Skin Cancer

The skin cancer is the most common cancer type and it is known that prevalence increases by 4% every year. Major reasons for that include diagnosis of more patients because of increase in early diagnosis methods and awareness raised about cancer; depletion pf the ozone layer; exposure to ultraviolet beams under the sun for tanning; increase in some diseases that weaken the immune system such as chronic kidney failure and AIDS.

Approximately half of the population develops skin cancer up to 65 years of age. Although there are many types of skin cancer, the most common types are basal cell carcinoma, squamous cell carcinoma and melanoma. The most common skin cancer type is melanoma (75% of cases). Risk of development of melanoma from atypical nevus (irregular shape) is 0.6 percent in time. The mortality is 3,6% per 1000 people every year.

What are the symptoms?

Basal and squamous cell skin cancers may appear in different forms.  The main symptom is an ulcer, a wound or a lesion which does not heal on the skin.  These lesions may be pink, red or white in a form of a soft cyst whereas they may appear as a hard nodule (a round swelling), a wound or a cyst which sometimes bleeds or a red, dry lesion which seems like eczema.   In general, if a skin lesion or ulcer which does not heal spontaneously within six months, the probability of a skin cancer should be considered.

How does it occur?

Melanoma-type skin cancers may be determined as a result of modification of a previous nevus whereas they may appear spontaneously on an intact skin after mid-ages in approximately half of the cases.  Main symptoms of melanoma are asymmetry, irregular border, mixed color and a size larger than 6 mm or rapid growth of a lesion.  Although melanomas have a dark color in general, they may be colorless.

What are the risk factors?

The most important risk factor for basal and squamous cell carcinomas is sunlight or ultraviolet beams.  These cancers appear on head, face and neck more due to exposure to the sunlight.  Human papilloma virus (HPV) infections, immune system suppression, contact with carcinogen chemicals are risk factors.

Main risks for development of melanoma are dysplastic nevus and congenital nevus.  Dysplastic nevus exists in about 4 to 17 percent of the populations and according to the studies melanoma may develop in 0.6 to 2 percent of them.  Congenital nevus is present at birth and risk of melanoma increases in proportion with size of the nevus.  Pregnancy, menopause, and estrogen hormone replacement which cause hormonal changes in women cause an increase in development of melanoma.

Who are under risk?

Individuals with a light skin, hair and eye color. Those exposed to sunlight or ultraviolet more. Those who develop sunburns easier. Those who have excessive sunburns during childhood or adolescence. Individuals with a skin cancer history in the family. Those who have multiple nevi in different forms. Those who have immune system suppressing diseases. Those who were treated by radiotherapy for acne during adolescence.

Is early diagnosis possible?

Like all cancer types, treatment achievement of skin cancers depends on early diagnosis.  Individuals should observed their body thoroughly and have examinations in certain periods.  Individuals should refer to a doctor in case of appearance of a skin lesion which does not heal within six months or modification of an existing nevus.

How is it diagnosed?

Final diagnosis of skin cancers is biopsy of all or some part of the lesion.  The tissues removed by the physician are histologically examined and lesion type, malignancy status and depth are detected.

How is it treated?

Treatment of skin cancers may change according to the cancer type; however, the aim is complete removal or elimination of the cancer.  Majority of skin cancers are removed through surgical methods by plastic surgeons or dermatologists.  The skin cancer is widely removed not to leave any tumor cell and the wound is sutured.  However, if the area after complete removal of the skin cancer is big, the area is repaired by skin graft or local flap and the skin gains previous appearance.  Other treatment methods used for treatment of skin cancers are cryotherapy (treatment through freezing), electro dissection (treatment through cauterization), radiotherapy, topical chemotherapy, systemic chemotherapy and immune-therapy.  Sentinel lymph node biopsy technique is used for early diagnosis and treatment of malignant skin cancers such as melanoma.  Here, in addition to wide resection of the cancer surgically, the lymph node of which the cancerous area is connected is revealed, removed and a biopsy is performed.  The purpose is to direct the early diagnosis by examining a lymph gland which was not enlarged but may have cancer.

Does it appear again?

Basal cell carcinomas tend to recur on the area that they appear and they do not invade the distant organs.   Although squamous cell cancers have a similar progress, they may invade distant organs and lymph glands.  Melanomas have a fatal progress and they invade lymph glands and distant organs if not treated earlier. 


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