SKIN CANCER: CAUSATION, DETECTION, TREATMENT AND PREVENTION

CAUSATION

Skin cancer can arise via the action of genetic and environmental factors and the interaction of these determinants.

Genetic factors are a very important determinant of the predisposition to develop skin cancer and in many situations, can be the main operative factor.

Environmental factors alone or in combination with genetic factors account for a large proportion of observed skin carcinomata

Generally, the most important environmental factor is exposure to radiation that usually involves sun exposure that can be recreational, work related or often both.

Therapeutic use of ultraviolet light and exposure to x rays can induce skin carcinomata.

Exposure to some chemicals such as arsenic and petroleum by products found in some work environments can be carcinogenic.

Occasionally, skin carcinomata can arise at the sites of previous physical trauma, in scarred areas or from low grade skin irritation seen in some inflammatory skin conditions.

Individuals that have a compromised immune system either produced by illness or immunosuppressive drugs are at a heightened risk of developing malignant and premalignant skin lesions. A compromised immune system can compound the risk posed by other causative factors outlined above.

DETECTION

The primary method of detection of skin carcinomata is by visual inspection by a suitably qualified medical practitioner. However, awareness by an individual of a skin lesion that is suspicious or “not quite right” is often an initiating event that leads to a medical consultation. Despite individuals’ reticence to self-diagnose, their perception of abnormality may be well founded and should not be ignored.

Over recent times the availability of online images of abnormal skin lesions has enhanced the community’s awareness of the presentation of abnormal skin lesions. This facility can also sometimes provoke unnecessary anxiety.

Medical diagnostic software to detect abnormal moles has been developed to aid in the diagnosis of abnormal skin lesions, however this aid has not yet reached the level of reliability to be solely relied upon in diagnosis.

Smartphone attachments and apps are now available to diagnose abnormal skin lesions but are significantly inferior to medical grade computer assisted diagnostic tools.

A handheld magnifying instrument (called a dermatoscope) is a useful adjunct to naked eye diagnosis by trained medical personnel.

The mainstay of diagnosis is by pathological histological examination after a skin biopsy or excision specimen has been obtained. This procedure allows for an exact pathological diagnosis to be made and in the case of skin cancer can often allow for a more accurate prognosis.

TREATMENT

Skin cancers and premalignant skin lesions can be treated using several methods

The most definitive method of treating these lesions is by surgical excision however less aggressive lesions can be treated by other surgical and medical modalities

Other surgical techniques include shaving, curetting, electro-desiccation and cryotherapy

Medical treatments can include topical and oral anticancer medications, phototherapy and x ray therapy.

It is not uncommon for combinations of these treatments to be used

PROTECTION

The best protection against developing skin cancers and pre-malignant skin lesions is protection from avoidable environmental influences.

In the case of ultraviolet radiation this includes covering via clothing and the use of sunscreens and avoiding recreational or occupational sun or tanning parlour exposure.

Care also needs to be exercised to avoid industrial carcinogens. These are usually well documented

Recently several oral and topical chemo preventive measure have been identified that can decrease the onset of some malignant and pre-malignant skin lesions. These include some derivatives of Vitamin A, B and D