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Skin Cancer

What is skin cancer?

The skin, the largest organ in the body, has many tasks. The skin covering internal organs protects the body from possible injuries, prevents the loss of excess water and fluid, and supports the body's supply of vitamin D. In addition, it protects both against microbes such as bacteria and against harmful ultraviolet (UV) rays and helps control body temperature. Skin cancer or dermal cancer is a malignant (malignant) growth that occurs on the skin for many reasons. The skin is formed by 3 layers: the epidermis, dermis and subcutis.

Epidermis: Uppermost layer of the skin is the epidermis. Epidermis is very thin and has a thickness of about 0,05-0,1 mm. It protects lower layers of the skin and organs from external influences. Keratinocytes are main types of cells of the epidermis. These cells produce an important protein called keratin, which helps the skin to protect the body. Outermost part of the epidermis is called horny layer (stratum corneum). In this part, dead keratinocytes are replaced with new ones. Cells in this layer are called squamous (flat) cells due to their flat shapes. Living squamous cells are located under this layer (stratum corneum). These cells move from the lowest part, that is base layer, to upper part, that is outer layers of the epidermis. The cells in the basement layer are called basal cells. Their tasks are to divide to form new keratinocytes, thereby to ensure regeneration of the skin. Thus, older keratinocytes which decrease over time on the surface of the skin, are replaced by new cells.

Melanocytes are cells located in the epidermis that can turn into melanoma (skin cancer). These skin cells produce brown pigments that are called melanin and give the skin a bronze or dusky color. Melanin protects lower layers of the skin from some harmful effects of the sun. In many people, when the skin is exposed to the sun, melanocytes produce more of these pigments, causing the skin to bronze. The epidermis is separated from lower layers of the skin by a basal membrane. This is an important structure. Because when skin cancer progresses, it develops towards this barrier and lower layers.

Dermis: It is the name given to middle layer of the skin and is a much thicker layer than the epidermis. It contains hair follicles, sweat glands, veins and nerves that are held by a protein called collagen which gives the skin durability and elasticity.

Subcutis: The lowest layer of the skin is called the subcutis. The lowest part of subcutis and dermis forms a network of collagen and fat cells. Subcutis helps maintain body temperature. Also, this layer has a shock-absorbing effect, which helps to protect the body organs from injury.

What are the symptoms of skin (Skin) cancer?

The most important symptom of skin cancer is a new spot or size and shape of spot in the skin or change of its color. Another important sign is that the skin spot looks different from other spots on your skin. This is also called ugly duck sign. If you observe one of these warning signs, you should appeal your physician without loss of time.

Other Warning Signs:

  • Non-healing wound
  • The pigments spreads the skin around it by exceeding the spot.
  • Redness or a new swelling beyond its limit
  • Increased sensitivity- itching, tenderness, or pain
  • Alteration of the surface of the nevus- bulging, bleeding, or appearance in the form of nodule or bump

It can sometimes be difficult to distinguish the difference between a normal nevus and melanoma. The right thing in this case is to contact a specialist dermatologist as soon as possible.


How is skin (Derma) cancer diagnosed?

The most important symptom of skin cancer is new spot or size and shape of spot in the skin or change of its color. Unusual and unhealing wounds, bumps, spots, scratches, or change in the appearance of the skin, any presence of color change from pink to black, change of the surface of the nevus (bulging, bleeding, or an appearance in the shape of nodule or bump), itching, or tenderness and pain may be sign of melanoma or other type of a skin cancer or may be warning that cancer may develop. When such symptoms are encountered, contacting a specialist dermatologist without loss of time will allow you to quickly find a solution to early detected health problem.

Self-Examination of the Skin for Skin Cancer: It is very important to check the skin twice a month. Knowing the characteristics of nevus, spots and macula is is important to recognize the body enough to notice a new mole or spot. Self-skin examination should be carried out in a well-lit room in front of a tall dressing mirror, where whole body can be observed. Using a hand mirror, it becomes easier to view blind corner of the body such as back and hip in tall dressing mirror. In men, 1 of 3 melanomas is observed on the back. All areas of the body such as back, palms, plantar area, scalp, eyes, genitals regions, and nails should be checked.

Medical History and Physical Examination: Physical examination for skin cancer should firstly be performed by a qualified dermatologist. By use of a a technique called dermatoscopy (also known as epiluminescence microscopy or surface microscopy), spots and nevi on the skin are closely examined, and if their images can be obtained, and possible spread in lymph nodes under the skin near suspicious area. Some skin cancers spread to the lymph nodes. When this happens, lymph nodes that have been affected can grow and become harder than usual. It can be very effective in early detection of skin cancer. It is important for people, who have dysplastic nevus syndrome and have history of melanoma in their families, to have regular skin examinations.

Dermatoscopy in the Diagnosis of Skin Cancer

Dermatoscopy is a skin surface microscopy; it is used for the diagnosis of nevi and other pigmented lesions. In this method, lubricated skin surface is examined with a dermatoscope that provides an illuminated amplification. Dermatoscope is similar to the otoscope used for ear examination and has been widely used for about 50 years. Until a few years ago, follow up of the nevus was provided by taking photos of dermatoscopic images. Then, computer technology has been added to this method and digital dermatoscopy has been developed. With this method, a map of nevi on the body is created and their point localizations are determined. Then, a dermatoscopic image is taken and recorded for each nevus. This provides a chance to compare it with the image that will be obtained at next control.

Digital dermatoscope mathematically calculates suspicious changes observed in the nevus and creates an index that shows the risk of malignant melanoma. This index helps to diagnose and plan the treatment. The chance of diagnosing early-stage melanoma with naked eye is 60%, while it increases by 90% with digital dermatoscopic examination.

Skin Biopsy: If it is thought that suspected area may have skin cancer, a sample is taken this area and s examined in the laboratory. This is called a skin biopsy. A skin biopsy can be done in many different ways. Biopsy will be decided according to the location of the suspicious area on the body, its size, and the type of skin cancer suspected. If suspicious nevus or spot are found to be cancerous or precancerous, your physician may request to perform further tests or treatments. If suspicious nevus or spot is small and regional, a larger-scale biopsy (to get more tissue) or some kind of surgical intervention may be performed. In skin cancer that has spread, execution of immunotherapy, targeted therapy, chemotherapy and radiotherapy for imaging tests and treatment shall be required.

How is skin (Skin) cancer treated?

In the treatment of skin cancer, it is aimed to remove all cancerous tissue without leaving any residue. Quite high rate of success can be achieved with surgical treatment. By removing cancerous tissue in sufficient depth and width, recurrence of the cancer is prevented. As well as destroying cancerous cell in the treatment of skin cancer, it is paid attention that there is no remaining scar esthetically and no occurrence of loss of function. For the face where skin cancer is most common, the patient's age, general condition, tumor size, skin characteristics, and the possibility of spreading to the lymph nodes become important.

Rather than one type of skin cancer treatment, treatment methods private to the person are offered. In terms of surgery and radiotherapy, there is usually no problem in the treatment of small tumors. Another important point in the treatment of skin cancer is execution of tumor removal by an experienced team.

If there are too many scars remained after surgical treatment and control of the tumor with radiation can be achieved without serious side effects, radiation therapy may be preferred as primary treatment model. Non-melanoma skin cancer that occurs on the cheek, forehead, or nasal dorsum, especially if it is basal cell, can be treated very successfully with radiation therapy. In the treatment of small tumors, cryosurgery method can be preferred. In the treatment where liquid nitrogen is applied to the tumor, abnormal cells die. After defrosting, dead tissues leave the body. In the treatment method called curettage, cancerous area is scraped with a spoon-shaped curette, and bleeding is stopped with an electric current supplied by a special device, and cancer cells are killed. At the end of the operation, a flat, white mark remains on the skin. Local chemotherapy applied in the form of a cream or lotion is also being considered as an option for superficial skin cancers.

What should be considered after skin (Skin) cancer treatment?

As with all cancers, post-treatment controls have great importance. Controls are required firstly at 3- or 6-months periods, then annually and at longer periods. Recurrence risk of non-melanoma skin cancer is highest in the first 3 years after basal cell carcinoma treatment and in the first 2 years after squamous cell carcinoma treatment. During this period, close monitoring is usually required. But long-term follow-up is also important since non-melanoma skin cancer can reappear at any time. Follow-up visits for non-melanoma skin cancer are usually scheduled every 6 to 12 months. It depends on the type of cancer and risk category of non-melanoma skin cancer. If the patient had received high-risk non-melanoma skin cancer treatment, follow-up visits are usually more frequent in the first 2-3 years. It is important to protect the skin from the sun after treatment.

Why should I have skin (Derma) cancer treatment at Memorial Health Group?

We offer skin cancer treatment with experienced specialist physicians and superior technology and a patient-oriented healthcare approach at Memorial Health Group Hospitals, Department of Dermatology. We contribute to physical and psychological recovery process of the patient in our hospitals, we provide a warm environment for the patients and his/her relatives with our friendly and experienced specialist nurse staff, patient care staff and all our medical professionals.


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