Basal cell carcinoma

Basal cell carcinoma
Over 90% of basal cell carcinomas occur in fair-skinned, blue-eyed individuals over the age of 40. The lesions form on sun exposed areas such as the eyelids, bridge of the nose, hands, or forearms. They appear translucent and red, with a rolled border. They usually reach 1 cm to 3 cm in size before they ulcerate and bleed. They often have a central ulceration. They are very slow-growing cancers, taking months to years to grow, and they never spread to other parts of the body. They can be cured with topical chemotherapy, radiation, or surgery. Since they are related to a lifetime of sun exposure, there is a 40% chance of new basal cell cancer occurring over a five-year period after initial treatment.

Skin Cancer Lesions

Actinic (solar) keratosis
Actinic keratoses are precancerous lesions that arise due to increased production of keratin (a tough, fibrous protein) in sun-exposed areas such as face, hands, neck and forearms. The lesion is scaly, flat, 2 mm to 2 cm wide, and has an irregular outline. It ranges from red to pink in colour and grows laterally. They can be itchy or painful, and the number of lesions often increases with age. It arises due to repeated sun exposure and usually occurs in people over the age of 40. About 2% of actinic keratoses can change into squamous cell carcinoma.


Squamous cell carcinoma
Squamous cell carcinoma lesions occur on the head, neck, and back of hands. 90 to 95% appear on sun-exposed areas. The lesions have irregular borders, are usually quite thick, range from red to brown in colour, and may ulcerate (form an ulcer). You are more likely to develop squamous cell carcinoma if you are fair-skinned, have blond or red hair, or work outdoors. Upon surgical removal of the cancer, the person is usually cured. However, in some case, it can spread to other organs in the body if not removed in time.

Skin cancer facts

All of the following play a role in determining your risk of developing skin cancer:
the total amount of sun received over the years
the number of sunburns or tans you have had
your skin type
your family history
the environment you live in

Nearly 50% of people over the age of 65 have or have had some form of skin cancer. Almost all skin cancers are preventable. There is some good news however: 95% of all skin cancers are curable with removal if they are found early enough.
Light-skinned individuals are most at risk of developing skin cancers such as basal cell carcinoma and squamous cell carcinoma (non-melanoma skin cancers). The lesions usually show up on sun-exposed areas such as backs of legs, arms, neck, face, and scalp.
These cancers are usually not metastatic. This means that, typically, they don't spread to other parts of the body and are cured upon removal of the lesion. Nearly 70% of non-melanoma skin cancers are basal cell carcinomas and 30% are squamous cell carcinomas.
Malignant melanomas are more serious, as they can quickly spread to other organs in the body and can result in death. They account for 2% of all skin cancers.
It takes about 10 to 20 years or more for skin cancers to develop, which means that a cancer discovered in your 50s may be due to sun exposure in your early 20s.

The facts of sunburns

The Facts
Sunburn is a kind of radiation damage done by the sun. It's by far the most common form of radiation damage. While most people know radiation is dangerous, they voluntarily expose themselves to the harmful ultraviolet (UV) light of the sun on a regular basis.
Radiation can provoke cancer, and the popularity of sunbathing has brought a steady climb in new cases of skin cancer and actinic keratosis, a precursor to skin cancer. Actinic keratosis and all types of skin cancer, particularly nonmelanoma types (basal and squamous cell cancer), are directly linked to sun exposure. Exposure in early life is especially relevant. Many people get the bulk of their sun exposure during childhood, and it's been shown that even one childhood sunburn increases the risk of developing skin cancer later in life. However, sunburn is not required to damage skin. A tan is also clear evidence of UV skin damage.
In Canada, skin cancer is still fairly rare in people under 40. The amount of UV radiation is more variable in northern than southern latitudes, so the total dose received accumulates more slowly. In Australia, where people are exposed to far more UV light from an early age, skin cancer is a disease that more often strikes people in their 20s and 30s.
The depletion of the ozone layer has raised the degree of exposure, but not by as much as sun-worshipping habits. Regardless, the extra cancer cases from the ozone effect mostly haven't had time to develop yet.
If it weren't for skin cancer, sunburn would be a minor health problem, with only the most extreme cases requiring hospital treatment. As it is, any sun or other UV exposure, including a gentle tan, increases the risk of skin cancer.

Are YOU at risk?

Could you be at risk for skin cancer? It depends on your genes, your lifestyle, and your environment.
Skin cancer is usually caused by overexposure to ultraviolet (UV) light, such as from sunlight or tanning beds. The UV light damages genes in your skin cells. If enough damage occurs, the cells may begin to grow uncontrollably, leading to skin cancer. UV light may also make it harder for your immune system to detect and destroy skin cancer cells.
To get an idea of your own personal risk, consider two things: the amount of UV light you're exposed to, and how much protection you have from UV light. The greater the exposure to UV light, and the less protection you have, the greater your risk.

Things that can increase your UV light exposure include:
working at outdoor jobs
sunbathing
participating in or watching outdoor sports
using tanning beds or salons

Things that reduce your protection from UV light include:
having fair skin that burns easily (darker-skinned people have more melanin, a skin pigment that helps protect skin from UV light)
living close to the equator, at a high altitude, or being outside on days where the UV index is higher (greater risk of sun damage)
having health conditions (such as HIV) or taking medications (such as cancer or transplant medications) that suppress the immune system, since these decreases the body's ability to find and destroy skin cancer cells
Other factors that increase the risk of skin cancer include severe sunburns, excessive X-ray exposure, arsenic poisoning, or burns from radium. One particular type of skin cancer, malignant melanoma, has some extra risk factors, including a family history of skin cancer, large numbers of moles, or unusual moles.

Self-examination

Skin cancer is the most common of all cancers. Most types of skin cancers are preventable, and when skin cancer occurs, cure rates are high if it is diagnosed and treated early. If allowed to progress, though, skin cancer can result in disfigurement and even death. This is why regularly examining your skin (for example, once a month) is essential, especially because a skin cancer lesion often won't hurt or feel uncomfortable, so it's easy to overlook. It is also important to have your skin examined by your doctor at least once a year, especially if you are over the age of 40.
How to conduct a monthly skin self-exam:
Start with the head and end with the feet.
Look at the scalp, the face, the neck, beneath facial hair, on the trunk, the armpits, the hands, the finger webs, the toe webs, the nail beds, and the soles of the feet.
Use a mirror to examine your back and the skin between the buttocks.
It is important that you see your doctor as soon as possible if you notice a mole, birthmark, beauty mark, spot, or sore that:
has irregularly shaped outline
changes colour or is dark black in colour
increases in size or thickness or shape
changes in texture
is bigger than 6 mm
bleeds
itches or hurts
crusts or scabs
ulcerates or bleeds
fails to heal within three weeks, leading to ulceration, scabbing, or bleeding

Actinic keratosis - a warning sign!

Actinic keratosis is an early warning sign of skin cancer. These rough, scaly skin lesions are found on areas of the skin that have been exposed to the sun over time. Although they are not considered to be a form of skin cancer, they can turn into skin cancer if they aren't treated promptly.
Like skin cancer, actinic keratosis is caused by too much exposure to UV light, such as from sunlight. People with fair skin that burns easily are at a higher risk of actinic keratosis.
How can you tell if you may have actinic keratosis? Check your skin, especially any sun-exposed areas, for rough, scaly lesions that may be skin-coloured, red, pink, grey, or brown. The lesions are often covered with a crust. Actinic keratosis is often found on the face, scalp, ears, neck, arms, and hands. If you notice anything that fits this description, or any other skin changes you're concerned about, check with your doctor.
If your doctor diagnoses actinic keratosis, there are a number of treatment options. Surgery can be used to remove the lesions, either by cutting out the lesion, using liquid nitrogen to "freeze" the lesion, using a laser to destroy the cells of the lesion, or using bursts of electricity to dry out the lesion and make it easy to remove. Medications, such as fluorouracil and imiquimod, can be applied to the skin to help clear up the lesions. Photodynamic therapy, which uses a special light source in combination with medication, can also be used to treat actinic keratosis.
How can you prevent actinic keratosis? The same way you can protect yourself from skin cancer - by avoiding exposure to UV light and monitoring on your skin. So using sunscreen, avoiding the peak sun hours (10 am to 4 pm), covering up with clothing and sunglasses, and doing monthly skin self-exams can all reduce your risk of actinic keratosis, or help catch it early if it does develop.