Project

Introduction

Skin cancer poses a significant health concern worldwide, with its prevalence notably
high, particularly in regions with increased exposure to ultraviolet (UV) radiation such
as the Northern hemisphere. According to the World Health Organization's latest
data in 2020, skin cancer-related deaths in Algeria alone reached 711, constituting
0.38% of total deaths. The age-adjusted Death Rate stands at 2.00 per 100,000 of the
population, positioning Algeria at #86 globally in terms of skin cancer mortality rates.

In the United States, the gravity of this disease is starkly evident, with statistics
indicating that one in five Americans will develop skin cancer in their lifetime, making
it the most common form of cancer in the country. Such alarming prevalence
underscores the imperative of proactive measures to mitigate its incidence. Primary
among these is the avoidance of excessive sun exposure, coupled with the judicious
use of protective measures such as sunscreen and protective clothing.

Furthermore, advancements in diagnostic techniques offer promising avenues for

early detection and intervention. The adoption of pre-diagnostic technologies
facilitates timely identification and treatment, significantly enhancing prognosis and
survival rates.

Against this backdrop, understanding the epidemiology, risk factors, and preventive
strategies of skin cancer is paramount. This comprehensive approach serves as the
cornerstone of our efforts to combat this pervasive malignancy and safeguard public
health.

What is skin cancer

Skin cancer is the abnormal growth of skin cells, primarily caused by repeated exposure to
ultraviolet (UV) rays from sunlight, sunburns, tanning beds, and sunlamps. It can also occur
on areas of the skin not typically exposed to sunlight.

There are three main types of skin cancer: basal cell carcinoma (BCC), squamous cell
carcinoma (SCC), and melanoma. BCC and SCC are slow-growing and rarely spread, but
they can be disfiguring. Melanoma, although less common, is the most dangerous,
responsible for the majority of skin cancer deaths.

Early detection through regular skin checks and limiting UV exposure are crucial for
successful treatment and reducing the risk of skin cancer.
Types of skin cancer

Skin cancer encompasses several types, each originating from different cells within the skin. The most
prevalent forms include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma, and
the less common Merkel cell carcinoma.

Basal cell carcinoma (BCC) is the most frequently diagnosed skin cancer, constituting approximately
80% of cases. It arises from basal cells within the epidermis and typically progresses slowly. While
BCC seldom metastasizes, it can infiltrate nearby
tissues if left untreated, occasionally leading to
disfigurement and bone destruction. Recurrence is
possible, and individuals with BCC are prone to
developing new lesions elsewhere.

Squamous cell carcinoma (SCC) accounts for about 20% of skin cancers and originates from
squamous cells in the epidermis. Often emerging from
precancerous lesions known as actinic keratosis, SCC
grows at a slower pace compared to melanoma but has
a higher tendency to invade deeper skin layers and
metastasize. Prolonged sun exposure is a significant risk
factor for SCC development.

Melanoma, though less common, is the most lethal form of skin cancer. It arises from melanocytes
located in the bottom layer of the epidermis. Despite
representing only 1% of skin cancer cases, melanoma
spreads rapidly if left unchecked, posing a grave risk
to affected individuals. Early detection and treatment
are crucial for favorable outcomes.
 Merkel cell carcinoma, while rare, is an aggressive form of skin cancer originating from Merkel cells
in the basal layer of the epidermis. Although comprising a small fraction of skin cancer cases, Merkel
cell carcinoma tends to grow and metastasize swiftly,
ranking as the second leading cause of skin cancer-related
mortality after melanoma.

Symptoms

Where skin cancer develops

Skin cancer symptoms vary depending on the type of cancer, but they often manifest on sun-
exposed areas such as the face, ears, neck, lips, and hands. Here's a breakdown of common skin
cancer symptoms:

 Basal Cell Carcinoma (BCC): BCCs typically appear as small, painless bumps with a pink, pearly
surface. As they grow, the center may become sore and form a crater that bleeds, crusts, or scabs.
Common locations include the face, ears, back, and neck.
 Squamous Cell Carcinoma (SCC): SCCs often start as small, red, painless lumps or patches that
gradually enlarge and may become non-healing sores. They commonly occur on the head, ears,
and hands.
 Melanoma: Melanoma usually presents as a dark spot on the skin, commonly found on the back,
chest, and legs. It can also develop from existing moles. To identify potential melanomas, follow
the ABCDE guideline:
 A: Asymmetry - One half of the spot doesn't match the other.
 B: Border irregularity - Edges are ragged, notched, or blurred.
 C: Color variation - Pigmentation is uneven, with shades of tan, brown, or black, possibly
with dashes of red, white, or blue.
 D: Diameter - The spot is larger than ¼ inch in diameter (about the width of a pencil
eraser), though melanomas can be smaller.
 E: Evolution - Changes in size, shape, or color, or the appearance of symptoms like itching,
pain, or bleeding. A crusty surface or numbness may also indicate melanoma.
 Skin cancer diagnosis

To diagnose skin cancer, your doctor may:

 Examine your skin. Your doctor may look at your skin to determine whether
your skin changes are likely to be skin cancer. Further testing may be needed to
confirm that diagnosis.
 Remove a sample of suspicious skin for testing (skin biopsy). Your doctor
may remove the suspicious-looking skin for lab testing. A biopsy can determine
whether you have skin cancer and, if so, what type of skin cancer you have.
Determining the extent of the skin cancer

If your doctor determines you have skin cancer, you may have additional tests to
determine the extent (stage) of the skin cancer.

Because superficial skin cancers such as basal cell carcinoma rarely spread, a
biopsy that removes the entire growth often is the only test needed to determine the
cancer stage. But if you have a large squamous cell carcinoma, Merkel cell
carcinoma or melanoma, your doctor may recommend further tests to determine the
extent of the cancer.

Additional tests might include imaging tests to examine the nearby lymph nodes for
signs of cancer or a procedure to remove a nearby lymph node and test it for signs of
cancer (sentinel lymph node biopsy).

Doctors use the Roman numerals I through IV to indicate a cancer's stage. Stage I
cancers are small and limited to the area where they began. Stage IV indicates
advanced cancer that has spread to other areas of the body.

The skin cancer's stage helps determine which treatment options will be most
effective.

Treatment

Skin cancer treatment strategies encompass a range of interventions tailored to the specific type, size,
depth, and location of lesions. The following summarizes professional treatment options based on the
provided information:

For precancerous skin lesions and early-stage skin cancers:

 Freezing (Cryosurgery): Actinic keratoses and small, early skin cancers can be treated by freezing them
with liquid nitrogen, causing the affected tissue to slough off upon thawing.
 Excisional Surgery: Surgical removal of the cancerous tissue and a margin of healthy skin is a common
approach. Wide excision, removing additional normal skin around the tumor, may be necessary in certain
cases.
 Mohs Surgery: A specialized procedure suitable for larger, recurring, or challenging-to-treat skin cancers,
particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs surgery involves removing
the skin growth layer by layer and examining each layer under a microscope until no abnormal cells remain,
minimizing the removal of healthy surrounding skin.
 Curettage and Electrodessication or Cryotherapy: Scraping away cancer cells with a curet and using an
electric needle or liquid nitrogen to destroy any remaining cancer cells. This method is suitable for basal cell
cancers or thin squamous cell cancers.
 Radiation Therapy: High-energy beams like X-rays are utilized to target and kill cancer cells, particularly
when complete surgical removal is not feasible.
 Chemotherapy: Topical creams or lotions containing anti-cancer agents may be applied directly to the skin
for cancers limited to the surface. Systemic chemotherapy is reserved for advanced cases where cancer has
spread to other parts of the body.
 Photodynamic Therapy: A combination of laser light and light-sensitive drugs is used to destroy skin
cancer cells.
 Biological Therapy: Harnesses the body's immune system to target and kill cancer cells.

For melanoma:

 Surgery: Initial treatment involves surgical removal of the visible tumor along with a margin of healthy skin.
Mohs surgery may be employed for meticulous removal while preserving healthy tissue.
 Lymph Node Dissection: If melanoma has spread, lymph nodes in the area may be removed to assess
cancer spread.
 Additional Therapies: Immunotherapy, targeted therapy, radiation therapy, and chemotherapy may be
considered for thicker tumors or those that have spread.

In summary, treatment modalities for skin cancer encompass surgical, non-surgical, and adjuvant therapies
tailored to individual patient characteristics and disease stage, aiming for optimal outcomes while
minimizing adverse effects and preserving quality of life

References

 "Skin Cancer." Harvard Health Publishing, Harvard Medical School,

2022, www.health.harvard.edu/topics/skin-cancer.
 Skin Cancer: Symptoms and Causes." Mayo Clinic, Mayo Foundation for
Medical Education and Research, 2022, www.mayoclinic.org/diseases-
conditions/skin-cancer/symptoms-causes/syc-20377605.
 Algeria - Skin Cancers." World Life Expectancy, 2022,
www.worldlifeexpectancy.com/algeria-skin-cancers.
 The skin cancer foundation The Skin Cancer Foundation Official Website - The
Skin Cancer Foundation