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How To Spot The Signs Of Skin Cancer
Skin cancer is the most common form of cancer in the UK, but most skin cancers can be cured if detected early, according to the British Skin Foundation.
HELLO! Caught up with Dr. Peter Dziewulski to better understand the disease, from spotting the signs early to treatment options available. He detailed the different types of skin cancer and shared ways to avoid catching it in the first place.
Read on for his detailed explainer on skin cancer.
Skin cancer is easier to treat if spotted early What is skin cancer?Skin cancer refers to a group of cancers arising from the skin. Skin cancer is one of the most common cancers in the world. The groups can be divided into melanoma and non-melanoma skin cancer.
Non-melanoma skin cancers refer to a group of cancers that arise in the upper layers of the skin and grow slowly. In the UK, around 147,000 new cases of non-melanoma skin cancer are diagnosed each year. It affects more men than women and is more common in the elderly.
Melanoma is a less common type of skin cancer but can behave in a more aggressive way and can be more serious. Around 16,700 people are diagnosed with melanoma in the UK each year. The number of people diagnosed with melanoma has increased over the last few decades.
What are the different types of skin cancer? Non melanoma skin cancer (NMSC)This includes 2 main types: basal cell carcinoma (BCC), also known as a rodent ulcer, starts in the cells lining the bottom of the epidermis and accounts for about 75 in every 100 skin cancers.
The other type is squamous cell carcinoma (SCC), which starts in the cells lining the top of the epidermis and accounts for about 20 in every 100 skin cancers.
The two types are named after the skin cells where the cancer develops. It's possible for a non-melanoma skin cancer to be a mixture of both these types. There are other types of NMSC that are much less common and include Merkel Cell Carcinoma, Adnexal (mainly sweat gland) tumours and Cutaneous Lymphomas (from white blood cells). Non melanoma skin cancer is different from melanoma.
There are different types of skin cancer What is melanoma skin cancer?Melanoma skin cancer is the fifth most common cancer overall in the UK. The number of people diagnosed with melanoma has increased over the last few decades.
Melanoma is the type of skin cancer that arises from pigment cells lying deeper in the skin. It often develops from a pre-existing mole. This can be a mole that is already on the skin or a new mole or lesion that has recently appeared.
Melanoma starts in cells in the skin called melanocytes. These cells are in the deep layer of the epidermis between the layer of basal cells.
What causes melanoma?The risk of developing melanoma depends on many things including lifestyle factors and some medical conditions. In the UK, around 85 out of 100 melanomas (around 85%) are caused by too much ultraviolet radiation (sun damage). Ultraviolet light comes from the sun or sunbeds.
Sunburn increases the risk of melanoma. Research shows that the type of ultraviolet light used in sunbeds (UVA) can cause all types of skin cancer.
The risk of melanoma increases with age. In the UK, more than 25 out of 100 people (more than 25%) diagnosed with melanoma are aged 75 and over, though younger people can also develop it.
It's rare for black people in the UK to get melanoma. If African or Asian people do get melanoma, it is usually a type of melanoma that develops on the soles of the feet or the palms of the hands (acral lentiginous melanoma) or underneath the nail.
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How can you spot the early signs of skin cancer?Skin cancers can have a variety of appearances and the symptoms can vary. Common symptoms of skin cancer include an ulcer or sore, or area of skin that:
- Doesn't heal within four weeks
- Looks unusual and/or is painful
- Is itchy, bleeds, crusts, or scabs for more than four weeks. The sore can look see through, shiny and pink or pearly white. It can also look red. It may feel sore, rough and have raised edges.
Look at hard to see parts of your bodyWe might miss cancer if it's somewhere hard to see, such as our back.
To look at areas that can't be seen easily, mirrors may be useful, mobile phone camera photos or asking a partner or a friend to look can all be helpful. Taking photos of anything that doesn't look quite right can be helpful particularly if the lump or mole is changing. You can show these pictures to your doctor if you're concerned.
How to spot skin cancerRegularly self-checking the skin for signs of skin cancer can help lead to an early diagnosis and increase the chance of successful treatment.
Using the ABCDE system is helpful:
A – Asymmetrical - Melanomas often have an uneven shape. The two halves of the area may be different shapes (asymmetrical).
B – Border - Melanomas are more likely to have irregular edges (border) and can be blurred or jagged.
C – Colour - Melanomas often have an uneven colour and contain more than one shade of black, brown and pink.
D – Diameter - Most melanomas are more than 6mm wide.
E – Evolving – or changing in size, shape or colour. In addition, bleeding, itching, or becoming crusty.
When to see a doctor about skin cancerIf there are concerns about any changes then a visit to your doctor should be made. They may wish to examine the skin with a dermatoscope and/or refer on to a specialist (usually a dermatologist).
Look for early signs of skin cancerThe specialist will examine the skin and arrange removal of the mole or abnormal area of skin to see if it might be a skin cancer. This is called an excision biopsy. The abnormal area or mole is sent to a laboratory. A specialist doctor (pathologist) looks at the tissue under a microscope to give a definitive diagnosis.
Skin cancer treatmentThis may be all the treatment that is required. Often a second operation needs to be undertaken to ensure complete removal of the cancer and to reduce the risk of the cancer coming back in the same area. This is called a wide local excision. This is usually done under a local anaesthetic (like the dentist) as an outpatient or same day case.
Surgery for skin cancerSurgery is the main treatment for non-melanoma skin cancer. It involves removing the cancerous tumour and some of the surrounding skin. Other treatments for non-melanoma skin cancer include freezing (cryotherapy), anti-cancer creams, radiotherapy and a form of light treatment called photodynamic therapy (PDT).
At least 9 out of 10 non-melanoma skin cancer cases are successfully cured.
If a larger piece of skin is removed as happens for melanomas or in areas where there is not much loose skin, then the surgeon may need to replace the missing skin with either a skin graft or a flap. These are pieces of skin that are taken with (flap) or without (graft) their own blood supply to replace the missing skin. This procedure is usually undertaken by a plastic surgeon.
For patients with certain types of higher risk melanoma a lymph node biopsy (Sentinel Lymph Node Biopsy) is offered to see if melanoma cells have travelled to the local lymph nodes. This test identifies patients who might benefit from further treatment (either surgery or drug therapy). This procedure is usually undertaken under a general anaesthetic.
In certain patients with higher risk melanomas or those patients with a positive sentinel lymph node test imaging is used (CT, MRI, PET CT scans) to see if the melanoma has spread to other organs.
For patients with melanoma that has spread to the lymph glands or further afield (liver, lungs, brain) then patients will be referred on to an Oncologist who use drugs to treat the disease. The commonly used types are:
Immunotherapy drugs that help the body's natural defence system or immune system to attack the cancer.
Targeted cancer drugs that work by targeting the differences in cancer cells that help them to grow and survive.
Researchers continue to look at new and different treatments with targeted cancer drugs and immunotherapies to identify more successful ways of treating the disease.
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Skin cancer survivalSurvival depends on many factors. Survival statistics are obtained by studying large numbers of patients to see what happens to them. These statistics are a guide but can't accurately predict what will happen to any individual patient.
In general people with melanoma in England almost all people (almost 100%) will survive their melanoma for one year or more after they are diagnosed, around 90 out of every 100 people (around 90%) will survive their melanoma for five years or more after diagnosis, more than 85 out of every 100 people (more than 85%) will survive their melanoma for 10 years or more after they are diagnosed.
Find out more about skin cancer here.
Skin Cancer By Race And Ethnicity
Race and ethnicity influence a person's skin tone, which affects the appearance of skin cancer. In lighter skin tones, skin cancer may be red, brown, or black. In deeper skin tones, it may be a similar color to the surrounding skin or darker.
Skin cancer is the number one type of cancer in the US and around the world.
White people are more likely to develop many types of skin cancer than any other racial group. This is because they have less melanin in their skin, which gives skin its color. Melanin provides some protection against UV light, which is a leading cause of skin cancer.
However, people of any race or ethnicity can develop skin cancer, and UV exposure may not be the only risk factor at play. It is likely that numerous factors influence a person's risk for developing skin cancer.
In this article, learn more about the differences in skin cancer by race and ethnicity, including survival rates in the United States.
The relationship between race, ethnicity, and skin cancer is complex. One of the main differences in its presentation occurs due to variations in skin color.
Skin tone has a significant influence on how skin cancer looks. People with lighter skin tones may develop growths different in color to the surrounding skin, making them more noticeable. However, in those with darker skin, cancerous growths may be skin-colored and therefore less noticeable.
This is true both across racial groups and within them. For example, a Black person with lighter skin may notice a dark-colored growth more easily than a Black person with highly pigmented skin.
Another factor for people to consider is a potential difference in skin cancer's location. In skin of color, melanoma is more likely to appear in less obvious places, such as:
If a new growth or rash appears, people can use the ABCDE acronym to check for any cancerous signs. The acronym stands for:
People should also look for:
A person should speak with a doctor as soon as possible about any growths with these characteristics.
White people appear to have a generally higher vulnerability to skin cancer than other groups. This is probably due to the lack of melanin in lighter skin, making it easier for UV light to cause damage.
By contrast, deeper skin tones with more melanin filters at least twice as much UV light. Researchers believe this is why skin cancer rates are lower in People of Color.
However, a 2020 article also highlights that a lack of diversity in trials and studies, and a shortage of people of color in the field of dermatology, means that scientists may not accurately understand how common skin cancer is in skin of color.
Here are the different rates for specific types of cancer:
Non-melanoma skin cancerNon-melanoma skin cancer includes squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).
SCC is the most common skin cancer among African American and Asian Indian people and the second most common among Hispanic, Chinese, and Japanese Americans. Research suggests that overall, it comprises 30–65% of skin cancers among dark-skinned people and 15–25% of skin cancers among white people.
BCC is highly prevalent among white people, comprising 65–75% of skin cancers among this group. In lighter-skinned individuals, it may appear pink or pearly.
It makes up 20–30% of skin cancers among People of Color but is more common among Latinx, Chinese, and Japanese people than Black people.
BCC is closely correlated with UV exposure and occurs more often in People of Color who live in sunny climates.
MelanomaMelanoma is fairly uncommon, accounting for just 1% of all skin cancer cases. However, it is a much more deadlier type of skin cancer, due to its predilection towards spreading throughout the body.
Melanoma rates have risen over the last two decades for all races, according to the Centers for Disease Control and Prevention (CDC). This increase is highest among white people.
Melanoma is about 20 times more common in white people than in Black people. The lifetime prevalence of melanoma between races is:
Overall, the average annual odds of dying from melanoma from 2016–2020 were as follows:
Survival rates are a way of measuring how long a person lives following their initial cancer diagnosis. Factors that can influence survival include cancer stage and location, cancer type, sex, age, and a person's general health status.
In the U.S., systemic racism also means that race and ethnicity influence health outcomes. Racism creates socioeconomic inequity, reduces access to health insurance, and negatively affects the diagnosis and treatment of skin cancer.
The following sections look at differences in survival rates for BCC, SCC, and melanoma.
Non-melanoma skin cancersOver time, mortality rates for BCC and SCC have improved, making deaths from these types of skin cancer uncommon.
However, previous studies have shown that this improvement affects Black people less consistently than white people. Mortality rates from SCC are disproportionately high in People of Color, with estimates ranging from 18–29%.
MelanomaAlthough it is an uncommon type of skin cancer, melanoma causes 75% of skin cancer deaths. A 2016 study found that, between 1982–2011, non-Hispanic Black people with melanoma had the highest mortality risk from this type of cancer, 81 months after receiving a diagnosis.
The group with the highest survival rate was non-Hispanic white people, followed by Hispanic people and other ethnicities.
More recently, a 2021 study noted a 25% difference in absolute survival between Black and white populations.
The differences in skin cancer symptoms, incidence rates, and survival rates by race are due to several factors.
Differing symptomsHaving a lighter skin tone can make it easier to see skin cancer lesions, which may mean a person recognizes it sooner. People with darker skin may not recognize a growth as being potentially cancerous until it has grown larger.
Additionally, a lack of representation of darker skin tones in medical textbooks may mean doctors have less knowledge on the appearance of skin cancer in People of Color. A 2018 textbook review found that none had images of six common skin cancers in skin of color.
Another 2020 study also found that students in two U.S. Medical schools were less accurate in diagnosing SCC and some other common skin conditions in skin of color than in white people.
Delay in diagnosis and treatmentBlack people are more likely to receive a skin cancer diagnosis at a later stage of the disease than white people. Some research also suggests Black people are more likely to face longer delays between diagnosis and treatment.
Researchers note several reasons for this, including:
In the U.S., Hispanic people have seen a 20% increase in melanoma over the past two decades. Researchers are not sure why this is but speculate that language barriers may mean that public health information about skin cancer and sun protection is not as accessible to people with English as a second language.
BehaviorExposure to UV light is a key cause of skin cancer. This means that spending extended time outside, sunbathing, and using tanning beds raise the risk of some types of skin cancer. Researchers believe that the rising popularity of tanning bed use, in particular, has increased melanoma rates in the past several decades.
People with lighter skin may be more likely to engage in this behavior to develop a tan. However, other behaviors may also affect the risk for Hispanic and Black people.
For example, a 2019 study notes that the increase in melanoma among Hispanic people in the U.S. May be due to people adopting American culture, which may result in people taking fewer precautions against sun damage or spending more time outside.
It is also possible that misconceptions about skin tone and its ability to protect against the sun lead people to assume they have a very low risk of skin cancer or do not need to wear sunscreen.
Skin cancer is easier to treat in its early stages. People of all skin tones should regularly check their skin for any new or unusual growths. The American Academy of Dermatology recommends doing this once a month.
People should consult a doctor about any changes. An annual skin exam with a dermatologist can also help.
People of Color may prefer to speak with a dermatologist with experience treating diverse skin types. A person can find a doctor with this knowledge and experience by searching the Skin of Color Society directory.
Skin cancer looks different due to a person's skin tone. It may appear red, black, or brown in people with lighter skin. In those with darker skin, the main feature may be a difference in texture rather than color. People of Color are also more likely to develop melanoma in places such as the palms, soles, and nails.
This may affect how quickly doctors can diagnose skin cancer. Other factors that affect skin cancer diagnosis and treatment include misconceptions about skin cancer risk in skin of color and health inequity. This makes it more difficult for some groups to access health insurance and timely cancer treatment, significantly affecting survival rates.
Overall, skin cancers are much more common among white people, but it is important for everyone to perform regular skin checks to avoid missing early signs.
Skin Cancer: More People Die From Types That Aren't Melanoma, Says Surprise New Finding
If you mention skin cancer, most people think of melanoma—the deadliest skin cancer. The other ones are pretty benign, right?
Not so. Worldwide, more people are now dying of non-melanoma skin cancer (NMSC) than melanoma, a new study has found.
The study, by researchers at the University Hospital of Nice in France, used patient data collected by the International Agency for Research on Cancer (part of the World Health Organization). It showed that while melanoma caused 57,000 deaths globally in 2020, non-melanoma skin cancer accounted for even more, with 63,700 people losing their lives.
In some ways, the study upends conventional wisdom on how much of a threat to life NMSC represents. NMSC is considered to be less serious than other types of cancer—rarely fatal and often left out of national cancer registries' reports of overall cancer numbers. However, "rarely fatal" is not the same as "never fatal," and if a sufficiently large number of people develop this type of cancer, then that can add up to a lot of deaths, as this new report shows.
Melanoma and NMSC share some features, with both being closely linked to exposure to ultraviolet radiation (UV) from either the sun or tanning beds. UV is able to produce cancer-causing mutations that drive the formation of both melanoma and NMSC.
The past several decades have seen large increases in the incidence of both types of cancer, as people's holiday destinations and attitudes to tanning have changed. Most of these cancers occur in white people, but people with darker skin tones can also get skin cancer. Unfortunately, it often goes undiagnosed due to a lack of awareness in both patients and dermatologists.
Melanoma and NMSC do have some important differences, though. While UV is a risk factor for both, NMSC is more associated with chronic exposure throughout a person's lifetime. Consequently, tumors often arise on the face and head. In contrast, occasional severe sunburns are more closely linked to melanoma, particularly on the trunk.
There are two main types of NMSC: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Both arise from a type of skin cell called a keratinocyte.
Keratinocytes are the main type of cells that make up the epidermis, the outer layer of our skin. Mutations in keratinocytes, caused for example by exposure to UV, can override the internal checks and balances that usually prevent cells from uncontrollably dividing, resulting in a tumor forming.
In contrast, melanomas occur as a consequence of cancer-activating mutations in a different type of skin cell called a melanocyte. There are about ten times fewer melanocytes than keratinocytes in the epidermis, but they play an important role in protecting our skin from damage by producing melanin. Melanin is the pigment that determines our normal skin color and which is produced in greater amounts after exposure to UV, causing a tan.
How deaths occurMost cancer deaths are caused by secondary tumors that arise when cells from the original tumor break away and spread, or metastasize, to distant sites in the body. Skin cancers are no exception. However, metastasis is a very challenging process for cancer cells. They first need to invade surrounding tissue, then survive the stress of transport around the bloodstream before finally being able to establish a colony in an environment that is quite different to the skin.
Melanoma cells are much more effective at achieving all of the steps of metastasis than NMSC cells are. For example, melanoma cells share some characteristics with cells found in the brain and so can readily adapt to the brain as a new environment, forming secondary tumors there.
If it's the case that NMSC is far less likely to form dangerous secondary tumors, then why is it that it causes more deaths than melanoma? This partly comes down to the numbers involved.
While we have a pretty good idea of how many people across the world get melanoma each year, the numbers for NMSC are much less clear. However, we do know that the current official statistic of 1.2 million cases per year (compared to 325,000 for melanoma) is likely to be a substantial underestimate. This is because of inconsistencies in how data on NMSC cases are gathered and reported between different countries.
These gaps in the data mean that it is quite difficult to get a full picture of trends in the number of cases of NMSC and how likely they are to cause death. Despite this gap, a particularly worrying part of this latest report is its conclusion that where you live in the world has a big impact on how likely you are to survive an NMSC diagnosis.
Like all cancers, the earlier a NMSC can be diagnosed and treated, the better the chance of a positive outcome. It remains to be determined whether a tendency to regard NMSC as relatively innocuous has played any role in this trend, or whether it's entirely due to other factors such as having ready access to diagnosis and treatment.
An optimistic viewAnother, more optimistic, reason for NMSC overtaking melanoma as a cause of cancer death may be the significant progress made in treating melanoma over the past few years.
For example, after decades of increases in the annual number of melanoma deaths, the UK has recently turned a corner and fewer people are now dying, despite the number of cases continuing to rise. This trend is thanks to the availability of a range of new targeted treatments for melanoma that are saving lives every day.
However, prevention is always better than treatment and it's clear that more still needs to be done to prevent these cancers from occurring in the first place. This can be achieved by ensuring that sun protection messages reach everyone at risk.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Citation: Skin cancer: More people die from types that aren't melanoma, says surprise new finding (2023, October 13) retrieved 31 October 2023 from https://medicalxpress.Com/news/2023-10-skin-cancer-people-die-melanoma.Html
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