Skin cancer (excluding melanoma) comes from the skin epithelium that covers the outer surface of the body including 7 layers of cells. The basal cell layer produces basal cell carcinoma, the squamous cell layer produces squamous cell carcinoma. Dependent glands of the skin such as sweat glands, sebaceous glands produce sweat glands cancer and sebaceous glands cancer.
Skin cancer is completely curable if detected early
The most common skin cancer is the basal cell carcinoma, which is located directly on the basement membrane of the skin. This cancer is usually in the elderly, the common place in the face, accounting for 65% of the total number of skin cancers. Basal cell carcinoma is slow-growing, almost no node metastasis, no spread metastasis and good prognosis.
Skin cancer is curable if the cancer patient is detected early, treated primarily with surgery. In order to solve well for cancer patients, it is necessary to make sure to remove all tumors, ensure function and especially plastic and aesthetic issues for patients. However, proper surgery, ensuring oncology, requires specialized doctors in this field. Skin cancer patients should find good specialized cancer hospitals, has a modern testing system and a team of highly trained doctors who have effectively treated many skin cancer patients. In particular, with the extensive removal of the head and neck area, it is required to create the image to ensure the function and aesthetics of the patient, so in addition to knowledge doctors need to have skills and ingenuity.
Patients who detect abnormal skin lesions, especially developing on old scars or lesions, moles, lesions that grow quickly in size, should come to the specialized cancer hospitals real soon in order to get detected early for good skin cancer cure.
1- Overview of skin cancer
What is skin cancer? Skin cancer is one of the most common and fairly easy to diagnose. Skin cancers (not including melanoma) are cancers derived from the skin epithelium covering the outer surface of the body, including many layers of cells. The basal cell layer produces basal cell carcinoma, the squamous cell layer produces squamous cell carcinoma. Dependent glands of the skin such as sweat glands, sebaceous glands generate cancer glands, sebaceous glands …
Skin cancer is more common in whites, mainly in the elderly, more men than women. The disease usually occurs in open skin with a 90% rate in the head and neck area. The incidence of skin cancer in Vietnam is about 2.9-4.5 / 100,000 people.
Can skin cancer be cured? Skin cancer can be completely cured if detected early.
2- Causes of skin cancer
Skin exposed to radiation:
Ultraviolet radiation: Ultraviolet radiation from sunlight and ultraviolet light such as carbon arc, mercury, cold quartz … These are the main risk factors for skin cancer. . The skin is constantly exposed to sunlight at high intensity and for a long time is the most important pathogen causing skin cancer. The disease often occurs in people working outdoors fishermen, farmers, workers …
Ionizing radiation: Skin cancer usually develops after 14-15 years of exposure to ionizing radiation.
How many types of UV rays? Which type adversely affects the skin?
The family syndrome
Some genetic syndromes that increase the risk of skin cancer include:
Dermatomyopathy: there is a recessive mutation of chromosomes characterized by hypersensitivity to ultraviolet rays. The disease manifests itself as skin lesions of the whole body with thick, fibrous, flaky skin. Patients usually get skin cancer before they are 20 years old. Prevent disease by avoiding solar radiation.
Nevoid basal cell syndrome: characterized by an autosomal dominant mutation combined with jaw bone cysts or recesses in the palms and feet. Multiple foci of basal cell carcinoma associated with skin fibrosis, abnormalities in ribs and spine.
Gardner’s syndrome: predominant genetic syndrome with cystic and subcutaneous cyst lesions.
Torres Syndrome: Inherited basal cell carcinoma and non-metastatic adenocarcinoma cancer in patients with multiple dry fibrosis. The disease is often accompanied by colon cancer and Vater cancer.
Pre-existing skin conditions
Photochemical hyperkeratosis: 1-20% turns into skin cancer. Lesions are rough, scaly patches of the rash that open on open skin like the head and neck, and may regress on their own if the patient changes careers and reduces exposure to ultraviolet radiation.
Bowen’s disease: 3-5% turns into skin cancer. The disease manifests itself by scaly erythematous spots, clear edges of the disease, commonly seen in the elderly.
Freckles: People with more spots, freckles have a higher risk of skin cancer.
Infection: Human papilloma virus infection (HPV) is directly related to squamous cell skin cancer. HPV is found in the majority of rice granular epithelial hyperplasia – a precancerous lesion.
Chronic dermatitis or skin trauma: Cancer may develop on previously damaged skin areas such as old burns, drainage holes, long-standing ulcers, skin tattoos. These cancers tend to spread and metastatic regional lymph nodes.
Immunity: The risk of skin cancer in people with acquired immune deficiency syndrome or after organ transplantation is increased 16 times. In this case, the tumor grows stronger and the lesions become more diffuse.
Exposure to carcinogenic chemicals
Some chemicals cause skin cancer in the case of long skin contact with asphalt, coal tar, lubricant, herbicide … Arsen is the most common type because it is used in many industries, medicine. In fact, there is a high concentration of it in drinking water in some countries.
3- Symptoms of skin cancer
Signs of skin cancer depend on the type. Early skin cancer is often confused with other benign skin lesions such as ulcers, old scars …
Basal cell carcinoma:
Common in the face, nose, cheeks, temples.
The disease begins with a small ulcer, shallow edge, smooth bottom, thin crust, capillary dilated bottom surface, can be infected with black easily confused with melanoma.
The sores usually come from warts, moles, and chromatin.
The ulcers develop slowly, with banks all destroying and spreading along the skin surface, less deeply invasive.
Some cases of deep ulceration exposed facial bones, superinfection, surrounding red masonry.
Basal cell skin cancer has virtually no lymph node metastasis and no metastases far away.
Squamous cell carcinoma of the skin:
Squamous cell cancer is common in the scalp.
Cancer comes from an old scar, like a burn scar. The tumor is lumpy, the surface is crumpled, bleeding easily
The tumor progresses rapidly, the ulcerative spread spreads along the superficial surface, and can invade the skull, deformity and serious infection.
Squamous cell carcinoma or regional lymph node metastases such as neck area, occipital region, pre-ear lymph node, lymph node under chin, under jaw .
Skin-dependent gland cancers:
Includes sweat gland, sebaceous gland.
Cancer is often located under the skin surface, pushing the skin protrusion high, easily mistaken for software cancer.
Tumor firm, sticky, limited mobility with red masonry and pain.
Rapidly growing tumor invades down the deep layer into the muscles and bones.
4- Subjects at risk of skin cancer
White people are the most common:> 200 / 100,000 people, blacks least expensive <10 / 100,000 people
Outdoor workers are exposed to ultraviolet rays
Workers exposed to toxic chemicals
People with precancerous skin conditions
Persons with weakened immune systems: HIV, after organ transplantation, immunosuppressant drugs in patients with autoimmune disease
People with genetic syndromes such as Gardner syndrome, Torres syndrome, Bowen syndrome …
5-Prevention of skin cancer
Avoid direct exposure to the sun.
Do not sunbathe in the period from 10 hours to 16 hours, only sunbathing in the early morning, not to sunburn.
People who have to work outdoors need to wear labor protection such as using a hat, a hat, long-sleeved clothes or shading umbrellas from the sun.
Beauty methods such as whitening baths remove the stratum corneum on the skin, young cells are exposed to sunlight and harmful factors from the environment, so it is easy to get skin diseases, especially skin cancer.
Wearing colorful or dark-colored clothes made of natural materials has a better skin protection effect than wearing light-colored clothes made of artificial materials.
When working in contact with chemicals and radiation, good hygiene and safety in labor, such as wearing gloves, boots, protective clothing, glasses and masks, must be well implemented.
Regularly clean the skin, avoid and promptly treat inflammatory symptoms on the skin.
Attention should be paid to propaganda and meticulous examination to detect early skin lesions because they are easy to see and effectively treat at this stage.
6- Measures to diagnose skin cancer
Diagnosis of skin cancer is based on clinical symptoms and biopsy results. There are 4 symptoms of early diagnosis of skin cancer:
Long-lasting ulcer or bloody ulcer
The horn is thick, ulcerative, easy to bleed
Ulcer or tumor on an old scar background
Chronic red nodules are ulcerative, changing the size of a mole.
Also when magnifying glass, newly created blood vessels are quite clearly observed. May have lesion histopathological diagnosis.
7- Treatments for skin cancer
The principles of treatment
Based on the type of histopathology, tumor location, degree of spread, stage of disease.
Radical treatment of skin cancer mainly with surgery.
Skin-dependent adenocarcinoma has little response to radiation or chemotherapy, so the surgical role is huge. It is necessary to systematically remove regional tumors and lymph nodes when there is a metastasis.
Radical treatment of skin cancer to reduce symptoms, combat bleeding, limit infections, fight pain.
Skin cancer surgery
About 80% of skin cancers are treated with surgery.
The principle of surgery: take enough tumor, make sure the surrounding area is no longer cancerous. Should consider carefully the factors: location, size, extent of infiltration, the width of the tumor, cosmetic issues are secondary.
Rays of radiation
-The basal cell carcinoma is sensitive to rays so the effect may be equivalent to surgery. However, pay attention to locations near the eyes, nose and mouth mucosa prone to burns.
-Additional radiation therapy after surgery for skin cancer is indicated with the purpose of preventing local and regional recurrences.
After surgery, basal cell carcinoma that the area has access to can be complementary to radiotherapy, especially near-bone surgery.
After the surgery, the squamous cell skin cancer should also have an additional radiation treatment. + Most cases of lymph node metastases, after lymphadenectomy, also need additional radiation therapy with radiation dose of about 55-60 Gy.
Topical chemicals: Using 5-FU cream can treat premature cancer or small bowel carcinoma lesions.
Preoperative chemotherapy is indicated for highly malignant skin cancers. Chemicals that regress tumors and lymph nodes facilitate surgery, reducing the possibility of cancer cell proliferation.
Postoperative chemotherapy to reduce the possibility of recurrence and metastasis.
In case of widespread cancer that cannot be operated, chemotherapy alone or in combination with radiation therapy to reduce symptoms and improve quality of life.
Treatment of relapse
Recurrence after surgery for basal cell skin cancer can be operated again to widen tumors or radiation, the results are still relatively good.
Recurrence after surgery for squamous cell or skin-dependent skin cancer usually has a bad prognosis due to high malignancy. Surgery to widen the damage and shape the area of the skin gap, if the area is approached, the radiation will be postoperative.
Recurrent lymph node: removal of ganglion, radiotherapy after surgery.