Skin cancer treatment
Skin cancer is a collective name for all malignant neoplasms of the skin typically caused by sun exposure. The most common types include basal and squamous cell carcinomas and melanoma. There are different treatments: surgery (Mohs micrographic surgery, excision, cryosurgery, electrodesiccation), chemo-, immuno-, target, and photodynamic therapies.
The term skin cancer covers various formations of the skin, which occur in the following forms:
Light skin cancer, including basal and squamous cell carcinoma, is the most common form of malignant skin tumours.
- Basal cell carcinoma is a malignant formation formed from the epithelium's basal layer. Even though basal cell carcinoma rarely metastasises, this type recurs quite often.
- Squamous cell skin cancer is formed from keratinocytes (the central cells of the epidermis of human skin). At first, it appears as a small ulcer, but it grows with time and can even bleed. However, it is not so dangerous as melanoma because it forms little or no metastases in other body parts.
Black skin cancer (malignant melanoma) can develop on all skin areas of the body - even those that are hardly exposed to the sun (such as the genital area, hairy scalp, soles of the feet, and under the nails). However, it is significantly rarer than white skin malignancy.
Some relatively rare forms include angiosarcoma, dermatofibrosarcoma protuberans, malignant fibrous histiocytoma, liposarcoma, and Kaposi sarcoma.
In commonness, the disease ranks third after breast and lungs oncology. Thousands of people hear the diagnosis of "skin cancer" every day. As a result, around 60,000 people die from melanoma annually. Although the risk increases with age, younger people are also increasingly affected: 20-year-olds with a melanoma diagnosis are no longer a rarity.
Common causes for skin malignancy
The cause of almost all types of skin cancer is intensive sun exposure over many years. People exposed to intensive UV radiation in their free time or work outdoors frequently become ill. But there are also different risk factors which increase the possibility of getting skin neoplasm:
- Chronic wounds, burn scars or other skin diseases;
- As a complication of radiation dermatitis;
- Burns, the effect of ultraviolet radiation, tattoos. At the same time, tattoos applied to undamaged areas of skin and skin with moles and moles are dangerous;
- If there are oncology cases in the family, then relatives have an increased risk;
- Living in southern regions with high solar activity;
- Light skin type;
- Tan or use tanning beds;
- Influence of ionising radiation;
- A lot of moles, especially with unusual shapes;
- Immune system suppression with drugs (e.g. after transplantation).
In addition, the occurrence of skin cancer is influenced by the age factor - with age, the "chances" of the condition boost.
Typical skin signs range by cancer types
Many skin cancers manifest themselves in a variety of skin changes. The first signs depend on the type of tumour. Externally, it can be such signs as hyperemia, swelling of tissues, bleeding, itching, and pain. Only a specialist can accurately recognise the signals after a preliminary examination.
Basal cell carcinomas develop from cells in the deep cell layer of the skin and include such symptoms:
- Occur in the head and neck area, less frequently on the arms or legs;
- Skin - coloured to reddish nodular tumours;
- Pearly borders and small blood vessels;
- Red spots (often on the trunk);
- Scarred changes;
- Tend to form ulcers, which are noticeable by oozing and minor bleeding.
Squamous cell carcinomas of the skin usually affect the head or neck, more rarely the hands, forearms or legs and manifest as:
- A keratinised nodule or a keratinised, slightly raised plaque;
- Bleeding nodules;
- Tumours that grow beyond the level of the skin.
Malignant melanomas can differ significantly in appearance and occur in any body part. Usually, these are dark or black spots. But they can also be grey, dark grey, lead-grey, blue-grey, reddish, flat, raised (beyond the skin's surface), or nodular. And by far the most significant feature is the evolution of tumours: changes in shape, colour and size.
If there are any formations on the skin - moles, warts, papillomas, it is important to avoid injuring them and carefully monitor their condition. The following things can indicate a rebirth (transition from benign to malignant process):
- The thickness of the neoplasm is more than 5 cm, and the diameter is more than 6 cm;
- Spread of changes to the subcutaneous tissue and nerve fibres;
- The appearance of poorly or poorly differentiated cells.
Modern diagnostic solutions
If there are any suspicion and skin changes, you should not ignore the signs of the disease. Even minor abnormalities should be a reason to visit a specialist. The dermatologist provides unique diagnostic methods if there is a noticeable change in the skin:
Reflected light microscopy (dermatoscopy) allows a more accurate assessment of a suspicious skin spot. It is possible by a high-magnification magnifying glass with a built-in lamp, which dermatologist holds against the skin's surface. The method helps detect tumours in the early stages and prevents unnecessary tissue removal. Tissue removal (biopsy) makes it possible to examine suspicious tissue under a microscope. If the suspicion of melanoma is confirmed, the tumour is completely removed (excision) with a safety margin depending on the tumour thickness.
An ultrasound examination of the neighbouring lymph nodes determines whether they are already invaded by cancer cells. In the case of larger tumours that have grown far into the tissue or have already spread to the lymph nodes, further imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) are necessary to determine the extent of spread. It is worth noting that each situation is individual, and only after an examination and dermatoscopy doctor can refer the patient to further procedures, make a diagnosis and prescribe treatment.
The stages of skin cancer include:
- Stage I - the size of skin carcinoma is less than 2 cm, and the thickness is less than 2 mm;
- Stage II - the size of the tumour is more than 2 cm, and it penetrates deeper into the epidermal tissue, and the thickness does not exceed 4 mm;
- Stage III - the tumour increases in size, progress rapidly, and spreads to nearby lymph nodes;
- Stage IV - the tumour affects deep tissues and has metastases.
Skin cancer treatment
The primary treatment method is surgical. In the presence of metastases, it is supplemented with systemic treatment depending on the type of cancer: chemotherapy, immunotherapy, targeted therapy or radiation therapy.
Surgery is the most essential and effective treatment option for skin cancer. During the procedure, the surgeon removes malignant tissues with a safety margin. The size of the safety margin depends on the tumour thickness. There are a few different types of surgical procedures:
- Excision of skin formation. First, the suspicious pigmented mole is removed (excision) to secure the diagnosis. In a second step, a so-called post- excision may be necessary to ensure a safety margin of 1–2 cm.
- Cryosurgery. Sometimes, cold surgery (cryotherapy) is effective as skin cancer therapy. The doctor uses liquid nitrogen ("iced") on the changed skin areas. Ice crystals form inside the cells and kill them.
- Electrodesiccation. It uses high-frequency electricity applied with a needle-shaped electrode for drying damaged skin.
- Mohs micrographic surgery. Surgeons use this operation to remove as little normal tissue as possible. First, he inserts a thin layer of cancerous tissue. Then, a second thin layer of tissue is removed and viewed under a microscope to check for cancer cells.
Chemotherapy can be given before the primary treatment (neoadjuvant) or after the operation (adjuvant). It reduces the tumour size before surgery and improves the condition after the therapy. In the case of skin cancer, chemo drugs can be applied directly to the skin (topical chemotherapy). Immunotherapy stimulates the immune system and encourages it to fight cancer cells. Oncologists usually use interferon as an injection for that. Target therapy has only recently been approved for late stages. It is a combination of different drugs against a specific change (mutation) in the cancerous cells in the skin.
Radiotherapy uses high-energy X-rays directed at the malignant tissues in several sessions, killing the cancer cells. Irradiation is useful when the tumour is very large or in an unfavourable location (e.g. near the eye). In addition, doctors might use proton therapy (more advanced and precise radiotherapy) for ocular melanomas.
Photodynamic therapy. The changed skin areas are first treated with a drug that makes the tissue more light-sensitive. Then doctor irradiates the malignant area with very long-wave light (no X-rays).
In addition, new cancer vaccine are been developed for skin cancer treatment. It has positive prospects and fantastic results for advanced cases. Despite many treatment solutions, a regular examination by a dermato-oncologist, avoiding the open sun and using sunscreen will help detect skin cancer at an early stage, when the prognosis for recovery is the most optimistic.
What patients with skin neoplasm can expect?
The prognosis tightly depends on the stage of the oncological process. It is essential not to miss the first manifestations of skin cancer to achieve the best treatment results. Lack of timely therapy leads to progression, metastases and complications.
Five years after being diagnosed with skin cancer, 93% of women and 91% of men are still alive. However, in individual cases, the life expectancy of a melanoma patient can be higher or lower.
For more spear oncology, the five-year survival rate is 66% for patients with cancerous cells in lymph nodes and 27% with distant metastases.
How to check for melanoma?
If you notice some changes on the skin, the doctor will first ask about personal and family medical history (anamnesis). It includes what skin changes you have seen and whether there is skin cancer or other cancer diseases in the immediate family. Then the dermatologist performs diagnosis, such as reflected light microscopy (dermatoscopy) and skin biopsy.
Is melanoma curable?
Melanoma is entirely curable when the tumour thickness is low in the early stages. In recent years, a large number of therapies are also suitable for the treatment of patients in an advanced stage with metastases.
How is melanoma treated?
Surgery (Mohs surgery, excision of skin tumour, cryosurgery, electrodesiccation) is the best option in skin cancer treatment. However, in the case of metastases or contraindications, there are different methods: immuno-, target, and photodynamic therapy.
How fast does melanoma spread?
The spreading of skin cancer depends on its type. The superficial melanoma usually grows superficially on the skin over a more extended period before it grows deeper into the skin. Nodular melanoma grows faster and deeper into the skin.
How to remove melanoma?
During the procedure, the malignant tissue is removed with a safety margin to clear all cancer cells as reliably as possible. The size of the safety margin depends on the thickness. The procedure is called Mohs surgery.
Where can I get Skin cancer treatment?
What are the best clinics for Skin cancer treatment?
Who are the best doctors for Skin cancer?
Prof. Dr. med. Florian Bassermann from University Hospital rechts der Isar Munich
Prof. Dr. med. Tilo Biedermann from University Hospital rechts der Isar Munich
Prof. Dr. med. Markus Braun-Falco from Dermatology Centre Prof. Braun-Falco Munich
Prof. Dr. med. Uwe Reinhold from Dermatological Centre Bonn
Prof. Dr. med Harald-Robert Bruch, MSc, PhD from Oncological and Haematological Praxis Clinic Bonn