Surgical oncology of the skin

Skin cancer is more common among people whose skin is whiter and have spent much time exposed to sunlight. Skin cancer can occur on any part of the body, but is most common in areas with greater exposure to sunlight, such as the face, neck, hands and arms.
What is skin cancer?
The skin is an organ that protects the body against heat, light, infections and wounds. It also stores water, fat and vitamin D. It consists of two main layers and various kinds of cells. The outer layer, known as the epidermis, contains three classes of cells: flat cells in flake-form in its most superficial layer called squamous cells, round cells in the basal layer known as basal cells and cells called melanocytes which give color (melanin) in the skin.
The inner layer of the skin is known as the dermis. This layer is thicker and contains blood vessels, nerves and sweat glands. The hair of the skin also grows in the dermis, in tiny pockets called follicles. The dermis produces sweat, which helps to cool the body, and oils which prevent skin dryness.

Skin cancer is a disease where cells are cancerous (malignant) in the outer skin layers.

Skin cancer is more common among people whose skin is whiter and have spent much time exposed to sunlight. Skin cancer can occur on any part of the body, but is most common in areas with greater exposure to sunlight, such as the face, neck, hands and arms.

The appearance of skin cancer may vary. The most common sign of skin cancer is a change in the appearance of the skin, such as a non-healing wound. Sometimes there can be a small bump. This lump can be soft-looking, shiny, waxy, or may be red or reddish brown. Skin cancer can also appear as a rough or scaly red mark. Not all skin changes mean skin cancer, however a doctor should be consulted when you notice any change. If you have a spot or bump on the skin, the doctor can remove this for the tissue to be analyzed under a microscope. This procedure is known as a biopsy. A biopsy can usually be done at the medical center. Before the biopsy, a local anesthetic is administered to numb the area for a short period.

Upon detection of skin cancer, more tests will be carried out in order to determine if the cancer has spread. This procedure is called cancer staging. The doctor needs to know the stage and type of skin cancer for the correct treatment. The stages following are used for the classification of treatment.

Types of skin cancer

There are several types of cancers that originate in the skin. The most common are the Basal cell cancer and Squamous cell cancer (these types of skin cancer are called "cancers of non-melanoma skin"). Melanoma is a type of skin cancer that originates in melanocytes. It is not as common as the cancer of the basal or squamous cells, but it is a lot more serious.

The majority of non-melanoma skin cancers can be cured. The chance of recovery (prognosis) and choice of treatment depend on the type of skin cancer you have and how far it has spread.

Other cancers that can affect the skin are Cutaneous T cell lymphoma (a cancer of the lymphatic system) and Kaposi sarcoma. Cancers that appear on other parts of the body can also spread (metastasizing) to the skin.

Basal cell cancer (Basal-cell carcinoma)
The basal cell cancer is the most common type of non-melanoma skin cancer. In general it occurs in areas of skin that have been exposed to the sun. This cancer often appears as a bulge with a smooth, pearly appearance. Another type of this cancer has the look of a scar and a firm touch. Basal cell cancers can expand to tissues around the cancer, but generally do not spread to other parts of the body (usually do not metastasize).

Squamous-cell carcinoma (epithelioma)
Squamous cell tumors also occur in areas of skin that have been exposed to sun, often at the top of the nose, forehead, lower lip and hands. They can also appear on areas of skin that have been burned or exposed to chemical products or radiotherapy. This cancer usually appears as a red, hard lump. Occasionally the tumor can appear scaly, may bleed or develop a crust. Squamous cell tumors can spread to the lymph nodes in the area (lymph nodes are small glands that are located throughout the body and whose function it is to produce and store cells which fight the infection).

Actinic keratosis
Actinic keratosis is a noncancerous condition of the skin but can, in some people, become a basal cell or squamous cell cancer. It appears on the skin as scaly, rough patches of red or brown color, usually in areas that have been exposed to the sun. It appears on the skin as scaly, rough patches of red or brown color, usually in areas that have been exposed to the sun.



Recurrence or relapse
A recurrent disease means that the cancer has come back (recurred) after it has been treated.


There are treatments for all patients with skin cancer.

Three kinds of treatments are applied:
Surgery (removing the cancer)
Chemotherapy (using drugs to eliminate cancer cells)
Radiation therapy (using x-rays to eliminate cancer cells)
Many skin cancers are treated by doctors specialized in skin diseases (dermatologists, plastic surgeons). Usually the cancer can be treated at the doctor's surgery.

Surgery is the most common treatment for skin cancer. The doctor can remove the cancer using one of the following methods:

Electrodessication and curettage.
An operation in which an electric current dehydrates the tumor (electrodessication), then a special tool known as curette is used to remove the tumor.

Cryosurgery. An operation in which the tumor is frozen and destroyed. Simple excision. An operation in which the cancer is extracted from the skin along with some healthy tissue located around it.

Micrographic surgery. An operation where the cancer is removed along with as little normal tissue as possible. During this surgery, the doctor removes the cancer and then uses a microscope to examine the cancerous area, making sure that no cancer cells are left.
The surgery can leave a scar on the skin. Depending the size of the cancer, it is possible to take skin from another part of the body, in order to be placed where the cancer was removed. This procedure is known as skin graft. New surgical methods or surgical grafts exist, through which the scarring can be reduced.

The radiation therapy consists in the use of X-rays to remove cancer cells and shrink tumors. The radiation therapy for skin cancer comes from a machine that remains outside the body (external radiation therapy).

Chemotherapy consists in the use of drugs to kill cancer cells. Chemotherapy treatment is often administered via a cream or lotion, applied to the skin in order to defeat the cancer cells (topical chemotherapy). The chemotherapy may also be given by tablets, or it can be introduced to the body via a needle, into a vein or muscle. This type of chemotherapy is called systemic treatment, as the drug enters the bloodstream, travels through the body, and can destroy cancer cells situated outside the skin. The systemic chemotherapy is being evaluated in clinical testing.

The objective of biological therapy is to try and have the body itself fight off the cancer. The biological therapy uses substances, produced by the body itself or fabricated in a laboratory, in order to boost, direct, or restore the body's natural defenses against the disease. Biological therapy is known as the Immunotherapy.

Photodynamic therapy uses a special type of light and special chemicals to eliminate cancer cells.


Types of Treatment

Treatment for skin cancer depends on the type and stage of disease, your age and general health.

The patient can receive treatment that is considered standard, based on the results obtained from various patients in past studies, or can choose to participate in a clinical test. Not all patients are cured with a standard therapy and some standard treatments could have more side effects than desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the latest information.

Treatment of Basal-cell carcinoma The patient could receive one of the following treatments:
Micrographic surgery. The cancer is extracted along with the least amount of normal tissue possible. During this surgery, the doctor removes the cancer and then uses a microscope to examine the cancerous area, making sure that no cancer cells are left.

A surgery that removes the cancer of the skin and some of the surrounding healthy tissue.

Electrodessication and curettage. An operation in which electric current dehydrates the tumor (electrodessication), then a special tool known as curette is used to remove the tumor.

Cryosurgery. An operation in which the tumor is frozen and destroyed.
Radiation therapy.
Topical chemotherapy.
Clinical chemoprevention trials.
Clinical trials of biological therapy.

Photodynamic therapy. A technique in which photosensitive drugs are used to destroy the cancer. It is important to undertake regular skin examinations so that cancer can be treated in case it recurs.

Treatment of squamous-cell carcinomaThe patient could receive one of the following treatments:
Micrographic surgery. Removes the cancer and as little amount of normal tissue as possible. During this surgery, the doctor removes the cancer and then uses a microscope to examine the cancerous area, making sure that no cancer cells are left. Surgery that removes the cancer of the skin and some of the surrounding healthy tissue.

Electrodessication and curettage. An operation in which electric current dehydrates the tumor (electrodessication), then a special tool known as curette is used to remove the tumor.

Cryosurgery. Operation in which the tumor is frozen and destroyed.
Radiation therapy.
Topical chemotherapy.
Clinical trials of biological therapy with or without chemoprevention therapy.
It is important to undertake regular skin examinations so that cancer can be treated in case it recurs.

Treatment of actinic keratosis

The patient could receive one of the following treatments:
Topical chemotherapy.
Cryosurgery.
An operation in which the tumor is frozen and destroyed.
Electrodessication and curettage. An operation in which electric current dehydrates the tumor (electrodessication), then a special tool known as curette is used to remove the tumor.
Removal of the outer skin layer with a special machine (dermabrasion).
Scraping of the outer layer of the skin (abrasion of scrape).
Laser therapy. This procedure uses a highly focused beam of light that destroys only the cancer cells. (This information was obtained from the National Cancer Institute© and is not owned or Dr. Gabriel SECPRE Ustáriz Sesma)

What is a melanoma?
Melanoma is a skin disease in which cancerous cells (malignant) are found in cells that give them color (melanocytes). Melanoma usually occurs in adults, but can occasionally also be found in children and adolescents. The skin protects the body against heat, light, infection and injury. It consists of two main layers: the epidermis (outer layer) and the dermis (inner layer). The melanocytes are found in the epidermis and they contain melanin, a pigment responsible for the color of the skin. The melanoma is sometimes called cutaneous melanoma or malignant melanoma.

Melanoma is a more serious type of cancer as the common cancers such as basal or squamous cell cancers, which originate in the basal cells or squamous cells of the epidermis.

Like most cancers, melanoma is best treated when detected (diagnosed) early. Melanoma can spread (metastasize) quickly to other parts of the body via the lymphatic system or blood. (Lymph nodes are small glands that are found throughout the body; they produce and store cells that fight infection). You should consult your doctor if you have any of these signs of melanoma:

• change in size, shape or color of a mole;
• exudation or bleeding from a mole;
• A mole that feels itchy, hard, lumpy, swollen, or tender to the touch.

Melanoma can also appear on the body as a new mole. Men most often get melanoma on the trunk (the area of the body between the shoulders and hips) or the head or neck; women most often tend to get melanoma more often on the arms and legs

If you have signs of skin cancer, the doctor will examine your skin carefully. If a mole or pigmented area does not look normal, the doctor will remove (local excision) and examine it under a microscope to check for cancer. This is usually done at the doctor's surgery. It is important that this biopsy is done correctly.