Skin cancer

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Skin cancer Microchapters

Patient Information

Overview

Historical Perspective

Classification

Melanoma
Basal cell carcinoma
Squamous cell carcinoma of the skin
Actinic keratosis
Bowen's disease
Keratoacanthoma
Dermatofibrosarcoma protuberans
Merkel cell carcinoma
Kaposi's sarcoma
Angiosarcoma
Cutaneous B cell lymphoma
Cutaneous T-cell lymphoma
Sebaceous gland carcinoma

Pathophysiology

Causes

Epidemiology & Demographics

Risk factors

Screening

Diagnosis

Treatment

Prevention

Skin cancer
ICD-10 C43-C44
ICD-9 172, 173
ICD-O: 8010-8720
MeSH D012878

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Associate Editor(s)-in-Chief: Sara Mohsin, M.B.B.S.[5]

Overview

Skin cancer is the malignant growth on the skin which is the most common type of malignancy in Caucasians. Skin cancer generally develops in the epidermis (the outermost layer of skin), so a tumor is usually clearly visible. This makes most skin cancers detectable in the early stages. Skin cancer is broadly classified into melanoma and non-melanoma skin cancer (NMSC) with most common NMSC types to be squamous cell carcinoma and basal cell carcinoma. Most common cause of skin cancer is DNA mutations caused by UV irradiation over a proplonged period of time especially in fair-skinned individuals. Skin cancer is the fastest growing type of cancer in the United States. Skin cancer represents the most commonly diagnosed malignancy, surpassing lung, breast, colorectal and prostate cancer. More than 1 million Americans were estimated to be diagnosed with skin cancer in 2007. Skin cancer can be treated by surgery, or other non-surgical options such as cryotherapy, electrotherapy, curettage, photodynamic therapy, chemical peel, chemotherapy, radiation therapy, targeted therapy and biological therapy. Cancers caused by UV exposure may be prevented by avoiding exposure to sunlight or other UV sources, wearing sun-protective clothes, and using a broad-spectrum sunscreen.

Historical Perspective

Classification

Classification of skin cancer
Skin cancer type Characteristics
Malignant melanoma Most common type
Nonmelanoma skin cancers (NMSC)
Basal cell carcinoma (BCC) Most common types
Squamous cell carcinoma (SCC)
Actinic keratosis Can appear as:

Most commonly involves:

Bowen's disease[16] Rare types
Keratoacanthoma[17][18][19][20][21][22]
Dermatofibrosarcoma protuberans


Merkel cell carcinoma
Kaposi's sarcoma
Angiosarcoma
Cutaneous B cell lymphoma[23][24]
Cutaneous T-cell lymphoma[23] Manifests as any of the following:

It is further classified into:

Sebaceous gland carcinoma

Pathophysiology

Normal skin function

Normal skin anatomy

Layers of the epidermis.[1]
Anatomy of the skin showing the epidermis (including the squamous cell and basal cell layers), dermis, subcutaneous tissue, and other parts of the skin.[2]
Diagram of the layers of the epithelial skin layer: the epidermis.[3]

Epigenetics

UVA & UVB have both been implicated in causing DNA damage resulting in cancer by any of the following mechanisms:[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]

 
 
 
UVA exposure to the sun-exposed skin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Suppression of the contact hypersensitivity (CHS) response
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Increased intracellular ROS, PGE2, and PGE2 receptors in human dermal fibroblasts
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Decreased expression of transcription factor zinc finger E-box binding homeobox 1(ZEB1)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Decreased binding of ZEB1 to DNA methyltransferase 1 (DNMT1) promoter
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Senescence of DNMT1 (gene silencer)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
This leads to:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cellular senescence
 
 
 
Main effects of UV radiation on normal-appearing human skin
Acute Chronic
Molecular/cellular Clinical

Gross Pathology

Microscopic Pathology

Causes

Epidemiology & Demographics

Risk factors

Common risk factors for skin cancer include:[95][96][7]

Risk factors for the development of skin cancer
Risk factors Associated features
Excessive sun exposure
Artificial UV exposure Tanning is the response of skin to excessive UV radiations:
Fair skin
Genetic predisposition
Chronic non-healing wounds
Prior history of sunburns
High altitude or sunny climate
Prior chemotherapy
Moles
Advanced age
Precancerous skin lesions
Xeroderma Pigmentosum (XP)
Radiation exposure
Personal history of skin cancer[97][98][99][100][101]
Exposure to certain substances
Family history of skin cancer
Weakened immune system Due to:
Beta-Human Papilloma Virus
Male gender
Prolonged skin inflammation

Screening

According to different studies going on for so many years, following data is available regarding the different methods/tools and their effectiveness for skin cancer screening:

Diagnosis

The two sentinel features of skin cancer diagnosis are skin examination and subsequent biopsy of the suspected skin lesion. Common history, symptoms, physical examination findings and diagnostic tests are mentioned below:

History and Symptoms

Common sites of involvement

Common symptoms

Physical Examination

Laboratory Tests

Biopsy

Other Diagnostic Studies

Treatment

Different treatment options for skin cancer
Treatment option Description
Cryosurgery/Freezing
Electrotherapy
Curettage & electrodesiccation or cryotherapy
Photodynamic therapy
Chemical peel
Other drug therapy
Simple excisional surgery
Mohs micrographic surgery
Shave excision
Laser surgery
Dermabrasion
Chemotherapy
Radiation therapy
Targeted therapy
Biological therapy

Prevention

Although the possibility of skin cancer can't be eliminated completely, but the risk for developing skin cancer can be significantly reduced by acting on the following preventive measures in the first place to decrease the excessive exposure to UV rays:[96][117]

Primary preventive measures for skin cancer
Preventive method Details
Avoiding sunburns and suntans
Wearing protective clothing Wear the following while being in the outdoor environment:
Wearing SPF sunscreen
Avoiding tanning beds
Being aware of sun-sensitizing medications
Checking skin regularly and reporting any new or unusual skin changes to the doctor
Watching dysplastic nevi (abnormal irregular multiple moles) regularly
Reducing the exposure to ultraviolet (UV) radiation, especially during the early years of life

Effectiveness of sunscreen in prevention of skin cancer

Different sunscreen recommendations and recommendations' grading according to Canadian Task Force on Preventive Health Care (CTFPHC) GRADE System
Sunscreen property Recommendation Grade of Recommendations
SPF (Sun Protection Factor)
Water resistance
Organic vs inorganic sunscreens
Lip protection
  • Whole lip should be generously covered by high-SPF (>/= 30) and reapplication of lip sunscreen
Sunscreen application
Patient education on sunscreen
Sunscreen safety
Sunscreen benefits
Sunscreen vehicle
  • Weakly recommended
Expiry date
US FDA monograph list of active ingredients of sunscreen
Type of filter Name of UV filter Concentration in percentage
Organic UVB Filters Cinnamates Octinoxate (octyl methoxycinnamate, Parsol MCX) 7.5%
Cinoxate 3%
PABA derivatives 15% Para-aminobenzoic acid (PABA) 15%
Padimate O (octyl dimethyl PABA) 8%
Salicylates Octisalate (octyl salicylate) 5%
Homosalate 15%
Trolamine salicylate 12%
Others Octocrylene 10%
Ensulizole (phenylbenzimidazole sulfonic acid) 4%
Organic UVA Filters Benzophenones Oxybenzone (benzophenone-3) 6%
Sulisobenzone (benzophenone-4) 10%
Dioxybenzone (benzophenone-8) 3%
Others Butyl methoxydibenzoylmethane (avobenzone, Parsol 1789) 3%
Meradimate (menthyl anthranilate) 5%
Inorganic Filters Titanium dioxide 25%
Zinc oxide 25%
Measurement of UV protection afforded by sunscreens and clothing
Measurement system SPF (Sun protection factor) UVA‐PF (UVA‐protection factor) UPF (Ultraviolet protection factor)
Definition
Developed for
  • Clothing
Global acceptance
  • International
  • International
UV wavelengths protected
Examples
  • UPF cotton 5–10
  • UPF denim 1700
Knowing individual skin type and using the right sunscreen accordingly
Skin type by the Fitzpatrick Scale Skin color Skin tone or other common descriptors Sun exposure effects Recommended sunscreen SPF 1 MED- Minimal erythemal dose (as SED- standard erythemal dose) Susceptibility to skin cancer
I
  • Always burns (very readily)
  • Never tans
30+
  • 2-3
  • Very high
II
  • White
  • Always burns (readily)
  • Rarely tans
  • 3-4
  • Very high
III
  • White
  • Light‐intermediate (Dark European)
  • Sometimes burns (moderately)
  • Sometimes tans
15+
  • 4-5
  • High
IV
  • Tans easily
  • Burns less (occasionally)
  • 5-6
  • Moderate
V
  • Tans easily and substantially
  • Rarely burns
  • 8-12
  • Low
VI
  • Tans readily and profusely
  • Does not burn
  • 16-24
  • Low

Skin Cancer Prevention by using Facial-Aging Mobile App

Related Chapters

References

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