There are 3 main types of skin cancer: 1) Basal cell carcinoma. 2) Squamous cell carcinoma.  3) Melanoma.  Skin cancer treatment is with surgery or radiation therapy in most cases, although Melanoma is sometimes treated with chemotherapy or immunotherapy as well.

Skin Cancer

Navneet Sharda MD, an oncologist in Las Vegas, informs us that the skin structure is composed from three main layers:

1. Epidermis, which is the outer, thin layer of skin.

2. Dermis is the middle layer of skin and contains the following: blood and lymph vessels, hair follicles, sweat glands, collagen bundles, fibroblasts, nerves, and pain and touch receptors. This layer of skin is held together by collagen.

3. Subcutaneous fat layer is the deepest layer of skin and is formed from a collagen network and fat cells. It plays two essential roles: conserves the heat of the body and protects the body from injuries.

Layers of skin

Signs and Symptoms of Skin Cancer

Like any other type of cancer, skin cancer involves certain signs and symptoms. The most common signs that can be noticed by a patient before consulting a doctor are:

• Changes in color and size of a pre-existing mole, a new skin growth, bump or enlarging mass.
• Changes in the skin color of the surrounding areas of the mole (the skin can become red or swollen, or the pigmentation will spread beyond the border of the spot, mark or mole)
• Appearance changes like a scaly, oozing, bleeding, fragile, and a crusted or ulcerated look.
• Sensation changes like itching, burning, tenderness or pain.

Types Skin cancer can occur anywhere on the body, but more commonly develops in areas that are more exposed to the sunlight like face skin, neck skin, hands or arms skin.

There are three types of skin cancer:

• Basal cell carcinoma is the most common type of skin cancer. It develops in the deepest layer of the epidermis. It usually occurs in areas exposed more often to the sun like the nose. Initially, the tumor looks like a small, smooth and pearly bump or as a flat and firm scar. This type of cancer will very rarely spread to adjacent areas and almost never to other parts of the body.  It is slow growing.  It is almost never fatal.
  
  

  Basal Cell Cancer with the classic “rodent ulcer” appearance.

• Squamous cell carcinoma is another common type of skin cancer that develops in the keratinocytes layer of the epidermis. It usually occurs in those regions of the skin more exposed to the sun, like ears, lower lip, and back of the hands, or in areas of the skin that have been burned or exposed to chemicals and radiation. This type of cancer appears as a red firm or scaly bump that can bleed or form a crust.  It occasionally spreads to nearby lymph nodes and if left untreated for many years can metastasize to other organs.  It is highly curable in the early stages.  It is occasionally terminal when left untreated.
  
  

  Squamous Cell Cancer presents as heaped up area of flaky skin.

• Melanoma is the most virulent form of skin cancer. It occurs in the lower layer of the epidermis when melanocytes (the pigment cells) become malignant and grow and divide abnormally. This type of cancer can spread to other areas and organs of the body through the lymph vessels if not treated.  It is generally not related to sun exposure and forms in many different areas of the body.
  
  

  Melanoma has irregular borders but rarely a mass

STAGES

Basal cell carcinoma and squamous carcinoma stages:

Stage 0: For basal cell carcinoma this is called carcionama in situ: The tumor is limited to the epidermis. For squamous carcinoma, this is called squamous carcinoma in situ or Bowen’s disease: It is the first stage of the squamous carcinoma when the tumor is limited to the squamous cells.

Stage 1: The tumor has less than 2 centimeters size and has not spread to the lymph node or other organs.

Stage 2: The tumor is larger than 2 centimeters and has not spread to the lymph nodes or other organs.

Stage 3: The tumor has spread to the nearby tissue under the skin like muscles, bones or cartilage, or to the lymph nodes.

Stage 4: The cancer spread to distant organs in the body.

Melanoma stages:

Stage 0: Melanoma in situ: The tumor is confined to the epidermis and has not spread to nearby areas.

Stage IA: The melanoma has less than 0.75 mm.

Stage IB: The melanoma is thicker than 0.75 mm but less than 1.5 mm.

Stage IIA: The melanoma is thicker than 1.5 mm but less than 4 mm.

Stage III: The melanoma has spread to nearby nodes or less than 5 mm in-transit metastases.

Stage IV: The tumor spread to other parts of the body.

Medical Tests & Diagnosis

Skin cancer can be detected through a skin examination. There are two types of skin examinations:

Self-examination: Performed by the patient before consulting a specialist if suspicious moles or lesions occur.

Examination performed by a specialist: During a skin examination, the doctor closely examines the moles and skin lesions, and will often take photographs for comparison next year.

If the doctor suspects that a mole or skin lesion is cancer, a biopsy will be performed. A biopsy is a diagnosis procedure that involves surgical removal of the whole lesion or only a certain amount of abnormal tissue for a microscopic laboratory investigation. For skin cancer, a biopsy is a minor procedure that is performed under local anesthesia.

There are two types of biopsies:

Excisional biopsy: The entire tumor with the surrounding skin is removed. This type of biopsy is performed when the tumor is suspected to be melanoma.  It is best done by a Cancer Surgeon.

Incisional biopsy (Punch): Only a part of the lesion is removed. This type of biopsy is performed when the lesion is too large or the location requires maximum tissue preservation.

The biopsy will determine if the tissue removed is cancerous or not, and also can establish the cancer cells type.

Skin Cancer Treatment Options

There are several types of standard treatment used in treating skin cancer

Mohs micrographic surgery: A medical procedure that removes the tumor in thin layers. Each layer of the tumor removed is checked under a microscope for cancer cells and the procedure will continue until there are no more cancer cells in the removed layer.  This is what the Dermatologist does.

Simple excision: A medical procedure that removes the tumor along with some healthy skin around the tumor location, performed by most qualified doctors.

Electrodesiccation and curettage: This medical procedure involves two steps. First, the tumor is removed with a currette – a sharp, spoon-shaped medical instrument. Second, the operated area is treated afterwards with a needle-shaped electrode that sends out an electric current, which is felt to burn any remaining tumor.  This is rarely performed in the modern era.

Dr. Sharda with patient

Cryosurgery using Liquid Nitrogen: This procedure uses a special instrument that destroys the cancer tissues by freezing them with liquid-nitrogen, and works well for very small lesions.

Radiation therapy uses high focused x-rays to destroy the cancer cells. This type of treatment can cure even very large, advanced skin cancer, and preserves the tissues with very good cosmetic results.

Radiotherapy is used as the primary treatment for patients that would have bad cosmetic results from surgery, or whom refuse surgery.  It results in a good cosmetic result and is most often recommended as treatment of head and neck cancers.

Chemotherapy is a systemic treatment (affects cells throughout the entire body) that uses drugs that either stop the abnormal growth and dividing process of the cancerous cells or kills the cancer cells.  It is not a treatment for curable squamous or basal cell cancers, and is only used for  melanoma cancer.

Biological therapy (biotherapy or immunotherapy) is a type of treatment that uses the immune system of the patient to fight against cancer. It is mostly used as an adjuvant therapy after the melanoma is removed through surgery.  To learn more about immunotherapy please go here.

To schedule a consultation with Dr. Navneet Sharda call 702-547-2273.

Oncologist Dr. Navneet Sharda is the medical director of Cancer Care Center. For more than a decade  Cancer Care Center has been specializing in treatment of various types of cancers like multiforme, meningioma, tonsil, tongue, laryngeal, parotid, neck, lung, breast, lymphoma, non hodgkins lymphoma, hodgkins disease, hodgkins lymphoma, skin cancer, melanoma, esophageal, gastric, pancreatic, colon, renal, kidney, ovarian, sarcoma, uterine cancer, cervical cancer, vaginal, brain, breast, vulvar cancer, bone metastasis, bone, osteosarcoma, endometrial cancercarcinoma, tumor, malignant and cancerous Cancers. We offer threapylike chemotherapy, radiotherapy, radiation therapy, radiation oncology, oncology, oncologist,immunotherapy, brachy therapy, stereotactic radio surgery, IMRT, intensity modulated radiation therapy, conformal therapy, anaplastic astrocytoma, gioblastoma.