Skin cancer – symptoms, types and prevention of skin cancer

Skin cancer is a serious disease that attacks insidiously and can have many faces. Malignant skin cancers, although they develop gradually, are paradoxically easy to overlook. This is because many patients assume that since skin lesions may have various causes, skin cancer is in fact an unlikely explanation for them. Nothing could be more wrong! What does skin cancer look like and how does it manifest itself? What are the most common types of skin cancers?

Skin cancer – causes

The types of skin malignant neoplasms are distinguished on the basis of symptoms and their origin from individual layers of the skin. The most commonly diagnosed skin cancer it is basal cell carcinoma, which poses the smallest threat to the health and life of the patient. Squamous cell carcinoma is much less common, diagnosed early and removed and completely curable. The rarest skin cancer in this group is melanoma. This is the most dangerous type of skin cancer. Melanoma is a malignant tumorbut is not cancer as its origin is non-epithelial.

The cause of the development of basal cell carcinoma of the skin is a defective growth of cells in the deep layer of the epidermis. In turn, changes in the middle layer of the epidermis are the cause of squamous cell carcinoma. Melanoma, on the other hand, is formed as a result of modifications in pigment cells.

The main reason for the formation and development of these changes is the skin’s exposure to UV radiation, i.e. the sun’s rays. The UV spectrum includes:

1. UVA – with a wavelength of 320-400 nm;
2. UVB – with a wavelength of 280-320 nm;
3. UVC – with a wavelength of 200-280 nm.

The most mutagenic fraction of UVB is absorbed by the DNA of keratinocytes, causing disorders of tissue gene regulation, numerous mutations and, consequently, tumor transformation of cells. On the other hand, the use of UVA emitting devices (e.g. sunbeds) causes a situation in which UVA works synergistically with UVB and intensifies its harmful effects on the skin.

Factors that increase your risk of developing skin cancer include:

1. light complexion;
2. genetic predispositions;
3. immunosuppression;
4. age over 40;
5. long-term exposure to arsenic, gas tar, derivatives of aromatic hydrocarbons;
6. photosensitizing agents (e.g., psolaren);
7. chronic irritation of the skin as a result of injuries, chronic inflammatory processes, scars (often after burns);
8. some viral infections (human papillomavirus, basal cell carcinoma, Merkel cell carcinoma).

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Skin cancer – frequency of occurrence

Skin cancer is a disease that accounts for 8-10% of all diagnosed malignant neoplasms, 70-80% of which are basal cell carcinomas, and about 20% are squamous cell carcinomas.

Skin cancer most often affects patients who live in sunny countries, such as Australia and the southern regions of the United States. In recent years, however, the incidence of skin cancer in Europe has increased significantly and steadily.

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Skin cancer – symptoms and development

Skin cancer, like any other cancer, does not arise right away. It is preceded by precancerous changes that can turn into melanoma or skin cancer. It is a long-term and multi-stage process, so it is difficult to predict the time after which a neoplasm may develop after the appearance of a lesion on the skin.

It is also not known whether any unusual skin lesions will develop into a skin cancer or will resolve on their own. Therefore, it is difficult to answer the question of what skin cancer looks like or to talk about symptoms typical of skin cancer. However, none of the disturbing skin lesions can be ignored.

What should you know about melanoma? Read: Melanoma – a dangerous tumor visible to the eye

Skin cancer – precancerous conditions

The precancerous conditions that often underlie the neoplastic process include numerous skin lesions, usually associated with sunlight and UV rays, such as:

1. actinic keratosis;
2. skin horn;
3. parchment-like and pigmented skin;
4. radioderma;
5. chemical keratosis;
6. keratosis white.

Symptoms of skin cancer – actinic keratosis

Most often it occurs in the elderly and / or chronically exposed to sunlight, less often in younger people. Actinic keratosis is the result of frequent and long-term exposure to the sun’s rays. It is often related to the profession or sport practiced (sailors, farmers, builders).

Actinic keratosis most often appears after several to several dozen years. On the skin that becomes dry, flaky and loses its elasticity, gray-yellow discoloration appears.

The lesions are most often found on the skin of the face and head (especially on the forehead, temples, ears, baldness in men, auricles), less often on the hands, lower legs and forearms. Single or multiple keratosis foci appear on the affected skin – dry, sometimes with an uneven surface, usually a few millimeters in diameter.

The calluses closely adhere to the skin, and if scratched, a pink, oozing or slightly bleeding surface appears. Such efflorescence may persist for many years. In some cases, they can be the basis for the development of skin cancer, as evidenced by their enlargement, infiltration of the base (inflammatory rim, hardening) and a tendency to bleeding, occurring even after such a minor injury as wiping the skin with a towel.

In doubtful cases, treatment is preceded by a histological examination, i.e. taking a sample for examination. If there are no signs of transition to a skin tumor, liquid nitrogen freezing, photodynamic therapy or 5-fluorouracil ointment are used. If the features are present, treatment consists of deeper freezing with liquid nitrogen or surgical removal of the lesion. However, prevention turns out to be the most important: the use of sunscreen creams, preferably with a protection index of 50.

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Symptoms of skin cancer – skin horn

The dermal horn is a type of actinic keratosis. It is caused by the same factors as in senile keratosis. In children, the skin horn may be formed on the basis of inflammation and prolonged irritation, but it is not a precancerous lesion. A yellow-brown skin horn with a rough surface can take various shapes – conical or irregular. Sometimes it looks like animal horns. Usually these changes are not large, their base has a diameter of a few millimeters.

The cutaneous horn most often appears on the face, scalp, and exposed parts of the limbs. In 10-20% of cases, the elderly develop skin neoplasms from the skin horns. Such lesions should be surgically removed and subjected to histopathological examination. Another type of treatment is electrocoagulation, which is a method of cutting down proteins with an electric arc, also used to remove other skin lesions, e.g. fibromas or warts.

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Symptoms of skin cancer – parchment and pigmented skin

It is a rare genetic disorder that occurs most frequently when the parents are related, and is highly hypersensitive to sunlight. In places exposed to the sun (face, limbs), large pigment spots and numerous freckles appear, as well as discoloration and telangiectasia, which gives the skin a variegated appearance.

As a result, the skin of patients from early childhood, from the first exposure to the sun, is largely deprived of the ability to regenerate. Hence, various skin cancers develop very quickly: sarcomas, papillomas, cancers and melanomas. In severe forms of the disease, skin lesions may be accompanied by other developmental disorders mainly affecting the central nervous system.

So far, the methods of treating this disease are unknown. It is essential to avoid sun exposure and to use sunscreen with a protection index of 60, which should be used from early childhood. Early surgical removal of precancerous lesions is also important. Freezing with liquid nitrogen also produces good results.

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Symptoms of skin cancer – radioderma

Radioderma is a term that describes skin lesions resulting from chronic X-ray irradiation (often in patients treated with this radiation), as well as in people exposed to them at work.

These changes, also called porentgenic reactions (radiodermatitis), are uneven hardening and calluses of the skin with discoloration, discoloration, telangiectasia and very difficult to heal ulcers. These lesions turn into neoplastic lesions in 20% of cases. Treatment consists of surgical removal or freezing with liquid nitrogen.

Symptoms of skin cancer – chemical keratosis

These are skin lesions of the actinic keratosis type. In cases related to the use of arsenic (as a result of taking arsenic as a drug, excessive arsenic content in water, contact with inorganic arsenic at work), eruptions in the form of discoloration and discoloration are mainly located on the palms and soles, less often on the back, face and trunk .

In the case of professional contact with coal tar products and unrefined paraffin – on the hands, face and scrotum. Treatment consists of the use of vitamin A derivatives and surgical removal or freezing with liquid nitrogen.

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Symptoms of skin cancer – white keratosis

Actinic keratosis is a term that describes white spots or streaks with a slightly rough, furrowed surface located on the mucosa of the cheeks, tongue, lips and genitals – in women it mainly affects the labia, and in men it affects the foreskin and gastric groove. In women, changes occur more often in the genitals than in the oral cavity, while in men the opposite is true.

White keratosis may be asymptomatic or cause a feeling of drying and tightening of the mucous membranes, and sometimes burning. The disease in the oral cavity is promoted by poor hygiene, smoking, chronic irritation with mismatched dentures or teeth carious.

In half of the cases, these changes tend to turn into neoplasms, especially if they are located on the vulva. In the oral cavity, about 10% of skin eruptions undergo neoplastic transformation, as evidenced by, inter alia, erosions and ulcers appearing on mucous membranes.

At the beginning of the treatment of white keratosis, the irritants are removed – dentures need to be adjusted, teeth healed, smoking cessation, oral hygiene should be improved. Retinoids are used in external treatment. In other cases, it is necessary to freeze with liquid nitrogen or surgically remove the lesion.

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Skin cancer – types

Skin cancers are the most numerous group of skin malignant neoplasms of epithelial origin and of a heterogeneous nature. There are 3 main types of skin cancer.

Rak podstawnokomorkowy – Carcinoma basocellulare

Such skin cancer may develop from a precancerous condition (such as actinic keratosis) or it may appear on its own. It looks like a small pearly-shaped lump, smooth and shiny. It happens that it grows centrifugally, enlarging its surface. It is a locally malignant cancer – it is characterized by a slow course, during which it infiltrates the substrate and can destroy the surrounding tissues.

Most often it is located on the face – on the forehead or around the nose and eye sockets – and also on the back, less often on the limbs. It attacks mainly the elderly.

Basal cell carcinoma has several different varieties. The most common is the nodular form with a characteristic shaft surrounding it, often also with dilated blood vessels (telangiectasias). Ulcerative basal cell carcinoma is highly malignant, growing peripherally, infiltrating and penetrating into depth, resulting in damage to cartilage, bones and muscles. Located on the face, it even penetrates the brain.

Basal cell carcinoma can manifest itself quite inconspicuously – it can develop from a small thickening with single telangiectasias (dilated blood vessels). It can also look like a pearly-colored lump that is slowly growing, or a scabbed morning that refuses to heal.

Also read: Basal cell carcinoma – causes, symptoms, treatment

Squamous cell carcinoma – Carcinoma spinocellulare

It is a much rarer condition than basal cell carcinoma. It usually attacks middle-aged and elderly people, characterized by rapid growth and high malignancy. Squamous cell carcinoma is prone to infiltration of the substrate (it grows into the tissues located under the tumor), as well as to metastasis. Usually it is located on the border between the mucosa and the skin – e.g. in the labia, and also around the nose, eye sockets and genitals.

Such skin cancer often develops from precancerous conditions such as actinic keratosis or skin horn. It can also develop as a result of ulceration, chronic inflammation or scarring – then it is much more aggressive.

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Papillary cancer – Carcinoma verrucosum

This type of skin cancer affects the genitals, the feet and the mouth. It is related to the presence of the human papillomaviruses – HPV 6 and HPV 11. Its growth is usually very slow and its surface is covered with horny masses. Papillary cancer does not usually metastasize.

A significant risk factor in oral papillary cancer is reaching for tobacco – sniffing it through the nose or chewing it. Papillary cancer on the feet is often related to their mechanical injuries.

Skin cancer – prevention

Solar radiation is the most dangerous and serious factor in the development of skin cancer. Therefore, it is important in prophylaxis maximum reduction of skin exposure to UV rays, incl. by:

1. the use of protective preparations with a UV filter,
2. wearing appropriate protective clothing,
3. limiting the time spent in sunny places in favor of staying in the shade.

According to some studies, taking selenium preparations may be helpful in the prevention of basal cell carcinoma, and with retinoids in the prevention of actinic keratosis. They can help too polyphenols showing antioxidant propertieswhich can be found in e.g. green tea.

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Skin cancer – treatment

Skin cancer is diagnosed on the basis of the clinical picture as well as histopathological examination. It is also the responsibility of the diagnosing physician to examine the patient’s lymph nodes in the area where skin cancer has developed.

The primary and the most common a way to treat skin cancer there is a surgical excision of the lesion along with the healthy tissue margin. Cryosurgery it is used in cases of basal cell carcinomas with clear boundaries, neoplastic foci located over cartilage or bone tissue, tumors on the eyelids, nose and turbinates.

In addition, in the treatment of skin cancer, the following are used:

1. photodynamic therapy – a non-invasive method in which cancerous tissues are destroyed without damaging healthy tissue. Photodynamic therapy uses a phototoxic reaction that occurs as a result of the use of a photosensitizing substance and light of a wavelength appropriate for a given substance. This method is particularly effective in precancerous conditions (especially actinic keratosis), certain types of basal cell carcinoma, and the early stages of squamous cell carcinoma. The advantages of photodynamic therapy are mainly selectivity, sparing healthy surrounding skin, satisfactory cosmetic results, multiple use, use at any age;
2. 5% 5-fluorouracil ointment or imiquimod – is used for small and superficial outbreaks;
3. radiation therapy – it is currently a rarely used method of treating skin cancer. However, it is the best treatment for patients who cannot undergo surgery or cryosurgery due to their general condition or local conditions;
4. laser CO2 – used for nodules up to 5 mm in diameter;
5. interferon α-2 and recombinant interferon ß – used by intralesional injection in the treatment of basal cell carcinomas. The method is laborious, expensive and long-term.

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Skin cancer – prognosis

Skin cancer can be completely curable, and the prognosis depends primarily on the location, thickness, size, timing of cancer diagnosis and the degree of cancer differentiation.

In the case of diagnosis of basal cell carcinoma, a complete recovery is possible in more than 95% of cases. Most of the local relapses can be removed without major problems. However, it is worth remembering that there is a possibility of an aggressive course of this disease, even with metastases.

The prognosis is good for the diagnosis of squamous cell carcinoma which develops on the basis of keratosis. The highest degree of malignancy occurs in squamous cell carcinoma based on scars, chronic inflammations or in irritated areas.

It is worth mentioning that in the case of metastases and the involvement of local lymph nodes, 5-year survival is noted in 20-25% of patients.

Worse prognosis is also referred to when diagnosing changes occurring on the labia, penis or vulva, although the oral mucosa is considered to be the most difficult to treat and prognosis.

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