Diagnosing Skin Cancer: Techniques and Procedures

Causes of Skin Cancer

The primary cause of skin cancer is excessive exposure to sunlight, particularly when it results in sunburn and blistering. UV rays from the sun damage the DNA in skin cells, leading to the formation of abnormal cells. These cells then multiply uncontrollably, forming a mass of cancerous cells.

Risk Factors for Skin Cancer

Skin cancer can affect anyone, regardless of race or gender, but certain groups are more susceptible. Before age 50, skin cancer is more prevalent in women and individuals assigned female at birth (AFAB). After age 50, it is more common in men and individuals assigned male at birth (AMAB). It is about 30 times more common in non-Hispanic white people than in non-Hispanic Black people or those of Asian/Pacific Islander descent. Unfortunately, people with darker skin tones often receive a skin cancer diagnosis at later stages, making treatment more challenging.

While anyone can develop skin cancer, the risk is higher for those who:

• Spend a lot of time outdoors for work or leisure.
• Are prone to sunburn or have a history of sunburns.
• Live in sunny or high-altitude areas.
• Frequently tan or use tanning beds.
• Have light-colored eyes, blond or red hair, and fair or freckled skin.
• Have numerous moles or irregularly shaped moles.
• Have actinic keratosis (precancerous skin growths that are rough, scaly, and dark pink to brown).
• Have a family history of skin cancer.
• Have had an organ transplant.
• Take medications that suppress or weaken the immune system.
• Have undergone UV light therapy for skin conditions such as eczema or psoriasis

Diagnosis and Tests

How is skin cancer diagnosed?

A dermatologist will first inquire about any changes in your moles, freckles, or other skin spots, as well as any new growths. They will then perform a comprehensive examination of your skin, including often overlooked areas such as the scalp, ears, palms, soles, between your toes, around your genitals, and between your buttocks.

What tests are used to diagnose skin cancer?

If skin cancer is suspected, a biopsy is typically performed. This involves taking a small tissue sample, which is then sent to a laboratory where a pathologist examines it under a microscope. Your dermatologist will inform you if the lesion is cancerous, specify the type of skin cancer, and discuss treatment options.

What are the stages of skin cancer?

Cancer stages indicate the extent of cancer in the body, ranging from stage 0 to stage IV. Generally, higher stages signify more extensive spread and greater treatment challenges. The staging systems for melanoma and non-melanoma skin cancers differ.

Melanoma Staging

• Stage 0 (melanoma in situ): Melanoma is confined to the top layer of the skin.
• Stage I: Melanoma is low risk, has not spread, and is generally curable with surgery.
• Stage II: Melanoma shows signs that it may recur but has not spread.
• Stage III: Melanoma has spread to nearby lymph nodes or skin.
• Stage IV: Melanoma has spread to distant lymph nodes, skin, or internal organs.

Non-Melanoma Staging

• Stage 0: Cancer is confined to the top layer of the skin.
• Stage I: Cancer is in the top and middle layers of the skin.
• Stage II: Cancer affects the top and middle layers and targets nerves or deeper skin layers.
• Stage III: Cancer has spread beyond the skin to lymph nodes.
• Stage IV: Cancer has spread to other parts of the body, such as the liver, lungs, or brain.

Management and Treatment

How is skin cancer treated?

The treatment for skin cancer depends on its stage. Sometimes, a biopsy alone can remove all the cancerous tissue if the lesion is small and superficial. Other common treatments for skin cancer, which may be used alone or in combination, include:

• Cryotherapy:
  Liquid nitrogen is applied to freeze and destroy cancer cells, which then fall off after treatment.
• Excisional Surgery:
  The tumor and some surrounding healthy tissue are surgically removed to ensure all cancer cells are eliminated.
• Mohs Surgery:
  Precise removal of cancerous tissue, sparing as much healthy tissue as possible. This is often used for basal cell and squamous cell cancers, especially in sensitive or cosmetically important areas like the eyelids, ears, lips, forehead, scalp, fingers, or genital area.
• Curettage and Electrodesiccation
  : A looped instrument is used to scrape away cancer cells, followed by an electric needle to destroy any remaining cells. This technique is commonly used for basal cell and squamous cell cancers and precancerous growths.
• Chemotherapy:
  Anti-cancer medications are used to kill cancer cells. Topical chemotherapy is used for surface-level skin cancer, while systemic chemotherapy (oral or IV) is used for cancer that has spread.
• Immunotherapy:
  Medications are used to stimulate the immune system to recognize and attack cancer cells.
• Radiation Therapy:
  High-energy radiation is used to kill cancer cells or inhibit their growth.
• Photodynamic Therapy:
  The skin is treated with a light-sensitive medication, which is then activated by a specific light source, destroying precancerous cells while sparing normal tissue.

Complications and Side Effects of Treatment

The side effects of skin cancer treatment vary based on the method used. Chemotherapy can cause nausea, vomiting, diarrhea, and hair loss. Other potential side effects or complications include:

• Bleeding
• Pain and swelling
• Scarring
• Nerve damage leading to loss of sensation
• Skin infection
• Recurrence of the tumor after removal