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SKIN CANCER
  • Skin cancer is the most common cancer in the United States.
  • Basal cell carcinoma accounts for 70 - 80% of the total.
  • Squamous cell carcinoma accounts for 20%.
  • This does not include melanoma which is classified separately.
  • Some of the risk factors include fair complexion, tendency to sunburn easily, radiation induced dermatitis, thermal burns, certain scars and chronic ulceration.
  • Among the environmental causes, exposure to sunlight, primarily ultraviolet-B rays is most significant.
  • The incidence is maximum at lower latitudes.
  • Arsenic exposure, transplantation and subsequent immunosuppression by medication, human papilloma virus and HIV are some of the other risk factors.

BASAL CELL CARCINOMA

  • This malignancy arises from epidermal basal cells.
  • This is most common on trunk and extremities.
  • The lesions sometimes can be mistaken for benign conditions like eczema and psoriasis.
  • Sometimes the lesions look like melanoma.
  • The natural history is that of a slow growing locally invasive neoplasm.
  • The metastatic potential is very low, estimated to be less than 0.1%.
  • As a result, most of the lesions are curable.

TREATMENT

  • Electrodesiccation and curettage is the most commonly employed method of treatment.
  • Excision is done for more aggressive tumors.
  • Some of the other modalities of treatment are:
    • Radiation.
    • Cryosurgery with liquid nitrogen.
    • Mohs micrographic surgery.
    • Topical chemotherapy with 5-Fluorouracil.

SQUAMOUS CELL CARCINOMA

  • This is a cancer of keratinizing epidermal cells.
  • Unlike basal cell carcinoma, it can grow rapidly and has high metastatic potential.
  • It can develop anywhere in the body but usually arises on sun damaged skin.
  • This usually appears as an ulcer.
  • There are several lesions which can be said to be premalignant forms - actinic keratosis, actinic cheilitis.
  • Bowen's disease is localized only to epidermis (called in-situ).
  • Early recognition and treatment of these lesions that predispose to cancer and in-situ lesions can prevent subsequent development of invasive disease.
  • Metastatic spread is much higher in these skin cancers, 0.3 to 3.7%.
  • Lesions of the lower lip, chronic ulcerations, scars and genitalia is even higher.
    Treatment:
  • Surgical excision, radiation and Mohs micrographic surgery are standard methods of treatment. The treatment is more aggressive and definitive as compared to basal cell carcinoma. Majority of lesions are curable.

PREVENTION

  • Since majority of skin cancers are related to chronic UV-B exposure, they can be prevented by reducing exposure to UV-B rays beginning early in life.
  • Sunscreen should be used regularly and sun exposure avoided from 10:00 a.m. to 2:00 p.m.
  • Tanning salons should be avoided.