Skin CancerGone are the days when people sent children outside to play to get a littlecolor in their cheeks. They know too much about the dangers of unprotected sunexposure and the threat of skin cancer. Or do they? Despite the fact that 58%of parents remembered hearing about the importance of protecting their childrenfrom the sun, children are still playing in the sun without sunscreen orprotective clothing (3., p 1). Sunburn is the most preventable risk factor ofskin cancer.
Skin type and family history cannot be changed. Protection fromthe sun and education of the potential hazards of the sun need serious attention.The American Cancer Society estimates that over 850,000 cases of skin cancerwill occur in the United States during 1996. Of those cases, they predict that9,430 will end in death (4.
, p 1). Apparently, Americans still do not have anadequate amount of prevention information to help reduce the disfigurement andmortality from this cancer.Exposure to the ultraviolet radiation from the sun is the most frequently blamedsource of skin cancer. Due to the reduction of ozone in the earth’s atmosphere,UV radiation is higher today than it was several years ago. Ozone serves as afilter to screen out and reduce the UV light that reaches the earth’s surfaceand its people. Very simply, sunburn and UV light can damage the skin and leadto skin cancer (1., p 1). The American Cancer Society also faulted repeatedexposure to x-rays, artificial forms of UV radiation like tanning beds, andcontact with chemicals like coal tar and arsenic as other causes of skin cancer(4.
, p 1). Additionally, if there is a history of skin cancer in the family, anindividual may be at a higher risk (1., p 1).
Individuals who have experiencedonly one serious sunburn have increased their risk of skin cancer by as much as50% (1., p 4).There are three main types of skin cancer: basal cell carcinoma, squamous cellcarcinoma, and malignant melanoma. Basal cell carcinoma usually imposes itselfon areas of the skin that have been exposed to the sun. It usually appears as asmall raised bump with a smooth shiny surface. Another type resembles a scarthat is firm to the touch. Although this specific type of skin cancer mayspread to tissue directly surrounding the cancer area, it usually does notspread to other areas of the body (9., pp 2-3).
Squamous cell carcinoma growths also appear most frequently on areas of thebody that have been exposed to the sun. These areas can include the hands,lower lip, forehead, and the top of the nose. Additionally, skin that has beenexposed to x-rays, chemicals, or has been sunburned can host these tumors.
Thesquamous tumors may feel scaly or develop a crusty appearance. Some growths maybleed. These particular tumors may spread to lymph nodes in the surroundingarea (9., pp 2 -3).Malignant melanoma is a far more serious type of skin cancer. It can spreadquickly to other parts of the body through the lymph system or blood.
This typeof skin cancer is more common among adults. Findings have indicated that menmost often develop melanoma on the trunk of the body. Whereas, women most oftendevelop it on the arms and legs (6., pp 2-3). The warning signs of melanomaare: changes in the color, size, or shape of a mole, bleeding or oozing from amole, or a mole that is hard, lumpy, swollen, and is tender to the touch, orfeels itchy. A new mole can also be an indicator of melanoma.
A simple “ABCD”rule outlines the warning signs of melanoma. “A” is for asymmetry. One half ofthe mole does not match the other. “B” is for border irregularity. The edgesare ragged, notched, or blurred. “C” is for color. The pigmentation is notuniform.
“D” is for a diameter of greater than 6mm. Any progressive increasein size should be of particular concern (8., p 1).For both basal and squamous cell carcinomas, surgery is the most commontreatment. Electrosurgery is the process in which the cancer is scooped outwith a sharp instrument and then an electric current is used to burn the edgesaround the site to kill any remaining cancer cells. Cryosurgery freezes thetumor to kill the diseased tissue with liquid nitrogen. Simple excision cutsthe cancer from the skin along with some of the healthy tissue around it.Micrographic surgery removes the cancer and as little normal tissue as possible.
During this surgery, the doctor removes the cancer and then uses a microscope tolook at the cancerous area to make sure no cancer cells remain. This particulartreatment has the highest 5-year cure rate. Laser therapy uses a narrow beam oflight to remove the cancer cells. Surgery may leave a permanent scar on theskin. Depending on the size of the cancer removed during surgery, skin graftingmay be necessary. Radiation therapy uses x-rays to kill cancer cells and shrinktumors.
Chemotherapy uses drugs to kill the cancer cells. Topical chemotherapyis often administered as a cream or lotion placed on the affected skin to killthe cancer cells. Systematic chemotherapy is a treatment administered in theform of a pill or injection. This allows the drug to enter the bloodstream,travel through the body and kill cancer cells. Systematic chemotherapy is inthe process of being tested in clinical trials. Biological therapy, orimmunotherapy tries to get the person’s own body to fight the cancer.
It usesmaterials made from the infected person’s body to boost, direct, or restore thebody’s own natural defenses against the cancer. Photodynamic therapy uses acertain type of light and a special photosensitive chemical to kill cancer cells(9., pp 2-5).Malignant melanoma is classified by stages. In Stage 0 melanoma, abnormal cellsare localized to the outer layer of the skin cells and do not invade deepertissues. At stage I, cancer is found in the epidermis and/or the dermis, but ithas not yet spread to nearby lymph nodes.
The tumor measures less than 1.5millimeters thick. At stage II, the tumor measures 1.5 millimeters to 4millimeter thick. The cancer has spread to the lower part of the dermis, butnot into the tissue below the skin or into the nearby lymph nodes.
At stage III,indications are that the tumor has spread to nearby lymph nodes or there areadditional growths between the original tumor and the lymph nodes in the area.At stage IV, the tumor has spread to other organs or to lymph nodes far awayfrom the original tumor. The type of treatment is based on the stage of thecancer. Four of the most common kinds of treatments are: surgery, chemotherapy,radiation therapy, and biological therapy.
Surgery is the primary treatment forall stages of melanoma. After surgery, chemotherapy is normally used to killany cancer cells that may remain (6., pp 2-5).Individuals that have treatment for basal cell carcinoma should be clinicallyexamined every 6 months for at least 5 years. Thereafter, an examination forrecurrent growths or new tumors should be done on an annual basis.
It has beenfound that 36% of individuals who develop a basal cell carcinoma will develop asecond primary basal cell carcinoma within 5 years. Since squamous cellcarcinomas have definite metastatic potential, these patients should follow a 3month re-examination schedule for the first several years, and then follow a 6month schedule of examinations for an indefinite period of time (10., pp 4-6).Overall, there is an increased incidence of second primary melanomas in affectedindividuals. A minimum of 3 percent will develop second melanomas within 3years.
Thus, patients need close follow up for the development of subsequentprimary melanomas. An appropriate interval of re-examination may be 6 monthsfor patients with atypical moles and without a family history of melanoma. Ifpatients have not shown evidence of recurrence or a second primary melanoma bythe second anniversary of diagnosis, the interval between examinations can beextended to 1 year.
For patients with atypical moles, or a positive familyhistory of melanomas, examinations should be considered every 3 to 6 months (11).The American Cancer Society reports that basal cell carcinoma, the mostprevalent skin cancer, and squamous cell carcinoma have a notable prognosis ifdetected and treated early. Although, individuals with non-melanoma skincancers are at a high risk for developing future skin cancers. While melanomais the rarest of the skin cancers, it is the most deadly (7., pg.
1). TheAmerican Cancer Society also states, “Malignant melanoma can spread to otherparts of the body quickly; however, when detected in its earliest stages, andwith proper treatment, it is highly curable. The 5-year relative survival ratefor patients with malignant melanoma is 87%. For localized malignant melanoma,the 5-year relative survival rate is 94%; and rates for regional and distantdisease are 60% and 16%, respectively. About 82% of melanomas are diagnosed ata local stage” (8., p 2).
When the statistics show that over one million new cases of skin cancer will bediagnosed in the United States this year, Americans have their work cut out forthem. By the year 2000, Americans will have a 1 in 75 lifetime risk ofdeveloping melanoma or other skin cancers (5., p 1). Early detection is by farthe most crucial element of surviving this terrible disease.
Changing society’sbelief that being tanned connotes health and beauty continues to be a challenge.The notion has to be replaced with the belief that staying out of the sun, ortaking extreme precautions while in the sun is smarter.