skin cancer are sunburn in childhood, the use of tanning booths and outdoor work or leisure and sports activities. Smoking is another risk factor, especially for cancer of the lip and mucosa of the mouth.

Ionizing radiation can lead to skin cancer in patients who have received radiotherapy and in people who are exposed to this radiation because of their work. In addition, the involvement of the human papillomavirus (HPV) in the origin of certain tumors, such as carcinomas of the anus, penis or vulva caused by high-risk viruses in immunocompromised patients, is becoming increasingly well understood.

Types of predisposition in patients to skin cancer

Apart from the environmental factors mentioned above (UV radiation, tobacco, ionizing radiation), there are intrinsic characteristics of individuals that confer an increased risk of developing skin cancer.

The main risk factors for people, who may suffer from carcinoma are:

  • Having fair skin, light eyes, and blond or red hair.
  • Having a family or personal history of skin cancer.
  • Being immunosuppressed.
  • Having many atypical, irregular nevi.

There are syndromes secondary to genetic alterations whose carriers present multiple cutaneous tumors very early. The best known are Gorlin’s syndrome and xeroderma pigmentosum.

Early signs of skin cancer

Basal cell carcinoma usually manifests as a raised lesion, which grows gradually, bleeds sometimes with small abrasions and forms crusts that fall off and re-form. Sometimes they are dark in color, but sometimes they are red or have a pearl-like luster.

Typical locations are the nose, ears, forehead and cheeks. Young patients present with a subtype of basal cell carcinoma, which is mostly located on the back as reddish patches, a few centimeters in size, with small crusts on the surface, which are sometimes multiple.

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In the presence of a fleshy, bleeding, easily ulcerated nodule, which grows progressively, we must suspect an epidermoid carcinoma. Another possible form of presentation of this tumor is a keratotic, verrucous lesion, even forming a cutaneous horn. They appear mainly on the scalp, ears, lips and extremities.

To detect pigmented lesions suspicious of melanoma as early as possible, the ABCDE rule should be applied:

  • A. Asymmetric lesions.
  • B. With irregular borders.
  • C. With various colors.
  • D. With a diameter of more than 6 mm.
  • E. With changes in shape and size in their evolution.

Melanomas can arise from a previous mole, but also in skin where there was no previous lesion. There is a variant without pigment, much more difficult to suspect.

Diagnosis and treatment for melanoma diagnosis

The clinical history and physical examination are usually sufficient to establish the diagnosis. We have the help of dermoscopy, a non-invasive test that allows us to see the distribution of color in the lesion, as well as its vascularization, in an enlarged form and a little in depth. A series of figures and patterns have been defined that help to distinguish benign lesions from suspicious ones and even to make a more precise diagnosis.

Another non-invasive technique that is gaining importance in skin oncology consultations is ultrasound. With the technological improvements it has undergone in recent years, we can examine the structure of the skin and evaluate suspicious lesions, improving our diagnostic accuracy.

In any case, when in doubt, the most accurate and definitive test is skin biopsy.

The best treatment for basal cell carcinoma and squamous cell carcinoma, whenever possible, is surgical excision.

In superficial lesions, which are not yet invasive, we have other treatments such as photodynamic therapy and imiquimod cream. For the exceptional cases of metastatic or inoperable basal cell carcinoma, a drug called vismodegib has been available for a few years.

The best treatment for melanoma is to remove it as soon as possible, while it is still a very shallow tumor and without metastases. Until recently, we did not have any really effective treatment for advanced melanomas. However, new biologic drugs, especially those that act by stimulating the patient’s immunity against tumor cells, are opening up promising avenues of research and are already offering results in terms of prolonging patient survival.

How to protect ourselves against skin cancer

Given that the main cause of skin cancer is ultraviolet radiation, it is clear that the best way to prevent it is by applying good photoprotection. It is vital to educate our children in photoprotection and to avoid sunburn in childhood. The use of tanning booths is strongly discouraged.

It is also important for people to observe their skin, moles and other lesions, and to consult in the event of any suspicious change. Patients with multiple atypical nevi may benefit from regular checkups by a dermatologist.