Skin cancer: Types, Symptoms and Causes

Skin cancer is the most common cancer in the body. The most common presentation patient sees when there are changes in the skin colour or texture or there is some outgrowth on the skin. There are different categories of skin cancers.

Skin Cancers Types

1. Non- melanoma skin cancers (NMSC)- It includes Basal Cell Carcinoma and Squamous cell carcinoma. The features are-
   • More indolent
   • Less aggressive
   • Lower chance of metastasis and these are more localized.
2. Melanoma Skin cancers

Basal cell carcinoma

• These are slowly growing and locally growing cancers that arises from pluripotent cells within the basal layer of the epidermis. The most commonly involved site is Face, Around eyes and Nose. The types of Basal Cell Cancer are:
  • Nodular BCC
  • Superficial BCC
  • Pigmented BCC
  • Morphoeic BCC
  • Basosquamous BCC

                                     Basal cell carcinoma

It is associated with Xeroderma pigmentosa, Albinism and Gorlin syndrome.

Treatment of Basal Cell Carcinoma: 

1. Medical:
   • Low risk superficial and small nodular BCC
   • Imiquimoid, 5-Fluorouracil
2. Surgical: Excision with predetermined margins of about 4-5mm surgical margins.
3. Mohs micrographic surgery: done in recurrent BCC
4. Cryotherapy
5. Superficial and electron beam radiotherapy for primary or surgically recurrent BCC.

Also Read: Wilson's Disease: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

Squamous Cell Carcinoma

• It is a malignant tumour arising from epidermal keratinocytes or its appendages. It is the second most common skin tumour. It is associated with HIV, Renal transplant . It is most commonly occurred at Exposed areas and area of photodamage. On histology ,Keratin pearls are observed. The clinical features are:
  • Papule or Nodule or Plaque
  • Presence of induration
  • Crusting and scaling are other important features.

Treatment of Squamous Cell Cancer

• Wide surgical excision with margins.
• For advance case Radiation and Chemotherapy are the treatment of choice.

It is important to notice two more skin lesions. These are:

• Keratoacanthoma- It is known as well differentiated SCC. The most common location is Face. Histopathology will show epidermal lipping along with Central keratotic plug.
• Marjolin’s Ulcer- It develops at the sites of burns and scars. It has high tendency to develop into SCC cancer. It has high invasive potential.

Also Read: Polycythemia Vera: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Melanoma Skin Cancers

It is called as Malignant melanoma. It is the disease in which metastasis is seen. The predisposing factors include UV radiation exposure, any precursor lesions and Mainly occurs in western ethnicity. The precursor lesions are:

• Congenital melanocytic nevi- Usually located on the trunk and present with satellite lesions.
• Common Nevi- Risk of transformation to malignancy is very low .
• Dysplastic /Atypical Nevi- Usually presents with >5mm of size and it has irregularly distributed colors. With growing age it can emerge.

The Malignant Melanoma is identified using ABCDE rule:

1. Asymmetry ( Not symmetrical in appearance)
2. Border ( Blurry and jagged edges)
3. Color ( has more than one color)
4. Diameter (Large diameter)
5. Evolution ( Has sudden changes in size or shape)

Diagnosis is done by  Dermoscopy and the histopathology is gold standard test.

Types of Melanoma

• Superficial Melanoma ( Most common)
• Nodular Melanoma
• Acral Lenitiginous Melanoma: It is mainly present on the feet and is very common type which is seen in south asian people.

                                      Acral lentiginous Melanoma

• Subungual Melanoma: It presents as multiple, irregular bands of pigmentation on nails. It is called as Hutchinson sign.

Investigations of Melanoma

• Histopathology is the gold standard with ideal biopsy taken as a narrow 2mm margin excision.
• Pathological marker are Breslow depth ( The distance between the overlying epidermal granular layer and the deepest invasion), mitotic rate, ulceration and Sentinal node.
• Staging of melanoma ( TNM)

Treatment of Melanoma

• Wide local excision of melanoma.
• If tumour is aggressive then Immunotherapy, Target therapy and chemotherapy can be used.

Also Read: Factor V Leiden: Causes, Symptoms, Risk Factors, Diagnosis, Treatment And Complications

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