Skin Cancer

The Function of the Skin and Complications Associated with Skin Cancer
The skin is the largest organ of the human body and serves as the first line of defense against environmental hazards. It plays critical roles including regulating body temperature, preventing dehydration, producing vitamin D, and enabling sensory perception. It also acts as a protective barrier against harmful microorganisms, toxins, and ultraviolet (UV) radiation. When the skin is compromised by disease such as skin cancer, these functions can be severely impaired, leading to systemic complications. Advanced or untreated skin cancers may invade surrounding tissues or metastasize to distant organs, causing major medical challenges.

Skin cancer arises when there is abnormal, uncontrolled growth of skin cells, often triggered by DNA damage (typically from UV exposure) that is not repaired. Over time, these mutated cells multiply and form malignant tumors. Although skin cancer is one of the most common types of cancer globally, it is also one of the most preventable and treatable, especially when diagnosed early. Nevertheless, late-stage or aggressive forms like melanoma can be fatal without prompt and effective treatment.

Categories Associated With Primary and Secondary Skin Tumors

Skin cancers are typically divided into primary (originating in skin cells) and secondary (metastasized from other organs):

Primary Skin Cancer

  • Basal Cell Carcinoma (BCC): The most common type; slow-growing and rarely metastasizes.

  • Squamous Cell Carcinoma (SCC): Arises from keratinocytes; may metastasize if left untreated.

  • Melanoma: Originates in melanocytes; highly aggressive and prone to spreading.

  • Rare Types: Merkel cell carcinoma, dermatofibrosarcoma protuberans, and sebaceous carcinoma.

Secondary Skin Cancer
These are rare and occur when internal cancers such as breast, lung, or colon cancers metastasize to the skin. They are often a sign of advanced systemic disease.

Causes and Risk Factors

Common contributing factors to skin cancer include:

  • Excessive sun (UV) exposure

  • Tanning bed usage

  • Fair skin, light eyes, red or blonde hair

  • History of sunburns

  • Family history of skin cancer

  • Personal history of precancerous lesions (actinic keratosis)

  • Weakened immune system (e.g., organ transplant recipients)

  • Exposure to radiation or certain chemicals (arsenic)

  • Genetic syndromes (e.g., xeroderma pigmentosum)

Signs and Symptoms of Skin Cancer

Skin cancers may present with varying symptoms depending on the type. General signs include:

  • A new growth or sore that doesn’t heal

  • Changes in the size, shape, or color of an existing mole or spot

  • A mole with irregular borders, multiple colors, or asymmetry

  • A scaly or crusty patch of skin

  • Persistent itching, tenderness, or bleeding in a lesion

  • A pearly or translucent bump (typical of BCC)

  • A firm red nodule or flat lesion with a scaly surface (SCC)

  • A dark lesion under fingernails, toenails, or mucous membranes (melanoma)

Diagnosis of Skin Cancer

  1. Medical History & Physical Examination

    • Dermatologic assessment of suspicious moles or lesions using dermoscopy.

  2. Skin Biopsy

    • Excisional biopsy: Entire lesion is removed

    • Incisional or punch biopsy: A sample portion is taken

    • Shave biopsy: Surface layers are shaved off for analysis

  3. Histopathological Examination

    • Determines cancer type, depth, and margins.

  4. Imaging Studies

    • May include lymph node ultrasound, CT, MRI, or PET scan in suspected advanced or metastatic melanoma.

  5. Staging

    • Based on TNM system (Tumor size, Node involvement, Metastasis), especially for melanoma.

Best Treatment for Skin Cancer

Treatment depends on the cancer type, size, location, stage, and patient’s overall health:

A. Traditional Treatments

  1. Surgical Procedures

    • Excision: Standard method; removes the tumor with a margin of healthy tissue

    • Mohs Micrographic Surgery: Precise removal layer by layer; ideal for BCC/SCC on sensitive areas (face, hands)

    • Curettage and Electrodessication: For superficial BCCs and SCCs

    • Lymph Node Dissection: For melanoma with nodal involvement

  2. Radiation Therapy

    • Used when surgery is not feasible or for high-risk areas

    • External beam radiation used to destroy cancer cells in localized regions

    • May be palliative in advanced cases

  3. Systemic Chemotherapy

    • Less common for BCC and SCC

    • More often used for metastatic melanoma or rare aggressive skin cancers

    • Administered intravenously or orally; may have broad side effects

B. Advanced Treatments

  1. Targeted Therapies

    • For Melanoma:

      • BRAF inhibitors (vemurafenib, dabrafenib) for tumors with BRAF mutations

      • MEK inhibitors (trametinib, cobimetinib) used in combination

    • For Advanced BCC:

      • Hedgehog pathway inhibitors (vismodegib, sonidegib)

  2. Immunotherapy

    • Checkpoint inhibitors:

      • PD-1 inhibitors (nivolumab, pembrolizumab) approved for metastatic melanoma

      • CTLA-4 inhibitor (ipilimumab) may be combined for enhanced efficacy

    • Stimulates immune response to recognize and destroy cancer cells with less impact on healthy cells

  3. Cryotherapy

    • Freezing precancerous lesions or small skin cancers with liquid nitrogen

    • Quick and non-invasive, used in outpatient settings

  4. Photodynamic Therapy (PDT)

    • Photosensitizing agent applied to the skin, followed by light exposure

    • Destroys superficial cancers while sparing healthy tissue

    • Useful for actinic keratosis, superficial BCCs

  5. Laser Therapy

    • Ablative lasers can remove superficial skin cancers with high precision

    • Used adjunctively or for cosmetic restoration post-treatment

Prevention and Lifestyle Management

Skin cancer prevention is largely achievable through:

  • Sun protection: Use broad-spectrum sunscreen (SPF 30+), wear hats, sunglasses, and protective clothing

  • Avoiding tanning beds

  • Regular skin self-examinations

  • Dermatological check-ups: Especially for individuals with many moles or a personal/family history of skin cancer

  • Monitoring changes in moles using the ABCDE rule (Asymmetry, Border, Color, Diameter, Evolving)

  • Maintaining a healthy immune system

Prognosis and Survival Rates

  • Basal Cell Carcinoma: Nearly 100% cure rate if treated early

  • Squamous Cell Carcinoma: Cure rate ~95% if localized; risk of spread higher than BCC

  • Melanoma:

    • Stage I: 5-year survival rate >90%

    • Stage II–III: Decreases with lymph node involvement

    • Stage IV (metastatic): ~20–30% survival, though improved with immunotherapy

Conclusion

Skin cancer, though highly preventable and often curable when detected early, demands vigilant awareness and consistent dermatologic monitoring. With advances in immunotherapy, targeted treatments, and early surgical interventions, outcomes continue to improve significantly. Public education about UV exposure, mole monitoring, and regular check-ups can reduce incidence and mortality substantially.

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