Skin Cancer

Every hour one American is killed by skin cancer and every thirty seconds one American gets skin cancer.Cancer is a deadly disease that alters the DNA of a skin cell and causes it to reproduce at a rapid pace. Thisoverproduction of cells can be harmful and in many cases deadly.

Out of these cancers the most commonis Basal cell carcinoma. Many steps have been made in the treatment of Basal Cell Carcinoma, some havebeen very successful and some not.The cells that have the altered DNA are called malignant or cancerous cells.

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These cells are found in theouter layers of the skin. The skin’s main job is protect the body from infections and to insulate the body tokeep it at the proper temperature.The first layer of skin is called the epidermis. This is the layer that is closest to the surface of the skin.There are three types of cells in this layer. The first is the squamace. The squamace cells are flat and scalyand are located closest to the surface of the skin.

Second are the basal cells and finally are the melanocyteswhichgive the skin its color.The second layer of skin is the dermis, which is much thicker than the epidermis.This layer contains sweat glands, nerves and blood vessels. The dermis also contains follicles which aretiny pockets from which the hair grows. (Jablonski)The most common malignant cells are the basal cells. Cancer in the basal cell is called nonmelanomacancer. This means that the cancer did not start in the melanocytes located in the epidermis.

(Prestan 1650)Basal Cell Carcinoma is caused by overexposure to the sun. The sun gives off ultraviolet rays which areharmful to the human body. Basal cell carcinoma will affect body parts such as the eyes, ears and nose. Ifit is detected before it gets deep into the skin there will most likely be no problem treating the cancer. Theproblem is when it is detected after it has progressed into the deep portions of you tissue. If Basal cellcarcinoma is left untreated it can be very hard to treat and may even cause death. (Elson, 1)The common methods of treatment involve the use of Mohs micrographic surgery, radiation therapy,electrodesiccation and curettage, and simple excision. Each of these methods is useful in specific clinicalsituations.

Depending on the case, these methods have cure rates ranging from 85% to 95%.Mohs micrographic surgery, a newer surgical technique, has the highest cure rate for surgical treatment ofboth primary and recurrent tumors. This method usesmicroscopic control to determine the extent of tumor invasion. Although Mohs micrographic surgerymethod is complicated and requires special training, it has the highest cure rate of all surgical treatmentsbecause the tumor is microscopically outlined until it is completely removed. While other treatmentmethods for recurrent basal cell carcinoma have failure rates of about 50%, cure rates have been reported at96% when treated by Mohs micrographic surgery. (Thomas 135-142) “Mohs micrographic surgery is alsoindicated for tumors with poorly defined clinical borders, tumors with diameters larger than two cm, tumorswith histopathologic features showing morpheaform or sclerotic patterns, and tumors arising in regionswhere maximum preservation of uninvolved tissue is desirable, such as eyelid, nose and finger.

” (Thomas135)Next there is a treatment involving simple excision with frozen or permanent sectioning for marginevaluation. This traditional surgical treatment usually relies on surgical margins ranging from three to tenmillimeters, depending on the diameter of the tumor. (Abide 492-497) Tumor recurrence is not uncommonbecause only a small fraction of the total tumor margin is examined pathologically. Recurrence rate forprimary tumors greater than 1.5 cm in diameter is at least twelve percent within five years; if the primarytumor measures larger than three cm, the five year recurrence rate is 23.1%. Primary tumors of the ears,eyes, scalp, and nose have recurrence rates ranging from 12.

9% to 25%.Third there is electrodesiccation and curettage. This method is the most widely employed method forremoving primary basal cell carcinomas.

Although it isa quick method for destroying tumor, adequacy of treatment cannot be assessed immediately since thesurgeon cannot visually detect the depth of microscopic tumorinvasion. Tumors with diameters ranging from two to five mm have a fifteen percent recurrence rate aftertreatment with electrodesiccation and curettage. Whentumors larger than three cm are treated with electrodesiccation and curettage, a 50% recurrence rate shouldbe expected within five years.The fourth type is radiation therapy. Radiation is a logical treatment choice, particularly for primary lesionsrequiring difficult or extensive surgery (e.g., eyelids, nose, ears).

It eliminates the need for skin graftingwhen surgery would result in an extensive defect. Cosmetic results are generally good to excellent with asmall amount of hypopigmentation or telangiectasia in the treatment port. Radiation therapy can also beutilized for lesions that recur after a primary surgical approach. “Radiation therapy is contraindicated forpatients with xeroderma pigmentosum, epidermodysplasia verruciformis, or the basal cell nevus syndromebecause it may induce more tumors in the treatment area”.”Following treatment for basal cell carcinoma, the patient should be clinically examined every six monthsfor five years.” Thereafter, the patient should be examined for recurrent tumor or new primary tumors atyearly intervals.

It has been prospectively found that 36% of patients who develop a basal cell carcinomawill develop a second primary basal cell carcinoma within the next five years. Early diagnosis andtreatment of recurrent basal cell carcinomas or another primarybasal cell carcinoma is desirable since the treatment of the disease in its earliest stages results in less patientmorbidity. (Prestan 1649-1662)Carbon dioxide laser is most frequently applied to the superficial type of basal cell carcinoma.

It may beconsidered when a bleeding diathesis is present, since bleeding is unusual when this laser is used. (Lippman862-869)Topical fluorouracil (5-FU) may be helpful in the management of selected superficial basal cellcarcinomas. Careful and prolonged follow up is required, since deep follicular portions of the tumor mayescape treatment and result in future tumor recurrence (Dabski 378-379)In conclusion Basal Cell Carcinoma has many different treatment that are very helpful. Some more thanothers. Instead of going through the hassle of treating Basal Cell Carcinoma one should prevent it fromentering into your system.

“Basal cell carcinoma is 100% preventable with the daily use of sunscreen beginning in the childhoodyears” (Elson 1). Sunscreen prevents the ultraviolet rays from coming in contact with the skin thuspreventing the cancer from entering into you body.Works Cited(1) Abide, JM, Nahai F, Bennett RG. The Meaning of Surgical Margins: Plastic andreconstructive Surgery. : 492-497, 1984.(2) Dabski K, Helm F.

Tropical Chemotherapy: Schwartz RA: Skin Cancer: Recognition andManagement. New York, NY: Springer-Verlag, 1988, pp 378-389.(3) Elson, Melvin.

Internet Reference.”http://www.colombia.net/consumer/datafile/skincanc.html.(4) Internet Reference. “http://maui.

net/southsky/introto.html(5) Jablonski, Francis. Personal Interview. 10 March 1997(6) Lippman SM, Shimm DS, Meyskens FL: Nonsurgical treatments for skin cancer: retinoids andalpha-interferon. Journal of Dermatologic Surgery and Oncology: 862-869, 1988.

(7) Preston DS, Stern RS: Nonmelanoma cancers of the skin. New England Journal of Medicine327(23): 1649-1662, 1992.(8) Thomas RM, Amonette RA: Mohs micrographic surgery. American Family Physician/GP37(3): 135-142, 1988.