Recently a middle-aged man came to me for skin disease. He has had a mole on his thigh for years. So far it hasn’t caused any problems. It has been growing bigger for a few weeks now. Its color has also changed a little. He came to me as a family doctor for that.
After examining him, I said, ‘You should consult a dermatologist.’ He said ‘Why, Doctor, can’t you see?’ he asked. I said, ‘I suspect it might be cancer in your thigh.’ ‘Can you get skin cancer too, doctor?’ he asked. ‘Yes!’ I said.
Many of us are unaware of skin cancer. Skin cancer is more common in western countries because of their skin color and texture. But as Indians do not get that much skin cancer, there is less awareness about it. Hence this article. Before introducing skin cancer you need to pass on a little understanding of skin.
Body armor
The skin covering the body is the largest organ in the body. The skin is about 15 percent of the body weight. If the skin of a sixty-year-old person were to be spread over the entire surface, it would cover an area of 2 square meters. Its thickness varies from place to place. It is as thin as one and a half millimeters in some places and as thick as 6 or 7 millimeters in others.
Our skin is made up of three layers, Epidermis, Dermis, and Hypodermis. Epidermis is a shield that protects the internal organs of the body. The epidermis is made up of five layers. Each is made up of ‘keratin’ cells. It has old cells on its surface. New cells are born at its base and are coming towards the surface.
When these reach the surface, they become dead cells. Thousands of these dead cells are shed every day when we shower and change clothes. Thus it takes 35 to 45 days for a keratin cell to form and shed. Our skin is always new looking because of the keratin cells that ‘old fall out and new ones come in’.
The epidermis contains pigments called ‘Melanin’ which gives color to our skin. These are secreted by cells called ‘Melanocyte’. If the number of these pigments is too high, the skin color is black; The color is a little less; White color if very less. There are many sweat pores on the surface of the skin. Begins in the dermis and passes through the dermis to the epidermis and ends in the sweat duct, the sweat gland. There are about 30 lakh sweat glands in the body.
The dermis contains a glue-like protein called ‘collagen’ and a protein called ‘elastin’. These help to keep the skin supple and give elasticity to the skin. The reason why the skin is shiny is due to the oil glands (Sebaceous glands) in the skin.
The dermis contains a lot of blood vessels, lymph vessels, nerves, and fibers. Hair sprouts from the hair follicle here and comes to the epidermis. Under the skin there is a layer of fatty tissue.
Types of skin cancer
Skin cancer can be divided into three types. 1. Basal cell type (Basal Cell Carcinoma). 2. Squamous Cell Carcinoma. 3. Melanoma cell type (Melanoma). Primary cancer can also occur in the skin. Conversely, other cancers such as breast cancer and pancreatic cancer can spread to the skin. Then that cancer is called ‘secondary cancer’.
1. Basal cell type: Generally, this type of cancer occurs in fair-skinned people. So it is more for westerners. Black people don’t get it. In particular, it does not apply to blacks and Indians. This cancer occurs in the nose area, the skin between the eyes and the triangular area of the face between the mouth. It does not spread to lymph nodes. Hence, bottlenecks do not occur.
Usually, it starts as a small blister. So many people ignore it without understanding its seriousness. Over time this blister will enlarge, break and become ulcerated. This ulcer does not respond to conventional medications. At first the ulcer is not painful. The pain will start gradually. Bleeding may also occur. It can then penetrate the skin and spread to muscles and bones over the next few months. It is, in general, bland. Does not spread to nearby lymph nodes. So there are no bottlenecks.
2. Squamous cell type: Although it can occur anywhere on the skin, this type of cancer is more common in the forehead and ear region of the face. It is not as benign as the basal cell type. It tends to spread to nearby lymph nodes. Because of this, there will be bottlenecks in the neck. It can spread to many places in the body.
Initially, it starts as a small lump. It doesn’t hurt. If left untreated, the tumor may enlarge and rupture. Then, it turns into a sore that won’t heal. If the sore does not heal within three weeks, consult a doctor immediately. Now many people have diabetes, wrongly thinking that ‘diabetes is why the ulcer is not healing’ and many people do not seek treatment in the early stages of cancer.
3. Melanoma cell type: This is slightly more dangerous than the first two types. Initially, the rash appears as a small mole. It suddenly picks up speed and grows. There will be pain and bleeding. It often appears on the scalp, back, and toes. Spread to nearby lymph nodes and cause strictures. It can also spread to many places in the body.
What tests are available?
Biopsy is important for skin cancer. A small amount of tissue is removed from a non-healing sore or tumor and analyzed to determine whether or not it is cancerous, and if so, what type it is. Subsequently, X-rays, CT scans, and MRIs are used to determine whether the cancer has spread within the body. Scan, ‘Ped-CT’ scan tests are done. The results of these tests will determine its status.
Cancer stages
Stage 1: This is an early stage where the cancer is less than 2 cm in size.
Stage 2: This is the stage where the cancer is more than 2 cm in size. Spread to nearby lymph nodes. For example, a cancer on the face means a strangulation in the neck.
Stage 3: This is the stage where the tumor has spread to many lymph nodes in the body.
Stage 4: Skin cancer has spread to multiple organs such as the liver, spleen, and bones.
What are the treatment options?
The first two stages are treated with surgery and radiation therapy. Radiation therapy is given for stage III and stage IV cancer. Melanoma is treated with surgery, radiation therapy, and drugs.
When skin cancer is detected in its early stages, treatments are easier. If the cancer has penetrated deeply, treatment becomes difficult. Therefore, if a small rash, swelling, tumor or mole appears anywhere on the skin, it is better not to ignore it because it is not painful, but to consult a doctor at the beginning. That is the best way to prevent skin cancer!