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Skin Cancer Treatment

What is skin cancer?

Skin cancer is one of the most common forms of cancer affecting people across the globe. Cancer – also called malignant neoplasm – occurs when cells in the body divide uncontrollably. Cancer cells develop when the genetic material in the body cells is damaged and the body is unable to repair this damage. These damaged cells divide and multiply uncontrollably forming a tumour mass. Uncontrolled division of skin cells is called skin cancer.

Melanoma, the most serious type of skin cancer, begins in skin cells called melanocytes. Melanocytes produce the pigment melanin, which determines the colour of skin, hair and eyes. Melanoma is the leading cause of death from skin disease. Melanoma begins on the surface of the skin and can grow down into the skin, reaching the blood vessels, and spread around the body. When cancer spreads it is called metastasis.

Melanoma can occur anywhere on the skin but often occurs on sun exposed areas of the body such as the arms, face, back and legs. Melanoma cancers can also occur in the eyes, mouth or the internal organs, but this is much rarer than melanoma skin cancer. It is a very dangerous type of cancer and the patient’s chances of survival often depend on early diagnosis and treatment. Skin cancer is the most common type of cancer and is seen in people of all ages.

Causes of skin cancer

Skin cancer is caused by intense exposure to ultraviolet radiation from sun exposure or tanning bed usage. This can start a change in melanocytes that eventually turns them into melanoma cells. Risk factors include:

  • Frequent sun exposure
  • Fair, sun-sensitive skin
  • History of sunburns
  • Reduced immunity
  • Irregularly shaped moles
  • Previous history of melanoma
  • Older age (>50 years)
  • Hereditary conditions

Signs and Symptoms

Melanoma is often painless and unnoticeable at first, but usually produces a range of signs and symptoms that can be identified if looked for.

The first sign is a change in the shape, size and colour of an existing mole. It may also appear as a new irregular mole, or can appear black or blue-black in colour. Melanomas are typically located on the back, the shoulders or on the back of the legs. They often have an irregular border and uneven colouration. The mole or the skin around it may become reddish or swollen and can be painful.

Treatment

Your dermatologist diagnoses melanoma by visually examining the lesions. If any lesions are suspicious, a skin biopsy will be done where a part or the entire lesion will be removed and observed under a microscope for cancer cells. If a diagnosis of melanoma is confirmed, the cancer is categorised based on its severity as stage 0–IV. Treatment will depend on the stage of cancer, size and location of the tumour and the patient’s general health. Some of the treatment options include:

Surgical treatment

This is the standard treatment for melanoma. Wide surgical excision is done for removal of the tumour along with the surrounding normal skin depending on the depth of the melanoma. The surgical methods to remove tumour mass include:

  • Curettage and desiccation – Curettage involves scooping out the cancer mass with the help of a spoon-like instrument called a curette. Desiccation is then performed by applying an electrical current to control bleeding and kill the remaining cancer cells.
  • Surgical excision – Surgical excision involves removal of the entire tumour mass.
  • Cryosurgery – In this technique, liquid nitrogen is applied to freeze and kill the abnormal cancer cells.
  • Laser surgery – Cancer cells are destroyed and their growth is arrested using laser therapy.
  • Mohs micrographic surgery – Also known as ‘microscopically controlled excision’, this method involves the surgeon removing a small piece of the tumour mass and examining it under the microscope during surgery. The procedure of removing and examining continues until the cancerous growth is removed and the skin sample is free of cancer cells. This process is preferred for large tumours that reappear after previous treatments.

Immunotherapy

Also known as biological therapy, immunotherapy uses the body’s immune system to fight cancer or reduce the side effects caused by some cancer treatments. Some forms of immune therapy are cytokines such as interferon-alpha and interleukin-2, T-cell therapy and vaccine immunotherapy.

Gene therapy

Another new approach in treating melanoma is gene therapy. It involves the insertion of normal genes into cells to replace the defective genes causing cancer metastasis.

Chemotherapy

This is the use of drugs to kill the cancer cells. The drugs are given in cycles, where a treatment period is followed by a recovery period before beginning another treatment period. Some of the drugs used are carmustine, tamoxifen, cisplatin, or dacarbazine. Combination regimens are generally used in the management of melanoma.

Prevention

  • Avoid excessive exposure to the sun, especially during peak UV hours (10am to 4pm).
  • When outdoors, try to stay in the shade.
  • Wear long-sleeved, loose-fitting clothing and hats.
  • Use a good sunscreen that blocks both UVA and UVB rays and reapply at least every two hours; reapply every one hour after swimming. Children especially should be protected from sunburn until age 16.
  • Consult your doctor if you have moles that bleed or sunburn-associated sores that will not heal.

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