What is it
Non-melanoma Skin cancer is the most common type of skin cancer . It is called non-melanoma, because this group of tumors includes all types of skin cancer, except one: Malignant melanoma , which is cancer that develops from melanocytes.
According to a study carried out by the World Health Organization, around 5,000 new diagnoses of skin cancer are performed every year in Spain . Factors such as the deterioration of the ozone layer or the lack of daily prevention lead to the appearance of new cases.
Regarding the incidence in Spain, José Carlos Moreno, dermatologist, member of the Spanish Academy of Dermatology and Venereology (AEDV) and coordinator of the Euromelanoma 2015 campaign, explains that there are no reliable statistics in Spain. ” We can affirm that 1 in 10 people born in the year 2000 will suffer from skin cancer, ” he warns.
According to Moreno, genetic predisposition is the main cause of the appearance of skin cancer, although there are other well-identified factors that also intervene, such as ultraviolet radiation, some chemical agents, human papillomavirus infections and even immunosuppression. “Transplanted patients have a higher incidence of skin cancer than the normal population,” he says.
The most frequent causes are:
- The exposure excessive ultraviolet radiation (UV), whose primary source is sunlight. The degree of exposure to this radiation depends on the intensity of the light, the exposure time and whether the skin has been protected. People who live in areas where they are exposed to intense sunlight all year round are at a higher risk of developing this type of cancer. In addition, being outdoors for long periods of work or leisure without protecting oneself with appropriate clothes and sun protection increases the possibility of developing it.
- The lamps and tanning booths are other sources of ultraviolet radiation that may increase the risk of developing skin cancer non – melanoma.
- The exposure to certain chemicals such as arsenic, industrial tar, coal, paraffin and certain types of oils.
- The exposure to radiation , such as produced by radiation.
- Severe or prolonged skin lesions or inflammations , such as severe burns, skin covering the area where a serious bone infection occurred and skin damaged by certain inflammatory diseases.
- The treatment of psoriasis with psoralens and ultraviolet light administered to some patients with psoriasis.
- The xeroderma pigmentosum , a rare inherited disorder, reduces the ability of the skin to repair the damage to DNA as a result of exposure to sunlight. People who have this disorder develop a large number of skin tumors, sometimes from childhood.
- The basal cell nevus syndrome is a rare congenital condition that causes multiple malignant basal cell tumors (basaliomas). Most cases, although not all, are hereditary.
Non-melanoma skin cancer can look like different skin marks . The main warning signs are the appearance of a new mass, a spot or protrusion that is growing (over the course of a few months or one to two years), or an ulcer that does not heal within three months.
“The symptoms of this cancer are very variable. We find from progressive growth cysts , ulcers that do not heal, scars that grow, corneal excrescences (cutaneous horn) and especially moles that change shape or begin to present discomfort as pain, itching, bleeding, etc., “explains dermatologist José Carlos Brown.
The most common are:
- The basal cell carcinomas appear somewhat flat area, as flaky that becomes reddish, or small waxy, glossy and translucent to highlight areas which may bleed a minor injury. In these areas it is common to identify one or more visible irregular blood vessels, or show areas of blue, brown or black.
- The squamous cell carcinoma may appear as growing lumps, often rough, flat or reddened patches of skin that grow slowly surface. These two types of non-melanoma skin cancer can develop on a flat surface that only shows slight changes with respect to normal skin.
- The Kaposi sarcoma usually begins in a small area like that acquires a purple color becomes a tumor.
- The mycosis fungoides starts as a rash, often in the buttocks, hips or lower abdomen. It may look like a skin allergy or another type of skin irritation.
- The tumors of the annexes are presented as protuberances into the skin.
- The Skin sarcomas appear as large lumps under the surface thereof. Merkel cell tumors usually appear in the form of red-purple nodules or ulcers (sores) located on the face, or, less frequently, on the arms or legs.
The most important way to reduce the risk of developing non-melanoma skin cancer is to avoid exposure to sunlight and other sources of ultraviolet light without protection.
The simplest way to avoid excessive exposure to ultraviolet light is to stay away from the sun and in the shade whenever possible. This can be applied both in summer periods and the rest of the year, since climate effects, such as cloudiness or snow, do not reduce the incidence of solar radiation completely.
It is important that this precaution is taken from childhood , it has been shown that 80 percent of the damage that the sun can cause on the skin occurs before the age of 18.
Some recommendations to prevent the onset of this type of cancer are:
Protect yourself with clothes
Wear a shirt and a wide-brimmed hat to increase protection against solar radiation. Generally, tightly woven fabrics also offer better protection.
Regarding sunglasses , experts recommend using those that have a percentage of absorption of ultraviolet rays of 99 to one hundred percent , since it allows to protect the eyes and the area of skin around them properly.
On the other hand, specialists recommend covering the most sensitive areas that are exposed to sunlight throughout the year. 85 percent of malignant tumors appear on the face, the neckline and the scalp.
Use a protection cream of factor 15 or more in areas of skin exposed to the sun, particularly when the light is intense. People with fair skin and those who burn easily should apply sunscreen more frequently
For protection to be effective, protection must be applied before sun exposure and in all visible areas of skin. Many sunscreens lose effectiveness when the person sweats or swims and must be applied again to offer the highest level of protection.
Experts insist that the cream should be applied even if the day is foggy or the sky is covered with light or not very compact clouds, since ultraviolet light can penetrate them.
Do not use tanning booths
Excessive exposure to ultraviolet light may increase the risk of developing skin cancer, as it contributes to skin aging. For this reason dermatologists discourage their use
There are many types of non-melanoma skin cancers, but there are two types that are the most common: basal cell carcinoma and squamous cell carcinoma.
Basal cell carcinoma (basal cell cancer)
It is a slow growing tumor . It is very rare for a basal cell cancer to spread to distant parts of the body. However, if a basal cell cancer is left untreated it can spread to nearby areas and affect the bones, as well as other skin tissues. After treatment, basal cell carcinoma may reappear in the same place on the skin.
Squamous cell carcinoma (squamous cell carcinoma)
It develops in the upper layers of the epidermis and accounts for about 20 percent of all cases of skin cancer. It often appears on areas of the body exposed to the sun, such as the face, ears, neck, lips, and the back of the hands. It can also develop into scars or skin ulcers in other parts of the body.
Other types of non-melanoma skin cancers, less common than before, are:
- Kaposi’s sarcoma . It originates in the dermis, but can also be formed in internal organs. It usually develops in people affected by the human immunodeficiency virus(HIV).
- Lymphoma . The dermis contains a considerable number of lymphocytes (a type of cells of the immune system). When these become malignant they form the lymphoma . Although most of these cancers appear to originate in the lymph nodes or internal organs, there are certain types of lymphoma that originate in the skin. The medical term “primary cutaneous lymphoma” means “lymphoma that has originated in the skin”. Cutaneous T-cell lymphoma, also called mycosis fungoides, is the most common type of primary cutaneous lymphoma.
- Sarcomas . Sarcomas develop from connective tissue cells, usually in tissues that are deep beneath the skin. Much less frequently, these can occur in the dermis and subcutaneous tissue of the skin. There are several types of sarcoma that can develop on the skin including dermatofibrosarcoma protuberans and angiosarcoma.
- Merkel cell carcinoma . It develops from the endocrine cells of the skin. They often reappear after treatment and spread to nearby lymph nodes . They can also spread to internal organs.
- There are also benign tumors of the skin . Most of which are not cancerous, and only rarely do they become cancer. Among these tumors are most types of moles, seborrheic keratoses (raised, brown, brown or black spots with a “waxy” texture or a rough surface), hemangiomas (benign tumors of blood vessels) , lipomas (soft tumors of benign adipose cells) and warts (rough surface tumors caused by a virus).
- Actinic keratosis: It is a precancerous condition of the skin caused by exposure to sunlight. They are small rough spots that can be red, pink or the color of the skin. They usually develop on the face, ears, backs of hands and arms of people of middle age or older who have fair skin, although they can also appear on other areas of the skin exposed to the sun. Generally, people who have an actinic keratosis will develop many more. They usually grow slowly and do not cause more symptoms or signs than skin blemishes. It is possible, but not common, that actinic keratoses become squamous cell cancer. They also often disappear on their own, but may reappear.
- Squamous cell carcinoma in situ or Bowen’s disease : It is the earliest form of squamous cell skin cancer. The cells of this cancer are completely inside the epidermis, and have not spread to the dermis. It manifests in the form of reddish spots. Compared to actinic keratosis, spots of squamous cell carcinoma in situ are usually larger, often more than half a centimeter, more intense red, and are more scaly and rough.
“Given the suspicion of having any lesion that is persistent over time, that changes its characteristics or that tends to grow slowly but progressively the patient must go to the dermatologist to evaluate it and give a diagnosis,” Moreno recommends.
If there is any reason to suspect skin cancer, the doctor will use one or more methods to determine if the disease is actually present. The first step is to observe the size, shape, color and texture of the area in question and if it bleeds or flakes.
Next, he will examine the rest of the body to see if the patient has spots or moles that may be related to skin cancer. You may need to ask other questions or other tests.
If the doctor thinks that an area may have non-melanoma skin cancer, he or she will take a sample (biopsy) of skin from the suspected area and examine it under a microscope. This is called a skin biopsy . To do this test different methods can be used.
However, it is equally important for the patient to check the skin itself , preferably once a month. To do this, you must know the appearance of moles, imperfections, freckles and other brands you have on the skin to detect any changes.
It is recommended to do the self-exam in front of a full-length mirror . For hard-to-see areas you can use a hand mirror. You should examine all areas, including the palms of the hands and soles of the feet, the lower back and the back of the legs.
Removal is the most common treatment for this type of lesion, which can be completed with the so-called Mohs surgery depending on the location or if the spot has a considerable size.
- The simple excision involves removal of the tumor and surrounding tissue.
- Mohs surgery : The skin layer affected by the cancer is removed and subsequently, the doctor extracts the tissue surrounding the area by comparing both under the microscope.
- Cryosurgery: Liquid nitrogen freezes and destroys cancer cells.
- Laser surgery : It is used in very superficial carcinomas on which the laser beam is applied to vaporize the cancer cells.
- Electrodesiccation : the tumor is removed by scraping the tissue, and then the area where the spot was with an electric needle is treated to destroy the remaining cancer cells.
- Chemotherapy : The most frequently used medication is fluorouracil, which when used topically reaches the cells closest to the surface of the skin, so it will be used only in premalignant conditions. This medication reddens the area where it is applied and makes it more sensitive to the sun, so it is advisable that the area is well protected.
- Radiotherapy : Consists of the use of radiation to destroy cancer cells. The treatment lasts a few minutes and is not painful.
It is used in patients who can not undergo surgery, such as people of very advanced age. This treatment can cure those types of cancer that are in low stages. It can also be used as complement to the surgery.
Non-melanoma skin cancer is curable in 90 percent of cases if an early treatment is performed , according to data from the Spanish Association Against Cancer. However, there is a high probability that it will reappear over time, so it is advisable to undergo regular medical exams in order to be able to treat it again.
When should the patient go to the specialist?
According to Moreno, the time when patients should go to the specialist to make a consultation is “to any question that your primary doctor can not resolve.”
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