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Cancer from A to Z

Types of cancer, how to prevent them, diagnosis and treatment.

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Skin Cancer


The two most common kinds of skin cancer:

 

Basal cell carcinoma accounts for more than 90% of all skin cancers. It is a slow-growing cancer that seldom spreads to other parts of the body. However, if left untreated, it can spread to nearby areas and invade bone and other tissues under the skin.

 

Squamous cell carcinoma is much less common than basal cell carcinoma. It can be more aggressive than basal cell carcinoma and is also more likely to grow deep below the skin and spread to distant parts of the body.

 

These types of skin cancer are sometimes called nonmelanoma skin cancer. When they are found early, there is nearly a 100% chance for cure.

 

Actinic keratosis, or solar keratosis, is a precancerous condition that has the potential for developing into squamous cell carcinoma. It appears as rough red or brown, scaly patches on the skin. They are often more easily felt than seen. Like skin cancer, actinic keratosis is usually found on sun-exposed areas of the body, but it can be found on other parts of the body as well.

 

Another type of cancer that occurs in the skin is melanoma, which begins in the cells that produce pigment in the skin. It is less common than basal or squamous cell skin cancers, but it is more dangerous than either and can be deadly. If caught early, there is nearly a 97% chance for cure.

Symptoms of skin cancer vary from person to person and may include a:

  • Change on the skin, such as a new spot or one that changes in size, shape or color
  • Sore that doesn’t heal
  • Spot or sore that changes in sensation, itchiness, tenderness or pain
  • Small, smooth, shiny, pale or waxy lump
  • Firm red lump that may bleed or develops a crust
  • Flat, red spot that is rough, dry or scaly

Many of these symptoms are not cancer, but if you notice one or more of them for more than two weeks, see your doctor.

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Ensayo clínico en fase I de determinación de dosis del antiangiogénico multidiana Dovitinib (TKI258) más paclitaxel en pacientes con tumores sólidos.

The greatest risk for developing all types of skin cancers comes from sunburns. People with fair skin and those who tend to burn easily are more at risk.

 

Other risk factors include:

 

Age. The longer a person's skin is exposed to the sun over time, the higher the risk of developing skin cancer.

 

Appearance. People who have red or blond hair, fair skin, freckles and blue or light-colored eyes are more at risk of developing skin cancer.

 

However, darker-skinned people and those who tan easily can still develop skin cancer as well as suffer other long-term effects of exposure to ultraviolet light, like dry skin and premature aging.

 

Climate. People who live in sunny climates are at an increased risk for skin cancer.

 

Geography. People who live in southern states are at higher risk.

 

Family history. A family history of skin cancer, especially melanoma, increases the risk.

 

Personal history. A person who develops skin cancer is at risk of developing the same cancer again in the same place or developing a new skin cancer somewhere else.

 

Employment. Working around coal tar, arsenic compounds, creosote, pitch and paraffin oil increases the risk of skin cancer.

 

Previous injuries. Someone who has traumatized skin, such as a major scar or burn, could be at higher risk of developing skin cancer in that region.

 

Actinic keratosis. A precancerous condition of thick, scaly patches of skin. It may also appear as a cracking or peeling lower lip that does not heal with lip balm.

 

Preventing Skin Cancer
 

The main way to avoid skin cancer is to protect yourself from the sun's ultraviolet rays. There are several ways to do this. These include:

Stay indoors or avoid unnecessary sun exposure, especially between the hours of 10 a.m. and 4 p.m., when the sun's rays are the strongest. When you are outside, remember that the shorter your shadow, the more damaging the sun's rays.
Use sunscreen with a sun protection factor (SPF) of 15 or higher, depending on your skin type. SPF measures a sunscreen's protection against UVB rays only, so look for sunscreen that protects against both UVA and UVB rays.
Apply a sunscreen as part of your daily routine. Do so generously for maximum protection, especially on body parts easily overlooked (i.e., lips, tops of ears, head, back of neck and hands and feet). Some moisturizers and foundation include sunscreen.
Apply sunscreen 30 minutes before going into the sun.
If you are perspiring or in the water, you must reapply sunscreen more often regardless of the instructions on the packaging.
Wear protective clothing (e.g., wide-brimmed hats, long-sleeved shirts and pants, sunglasses with UV protection).
Stay in the shade, and avoid reflective surfaces such as water, sand, snow and concrete. You can burn from indirect exposure to the sun.
Beware of cloudy days. You can still get burned.
Don't use sunlamps or tanning beds. There is no such thing as a safe tan.
MD Anderson's Screening Guidelines
 

Promptly show your doctor any:

Suspicious skin area
Non-healing sore
Change in a mole or freckle
How to Do a Skin Self-Exam
 

The best time to do a skin self-exam is after a shower or bath. Check your skin in a well-lighted room using a full-length mirror and a hand-held mirror.

 

Begin by learning where your birthmarks, moles, blemishes and freckles are and what they usually look and feel like. Check for anything new, especially a change in size, shape, texture or color. Also notice any area of scaliness, itching, bleeding, tenderness or pain.

Look at the front and back of your body in the mirror, then raise your arms and look at your left and right sides.
Bend your elbows and look carefully at your fingernails, palms, forearms (including the undersides) and upper arms.
Examine the back, front and sides of your legs. Also look between the buttocks and around the genital area.
Sit and closely examine your feet, including the toenails, the soles and the spaces between the toes.
By checking your skin regularly, you will become familiar with what is normal for you. It may be helpful to record the dates of your skin exams and to write notes about the way your skin looks. If you find anything unusual, see your doctor right away.

A dermatology biopsy is the only way to correctly diagnose skin cancer. If your doctor suspects skin cancer, s/he will remove a small amount of tissue from the abnormal area on your skin.  The sample is examined under a microscope to determine the cause of the skin lesion. The biopsyresults will help your doctor make a diagnosis and plan your treatment.

Basal and squamous cell skin cancers are usually excised using the following surgical techniques:

 

Mohs Surgery

 

Mohs surgery is a procedure where very thin individual layers of cancerous tissue are removed one at a time and immediately examined under a microscope. If cancerous cells can be seen in the layer, the surgeon then continues shaving off layers of the tumor one at a time until all cancerous tissue has been removed. It causes less scarring and has a shorter healing period than removing the entire area at once.

 

Because it is very controlled, Mohs surgery may achieve the highest cure rate for many skin cancers. For both basal and squamous cell cancers, Mohs surgery cure rates can be up to 99% and 97%, respectively. For recurrent basal and squamous cell cancers, Mohs surgery cure rates are up to 94% and 90%, respectively. These cure rates are generally higher than traditional surgery that removes the entire tumor at once.

 

Mohs surgery is an outpatient procedure usually performed under local anesthesia, occasionally with mild sedation. Patients generally avoid general anesthesia, return home immediately and have a rapid recovery.

 

Cryosurgery

 

Cryosurgery is less invasive than conventional surgery. It involves only a small incision or insertion of the cryoprobe through the skin. In cryosurgery, a surgeon applies liquid nitrogen or argon gas to the cancerous tissue to freeze and destroy it. The tissue is then allowed to thaw, and additional freeze-thaw passes may be repeated.

 

Because physicians can focus cryosurgical treatment on a limited area, they can avoid the destruction of nearby healthy tissue. The treatment can be safely repeated and may be used along with standard treatments such as surgery, chemotherapy, hormone therapy and radiation. Cryosurgery may offer an option for treating cancers that are considered inoperable.

 

Laser Surgery

 

Laser devices for skin cancer destroy and vaporize tissue under local anesthesia. The laser uses an intense, focused beam of light to destroy skin cancer tissue. The laser destruction, plus the body's immune response to the injury, results in a blistered wound that takes several weeks to heal.

 

The laser can be set to remove the skin in controlled layers, depending on the depth of the cancer. The surgeon may remove the top layer only, or the top layer plus the next deeper layer and so on. Because the laser treats without direct skin contact, it can be aimed at difficult-to-reach locations such as between the toes. Laser therapy may leave white scars similar to cryotherapy, but if only a superficial pass is performed, then there may be no scarring at all. Deeper skin removal leaves an open wound that requires meticulous care until healing is complete.

 

Laser therapy is used in many situations, most commonly to:

  • Treat superficial skin cancers
  • Treat precancers
  • Reduce scars following skin cancer surgery
  • Treat a variety of noncancerous skin growths

Electrodessication

 

Otherwise known as "scraping and burning," electrodessication uses a scraping instrument (curette) and electrical currents to destroy and burn a skin cancer under local anesthesia. The abnormal area is treated along with a rim of surrounding skin called a safety margin.

 

Electrodessication is effective for small and superficial skin cancers. The extent of skin cancers, and whether they might be small enough to treat with electrodessication, is determined by a biopsy.