Skin cancer

Introduction:
Skin cancer is usually a result of too much exposure to the sun. While skin cancer is the most common form of cancer, many types are both preventable and treatable. Skin cancer is classified into five different types: Basal cell carcinoma (BCC) is the most common form and accounts for 90% of all skin cancers. It starts in the basal cells, at the bottom of the epidermis (outer skin layer), and is caused by long-term exposure to sunlight. It is the most easily treated. Squamous cell carcinoma (SCC) is the second most common type. It starts in the epidermis, eventually penetrating the underlying tissue if not treated. It is easily treated when found early, but in a small percentage of cases, this cancer spreads (metastasizes) to other parts of the body. Malignant melanoma (MM) is the most serious type of skin cancer and is responsible for the most deaths. However, it can be cured if it is diagnosed and removed early. Melanoma starts in moles or other growths on normal skin. Kaposi's sarcoma (KS) is caused by a virus in the herpes family. An aggressive AIDS-related form affects about one third of people with AIDS. A more slow-growing form occurs in elderly men of Italian or Jewish ancestry.

Signs and Symptoms:

Basal cell carcinoma:

Shiny bump that is pearly or translucent Flat, flesh-colored lesion appearing anywhere on the body

Squamous cell carcinoma:

Hard, red nodule on face, lips, ears, neck, hands, arms Flat lesion with scaly surface

Melanoma:

Change in color, size, shape or texture of a mole Skin lesion with irregular borders Enlargement of an existing skin lesion Large brown spot with darker speckles Hard, dome-shaped bumps anywhere on your body

The only way to know for sure whether a mole or spot on your skin is cancer is to have it examined by a doctor.

What Causes It?:

Exposure to ultraviolet (UV) radiation from the sun is the primary cause of skin cancer. Skin cancer may also be due to genetics (heredity), or radiation treatments. A virus causes Kaposi's sarcoma.

Who's Most At Risk?:

People at risk for developing skin cancer may have the following conditions or characteristics:

Fair skin Spend a lot of time outdoors in work or leisure activities History of sunburn Family history of skin cancer Many moles Are over age 40 Large dark-colored birthmark known as congenital melanocytic nevus Pre-cancerous skin lesions, such as actinic keratosis HIV (human immunodeficiency virus) -- a risk for Kaposi's sarcoma specifically

What to Expect at Your Provider's Office:

Your doctor will examine your skin for new, changed, or unusual moles. This may involve the use of a dermatoscope, which is used for close examination of skin growths. If your doctor suspects cancer, a biopsy (sample of the skin) will be taken. A biopsy can confirm whether or not you have skin cancer.

Treatment Options:

Prevention
In most cases, skin cancer is a preventable disease. If you are at high risk, avoid exposure to the sun. When you have to be in the sun, protect yourself by covering up, wearing a hat, and applying sunscreen with an SPF of at least 30. You should also have regular skin cancer screenings with your primary health care provider or dermatologist.

Treatment Plan
The primary goals of treatment are to remove the cancerous growth and stop the spread of the disease.

Drug Therapies

Melanoma that is deep or has spread and AIDS-related Kaposi's sarcoma may be treated with chemotherapy. Also, in cases where cancer is found only in the top layer of skin, topical creams or lotions containing chemotherapy drugs may be used.

Surgical and Other Procedures

Most skin cancer can be surgically removed. Cryotherapy (freezing), topical chemotherapy, or radiation also may be used. If the cancer is on or close to the skin's surface, photodynamic therapy (laser) may be used.

Complementary and Alternative Therapies

Alternative treatments are focused on preventing rather than treating skin cancer. In addition, some CAM treatments may reduce the side effects of conventional treatments, such as chemotherapy, or enhance skin health. You should never rely on alternative therapies alone for treating skin cancer. Any CAM therapies used along with conventional cancer treatment should be discussed fully with all of your doctors. Some CAM therapies can interfere with conventional cancer therapies.

Nutrition
Eating certain foods may help protect against skin cancer. It is hard to test the role of nutrients in preventing various forms of skin cancer, but several studies have looked at antioxidants (including vitamin C, vitamin E, beta-carotene, zinc, and vitamin A), folic acid, fats and proteins, and a variety of whole foods. While results are not absolutely clear, antioxidants may offer some protection from skin cancer. Foods such as fish, beans, carrots, chard, pumpkin, cabbage, broccoli, and vegetables containing beta-carotene and vitamin C may also help protect skin. Studies on animals suggest that lignans, substances found in foods such as soy and flaxseed, may help fight cancer in general, including the spread of melanoma from one part of the body to another. Other substances found in plants may help protect your skin from sun-related damage:

Apigenin, a flavonoid found in vegetables and fruits, including broccoli, celery, onions, tomatoes, apples, cherries and grapes, and in tea and wine Curcumin, found in the spice turmeric Resveratrol, found in grape skins, red wine, and peanuts Quercetin, a flavonoid found in apples and onions

Selenium has been touted as an antioxidant that might help prevent skin cancer. One study, however, suggests that selenium might actually increase the risk of developing squamous cell cancer. Talk to your doctor before taking a selenium supplement. Eating a well-balanced, healthy diet that consists mainly of fruits, vegetables, low-fat dairy, and whole grains can help your body cope with the effects of chemotherapy or other cancer treatment. Avoid foods that are high in fat and sugar; they can cause inflammation.

Herbs
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner. A number of herbs and herbal combinations are used to prevent and treat cancer in general. However, you should never use herbs alone to treat any kind of cancer. Be sure to talk to your doctor before using any herbs along with other treatments and work with practitioners knowledgeable in the use of herbal medicine.

Green tea (Camellia sinensis) contains polyphenols, compounds that are potent antioxidants. Antioxidants eliminate damaging particles in the body known as free radicals, which damage cell membranes, tamper with DNA, and even cause cell death. Free radicals are thought to play a role in cancer. The main polyphenol in green tea is epigallocatechin gallate (EGCG). Scientific studies suggest that EGCG and other green tea polyphenols may prevent skin tumors from starting or growing. Other herbs with antioxidant and skin-protecting effects include bilberry (Vaccinium myrtillus), ginkgo (Ginkgo biloba), milk thistle (Silybum marianum), ginger (Zingiber officinale), and hawthorn (Crataegus laevigata). Although there are no scientific studies on using these herbs to treat skin cancer, they have been used traditionally to protect the skin. For Kaposi's sarcoma, some naturopaths recommend a paste made from lemon balm (Melissa officinalis) cream, several drops of Hoxsey-like formula (a mixture of herbs and potassium iodide that may be effective against cancer), and powdered turmeric applied to lesions twice a day. You should only use this mixture under the close supervision of a physician.

Remember that certain herbs and nutrients can alter the way medications, including chemotherapy, act in your body. Make sure you keep your conventional and alternative health care providers informed about all the supplements, therapies, and medications you are using. Do not take any herbs or supplements without first talking to your oncologist.

Homeopathy
Many people with cancer use homeopathy as an additional therapy, along with conventional medicine. An experienced homeopath considers your individual case and recommends treatments that address both your underlying condition and any symptoms you may be having.

Acupuncture
While acupuncture is not used as a treatment for cancer itself, evidence suggests it can help relieve cancer-related symptoms (particularly the nausea and vomiting that often come with chemotherapy). Some studies have indicated that acupuncture may help reduce pain and shortness of breath. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness. Acupressure is a technique that you can learn and use to treat yourself.

Some acupuncturists prefer to work with a person only after they have completed conventional medical cancer therapy. Others will provide acupuncture or herbal therapy during active chemotherapy or radiation. Acupuncturists treat cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.

Prognosis/Possible Complications:
Prognosis varies depending on the type of skin cancer:

Basal cell carcinoma: generally excellent. Squamous cell carcinoma: excellent for small lesions removed early and completely. Malignant melanoma: 5-year survival is almost 100% for very superficial lesions removed early. However, thick lesions and melanoma that has spread to other organs have poor prognosis. Kaposi's sarcoma: good for superficial lesions of the slow-growing form in the elderly of Italian or Jewish ancestry. The course of AIDS-related Kaposi's sarcoma depends on the status of the person's immune system.

Following Up:
See your health care provider regularly for screenings to check for a recurrence of skin cancer.

Alternative Names:
Cancer - skin

Reviewed last on: 12/11/2009 Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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