Skin cancer is the most common type of cancer. Skin cancer is easier to cure than cancers of other organs, as it is an easily spotted and diagnosed tumour, unlike malignancies of the internal organs. However, the success of treatment is mostly influenced by early diagnosis and the right treatment method.
Cancer is a disease characterised by the uncontrolled multiplication of cells and their spread to other parts of the body. Cancer cells multiply faster than normal cells, but their maturation is slowed down and they do not fulfil their functions. Malignant cells spread to other organs and tissues through the blood and lymph, forming metastases. The main features of a malignant neoplasm are:
- Spreads to adjacent tissues and distant organs (metastasis);
- Rapid growth and change;
- Invasion of adjacent structures;
- Unclear borders, irregular contours;
- Characterised by urination, itching, bleeding, pain (later stages);
- Uneven colour;
- Enlargement of the irritated lymph nodes.
Malignant tumours according to their origin
Tumours are classified according to the histogenetic principle, i.e. they are classified according to the tissue of origin. Epithelioid tumours are the most common. Approximately 90% of adult malignant tumours originate from epithelial cells.
Types of malignant tumours
A malignant tumour is otherwise known as cancer. Malignant tumours are usually of the following type:
Carcinoma – usually arises in glandular epithelial cells, which are found in almost every organ of the body. It is the most common form of cancer. Carcinomas are the most common form of cancer.
Sarcoma is a malignant tumour of connective tissue (non-epithelial origin). Sarcomas are much less common than carcinomas. One important characteristic of carcinomas and sarcomas is the formation of so-called solid tumours which, if detected early enough, can be removed surgically.
Leukaemia, lymphoma – develops in the blood and lymph cells, as well as in the bone marrow and lymph nodes.
Where do malignant tumours most often occur?
Since epithelial cells are present in almost all organs, malignant tumours can be diagnosed almost anywhere. In women, tumours are most often found in the breast, ovarian cancer in women and prostate cancer in men. Cancers of the lungs, kidneys, mouth and intestines are often detected. In addition, malignant tumours spread to surrounding tissues and organs (metastasise) and this pressure sometimes results in the disruption of the blood supply to the tissues and organs, leading to death and necrotic processes. This is why a cancer stage designation (stage I, II, III, IV) is used to describe the spread of the cancer, which is the basis for the use of one or other cancer treatment method. The later the stage of the cancer, the more the cancer has spread throughout the body.
Skin cancer arises from skin cells that are altered for some reason. Because there are several different types of cells in the skin, skin cancer is divided into:
Epithelial (non-pigmented, non-melanoma) tumours:
- Basalioma (basal cell carcinoma);
- Basal cell carcinoma (basal cell carcinoma).
- Pigmented (melanocytic) tumours:
Non-pigmented skin tumours account for the majority of all skin cancers (about 80%). Basalioma is the most commonly detected malignant skin tumour. Squamous cell carcinoma is less frequently detected and accounts for up to 20% of all skin cancers. Melanoma, although the rarest form of skin cancer, is the most aggressive and, if diagnosed late, has the worst survival prognosis. According to the Lithuanian Cancer Registry, about 1800 new cases of non-pigmented skin cancer and about 200 cases of melanoma are diagnosed each year, of which two thirds are diagnosed in women. The incidence of melanoma has started to increase rapidly. In 1935, for example, the odds of developing the disease were 1 in 1 500 and by 2000 they were 1 in 75. The increased incidence is mainly due to increased life expectancy, increased time spent in the sun (and thus increased skin burns), the use of sunbeds, and ecological changes in the environment.
Around 90% of all skin cancers are directly related to the harmful effects of UV radiation from the sun. UV rays can contribute to all three types of skin cancer. Indiscriminate exposure to the sun, sunbathing both outdoors and in sunbeds, and the thinning of the ozone layer have led to skin cancer being diagnosed in younger and younger people nowadays.
What factors increase the risk of skin cancer?
- Fair skin. People with fair skin and therefore less melanin in their skin have a higher risk of developing skin cancer because the body is less protected from harmful UV rays and the skin burns more often.
- Severe skin burns. If you have ever had a severe sunburn on your skin, including blistering or even bleeding, you may be at a higher risk of developing skin cancer. Therefore, it is essential to use UV protection (especially for children).
- High number of moles. Skin cancer and moles are closely linked.
- Family history of skin cancer.
- Weakened immune system, use of various drugs, fatty food are also risk factors for cancer and can provoke the development of this disease.
- Radiation treatment for eczema, acne and other skin diseases can increase the risk of skin cancer, especially basal cell carcinoma.
Pre-existing malignant skin cancer. People with a history of melanoma have a higher risk of developing melanoma again.
Early diagnosis, blood tests, preserving photographs of suspicious moles, skin cancer tests, and then properly selected skin cancer treatment, followed by timely surgery to remove the tumour, are all factors that can make it easier to beat skin cancer.
What else increases the risk of skin cancer?
- Heredity. It has been shown that people with 1st or 2nd-degree relatives with malignant skin tumours (especially melanoma) also have an increased chance of developing skin cancer.
- Pigmented skin type (phototype). People with fair skin (about 70% of people in Lithuania) are more likely to develop skin cancer.
- Ionising radiation (e.g. radiotherapy) is associated with an increased likelihood of basal and squamous cell carcinoma, especially in areas that are additionally exposed to sunlight.
- Immunosuppression (due to HIV infection, long-term use of corticosteroids, post-organ transplantation) generally increases the likelihood of cancer in any location, not just skin.
- Chronic inflammation (burns, chronic ulcers, inflammatory diseases).
- Harmful environmental substances such as arsenic, radon, other chemicals.
- Certain hereditary diseases, e.g. xeroderma pigmentosa, bullous epidermolysis bullosa, albinism.
- Pre-cancerous skin conditions, e.g. actinic keratosis, atypical moles.
- High number of body moles (>50 moles).
- Childhood burns.
- Older age.
What does skin cancer look like?
The symptoms of skin cancer start with some visible changes in the skin. These can be new growths on the skin or precancerous lesions – changes that are not cancer but over time can be signs of skin cancer. It is therefore advisable to know what skin cancer looks like and how to recognise the disease.
As there are several types of skin cancer, the symptoms, diagnosis and, of course, treatment vary:
- Basal cell carcinoma is recognised as a small yellowish-pink nodule that appears anywhere on the body, but most commonly on the head, neck, face, nose, forehead and ears. It starts as a small pimple with blood vessels on the surface and then develops into a crust.
- Squamous cell carcinoma develops from actinic keratosis. Prolonged and intense exposure to UV rays, when the outer layer of the skin is damaged, results in actinic keratosis. The crust grows, becomes squamous (bleeds when scratched) and develops into squamous cell carcinoma. It usually appears on the face, usually around or on the ears or lips.
- Melanoma – dark, brown or black spots, moles. They can be flat, raised, or bulging outwards. May be characterised by itching, urination or bleeding.
What are the main symptoms of skin cancer?
The first signs of skin cancer are spots or nodules on the skin that start to grow, change shape and colour over time. It is when you notice the first symptoms of a skin lesion growing, changing and becoming irregular in shape, colour, asymmetrical, itchy or painful that you should be alarmed and consult a specialist.
The main signs of skin cancer
The initial signs of skin cancer are very deceptive. The resulting skin lesions are painless and usually go unnoticed. However, gradually the skin damage increases and the disease spreads. The signs of skin cancer depend on the type and stage of the cancer, so it is essential to seek medical attention if it has occurred:
- A wound or spot on the skin that doesn’t go away within 2 to 4 weeks;
- A bleeding, itchy, scabby skin lesion;
- Skin ulceration (without cause) that does not heal within 4 weeks;
- A reddish and hard nodule, sometimes ulcerated or scabbed over;
- Roughness of the skin;
- Enlarged lymph nodes.
For more information, see the sections ‘Basalioma’, ‘Squamous cell carcinoma’, ‘Melanoma’. If you notice any of these signs, do not delay and consult your dermatologist. Cancer treatment is always more effective in the early stages. This is why early diagnosis of skin cancer is important
Other important signs of skin cancer:
- Irregular edges of the mole, especially if the colour of the mole is also uneven (i.e. there is a combination of 3 colours in the mole), uneven surface relief;
- A non-healing ulcer for a long time;
- Bleeding, itchy mole;
- Growing mole;
- A mole that changes its colour, shape, surface relief.
It is important to note that skin cancer may not necessarily occur in the areas of the body that receive the most UV radiation. Sometimes tumours appear on the palms of the hands, soles of the feet and other areas of the body that are usually covered by clothing. In addition, skin cancer can develop not only from a mole but also in areas where there are no previous skin growths or lesions.
Patients can stop the progression of the disease early by self-examining their moles once a month. It is equally important to examine the palms, soles, armpits, axillae and other harder to see areas of the body (ask family members to help). In addition, it is important to note both existing moles (whether they are changing) and new skin growths. If you notice any suspicious skin lesions, do not delay and consult a medical specialist.
What is the treatment for skin cancer?
The treatment of skin cancer and the ways and options available depend on the following factors:
- The type of skin cancer;
- The stage of the skin cancer;
- The specific treatment method and its side effects;
- The patient’s medical condition and age;
- The size, shape and location of the tumour.
The main treatment for skin cancer is surgery, where the tumour is removed. Surgical treatment is usually carried out under local anaesthesia. The tumour is surgically removed and the wound is dressed. The removed mole is sent for histological examination to evaluate the cells that make up the mole under a microscope. Regular dressings are required after surgery. The stitches are usually removed 10-12 days after surgery. Around the same time, the histological examination of the mole is completed.
Thus, further treatment and follow-up of the patient is discussed individually with the patient depending on the results of the histological examination. This may include:
Regular follow-up visits to the doctor to monitor possible recurrence of the lesion and the appearance of new malignant formations;
General, specific blood tests;
Instrumental investigations (e.g. chest X-ray, ultrasound of internal organs and other investigations).
Laser treatment of skin cancer
Laser treatment or photodynamic therapy is an alternative treatment for skin cancer. Laser treatment uses a narrow, high-intensity beam of light to eliminate precancerous lesions in the outer layer of the skin.
In rare cases, skin cancer is treated with cryotherapy, which removes small superficial skin tumours by freezing. Chemotherapy treatment may be used when melanoma has spread (the skin cancer has spread to lymph nodes or other internal organs). This is preceded by a detailed examination, specific laboratory blood tests and instrumental tests to assess the spread of the tumour (metastases).
Signs of skin cancer
The first signs of the disease are rather deceptive and depend on the type and stage of the cancer. The following skin changes should be considered and noted first:
- A wound or spot on the skin that does not heal within a month;
- A sore or wound on the skin (usually itchy, painful, sometimes scabbed over or bleeding for more than a month);
- Ulcerated areas of the skin that are caused by unclear reasons and do not heal for more than a month.
The main cause of skin cancer is exposure to UV rays on the skin and a certain type of pigment in the skin. Also: sunbathing in tanning beds and long-term exposure to chemicals.
If you notice the first signs, or at least one of them, when:
- The skin lesion is growing;
- The skin changes and becomes irregular in shape;
- The skin changes colour;
- The skin lesion becomes asymmetrical;
- The skin lesion becomes itchy and painful.
It is worth being alarmed and seeking medical attention as proper treatment can prevent further progression of the disease.
The following diagnostic tests for skin cancer are carried out by doctors at our clinic:
- Dermatoscopic examination;
- Siascopic examination;
- Skin biopsy;
- Histological examination;
- Videodermascopic examination;
- Chest mapping;
- FAV method;
- Cytology and other tests.
So, if you notice that the lesion is growing, changing, irregular in shape, colour, asymmetrical, itchy, painful, bleeding, or not healing for a long time, you should see a doctor for the necessary tests and an effective treatment.
Diagnosis of skin cancer. Diagnosis of melanoma
First, the existing rashes are examined. Assess when the troublesome skin formation appeared, how it has changed, whether there is any discomfort, etc. The ABCDEF criteria are very important for the diagnosis of skin cancer (including melanoma):
- A (asymmetry) – asymmetry of the mole’s outline, colour, edges, shape;
- B (borders) – irregular, jagged edges of the mole;
- C (colour) – a mole of several colours;
- D (diameter): moles larger than 6 mm;
- E (evolution) – a rapidly changing mole;
- F (funny looking mole) – a new mole that stands out from other existing moles.
Examination by dermatoscope and siascope:
- Dermatoscopy is a non-invasive method of examining skin lesions that allows a close look at the structure of the skin lesion. All types of skin cancers have a distinctive architecture that can be seen during dermatoscopy. This examination allows a reliable differentiation between malignant and benign skin lesions.
- Siascopy (spectrophotometric intracutaneous analysis) is a modern, non-invasive and painless, rapid method for the examination of pigmented skin lesions based on the interaction of different wavelengths of light with the chromophores (melanin, haemoglobin and collagen) present in the skin. This method assesses changes in the skin as deep as 2 mm. The colour images obtained are correlated with the histological characteristics of the lesion. The siascope therefore helps to predict the risk of malignancy of a particular lesion, which is then used to select the method of removal.
- FAV method (description)
Morphological studies of tumours:
- Cytological examination – scrapings of tumour cells;
- Skin biopsy and histological examination.
These are the most important investigative methods in the diagnosis of skin malignancies. They allow the structure of the tumour cells, the depth of the lesion and other parameters important for the treatment and prognosis of the disease to be studied. Often, an excisional biopsy is performed, where the entire affected mole (or suspicious skin lesion) is removed for histological examination.
For more information, see “Early diagnosis of melanoma”, “FAV method”, “Siascopy” and “Diagnosis of epithelial tumours”.
If the skin lesion does not heal within 2 months, even after treatment, the suspicion of skin cancer increases. Do not delay and contact your doctors who will carry out all the necessary tests. Modern diagnostic methods help to diagnose the disease accurately and quickly, so that effective treatment can be given in time.
Skin cancer prevention
Preventing skin cancer is easier than curing the disease. It is therefore advisable to follow these recommendations:
- Stay in the shade. The sun is at its most active between 10am and 4pm, so avoid going outside during this time. Remember – if your shadow is shorter than your height, you need to go into the shade.
- Proper clothing is important: long-sleeved shirts, lightweight trousers, a wide-brimmed hat and sunglasses.
- Wear sunscreen that is: broad spectrum, waterproof, SPF 30 or SPF 50.
- Use a sufficient amount of sunscreen. Research shows that people tend to use too little sunscreen. For adults, a sufficient amount of sunscreen is about 30 ml (2 tablespoons).
- Use sunscreen every time you go outdoors, even on a cloudy day.
- The cream should be applied to all exposed areas of the body.
- Use broad spectrum sunscreens that protect against both UVA and UVB sunlight.
- The cream should be suitable for your skin type: gel products are more suitable for oily skin, lotions and oils for dry skin.
- Re-apply the cream every 2 hours, after bathing or after sweating.
- Avoid sunburn. Be careful around water bodies, sand and snowy environments. These environments reflect the sun’s harmful rays, increasing the likelihood of sunburn.
- Avoid sunbeds.
- Use self-tanning products for tanned skin.
- Have your skin examined regularly (at least once a month). If you notice any suspicious lesions, consult a dermatologist immediately.
- Even if there are no complaints, a preventive check-up by a dermatologist once a year is recommended.
It should be noted that a tan indicates that the skin is already damaged. Every time you are exposed to natural sunlight or use a tanning bed, your skin becomes more damaged. As this damage increases, the skin ages faster, increasing the chances of skin cancer.
You can read more about sunscreens in the sections “Sun protection” and “How to apply sunscreen correctly”.
- The Laser Centre provides high quality specific services. It is staffed by qualified dermatologists, PhDs and provides patients with quality treatment.
- Read more about skin cancer treatment here: skin cancer treatment.
- In case of any questions or uncertainties, please call +370 659 57933, +370 659 57976.
- For more information on skin cancer treatment, see Treatment of malignant skin tumours.