Throughout childhood, I recall the constant reminder to use sun screen while outside to avoid skin cancer, yet I hardly understood the need; other than knowing cancer was “bad.” Growing into my teen years, there were many times I used indoor tanning beds and was regularly lectured of the risks and damage which could be done to my skin. These constant suggestions from my parents, with the lack of clear reasoning is why I chose to research skin cancer. I wanted to make sense of these lectures I received and obtain a greater understanding of what other factors were incorporated into the development of skin cancer, as well as what would happen if I ever noticed an irregular spot on my skin.
While researching skin cancer and the treatment, I decided to take advantage of the online library through the college to ensure the information I received was valid. All articles used for this research are peer reviewed to provide confirmed information from recognized researchers within the field. Additionally, the articles chosen were all published within the past three years to eliminate the use of any out of date information. “Monitor your moles to guard against potentially deadly melanoma,” was used for the statistics it provided regarding cancer rates and who is found to be most susceptible to skin cancer. “Medicine; A Closer Look; Skin cancer takes many forms,” provided additional statistics as well as valuable information on differentiating from melanoma to non-melanoma carcinoma as well as diagnostic procedures. “Skin cancer: an overview of assessment and management” proved to be an extremely helpful article which described the various stages of melanoma as well as advanced treatment options. Finally, “Human biology: concepts and current issues” was utilized to provide much of the background and explanation of how the skin works and how skin cancer originates.
In many cases, skin is the first mechanism the body uses to defend against dehydration, injury, viruses and bacteria, and the regulation of body temperature. The outer layer of the skin, named the epidermis, consists of multiple layers of squamous epithelial cells. Two types of cells help create the epidermis; a tough, waterproof protein called keratin produced by keratinocytes and Melanocytes which produce a dark-brown pigment called melanin. Actively dividing keratinocytes near the base of the epidermis, referred to as basal cells, move toward the skins surface and flatten to become squamous epithelial cells. Once dead and dried, these squamous cells become the barrier which cover and protect the cells below it. The second type of cells, melanocytes and are located towards the base of the epidermis. The production of the pigment melanin by the melanocytes accumulate inside the keratinocytes to protect the body from the sun’s ultraviolet radiation. Increased activity of melanocytes from exposure to sunlight produces the development of a suntan (2). However, prolonged exposure to the sun’s ultraviolet rays can damage the epidermis cells causing sunburn, skin aging, and skin cancer.
While overall cancer rates have fallen by 20 percent, according to the American Cancer Society, skin cancer continues to rise (3). Skin cancer has become the most common form of cancer in the United State, and is broken into two classifications; non-melanoma, basal cell and squamous cell carcinoma, and melanoma. (2).
Basal cell and squamous cell carcinoma have been reported as the most common types of non-melanomas with more than 2 million people in the U.S. diagnosed each year (1). These non-melanomas arise when the basal cells begin to divide out of control and have a relatively low chance of metastasizing. If metastasizing does occur, it tends to be at a slow rate. Of these non-melanomas, basal cell carcinoma is the most common and will tend to appear as pink or flesh-colored bumps with a smooth texture, at times these bumps may bleed or crust and are present predominantly on the head and neck, but are also seen on the limbs and trunk (4). Squamous cell carcinoma will present itself as a pink scaly patch or nodule that may ulcerate and crust (2). While squamous cell carcinoma is related to chronic sun exposure, recent research has concluded that women who smoke cigarettes are more likely to be diagnose, compared to women who do not smoke (4). Although melanoma accounts for only 5 percent of all skin cancers, it is considered to be the deadliest due to the quick rate it can metastasize. Stemming from abnormal melanocytes, melanoma will present itself as dark spots or patches on the skin and should be evaluated according to the ABCD rule (1); Asymmetry, if the lesion is folded in two, the two halves would not match. Borders, the border is irregular. Color, contains mixed shades of tan, brown, and black. Diameter, the patch is greater than 6 millimeters (4). In melanoma cases, UV light has been determined responsible for 65 to 95 percent of cases, with approximately 10 percent of cases are from hereditary predisposition (4). Melanoma has been categorize into different stages ranging from stage 0 to stage 4, with stage 4 being the deadliest.
In order to diagnose skin cancer, dermatologists may use a magnifying glass or polarized light to better see details of suspicious marks. To obtain a definitive diagnosis of cancer, a biopsy is studied by microscope (1). Once a diagnosis has been made, treatment of both basal cell and squamous cell carcinoma will directly relate to the size, depth, and location of the tumor. Mild cases of non-melanoma can be treated with common topical medications or curettage and electrodessication, where a physician scrapes off the growth and desiccates the tumor site with an electrocautery needle (4). Melanoma treatment correlates to the staging of the carcinoma. Stage 0 melanoma has a 99.9 percent survival rate and consists of a patch that has not grown deeper than the epidermis. Stage II melanoma has an 85 to 99 percent survival rate and the tumor is less than 1 millimeter in thickness. Stages 0 to II melanomas are usually treated with excisional surgery, during which the surgeon removes the tumor along with a margin of normal skin as a safety measure leaving a cosmetic result acceptable to the patient (4). Stage III and stage IV melanomas are regional metastasis and distant metastasis where the cancers have spread to the lymph nodes. While surgical treatment of the carcinoma is still utilized, lymph node dissection will also be performed to stop the spread of the cancer cells. Radiation therapy, with the use of high-energy, pinpointed x-rays are used to kill cancer cells which remain after surgery. Additionally, chemotherapy and radiation may remove metastases symptoms that cannot be removed with surgery (4). Further treatment options through clinical trials have also become available to patients. Though, they have not been clinically proven successful, they are based on a better molecular understanding of the cancer (1).
Family history, fair skin, and blond or red hair are all factors which put a person in danger of melanoma; however, there are preventive measures which can be taken to decrease risk. It is recommended to keep out of the sun during the hours when it is strongest, between 10 a.m. and 4 p.m. When being outdoors is unavoidable, the skin should be covered with lightweight clothing and sunscreen. As an additional precaution, a head-to-toe self-check should be made monthly, to take note of any new moles or changes to existing moles. Even with the high survival rates in skin cancer, early detection is a crucial component and preventive measures should not be taken lightly (3). Works Cited
Adams, Jill U. "MEDICINE; A CLOSER LOOK; Skin Cancer Takes Many Forms; Gov. Brown Recently was Treated for Basal Cell Carcinoma. it Wasn't the Deadlier Melanoma." Los Angeles TimesMay 09 2011. ProQuest. Web. 5 May 2014 .
Johnson, Michael D.. "Cancer: Uncontrolled Cell Division and Differentiation." Human biology: concepts and current issues. 6th ed. Boston: Benjamin Cummings, 2012. . Print.
“Monitor your moles to guard against potentially deadly melanoma; thorough self-exams and regular checkups with a dermatologist can help protect you.” Women’s Health Advisor 17.4 (2013): 3+. Academic OneFile. Web. 23 Apr. 2014.
Wingfield, Carrie. "Skin cancer: assessment an overview of management: PHC699 Wingfield C (2012) skin cancer: an overview of assessment and management." Primary Health Care Apr. 2012: 28+. Academic OneFile. Web. 5 May 2014.