1.

Skin
The epidermis is mostly made up of fat, scale-like cells called squamous cells. Round cells
called basal cells lie under the squamous cells in the epidermis. The lower part of the
epidermis also contains melanocytes.
Melanocytes produce melanin, the pigment that gies skin its natural color. !hen skin is
e"posed to the sun, melanocytes produce more pigment, causing the skin to tan, or
darken.
#. Skin cancer
The outer layer of skin, the epidermis, is made up of different types of cells. Skin cancers are classified
by the types of epidermal cells involved:
Basal cell carcinoma develops from abnormal growth of the cells in the lowest layer of the
epidermis and is the most common type of skin cancer.
Squamous cell carcinoma involves changes in the squamous cells, found in the middle layer of the
epidermis.
Melanoma occurs in the melanocytes cells that produce pigment! and is less common than
squamous or basal cell carcinoma, but more dangerous. "t is the leading cause of death from skin
disease.
$asal cell carcinoma and squamous cell carcinoma rarely spread to other parts of the
%ody. &oweer, melanoma is more likely to spread.
'ic1Patients all have nodular basal cell carcinoma, a type of basal cell carcinoma that appears as a well-defned
growth with rolled edges. It may be pigmented or translucent with visible blood vessels. Also known as cystic basal cell
carcinoma, it usually appears on the face
'ic# The patient said that this lesion, which appears as a well-defned plaue, had been slowly growing
for years.
'ic( Advanced suamous cell carcinoma on the hands and forearms of an elderly patient.
'ic) !iagnosed cases of nodular melanoma, a very aggressive type that tends to grow down into the skin rather
than sideways
(. Ma*or risk
#omple$ion: Skin cancers are more common in people with light-colored skin, hair, and eyes.
%enetics: &aving a family history of melanoma increases the risk of developing this cancer.
'ge: (onmelanoma skin cancers are more common after age 40.
Sun e$posure and sunburn: Most skin cancers occur on areas of the skin that are regularly exposed
to sunlight or other ultraviolet radiation. This is considered the primary cause of all skin cancers.
Skin cancer can develop in anyone, not only people with these risk facto rs. )oung, healthy people **
even those with with dark skin, hair, and eyes ** can develop skin cancer.
). +tiology
,. 'athophisiology
-. Symptoms
'symmetry: one half of the abnormal skin area is different than the other half
Borders: irregular borders
#olor: varies from one area to another with shades of tan, brown, or black sometimes white, red,
blue!
+iameter: usually but not always! larger than 6 mm in si,e diameter of a pencil eraser!
'ny skin growth that bleeds or will not heal
-. Asymmetry. .f you could fold the lesion in two, the two hales would not match.
.. "order. Melanomas often hae uneen or %lurred %orders.

/. #olor. Melanoma typically is not one solid color/ rather it contains mi"ed shades of tan,
%rown, and %lack. .t can also show traces of red, %lue or white.

0. !iameter. !hile melanomas are usually greater than - millimeters 0a%out the si1e of a
pencil eraser2 when diagnosed, they can %e smaller. .f you notice a mole di3erent from
others, or which changes, itches, or %leeds een if it is smaller than - millimeters, you should
see a dermatologist.

,.$volving. 4 mole or skin lesion that looks di3erent from the rest or is changing in si1e, shape
or color.

5rusted or scaly area on the skin with a red, infamed %ase
Sore that does not heal
6. 7iagnostic
7ermatologists detect skin cancer through a isual e"amination of the skin and mucous mem%ranes. .f
malignancy 0cancer2 is suspected, a %iopsy will %e performed. This inoles num%ing the area and
remoing the lesion, or part of it, for microscopic e"amination. 4 %iopsy is the only way to de8nitely tell if
skin cancer is present
9. Treatment
Surgery
There are many different kinds of treatment for these cancers. The type of treatment that1s best for you depends
on how large the cancer is, where it is on the body, and sometimes on other factors such as the e$act type of skin
cancer it is. 2ften basal cell and squamous cell cancers can be completely cured by minor surgery. Some can be
cured by using medicine on the skin. 3or certain squamous cell cancers with a high risk of spreading, surgery
might be followed by radiation or chemotherapy.
imple excision this is like an e$cisional biopsy!
The skin is first numbed and then the tumor is cut out, along with some normal skin around it. The remaining
skin is carefully stitched back together. This surgery will leave a small scar.
#urettage and electrodesiccation
"n this treatment the cancer is removed by scraping it with a long, thin tool called a curette. The curette looks
something like a vegetable peeler. The area is then treated with an electric needle to destroy any remaining
cancer cells. The process is often done more than once. This treatment will also leave a scar.
Mohs surgery
"n this surgery, the doctor removes a layer of skin that the tumor may have spread to and then checks the sample
under a microscope. "f cancer cells are seen, more layers of skin will be removed and looked at until the
samples do not show cancer cells. This process is slow, but it means that normal skin ne$t to the tumor can be
saved and the skin will look better after surgery. 2nly doctors who have had special training should perform this
type of surgery.
4ymph node surgery
"f lymph nodes near the cancer are growing larger, it may be a sign that the cancer has spread to these nodes. "n
that case, the nodes will be removed by an operation called a lymph node dissection. The removed tissue will be
looked at under a microscope to see if there are cancer cells in it. This operation is more involved than surgery
on the skin. )ou would most likely have general anesthesia where you are given drugs to put you into a deep
sleep!.
' possible long*term side effect is lymphedema. 4ymph nodes in the groin or under the arm normally help drain
fluid from the limbs. "f they are removed, fluid may build up, leading to limb swelling. This swelling is called
lymphedema. 5lastic stockings or compression sleeves can help some people with this problem. 3or more
information, see our separate document, Understanding Lymphedema (For Cancers Other Than Breast
Cancer).
Skin grafting and reconstructive surgery
"f a large skin cancer has been removed, it may not be possible to stretch the nearby skin enough to sew the
edges of the wound together. "n these cases, skin grafts or some other methods can help the wound heal and
replace tissue. These can also help the treated skin look as normal as possible.
2ther forms of local treatment
2ther methods can be used to treat non*melanoma skin cancers that have not spread to lymph nodes or other
parts of the body. Some of these treatments are described as types of 6surgery6 since they destroy tissue. But
these methods don1t involve cutting into the skin.
#ryosurgery
"n this treatment liquid nitrogen is used to free,e and kill cancer cells. 'fter the dead tissue thaws it may blister
and crust. The wound may take a month or . to heal and will leave a scar. The treated area may have less color
after treatment.
7hotodynamic therapy 7+T!
This treatment involves giving patients a drug that collects in the cancer cells over the course of many hours or
days. The drug is either put right on the skin or in8ected into the blood. "t makes the cancer cells sensitive to
certain types of light. ' light source is then focused on the cancer. "t activates the drug so it kills the cells. '
possible side effect of 7+T is that it can make a person1s skin very sensitive to sunlight for a while, so patients
may need to be careful to avoid sunlight so they don1t get bad burns.
Topical chemotherapy
#hemotherapy often called 6chemo6! is the use of drugs to kill cancer cells. Topical chemo means that a drug is
put right on the skin usually in a cream or ointment! rather than being given by mouth or put into a vein.
9hen put right on the skin in the form of a cream, the drug reaches cancer cells near the skin surface. But it
does not reach cancer cells that have gone deep into the skin or spread to other organs. 3or this reason, this kind
of treatment is most often used only for certain types of skin cancer or other skin conditions that could become
cancer.
This treatment can cause the treated skin to be red and tender for a few weeks, which can be quite bothersome
for some people.
"mmune response modifiers
#ertain drugs can boost the body1s immune system response to the cancer, causing it to get smaller or go away.
These drugs do not kill the cancer cells and are not chemo. "nstead, they cause the body1s immune system to
react to the skin problem and make it go away.
Interferon is a man*made version of an immune system protein. "t can be put right into the tumor to boost the
body1s immune response to fight it. "nterferon may be used when surgery is not possible, but it may not work as
well as other treatments.
4aser surgery
This newer treatment uses a beam of light to kill cancer cells. "t is useful for squamous cell cancer that hasn1t
spread and for some basal cell cancers. "t1s not yet known whether laser surgery works as well as standard
methods of treatment.
:adiation therapy
:adiation therapy is treatment with high*energy rays such as $*rays! to kill cancer cells or shrink tumors.
5$ternal beam radiation focuses radiation from outside the body on the skin tumor.
The treatment is much like getting an $*ray, but the radiation is more intense. 5ach treatment is painless and
lasts only a few minutes, although the setup time ** getting you into place for treatment ** takes longer.
:adiation may be used as the main primary! treatment instead of surgery if the tumor is very large, or if it is in
an area that makes surgery hard to do. "t might also be used for older people who, because of poor health,
cannot have surgery. "n some cases, radiation can be used after surgery as additional ad8uvant! therapy to kill
small deposits of cancer cells that may not be seen during surgery. This lowers the risk of cancer coming back
after surgery. :adiation may also be used to treat non*melanoma skin cancer that has spread to lymph nodes or
other organs.
Side effects of radiation can include skin irritation, redness, and dryness. 9ith longer treatments, these side
effects may get worse. 'fter many years, new skin cancers may start in areas that had been treated with
radiation. Because of this, radiation is not usually used to treat skin cancer in young people.
Systemic chemotherapy
Systemic chemotherapy or chemo! uses drugs that are in8ected into a vein or given by mouth. These drugs
travel through the bloodstream to all parts of the body. "n contrast to topical chemo, systemic chemo can attack
cancer cells that have spread to lymph nodes and other organs.
#hemo drugs work by attacking cells that divide fast. This is why they work against cancer cells. But other cells
in the body divide fast, too. These cells are also likely to be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken.
These side effects may include:
&air loss
Mouth sores
4oss of appetite
(ausea and vomiting
&igher chance of infection due to low white blood cell counts!
5asy bruising or bleeding due to low blood platelets!
3eeling very tired all the time, called fatigue due to low red blood cells!
These side effects are usually short*term and go away once treatment is finished.
:. +pidemiology
Seasonal energy e;ciency ratio 0S++R2
1<.5onclusion
Skin cancer is e"ceedingly common and the incidence is rising rapidly, especially in
white populations. !hereas chronic sun e%posure is the main cause of skin cancer, the
deelopment of melanoma appears to %e related to intense, intermittent sun e"posure. So
it will %e %etter if we do some preventions like use skin protectors and reduce actiity in
outdoor in the afternoon.