What is Skin cancer: Skin cancer is the most common type of cancer found in humans. Around 1 million skin cancer cases were registered for every early and this annual rate is increasing drastically due to increase in risk factors. Skin cancer can be recognized by the changes in appearance of the skin. Skin cancer causes the skin cells to grow rapidly without any controlling limit.

Skin cancer is a combination of several diseases with different types of causes, symptoms and treatments. Skin cancer effects the basic life cycle of the cells and causes an abnormal growth and division of cells without any controlling limit, then it results in forming tumor (excess tissue) in the body.

Tumors are of two types, they are as follows:

• Benign tumor
• Malignant tumor

Benign tumor: This tumor is not cancerous. They can be treated easily. They don’t spread to other parts of the body. If this tumor continues to grow in the same site for long time then it causes damage to the distant organs.

Malignant tumor: This tumor is cancerous, they causes damage to the adjacent organs by spreading the cancer cells at high rate. The cells in this tumor invade the distant organs and forms new tumors through blood flow or by lymphatic system. The new tumor has the same characteristic features of the primary tumor. For example, if the skin cancer spreads to the lungs, the cancer cells in the lungs are actually belonging to the skin cancer cells. Then this disease is called as metastatic skin cancer.

Skin cancer types: Skin cancer is categorized into three different types they are

• Basal cell carcinoma
• Squamous cell carcinoma
• Melanoma

Basal cell carcinoma: This skin cancer is not metastatic .It doesn’t spread to other parts but causes damage to nearby tissues. The risk factors for basal cell carcinoma are listed below. The basal cell carcinoma looks like dome shaped bump. This bump shape is covered by the telangiectases blood vessels .the starting stage of this benign tumor cannot be detected easily because it is shiny and translucent. With the biopsy process we can detect the starting age of this skin cancer. Some of the carcinomas contain melanin pigment which makes the tumor to look dark rather than shiny.
Basal cell carcinomas generally appear on the back side or chest. Basal cell carcinomas make the skin dry with raw patches. These carcinomas take several years to grow into uncontrolled size and damage the nearby senses by disfiguring ear, nose or eye.

Squamous cell carcinoma: This cancer occurs in the squamous cells. These carcinomas appear to be thin, flat cells which look like fish scales. These Squamous cells present in the surface tissues of the skin. So if there is any abnormality in the squamous cells, then Squamous cell carcinoma occurs. Due to excess growth of squamous carcinoma cells a mound is formed which is called as keratoacanthoma.

Risk factors of basal cell carcinoma, Squamous cell carcinoma and Melanoma:

Age: This type of skin cancer occurs after the age of 50 years. But the sun burning effects starts in the early stage.

Sun exposure: People who face severe blistering sunburns can have the chance of occurring melanoma cancer. So, sunburns in young age will be a risk factor for casing basal cell carcinoma cancer. Take sun lotion creams to avoid the risk factor of melanoma cancer.

UV radiation: Due to long exposure to the ultraviolet radiations, the chances of having basal cell carcinoma cancer increases. People who stay in the sun for longer time will have more risk factors. Due to this UV rays the skin becomes grey and causes skin irritation. Aging of the skin appears due to increase in risk factors. So, please stay away from UV rays to reduce the risk factors of basal cell carcinoma cancer.

Therapeutic treatment: Taking this treatment for curing other cancer diseases can increase the chance of having basal cell carcinoma cancer.

Weak immune system: People with weak immune system will have more chances of getting skin cancer.

Family pedigree: Risk factors of skin cancer sometimes can be caused due to the family relation link. It some time runs in the families. So please take regular checkup to reduce the risk factors of this cancer.

Fair skin: People with fair skin have more chances to expose to melanoma cancer because it is easily burned and freaked out. So, people with fair skin should take some skin lotions to reduce the causing factors of melanoma cancer.

Having more moles on the body: Too many moles in the body can cause melanoma cancer for sure.

Skin cancer symptoms and signs:
• Gray skin
• Head aches
• Swollen lymph nodes
• Pain in moles
• Asymmetry
• Border irregularity
• Color diameter
• Weight loss
• Chronic cough
• Skin thickening
• Itching, tingling, Irritations.
• Redness
• Swelling
• Patches
• bleeding
Treatment for basal cell carcinoma and Squamous cell carcinoma:

Surgical operation: Surgery operation is carried to remove the entire tumor. This process is useful during the early stages of the tumor occurrence.

Curettage and desiccation: Curette is the instrument used by the dermatologists to remove the tumor by scooping out the cell carcinoma. And desiccation is the electric current process useful in burning the remained cancer cells. This treatment is carried for small cancers.

Radiation therapy: This treatment is based on the extent of the skin disease. Radiotherapy is a process of removing carcinoma cancer cells by using high intensity x-rays. These high energy x-rays are aimed at the effected part of the skin surface to destroy the cancer cells.

Cryo surgery: This is a new process evolved in treating the carcinoma cancer cells. In this process the cancer causing cells in the body are destroyed completely by injecting a freezing liquid through intravascular veins of the body. The freezing liquid used in this treatment process is nothing but argon or liquid nitrogen. This freezing liquid is directly injected into the body for the removal of cancer cells. This treatment is given when there is advancement in the skin cancer. This treatment produces side effects like damage to the urethra and bladder by damaging normal cells.

Mohs micrographic surgery: This treatment process gives 98 percent of success rate in removing carcinoma cells. This treatment causes very low side effects and damages very less normal cells. This process is carried by making small incision to the effected part of the body for removing the entire carcinoma tumor or part of it by micrographic instruments. The sequence of removing carcinoma cells is carried continuously without causing any pain. The cure rate is very high and this is the best process for treating advanced skin cancers.

Medical therapy by using creams: This treatment can be taken to avoid surgery. This medical therapy creams kills the cancer cells and increases the body immune system to protect from infections.

Treatment of melanoma cancer:
Surgery: Surgery is carried to remove the cancer tumor. Surgery can be carried in the early stages of the tumor occurrence. Surgery is taken place only if the cancer is located in only one part of the body. During the surgery process the damaged lymph nodes are also removed along with the tumor. This surgery process depends on the location, area and size of the tumor.

Chemotherapy: Chemotherapy drugs are called as anti-cancer drugs used to destroy cancer cells .there are many types of chemotherapy drugs available in the market for the treatment of cancer. These drugs are available in the form of pills but mostly given by drip into the blood veins.

Radiotherapy: Radiotherapy is a process of removing cancer cells by using high intensity x-rays. These high energy x-rays are aimed at the cancer affected part of the body to destroy the cancer cells. This process also causes damage to the normal cells for its side effects.

Biotherapy: Due to weak immune system in the body, there are chances for the development of cancer. So this Biotherapy treatment process is useful in rebuilding strong immune system in the body. Biotherapy is also called as immunotherapy or biological response modifier therapy. This treatment process is really useful in repairing, enhancing and stimulating the weak immune system of the body. This process can be carried along with surgery, chemotherapy and radiotherapy.

Melanoma cancer is treated as the serious skin cancer disease due to its risk factors. It is treated as a malignant tumor because it spreads through out the body. The treatment for this melanoma cancer should be carried in the early stages to cure it completely.

Basal cell carcinoma and Squamous cell carcinoma are most common type of skin cancers found in people. These two types of skin cancers are together called as Non-melanoma skin cancer. Melanoma skin cancer is termed as metastatic skin cancer because of its serious effects. Melanoma is a serious type of skin cancer which spreads through out the body.

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Skin cancer can be divided into two main groups:

Malignant melanoma and 
Non-melanoma skin cancer.

Malignant melanoma

Malignant melanoma is the rarest, but most serious form. It affects the pigment-producing cells (melanocytes) found in the skin and can appear as a new mole, or arise from an existing mole on the skin. Malignant melanoma has the potential to spread to other sites or organs within the body but is curable if treated early. Each year about 235 females and 150 males are diagnosed with malignant melanoma in Ireland.

Non-melanoma skin cancers (Basal cell carcinoma and squamous cell carcinoma)

Non-melanoma skin cancers are far more common but less dangerous than malignant melanoma and rarely fatal. Basal cell carcinoma and squamous cell carcinoma frequently appear on sun-exposed skin after many years of exposure. This exposure also causes premature ageing of the skin. Non-malignant skin cancers are easily treated by minor surgery. If left, non-melanoma skin cancers will grow and disfigure – therefore early treatment is recommended. Each year about 7,500 people are diagnosed with non-melanomatous skin cancers in Ireland with 3445 in females, 3889 in males.

Basal cell carcinomas

Squamous cell carcinomas

Solar keratoses (actinic) 
Solar keratoses develop on skin which has been damaged by long term sun exposure. Usually many are present and can appear as hard, scaly lumps. Some become unsightly as they slowly grow larger. The skin underneath solar keratoses can vary in colour from a normal fleshy shade to pink or red. Sometimes these skin lesions can become itchy. Common sites are the face, backs of hands, forearms, ears, scalp and neck. Solar keratoses are not skin cancers. However, a very small percentage can develop into a skin cancer in later life. Some specialists regard solar keratoses as precursors to skin cancer, therefore it is important to seek medical advice on treatment.

- Solar keratoses appear as hard scaly lumps on the skin. They may crust but do not heal. 
- Solar keratoses can be rough, scaly irregular patches which are easily felt but not clearly seen. 
- Often they are not troublesome in anyway but do not heal. 
- Some are very troublesome, if present on the lips or nose as they tend to bleed spontaneously.

Solar keratoses are most frequently treated by freezing using Liquid Nitrogen (Cryotherapy) or by applying a treatment cream. Some larger lesions may be removed by minor surgery under local anaesthesia. Treatment is usually carried out on an out-patient basis with the minimum disruption to your daily routine. All treatments aim to cure. The most appropriate treatment depends on the size, site and number of solar keratoses. Solar keratoses seldom recur following treatment but others may develop over the years.

Who is most at risk of developing skin cancer?.

People with very fair skin are most at risk of developing skin cancer. Those who cannot develop a tan are most at risk of malignant melanoma, but everyone is at risk of being sunburnt, especially indoor employees, children and babies. Malignant melanoma is more common in females. Non-melanoma skin cancers are most frequently seen in older age groups and outdoor workers who have a continuous all-year tan. The incidence of skin cancer is rapidly rising in the young adult population.

Are skin cancers treatable?

Both malignant melanoma and non-melanoma skin cancers are curable if treated in the early stages. A minor surgical procedure is all that is usually required to remove cancers of the skin. Regular inspection of skin and moles at home helps in recognising any abnormal skin lesions or changing moles. Change in size, shape and colour of a mole are the early warning signs of malignant melanoma, the most dangerous form of these skin cancer, because it can quickly metastasise to other parts of the body. However, if is detected soon after if first develops, it is curable by simple surgical excision. In Ireland, over 375 cases of melanoma are reported each year and up to 60 Irish people will die of this disease.

The most common form of skin cancer in Ireland is basal cell carcinoma BCC, of which over 3,500 new cases are reported each year. These numbers are almost halfed between male and female and the incidence shows a small increase over the past six years. This cancer very rarely spreads to other organs but if left undetected, will continue to grow slowly, and may invade the underlying tissues. Again, this tumour is curable by surgery or radiotherapy. The third type of skin cancer is squamous cell carcinoma SCC, which often develops from a solar keratosis or sunspot. If it is not treated early, it may spread to other parts of the body, but is again curable before that occurs by either surgery or radiotherapy. About 600 females and 1,000 males develop squamous cell carcinoma in Ireland each year. The other cancers include those of baso-squamous (mixed) carcinomas and other morphologies.

Sunshine is the single most important causative factor for all skin cancers.

Ultra-violet rays contained in sunshine are known to be harmful and can cause skin cancers. The increase in skin cancers in Ireland has been linked with the desire to have a tan, with repeated sunburn, fair skin types and genetic factors, such as number of moles.

Malignant melanoma is associated with frequent high intensity sun exposure. Whereas non-melanoma skin cancers are caused by long-term exposure to low intensity sunshine. The amount of sun exposure during childhood and frequency of sunburn are now believed to increase the risk of developing skin cancers in adult life. It is therefore most important to protect all children from intense sunshine. Hats, T-shirts and sunscreens are recommended at home, at school and on holiday.

Providing protection against the sun

Sunscreens are vital whenever exposed to strong sunlight, at home as well as abroad. Always reapply sunscreens after water sports, games or exercise. Children play outdoors during the hottest part of the day whilst at school, therefore it is wise to apply an SPF 15+ to your children before they go to school. Emulsions such as Anthelios XL contain aluminium hydroxide and can be used with infants and with highly intolerant skin. ROC make a rnumber of products in the MINESOL(TM) range, including mineral sunblock cream SPF 40, which is recommended for babies in case of inevitable exposure. This particular 100% mineral screen cream has a pleasant and almost invisible texture. During sunny periods liberal sunscreen application should become a daily routine each morning before dressing or 15 minutes before going out in the sun. Heatwaves in Ireland are not uncommon, therefore sunscreens are useful in handbags and first-aid boxes. It is important to apply sunscreens as recommended by the manufacturer. Most sunscreens identify a sun protection factor (SPF) which can range from SPF – SPF60+. The SPF is calculated by each manufacturer for their own particular product so it is important to remember that SPF may differ between brands of sunscreen. All sun protection factors are based on how long it takes for unprotected skin to burn (average length of time = 10 minutes). For example, if you use SPF 15+ the protection offered would last approximately 2-3 hours i.e. (10 minutes X 15 =150 minutes). The SPF is a rough guide only, therefore care and attention should be given to skin type, the strength of the rays or sunshine, time of day, season and latitude from the equator. Many products including Antherpos or Uvistat Lip screen or MINESOL(TM) Sun stick SPF 20 offer lip protection especially in people who are prone to recurrent herpes labialitis.

Sunbeds and solariums

Ultraviolet radiation (UVA rays) emitted from sunbeds and solariums is now known to have harmful effects on skin. Suncreams and Lotions such as Uvistat contain chemical agents and titanium dioxide and are UVA protectants. Excessive use of sunbeds can cause rapid ageing of the skin, long term damage and increase the risk of skin cancer. There is no such thing as a safe tan. Many people today use sunbeds to develop or maintain a tan. Some people believe that a suntan from a sunbed is a safe tan. Skin specialists say a tan is a sign of skin damage and advise everyone to avoid the use of sunbeds and solariums. This is especially important for the very fair skinned and persons under the age of sixteen. Likewise, persons with skin cancer or those with a family history of skin cancer should never use sunbeds or solariums.

NMS cancer statistics for Ireland

* Average of 7334 new cases per year, 1994-96: 3445 in females, 3889 in males.

* Average of 40 deaths per year: 10 in females, 30 in males.

* Age-standardised incidence rates about 48% higher in males than females.

* By far the most common type of cancer in both females and males.

* Recorded incidence rates higher in Republic of Ireland (RoI) than in Northern Ireland (NI), by about 16% for females and 26% for males, but this possibly reflects differences in registration practice.

On average each year, 3445 new cases of malignant non-melanoma skin cancer (NMS) were registered in females, 3889 in males, in Ireland as a whole. NMS cases (primarily squamous cell and basal cell carcinomas) were by far the most common category of cancer in both females and males (29% of all malignant cancer cases).

European-age-standardised rates were significantly higher among males than females, by about 48%. On average, females were estimated to have a 1-in-12 chance of developing these cancers by age 74, males a 1-in-8 chance. Median age at diagnosis was 72 years for females and 70 years for males. In the period 1994-96 only 10 deaths among females and 30 deaths among males were attributed to non-melanoma skin cancer each year. This represents about 1 death for every 200 incident cases, reflecting the fact that these cancers are rarely fatal. Reported mortality rates (EASRs) were significantly higher in males than females, by about 370% (95% confidence limits 200-645%), but inaccurate certification of causes of death may possibly contribute. On average, females were estimated to have a 1-in-6600 chance, males a 1-in-1600 chance, of dying from these cancers by age 74.

Comparison of incidence rates within Ireland

Recorded incidence rates of non-melanoma skin cancer (NMS) were significantly higher in RoI than in NI for both males and females. However, these differences may possibly reflect, in part, higher case ascertainment (completeness of registration) in RoI than NI, as a result of a more targeted effort to collate all NMS cases in RoI. Involvement of other factors cannot be excluded however.

Dr. Patrick Treacy is a cosmetic expert. He is Medical Director of Ailesbury Clinics Ltd and the global Cosmetic Medical Group. He is Chairman of the Irish Association of Cosmetic Doctors and is Irish Regional Representative of the British Association of Cosmetic Doctors. He is European Medical Advisor to Network Lipolysis and the UK’s largest cosmetic website Consulting Rooms. He practices cosmetic medicine in his clinics in Dublin, Cork, London and the Middle East.

Dr. Treacy is on the Specialist Register in the UK and Ireland and holds higher qualifications in Dermatology and Laser technology and skin resurfacing. He was amongst the first doctors worldwide to use the permanent facial endoprosthesis BioAlcamid for HIV Lipodystrophy patients. He was also the first person to introduce many techniques such as Radiofrequency assisted lasers, Fibroblast transplant and Contour Threads to Irish patients.

Dr. Treacy is an advanced aesthetic trainer and has trained over 300 doctors and nurses from around the world. He is also a renowned international guest speaker and features regularly on national television and radio programmes. He was invited to speak about stem cells and cosmetic medicine at the World Aesthetic Conference in Moscow this year.

The Irish College of Cosmetic Doctors 
The British Association of Cosmetic Doctors
The British Medical Laser Association 
The American Society for Aesthetic Medicine
The American Society for Lasers in Medicine and Surgery The European Society of Laser Dermatology
The European Society for Dermatological Surgery (ESDS)
The International Society for Dermatologic Surgery
The International Academy of Cosmetic Dermatology

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