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Skin Cancer: What to Look For and How to Avoid
By Shawn Sales
Skin cancer is a serious problem that seems to affect more and more people ever year. If a squamous cell carcinoma is not identified at an early stage, it may develop into a melanoma. A melanoma usually begins as a dark brown or black patch with irregular borders and is characterized by the uncontrolled growth of pigment-producing tanning cells. It may appear anywhere on the body without warning or start near a mole. It has a tendency to spread, making it essential to treat right away. Since melanoma is often linked to a change in one of your moles, and most of us have 100 or so, you should inspect them regularly and look for any changes in size and color, such as the appearance of a bump or the spreading of pigment around the border.1 Having an understanding of the deadly effects of melanoma is important to be aware of the risks that can cause the spread of this deadly disease.
Risk factors for squamous cell and basal cell carcinomas include: people who have light skin color, a family history of skin cancer, a personal history of skin cancer, chronic exposure to the sun (squamous cell) and a history of severe sunburns early in life (basal cell carcinoma). Risk factors leading to melanoma include; as above, a light skin color, a family history of melanomas, a personal history of melanoma and certain types and large numbers of moles. The presence of freckles, an indicator of sun sensitivity and sun damage, along with a history of sunburns early in life are also risk factors.2 It is important if any individual has a number of these risk factors that they conduct self-examinations of areas on their body where they have mole growth or irregular moles.
When a condition as deadly as skin cancer is found, proper treatment for the condition is critical. Several different treatments have recently been developed to treat both basal and squamous cell carcinomas. Basal cell carcinoma is a curable cancer, especially if detected early and removed promptly. Treatment is surgical and can result in scarring. Treatment options vary depending on size and location of the minor. The procedures to cure these legions can range from electrodesiccation and curettage to Moh's microscopic surgery, which is a specialized surgery to treat skin cancers. Typically, a diagnosis of Basal cell carcinoma indicates that the skin is damaged from the sun and that there is a risk for developing additional skin cancers.3 If the individual has been diagnosed with a basal cell carcinoma, they must pay attention to their body with an even greater amount of detail. After the body has developed one form of a carcinoma the risk of getting additional carcinomas grows dramatically.
Other cancer treatment methods may vary depending on how deep the cancer has penetrated into the skin. For a very superficial melanoma, treatment may require only a wide excision and a close follow-up head-to-toe skin exams. Melanomas that are classified as stage IIa or IIb may require a wide excision plus additional low-dose alpha interferon (immunotherapy). High-dose interferon may be used for melanomas classified as stage III with lymph node involvement and metastic disease. Therapy for metastic disease may also include single agent drug chemotherapy or a combination of drug chemotherapy.4 As technology has advanced, new non- invasive techniques have been developed in the treatment of skin cancer. These new treatment therapies show great promise for the future using topical solutions that cause less pain than the traditional invasive therapy techniques.
If squamous cell or basal cell carcinomas are not caught early, they may become a malignant melanoma and spread internally. At this stage, the chance for a complete recovery will decrease significantly in the individual. Treatment and follow-up for squamous cell skin cancer is the same as for basal cell skin cancer. Typically, Squamous cell carcinomas erupt more quickly and are usually more painful than basal cell carcinomas. As a result, patients tend to have their lesions checked by a physician sooner than they would for a basal cell carcinoma. These skin cancers can be extremely destructive, especially when located on the face, and due to its risk for metastasis, the sooner it is diagnosed and treated, the better 5. If the individual can execute their own self-examinations, they will be able to detect potential skin cancers at an earlier stage and potentially prevent metastasis from taking place.
It is critical that the public be educated about the risk factors and current trends that may heighten the spread of skin cancer. Having a better understanding of prescription drugs and other causes that may heighten this risk will benefit the public about contracting a carcinoma. Doctors should warn patients about prescription drugs and other immunosuppresive agents that may lead to the spread of the cancer. Patients who have been given immunosuppresive treatment that includes ciclosporin have a greatly increased risk of squamous-cell carcinoma of the skin, but studies have been largely restricted to patients who have had organ transplants. Tumors were seen most frequently in such patients who had a high pre-treatment risk of such cancers (e.g., elderly patients and patients from sunny climates).6 This study shows that taking medication and having surgery that may leave the body in a compromised immune state may also lead to a greater risk of skin carcinomas.
Not only have researchers found medications to increase the risk of skin cancer, but smoking has now also been linked to the spread of squamous cell carcinomas. The researchers found that smoking was only associated with the development of squamous cell carcinoma, not basal cell carcinoma or melanoma. The researchers concluded that current smokers were 3.3 times more likely to develop skin cancer, and that the risk dropped to 1.9 in former smokers. They also demonstrated a clear relationship between the number of cigarettes smoked and cancer risk. Those who smoked 1-10 cigarettes daily had a risk of 2.4; smoking 11-20 cigarettes a day increased the risk to 3.0, and those who smoked 21 or more cigarettes a day had a risk of 4.1. Pipe smokers were also at increased risk, but cigar smokers were not according to the research.7 This research is another reason to stay away from the sun if you smoke and another reason to quit smoking.
Another important element in preventing skin cancer is to avoid the over-use of tanning beds. While the tanning bed industry may advertise that it is the safe alternative to the sun the reality is that any tan that an individual aspires to can ultimately lead to skin cancer and premature aging. If the individual is completely inspired to have a tan at all costs they should consider alternatives such as sunless tanning lotions which are now safe and effective alternatives to sun exposure. Also, be aware of medications and how they may cause the skin to react in a more threatening manor when using a tanning bed.
Ultimately what may be your best defense is to make sure that your immune system is strong in fighting the harmful rays of the sun and new research has shown that eating fruits and vegetables has a protective effect against the spread of carcinomas of the skin.8 You should also remember that when you are out in the sun to be aware of the time of day that you are outside, and, if possible avoid being out in the sun between the hours of 10AM and 4PM when the suns rays are the most harmful. Always wear protective clothing when you are in the sun and try to take advantage of hats and scarves whenever possible to avoid potentially sun exposed areas such as the head, neck, and ears. If you have to be out in the sun always remember to wear protective sunscreen of an SPF factor of 15 or greater. With proper planning you can greatly diminish your chance of developing a skin cancer.
In conclusion, every individual should know their body and have self-exams often to look at any potential moles that may be prone to skin cancer. If the individual notices any change in their skin from month to month they should have it evaluated by a Doctor or a Dermatologist. Early detection for a carcinoma is the key to survival before it may metastasize and become a melanoma. The pamphlet below from the American Academy of Dermatology shows how and what to look for when conduction a self-examination:



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1NASD (Centers for Disease Control) National Skin cancer prevention Education Program: AT-A-GLANCE: 1997.
2NASD (Centers for Disease Control) The ABCD's of Skin Cancer, 1997.
3Jerant AF; Johnson JT; Sheridan CD; Caffrey TJ. Early Detection and treatment of skin cancer. American Family Physician 2000 Jul 15; 62 (2); 357-68, 375-76, 381-2
4Schober-Flores, Carol. The Sun's Damaging Effects. Dermatology Nursing 2001 Aug 13:(4):279-90.
5Schober-Flores, Carol. The Sun's Damaging Effects. Dermatology Nursing 2001 Aug 13:(4):279-90.
6Marcil, Isabelle; Stern, Robert S., Squamous-cell cancer of the skin in-patients given PUVA and ciclosporin: nested cohort crossover study. Lancet, 2001, 358:9287, 1042-46, 4 charts.
7Henderson CW., Smoking Triples Risk of Common Type of Skin Cancer. Cancer Weekly, 2001 Jan:10-12.
8De Stefani E; Brennan P; Bofetta P; Ronco AL; Mendilaharsu M; Deno-Pellegrini H. Vegetables, fruits, related dietary antioxidants, and risk of squamous cell carcinoma of the esophagus: a case-control study in Uruguay. Nutrition and Cancer 2000; 38(1): 23-9

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