How To Treat Skin Cancer

Treatment for skin cancer and the precancerous skin lesions known as actinic keratoses varies, depending on the size, type, depth and location of the lesions. Often the abnormal cells are surgically removed or destroyed with topical medications. Most skin cancer treatments require only a local anesthetic and can be done in an outpatient setting. Sometimes no treatment is necessary beyond an initial biopsy that removes the entire growth.

If additional treatment for skin cancer is needed, options may include:

1) Freezing - Your doctor may destroy actinic keratoses and some small, early skin cancer by freezing them with liquid nitrogen (cryosurgery). The dead tissue sloughs off when it thaws. The treatment may leave a small, white scar. You may need a repeat treatment to remove the growth completely.

2) Excisional Surgery - This type of treatment may be appropriate for any type of skin cancer. Your doctor cuts out (excises) the cancerous tissue and a surrounding margin of healthy skin. A wide excision — removing extra normal skin around the tumor — may be recommended in some cases. To minimize or avoid scarring, especially on your face, you may need to consult a doctor skilled in skin reconstruction.

3) Laser Therapy - A precise, intense beam of light vaporizes growths, generally with little damage to surrounding tissue and with minimal bleeding, swelling and scarring. A doctor may use this therapy to treat superficial skin cancers or precancerous growths on lips.

4) Mohs Surgery - This procedure is for larger, recurring or difficult-to-treat skin cancer, which may include both basal and squamous cell carcinomas. Your doctor removes the skin growth layer by layer, examining each layer under the microscope, until no abnormal cells remain. This procedure allows cancerous cells to be removed without taking an excessive amount of surrounding healthy skin. Because it requires special skill, the surgery should be done only by specially trained doctors.

5) Curettage and Electrodesiccation - After removing most of a growth, your doctor scrapes away layers of cancer cells using a circular blade (curet). An electric needle destroys any remaining cancer cells. This simple, quick procedure is common in treating small or thin basal cell cancer. It leaves a small, flat, white scar.

6) Radiation Therapy - Radiation may be used to destroy basal and squamous cell carcinomas if surgery isn't an option.

7) Chemotherapy - In chemotherapy, drugs are used to kill cancer cells. For cancers limited to the top layer of skin, creams or lotions containing anti-cancer agents may be applied directly to the skin. Topical drugs can cause severe inflammation and leave scars. Systemic chemotherapy can be used to treat skin cancer that have spread to other parts of the body.

Signs and Symptoms of Skin Cancers

Skin cancer develops primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it can also form on areas that rarely see the light of day — your palms, beneath your fingernails, the spaces between your toes or under your toenails, and your genital area.

Skin cancer affects people of all skin tones, including those with darker complexions. When melanoma occurs in those with dark skin tones, it's more likely to occur in areas not normally considered to be sun-exposed.

A cancerous skin lesion can appear suddenly or develop slowly. Its appearance depends on the type of skin cancer:

1) Basal cell carcinoma - this is the most common skin cancer. It's also the most easily treated and the least likely to spread. Basal cell carcinoma usually appears as one of the following:
- A pearly or waxy bump on your face, ears or neck
- A flat, flesh-colored or brown scar-like lesion on your chest or back

2) Squamous cell carcinoma - squamous cell carcinoma is easily treated if detected early, but it's slightly more apt to spread than is basal cell carcinoma. Most often, squamous cell carcinoma appears as one of the following:
- A firm, red nodule on your face, lips, ears, neck, hands or arms
- A flat lesion with a scaly, crusted surface on your face, ears, neck, hands or arms

3) Melanoma - this is the most serious form of skin cancer and the one responsible for most skin cancer deaths. Melanoma can develop anywhere on your body, in otherwise normal skin or in an existing mole that turns malignant. Melanoma most often appears on the trunk, head or neck of affected men. In women, this type of cancer most often develops on the arms or legs.

Warning signs of melanoma include:
- A large brownish spot with darker speckles located anywhere on your body.
- A simple mole located anywhere on your body that changes in color, size or feel or that bleeds.
- A small lesion with an irregular border and red, white, blue or blue-black spots on your trunk or limbs
- Shiny, firm, dome-shaped bumps located anywhere on your body.
- Dark lesions on your palms, soles, fingertips and toes, or on mucous membranes lining your mouth, nose, vagina and anus.

Other Causes Of Skin Cancer

Fair-skinned people who sunburn easily are at a particularly high risk for developing skin cancer. Other less important factors include the following:

1)Use of tanning booths and high levels of x-rays - too much exposure to tanning booths and high level x-rays can damage your skin, and this damage can lead to skin cancer.

2) Immunosuppression - impairment of the immune system, which protects the body from foreign entities, such as germs or substances that cause an allergic reaction. This may occur as a consequence of some diseases or can be due to medications prescribed to combat autoimmune diseases or prevent organ transplant rejection.

3) Heredity - if there is a history of skin cancer in your family, you are probably at a higher risk. People with fair skin, with a northern European heritage appear to be most susceptible.

4) Contact with certain chemicals - arsenic (miners, sheep shearers, and farmers), hydrocarbons in tar, oils, and soot (may cause squamous cell carcinoma) can cause skin cancer.

The following people are at the greatest risk of having skin cancer:

1) People with fair skin, especially types that freckle, sunburn easily, or become painful in the sun.
2) People with light (blond or red) hair and blue or green eyes.
3) Those with certain genetic disorders that deplete skin pigment such as albinism, xeroderma pigmentosum.
4) People who have already been treated for skin cancer.
5) People with numerous moles, unusual moles, or large moles that were present at birth.
6) People with close family members who have developed skin cancer.
7) People who had at least one severe sunburn early in life.

Main Cause Of Skin Cancer

Skin cancer begins in your skin's top layer — the epidermis. The epidermis is as thin as a pencil line, and it provides a protective layer of skin cells that your body continually sheds. The epidermis contains three main types of cells:

1) Squamous cells - lie just below the outer surface and function as the skin's inner lining.
2) Basal cells - which produce new skin cells, sit beneath the squamous cells.
3) Melanocytes - which produce melanin, the pigment that gives skin its normal color — are located in the lower part of your epidermis. Melanocytes produce more melanin when you're in the sun to help protect the deeper layers of your skin. Extra melanin produces the darker color of tanned skin.

Normally, skin cells within the epidermis develop in a controlled and orderly way. In general, healthy new cells push older cells toward the skin's surface, where they die and eventually are sloughed off. This process is controlled by DNA — the genetic material that contains the instructions for every chemical and biological process in your body. Skin cancer occurs when this process malfunctions. When DNA is damaged, changes occur in the instructions, which can cause new cells to grow out of control and form a mass of cancer cells.

Ultraviolet (UV) light exposure, most commonly from sunlight, is overwhelmingly the most frequent cause of skin cancer. Much of the damage to DNA in skin cells results from ultraviolet (UV) radiation found in sunlight and in commercial tanning lamps and tanning beds. UV light is divided into three wavelength bands — ultraviolet A (UVA), ultraviolet B (UVB) and ultraviolet C (UVC). Only UVA and UVB rays reach the earth. UVC radiation is completely absorbed by atmospheric ozone.

At one time scientists believed that only UVB rays played a role in the formation of skin cancer. And UVB light does cause harmful changes in skin cell DNA, including the activation of oncogenes — a type of gene that, when turned on, can turn a normal cell into a malignant one. UVB rays are responsible for sunburn and for many basal cell and squamous cell cancers.

But UVA also contributes to skin cancer. It penetrates the skin more deeply than UVB does, weakens the skin's immune system and increases the risk of cancer, especially melanoma. Tanning beds deliver high doses of UVA, which makes them especially dangerous.

Sun exposure doesn't explain melanomas or other skin cancers that develop on skin not ordinarily exposed to sunlight. Heredity may play a role. Skin cancer can also develop from exposure to toxic chemicals or as a result of radiation treatments.

An Introduction On Skin Cancer

Skin cancer is the most prevalent of all types of cancers. It is estimated that more than one million Americans develop skin cancer every year. Skin cancer is a malignant growth on the skin which can have many causes. Skin cancer generally develops in the epidermis (the outermost layer of skin), so a tumor is usually clearly visible. This makes most skin cancers detectable in the early stages. There are three common types of skin cancer, each of which is named after the type of skin cell from which it arises. Cancers caused by UV exposure may be prevented by avoiding exposure to sunlight or other UV sources, and wearing sun-protective clothes. The use of sunscreen had been recommended in the past, but there is an increasing body of evidence that sunscreen is not entirely safe.

Fair-skinned people who sunburn easily are at a particularly high risk for developing skin cancer. Other less important factors include repeated medical and industrial x-ray exposure, scarring from diseases or burns, occupational exposure to compounds such as coal tar and arsenic, and family history.

Unlike many other cancers, including those originating in the lung, pancreas, and stomach, only a small minority of those afflicted will actually die of the disease. Skin cancers are the fastest growing type of cancer in the United States. Skin cancer represents the most commonly diagnosed malignancy, surpassing lung, breast, colorectal and prostate cancer.

The term "skin cancer" refers to three different conditions. From the least to the most dangerous, they are:

1) basal cell carcinoma (or basal cell carcinoma epithelioma)
2) squamous cell carcinoma (the first stage of which is called actinic keratosis)
3) melanoma

All three types of skin cancer are on the rise — but most skin cancers can be prevented by limiting or avoiding exposure to ultraviolet (UV) radiation and by paying attention to suspicious changes in your skin. And with early detection, you can receive successful treatment for most skin cancers, even the most aggressive forms.

Breast Cancer Treatment

A diagnosis of breast cancer is one of the most difficult experiences you can face. In addition to coping with a potentially life-threatening illness, you must make complex decisions about treatment.

Treatments exist for every type and stage of breast cancer. Most women will have surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy. Experimental treatments are also available at cancer treatment centers.

Way to Treat Breast Cancer:

1) Surgery - Today, radical mastectomy is rarely performed. Instead, the majority of women are candidates for simple mastectomy or lumpectomy. If you decide on mastectomy, you may opt for breast reconstruction.

2) Sentinel Lymph Node Biopsy - Because breast cancer first spreads to the lymph nodes under the arm, all women with invasive cancer need to have these nodes examined. Rather than remove as many lymph nodes as possible, surgeons now focus on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first place cancer cells will travel. If a sentinel node is removed, examined and found to be normal, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed. This spares many women the need for a more extensive operation and greatly decreases the risk of complications.

3) Axillary Lymph Node Dissection -If the sentinel lymph node does show the presence of cancer, then your surgeon removes additional lymph nodes in your armpit (axilla). The removal of these lymph nodes does increase the risk of serious arm swelling (lymphedema), but newer surgical techniques make this complication much less likely. Knowing if cancer has spread to the lymph nodes is important in determining the best course of treatment, including whether you'll need chemotherapy or radiation therapy.

4) Reconstructive Surgery -If you want to have breast reconstruction done, discuss this with your surgeon before you have any surgery done. Not all women are candidates for reconstruction. A plastic surgeon can describe the various procedures, show you photos of women who have had different types of reconstruction, and discuss which type of reconstruction might be best in your case. Your options include reconstruction with a synthetic breast implant or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date.

5) Radiation Therapy - Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. It's administered by a radiation oncologist at a radiation center. In general, radiation is the standard of care following a lumpectomy for both invasive and noninvasive breast cancers. Oncologists are also likely to recommend radiation following a mastectomy for a large tumor, for inflammatory breast cancer, for cancer that has invaded the chest wall or for cancer that has spread to more than four lymph nodes in your armpit.

6) Chemotherapy - Chemotherapy uses drugs to destroy cancer cells. The size of the tumor, characteristics of the cancer cells, and extent of spread of the cancer help determine your need for chemotherapy. If your breast cancer has a high chance of returning or spreading to another part of your body, your doctor may recommend chemotherapy after surgery to decrease the chance that the breast cancer will recur. This is known as adjuvant chemotherapy. If your breast cancer has already spread to other parts of your body, chemotherapy may be recommended to try to control the breast cancer and decrease any symptoms the breast cancer is causing.

7) Hormone Therapy - perhaps more properly termed hormone blocking therapy — is often used to treat women whose breast cancers are sensitive to hormones — estrogen and progesterone receptor positive cancers. Similar to chemotherapy, this form of therapy can be used to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.

8) Clinical Trials - Clinical trials are used to test new and promising agents in the treatment of breast cancer. Clinical trials represent the cutting edge of technology, but they're often unproven treatments that may or may not be superior to currently available therapies. Talk with your doctor about clinical trials to see if one is right for you.

Different Ways In Determining Breast Cancer

Screening or looking for evidence of breast cancer before signs or symptoms appear is the key to finding breast cancer in its early, treatable stages. Depending on your age and risk factors, screening may include breast self-examination, examination by your nurse or doctor (clinical breast exam), mammograms (mammography) or other tests.

Breast Self-Examination — Breast self-examination is an option beginning at age 20. By becoming proficient at breast self-examination and familiar with the usual appearance and feel of your breasts, you may be able to detect early signs of cancer. Learn how your breasts typically look and feel and watch for changes. If you detect a change, promptly bring it to your doctor's attention. Have your doctor review your examination technique if you'd like input or you have questions.

Clinical Breast Exam — Unless you have a family history of cancer or other factors that place you at high risk, the American Cancer Society recommends having clinical breast exams once every three years until age 40. After that, the American Cancer Society recommends having a yearly clinical exam. During this exam, your doctor examines your breasts for lumps or other changes. He or she may be able to feel lumps you miss when you examine your own breasts and will also check for enlarged lymph nodes in your armpit (axilla).

Mammogram — A mammogram, which uses a series of X-ray images of your breast tissue, is currently the best imaging technique for detecting tumors before you or your doctor can feel them. For that reason, the American Cancer Society has long recommended screening mammography for all women over 40.

Two types of mammograms include:

1) Screening mammograms - Screening mammograms are performed on a regular basis — about once a year — to check your breast tissue for any changes since your last mammogram.

2) Diagnostic mammograms - Your doctor may recommend a diagnostic mammogram to evaluate a breast change detected by you or your doctor. During a diagnostic mammogram, the radiologist performing the exam can take additional views to evaluate the area of concern more closely.

Yet mammograms aren't perfect. A certain percentage of breast cancers — sometimes even lumps you can feel — don't show up on X-rays (false-negative result). The rate is higher for women in their 40s. That's because women of this age and younger tend to have denser breasts, making it more difficult to distinguish abnormal from normal tissue.

At other times, mammograms may indicate a problem when none exists (false-positive result). This can lead to unnecessary biopsies, to fear and anxiety, and to increased health care costs. The skill and experience of the radiologist reading the mammogram also have a significant effect on the accuracy of the test results. In spite of these drawbacks, however, most experts agree mammography is the most reliable screening test for most women.

Other Tests

1) Computer-aided detection (CAD). In traditional mammography, your X-rays are reviewed by a radiologist, whose skill and experience play a large part in determining the accuracy of the test results. In CAD, a computer scans your mammogram after a radiologist has reviewed it. CAD identifies highly suspicious areas on the mammogram, allowing the radiologist to focus on specific spots, but many of these areas may later prove to be normal. Still, using mammography and CAD together may increase the cancer detection rate.

2) Digital mammography. In this procedure, an electronic process is used to collect and display X-ray images on a computer screen. This allows your radiologist to alter contrast and darkness, making it easier to identify subtle differences in tissue. In addition, digital images can be transmitted electronically, so women who live in remote areas can have their mammograms read by an expert who is based elsewhere. Digital mammography has been found to be most helpful in evaluating dense breast tissue in women in their 40s.

3) Magnetic resonance imaging (MRI). This technique uses a magnet and radio waves to take pictures of the interior of your breast. Although not used for routine screening, MRI can reveal tumors that are too small to detect through physical exams or are difficult to see on conventional mammograms. MRI doesn't take the place of mammograms, but rather is performed as an additional (adjunct) study of the breast.

4) Breast ultrasound (ultrasonography). Your doctor may use this technique to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to produce images of structures deep within the body. Because it doesn't use X-rays, ultrasound is a safe diagnostic tool that can help determine whether an area of concern is a cyst or solid tissue. But breast ultrasound isn't used for routine screening because it has a high rate of false-positive results — finding problems where none exist.

In general, testing is beneficial only if the results will help you make a decision about how you might best reduce your breast or other cancer risk. Options range from lifestyle changes and closer screening and therapy with medications such as tamoxifen to extreme measures such as preventive (prophylactic) bilateral mastectomy and removal of your ovaries (oophorectomy).

Stages Of Breast Cancer

Staging is a classification that reflects the extent and spread of a tumor and has an impact on treatment decisions and also the prognosis for recovery.

Staging in breast cancer is based on the size of the tumor, which parts of the breast are involved, how many and which lymph nodes are affected, and whether the cancer has metastasized to another part of the body.

Cancers may be referred to as invasive if they have spread to other tissues. Those that do not spread to other tissues are called noninvasive. Carcinoma in situ is a noninvasive cancer.

Breast cancer is staged from 0 to IV.

Stage 0 is noninvasive breast cancer, that is, carcinoma in situ with no affected lymph nodes or metastasis. This is the most favorable stage of breast cancer.

Stage I is breast cancer that is less than 2 cm (3/4 in) in diameter and has not spread from the breast.

Stage II is breast cancer that is fairly small in size but has spread to lymph nodes in the armpit OR cancer that is somewhat larger but has not spread to the lymph nodes.

Stage III is breast cancer of a larger size, greater than 5 cm (2 in), with greater lymph node involvement, or of the inflammatory type.

Stage IV is metastatic breast cancer: a tumor of any size or type that has metastasized to another part of the body. This is the least favorable stage.

Signs and Symptoms of Breast Cancer

Breast cancer is the second-leading cause of cancer deaths in American women and the disease that many women fear most. Although breast cancer is primarily a disease of women, almost 1% of breast cancers occur in men. In 2007, it is estimated that 2,030 men in the U.S. will develop invasive breast cancer. Death rates from breast cancer have been gradually declining and continue to decline. These decreases are likely due both to increased awareness and screening and improved treatment methods.

Knowing the signs and symptoms of breast cancer may help save your life. When the disease is discovered early, you have more treatment options and a better chance for a cure.

Most breast lumps aren't cancerous. Yet the most common sign of breast cancer for both men and women is a lump or thickening in the breast. Often, the lump is painless. Other potential signs of breast cancer include:

1) A spontaneous clear or bloody discharge from your nipple, often associated with a breast lump
2) Retraction or indentation of your nipple
3) A change in the size or contours of your breast
4) Any flattening or indentation of the skin over your breast
5) Redness or pitting of the skin over your breast, like the skin of an orange

A number of conditions other than breast cancer can cause your breasts to change in size or feel. Breast tissue changes naturally during pregnancy and your menstrual cycle. Other possible causes of noncancerous (benign) breast changes include fibrocystic changes, cysts, fibroadenomas, infection or injury.

If you find a lump or other change in your breast — even if a recent mammogram was normal — see your doctor for evaluation. If you haven't yet gone through menopause, you may want to wait through one menstrual cycle before seeing your doctor. If the change hasn't gone away after a month, have it evaluated promptly.