Cancer Glossary & Scientific Reference

Skin cancer

compiled by Healing Cancer Naturally from material © 1994-2000 Encyclopædia Britannica, Inc.

Skin cancer is one of the most common forms of cancer in humans. Skin cancers occur in highest incidence on the exposed skin of the head and neck of persons chronically exposed to sunlight. The incidence and prevalence of skin cancer can be greatly reduced by simple preventive measures, such as avoidance of exposure to the Sun and to excessive ionizing radiation.
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Primary skin cancers can be divided into two types: epidermal cancers, which originate in keratinocytes, melanocytes, or skin appendages (e.g., sweat glands, the pilosebaceous apparatus); and dermal cancers, which originate in neural, vascular, mesenchymal, or lymphoreticular tissues. Malignant tumors arising from keratinocytes or melanocytes are the most frequent skin cancers.

Basal cell carcinoma

Basal cell carcinoma, rare in Negroes and Asians, is the most common malignant skin tumor in Caucasians (about 82 percent of all cases). It arises from basal cells in the deepest layer of the skin (the undifferentiated basal keratinocytes of the epidermis). The initial lesion is a small pimple-like elevation, which enlarges very slowly and after a few months forms a shiny, somewhat translucent lesion that eventually develops a small central ulcer. When the scablike surface is denuded it tends to bleed and then appears to "heal" by forming another shiny covering. Although basal-cell carcinomas grow slowly and only very rarely metastasize, they do invade locally and cause considerable destruction of adjacent tissues, which can result in disfigurement. Either ample surgical excision or radiation therapy is curative.
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Although multiple basal cell carcinomas may develop early in life as an inherited trait (nevoid basal cell carcinoma syndrome, or as a complication of xeroderma pigmentosum), most arise later. These cancers rarely metastasize but may be highly invasive locally; they are then known as rodent ulcers. The lesions occur in fair-skinned persons and on areas of skin that receive the greatest exposure to sunlight.

Treatment with inorganic arsenical drugs and exposure to ionizing radiation (X rays, radium) may also contribute to some cases. Avoidance of unnecessary sunlight and careful control of ionizing radiation significantly lowers the incidence of basal cell carcinoma. Although metastases are rare, the cancer may spread locally and invade surrounding tissues. When this occurs, treatment may be difficult and lengthy.
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Squamous cell carcinoma

Squamous cell carcinoma is less common than basal cell carcinoma but has a higher rate of metastasis. Squamous-cell carcinoma arises from the platelike flat cells that constitute the major cellular component of skin. The early lesion is less localized and elevated than that of basal-cell cancer. It is red and scaly and may be confused with eczema or infection. Eventually, the lesion becomes larger, elevated, and ulcerated. The behaviour of squamous-cell carcinoma differs somewhat from that of basal-cell cancer, in that the cells are not only capable of local invasion but also may metastasize to regional lymph nodes and, rarely, to more distant sites. Treatment is identical to that for basal-cell cancer.

Squamous cell carcinoma is common in children with xeroderma pigmentosum, who are unable to repair DNA damage caused by ultraviolet irradiation. In most persons this inability is due to the deficiency of an endonuclease enzyme. Incomplete repair of damaged DNA causes mutations that appear as basal or squamous cell carcinomas, malignant melanomas, and keratoacanthomas.

In adults, squamous cell carcinoma rarely occurs in the absence of an external cause. Protracted exposure to sunlight is the usual cause, but chronic scarring from burns, as well as reactions to vaccinations, radiation dermatitis, and chronic ulceration, may contribute to some cases.

Squamous cell carcinoma is also an occupational hazard, as was noted at the end of the 19th century in regard to chimney sweeps who contracted cancer after exposure to tars.

Tar-induced squamous cell carcinoma occurs today in workers who distill tar vapour in the manufacture of coal gas and in machinery operators whose clothes and skin become soaked in mineral oil.

Because of the high rate of metastasis of squamous cell carcinomas, early diagnosis is important, especially in persons with a skin ulcer that fails to heal. Skin lesions that precede squamous cell carcinoma include white patches in the mucous membranes of the mouth, genitalia, or anus; warty lesions called keratoses (which are especially common after chronic exposure to the Sun, when they are called solar keratoses); and the lesions of Bowen's disease--persistent red scaly plaques that on microscopic examination are found to contain grossly abnormal keratinocytes. When squamous cell carcinoma follows Bowen's disease, there is often a history of treatment with an inorganic arsenical drug.

Malignant melanoma

In Western countries, the mortality from the skin cancer malignant melanoma is increasing by about 4 percent per year. This type of skin cancer arises from the melanocytes of the skin, and the tumor is therefore often, but not invariably, pigmented with melanin. In adults malignant melanoma arises as a new lesion or as a change in a benign pigmented mole. Malignant melanoma metastasizes frequently, and excision of the tumor together with a collar of surrounding healthy skin is curative if done early [statement by conventional mainstream oncology, compare On Conventional Cancer Treatment].

Primary cancers arising in the dermis are much less common than epidermal malignant tumors. Mycosis fungoides is a malignant tumor of the T lymphocytes of the dermis. Despite the name, fungal infection does not cause the cancer.
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Kaposi's sarcoma

Extrinsic causes of dermal cancers are rare. An exception is the malignant cutaneous vascular tumor called Kaposi's sarcoma. Kaposi's sarcoma, also called IDIOPATHIC MULTIPLE PIGMENTED HEMORRHAGIC SARCOMA, is a rare cancer characterized by red-purple or blue-brown macules, plaques, and nodules of the skin and other organs. The skin lesions may be firm or compressible, solitary or legion.

The disease was reported in 1872 by Moritz Kaposi. Before its appearance in those afflicted with acquired immune deficiency syndrome (AIDS), Kaposi's sarcoma was considered an extremely rare cancer. It was noted primarily among men of Mediterranean descent but had also been observed in an endemic form among African men. A unique form of Kaposi's sarcoma--with internal (especially lymphatic) rather than cutaneous involvement--had also been recognized among young children in certain areas of equatorial Africa. The lack of health statistics in Africa seriously hampered efforts to study the history of the disease there, and the reason or reasons for the variation in forms of the cancer remain unclear.

Since about 1980 Kaposi's sarcoma has become increasingly evident in AIDS victims. Of the groups that have been identified as high-risk for AIDS, male homosexuals are far more likely to develop the cancer than are other AIDS victims. Kaposi's sarcoma, in fact, was the disease that indicated the presence of AIDS in nearly half of the U.S. cases of AIDS that were reported to the Centers for Disease Control in Atlanta, Ga. The breakdown of the immune system and the production of a growth factor by white blood cells infected with the AIDS virus seem to encourage the sarcoma's occurrence--i.e., it is considered an opportunistic tumor. There is no known cure for Kaposi's sarcoma, although partial and complete remissions have been accomplished.
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