SKIN CANCER

Ultraviolet rays from artificial light sources, such as tanning booths and sunlamps, are as dangerous as the sun’s rays and should be avoided.

• Basal cell carcinoma usually initially manifests as a pink papule, similar to a “pimple”, but unlike a benign lesion, it does not heal, but rather grows slowly. It may bleed and a scab may appear on its surface. Superficial basal cell carcinoma can manifest as a pink, shiny, slightly palpable plaque that grows slowly. Sometimes these types of tumors can be brown or blackish in color, simulating a mole that grows slowly. In the event of any newly appearing lesion that does not heal spontaneously, we must consult to rule out this type of tumor.
• Squamous cell carcinoma usually appears on skin damaged by the sun, usually in an area where there are actinic keratoses, although it can appear without previous actinic keratoses. It is a scab that falls off when you pull it off and seems to heal, but then it reappears. Little by little this scab becomes thicker and more adherent, with a pink inflamed area at the base. The lesion grows progressively and may bleed or be painful to the touch. When faced with a crusty lesion that does not resolve, or that seems to heal but comes back, we must consult to rule out not treating this tumor.
• Melanoma can appear on a pre-existing mole or it can appear again in an area of skin where there was no mole before, which is more common. We should be alarmed if we observe a mole that changes or grows, or if a new “mole” appears that begins to grow in a relatively short period (months). We must also suspect a lesion that meets the ABCDE criteria (see “melanoma cancer” chapter).

Previously, it was thought that the warning signs were itching or bleeding, but these symptoms, if they appear, do so in more advanced stages, and our objective is to diagnose melanoma in the early phase when these symptoms do not yet appear.

Although not all changes in the skin mean that you have cancer; It is advisable to go to the dermatologist if you notice any changes. Early detection and appropriate treatment increase the chances of cure.

• Genetics: there are certain conditions that predispose to skin cancer and melanoma, such as xeroderma pigmentosum or albinism. In addition to these diseases, there are several genetic mutations that are associated with an increased risk of skin cancer and other types of cancer, such as the CDKN2A mutation that confers an increased risk of melanoma and pancreatic cancer. Several mutations have recently been identified that increase the risk of melanoma. In families where a mutation is present, it is common to find several members of the same family with melanoma. In addition to specific genetic mutations, there is also a certain familial predisposition to skin cancer and/or melanoma, which is not inherited with a specific gene, but rather several genes that confer a propensity to be more susceptible to suffering from it.
• Environmental: Ultraviolet rays are the main external cause that increases the risk of skin cancer and melanoma. They produce mutations in the DNA of cells and decrease our body’s ability to repair these mutations, so a mutated cell can proliferate and result in skin cancer. Ultraviolet rays are an important part of solar radiation (UVA+UVB) and are also found in tanning booths (UVA). At higher altitudes, in summer and on surfaces that reflect rays, is when they have more power to damage the skin.
• Ionizing radiation: X-rays (x-rays, CT, fluoroscopy, radiotherapy, etc.) also damage cellular DNA and increase the risk of skin cancer.
• Immunosuppression: Patients with low defenses due to other cancers (lymphoma, leukemia) or due to receiving immunosuppressive drugs (after a transplant or autoimmune diseases) have an increased risk, since their defenses have more difficulty detecting a mutated cell and it is “escapes” the control of the immune system and can cause cancer. The most common situation of immunosuppression is old age.

In addition to these, there are other less common types of cancer, such as Merkel carcinoma and other tumors that can appear in the skin, such as Kaposi’s sarcoma, sarcomas and cutaneous lymphomas.

• Basal cell carcinoma, which originates in the cells of the basal stratum germinative, the last layer of the skin.
• Squamous cell carcinoma, which affects squamous cells.
• Melanoma cancer affects melanocytes, the cells that produce melanin, the skin pigment that tans the skin to protect the deeper layers from solar radiation.

Carcinomas are the most common types of skin cancer and also those with the best prognosis (greater chance of recovery). Melanoma, although not as common, is much more serious if diagnosed late.

In addition to repeated sun exposure, genetic or other factors such as immunosuppression can contribute to the development of these cancers. Carcinomas usually appear in areas of our skin that are usually exposed to the sun, such as the face and the back of the hands; However, melanoma, although it tends to appear in uncovered and exposed areas, can also appear in areas that are not exposed to the sun, such as the soles, genitals, scalp and nails.

Another important difference between non-melanoma skin cancer (carcinomas) and melanoma is that carcinomas are usually cancers located in the skin, and although they can be very destructive locally, they rarely spread to other organs, which is known as metastasis. On the contrary, melanoma, after an initial superficial phase, tends to invade in depth and its cells can spread to the lymph nodes and metastasize to other organs, being potentially fatal. For this reason, it is vitally important to make an early diagnosis in the initial stages, to be able to detect it in its initial phase when it is still curable by removal.