Cancer lesions on the skin may have several different forms and causes. In any case, early diagnosis can ensure effective treatment, but prevention is always the best treatment!
Actinik hyperkeratosis (AK) is the most common precancerous skin lesion. People with light skin have a high chance of developing one or more of these common precancerous forms if exposed to the sun and reach an advanced age, although we have seen such lesions in young people for the last decade.
The place of residence has an important role: the closer one lives in Ecuator, the greater is the likelihood of developing AK. Actinic lesions are more common in men, while Caucasians are more sensitive to the harmful effect of solar radiation than other races.
AK, also known as Solar Hyperkeratosis, is a skin lesion covered with scabs. It usually occurs in the bald head, face, hands and other areas of the body that are often exposed to the sun. At first they are often so small that they are recognized by touch and not by sight, while early enough they may disappear to appear again later.
Most become red, but some will be light or darker, pink, red or a combination of them, or the same color as the skin color. Occasionally they cause itching or have a feeling of pinching or pulling. They can be inflamed or surrounded by redness. In rare cases, AK may even bleed.
AK can be the first step leading to Squamous Cell Carcinoma and for this reason it is known as precancerous stage. Up to 15% of cases of AK can develop into Squamous Cell Carcinoma. The more lesions has an individual, the greater the chance that one or more can turn into skin cancer.
WHAT IS THE CAUSE?
Chronic exposure to the sun is the reason for almost all AKs. Sunlight damage is cumulative. So even a short amount of exposure to the sun is added to, throughout the life of the individual. Cloudy days are also not safe, because 70% -80% of solar UV rays can pass through the clouds. These harmful rays can still be reflected in sand, snow and other surfaces, and thus causes more sun damage. Ultraviolet radiation produced by lamps in tanning salons may be even more dangerous than the sun.
Because the total amount of time we spend in the sun is added year by year, older people are more likely to develop AK. However, in our time some people at the age of 20 have been affected. However, AKs are more common in individuals over the age of 50 years.
Also, individuals whose immune system defense is weakened from chemotherapy, AIDS, organ transplantation, or excessive exposure to UV radiation are less able to fight the effects of radiation and are more likely to develop radial hyperkeratosis.
While AK is the most common precancerous form, not all lesions growths become cancerous. Unfortunately, there is no way of recognizing which types of AK are precursors of squamous cell carcinomas, so it is fortunate that there are so many effective treatments that eliminate actinic hyperkeratosis. Before choosing a treatment, the doctor will have to make a biopsy to decide if radial hyperkeratosis is malignant.
In addition to existing medicines, Cryosurgery is the most commonly used treatment when there is a reduced number of lesions. No incision or anesthesia is required. Liquid nitrogen is applied with a spray device or a cotton swab that cools the lesions. The lesions gradually shrink or appear crust and fall. Transient redness and swelling may occur after treatment, and in some patients, colorless spots may remain forever.
If a form of treatment is good, two may be better. Some of the treatment options are particularly effective when used together or in frequency. This approach can improve the healing rate and reduce side effects.
Other methods we use are Chemical Exfoliation, Laser Removal, and Photodynamic Therapy (PDT).
The best way to prevent actinic hyperkeratosis is to protect ourselves from the sun. Listed below are some habits for our sun safety, which really work.
- Look for the shade, especially between 10 am and 4 pm
- Avoid burns
- Avoid sunbathing and artificial tanning in UV tanning chambers (solarium).
- Cover with appropriate clothing, including a wide-visor hat and sunglasses with UV lenses.
- Use a wide range (UVA / UVB) sunscreen with SPF 15 or above, every day. For extended outdoor activity, use a waterproof, wide-range (UVA / UVB) sunscreen with a protection index of 30 and above.
- Apply a quantity (2 tablespoons) of sunscreen to your entire body 30 minutes before going out. Apply again every two hours or after swimming or increased sweating.
- Keep newborns away from the sun. Sunscreens should be used in infants after the age of 6 months.
- Examine your skin from the head to the toes every month.
- Visit your doctor every year for a professional skin checkup.
Basal Cell Carcinoma
Basal Cell Carcinoma (BCC) is the most common form of skin cancer. Over 30% of new cases of cancer are skin cancers and the majority of these are Basal cells. These growths appear in the basal cells found in the deeper layers of the epidermis (the surface layer).
Anyone with a history of sun exposure may develop BCC. However, high risk groups are those with fair skin, blond or red hair and blue, green or gray eyes. Those most affected are the elderly, but as new cases increase in numbers each year over the last decades, the average age of patients on their appearance has steadily decreased.
Almost all BCCs occur in body parts that have been extensively exposed to the sun – especially on the face, ears, neck, head, shoulders and back. In rare cases, however, tumors grow in non-exposed areas.
After the medical examination by the specialist, the diagnosis of BCC is confirmed by biopsy, if in doubt. If cancer cells are present, treatment is required. Fortunately, there are many effective methods for eliminating BCC. The choice of treatment is based on the type, size, area and depth of the tumor infiltration. It also depends on the patient’s age and general health condition and, ultimately, the appearance of the tumor.
Local anesthesia is commonly used with various surgical techniques. Pain or discomfort during the surgical procedure is minimal and postoperative pain is rare. The healing rate is 99%!
In Microsurgical Surgery with the MOHS method, with local anesthesia, the physician removes the tumor with a very thin layer of tissue around it. As the patient waits, the removed piece is immediately sent to the histopathological laboratory where the frozen sections of the tissue are examined under the microscope by the specialist. If there is skin cancer in some area of the tissue, then the procedure is repeated only in the area where the cancer cells were identified until the last tissue sample was found free of cancer cells. This method can save a larger amount of healthy tissue and has the highest rate of healing (99%). It is often used in basal cell tumors located in areas of major importance and in recurrent tumors or in difficult areas such as eyes, nose, lips and ears.
In Abrasion and Electrocautery, again with local anesthesia, the doctor removes the tumor by scraping it with a scraper (a pointed, round shaped tool). Heat produced by a diathermia destroys the remnants of the tumor and controls the bleeding. The scraping process may be repeated two or more times during the same session and helps to make sure that all cancer cells are damaged. This technique can achieve healing rates that reach those of surgical excision, but may not be so useful in aggressive BCCs or those at a high risk.
Other methods are Radiation where X-ray beams are directed to the tumor and there is no reason for surgical incision or anesthesia, Photodynamic Therapy (PDT), which is particularly useful for patients with multiple BCC, Cryosurgery, where the tumor is destroyed by liquid cooling without the need for an incision or anesthesia, surgical laser removal and, of course, topical application of creams, gels and solutions.
Acanthocytic Carcinoma (SCC) is the second most common skin cancer. This form of cancer is found in the acanthocytes, which make up most of the skin’s surface layer (the epidermis).
SCCs can occur in any area of the skin, including mucous membranes of the mouth and genitals. Of course, it is more often observed in places exposed to the sun, such as in the ear lobe, the lower lip, the face, the bald part of a head, the neck, hands, arms and legs. Often the skin at these points appears visually as if it is damaged by the sun, shows wrinkles, changes in color as well as loss of elasticity.
People with light skin, blond hair and blue, green or gray eyes belong to the high-risk groups. But anyone with a history of significant sun exposure also belongs to the high-risk group. Individuals whose occupation requires long hours of outdoor living or who spend enough of their spare time in the sun are at risk. Someone who previously had BCC is more likely to develop SCC, as is the case with people who have hereditary susceptibility to UVA radiation.
Certain tumor tumors or precancerous lesions, most of which result from accumulated solar radiation, are related to the development of SCC. Among these are Radiation or Solar overload, Radial Cheilitis, Leukopoplakia and Bowen Disease.
SCC manifests as a persistent thick, rough, lepidopteran lesion, which may bleed if accidentally hit. It often looks like a ulcer and sometimes appears as an open wound with raised borders and scratches on the surface or covering an uplifted dirty base.
When SCC is detected at an early stage and is removed immediately, it is almost always cured and any damage it causes is negligible. But if it is not treated, then it finally catches the underlying tissues and becomes dysphoric. A small percentage, in fact, can be metastasized to distant tissues and organs and may even be fatal. So the doctor should treat any suspicious growth without delay. The diagnosis will be made by taking a piece of tissue (biopsy) to be checked under the microscope. If cancer cells are observed, treatment is required.
Fortunately, there are several effective ways to treat the SCC. The type of treatment depends on the type, size, location, depth of the tumor, age and general health of the patient. The treatment takes place in the doctor’s office or in a clinic. In most surgical procedures local anesthesia is administered, the pain and discomfort experienced by the patient is minimal and there is rarely severe pain after treatment.
As for the Microscopic Surgery with the MOHS method, what applies to BCC and 94% -99% is the best treatment for all SCCs. In the case of Surgical Removal, the doctor uses a scalpel to remove the entire volume along with the surrounding area with healthy skin limits for safety reasons. Then the wound around the surgical field closes with sutures. The tissue that is removed is sent to the laboratory for microscopic examination to confirm that all cancer cells have been removed. The success rate with this technique accounts for about 92% of the primary growths. The rate falls to 77% in cases of recurrent squamous cell carcinoma.
In the case of Radiation X-ray beams are directed to the tumor and there is no reason for surgical incision or anesthesia. The destruction of the tumor usually requires a series of treatments lasting 1-4 weeks. Sometimes treatment is required to be daily for one month. Success rates range from 85% to 95%. This technique involves long-term cosmetic problems, risks associated with radiation as well as multiple visits. For these reasons, this form of treatment is applied to tumors that have difficulty in dealing with surgery and in patients where surgery is not appropriate, as in the case of the elderly or those with severe health problems.
CASE OF SUBMISSION
Anyone affected by a SCC has an increased likelihood of developing a second growth, especially at the same spot or within a short distance. This is because the skin has irreversible damage to the sun. Such relapses typically occur within the first two years of the day of surgical treatment. A SCC may recur even when the growth has been carefully removed the first time. Therefore, the point where the previous treatment was applied should be carefully examined. Any change observed should be promptly referred to the surgeon. SCC in ears, nose and lips are particularly prone to recurrence.
Even in the case where no suspected signs are observed, regular visits to the surgeon are required to examine the entire body postoperatively. If cancer recurs, the surgeon may again propose for the next time an alternative form of treatment, and specific methods such as MOHS miniature surgery, which is particularly effective for cases of cancer recurrence.