The skin is the largest organ in the human body with an area of 2 m2. We categorize the cancers of this organ which protect our body from all kinds of external danger and ensure the continuity of our lives as malignant melanoma and non-melanoma skin cancer. Non-melanoma skin cancers are the most common cancers of the white race and the majority of these cancers are basal cell carcinoma and squamous cell carcinoma. The most important factor in formation of skin cancers is the ultraviolet radiation from the rays of the sun.
Basal cell carcinoma
This type of cancer generally manifests itself as slowly growing masses in the face region with sunk middle parts and a tendency of post-traumatic hemorrhage. After famous actor Hugh Jackman was operated six times because of this cancer, the disease became well-known in our country and the world.
This type of cancer usually does not translocate to other regions of the body, but can be fatal, albeit rarely, especially in patients with very advanced stages.
As with all skin cancers, the main risk factor for this type of cancer is overexposure to sunlight. Although this type of cancer occurs as a result of collective effects of sun exposure over the years and more frequently seen in older people, it should not be overlooked that it can also be seen in young individuals.
Additionally, the use of solarium can increase the risk of development of all skin cancers due to its effect of ultraviolet radiation.
Once a patient has had basal cell carcinoma, the probability of developing a recurrent cancer is considerably increased. Ginger hair color, young age and the emergence of cancerous masses around nose, eyelid and ear area are factors that increase the likelihood of recurrence.
Squamous cell carcinoma
Squamous cell carcinoma, which is the second most common skin cancer, is a more aggressive type of cancer that can spread around the body and may become fatal in advanced stages.
Similar to basal cell carcinoma, the most important risk factor is overexposure to sunlight. In addition; having light skin, albinism, immune system deficiency, some genetic diseases and HPV virus infections also increase the likelihood of cancer development.
This cancer typically manifests itself with crusted lesions with sunk middle parts and slightly raised edges that appear in sun-exposed areas and have occasional bleeding.
Similar to basal cell carcinoma, once a patient is diagnosed with squamous cell carcinoma, the recurrence risk is significantly elevated.
Malignant melanoma
Malignant melanoma is the most common cause of death due to skin cancer and is almost always completely cured when caught in the early stages; thus, it is very important to raise awareness for this disease.
Ultraviolet rays are known to affect different mechanisms in the development of malignant melanoma. These mechanisms include suppression of immune system in the skin, increase in the frequency of cell division in cells called melanocytes that give color to the skin, increase in the production of metabolic by-products called “free radicals” which are harmful to cells and tissues and damage to the DNA of melanocytes.
Apart from ultraviolet radiation, viruses and some chemicals also play a role in the development of malignant melanoma.
Malignant melanoma is a disease of the white race, especially in blonde and ginger individuals, people with freckles and those who are easily sun burned.
Also, a history of severe sunburn in childhood (burn marks with blisters) increases the risk of malignant melanoma.
The incidence of malignant melanoma increases in our country, as well as worldwide.
People with risk factors need to be more conscious and careful about malignant melanoma. It should not be forgotten that each individual needs to be their own doctor first. Some of these main risk factors are presence of moles that change shape and color, presence of more than 50 moles that are larger than 2 mm, history of malignant melanoma in the family, history of malignant melanoma in the individual and presence of congenital giant moles.
If asymmetry develops in any colored lesion in the body, irregularity develops at the borders of the lesion, different tones of color is present in the lesion together, the lesion diameter is large and the lesion is getting bigger, then the situation needs to be taken seriously. If one or more of these findings are encountered, a plastic surgeon must be consulted immediately.
In terms of public health, the most important duty for us, doctors, is to prevent the development of a disease, before its treatment. For this reason, the primary aim of this article is to explain what is needed to be done to prevent skin cancer. Let us briefly explain the cautions that can be used for prevention of the disease:
- Avoiding sun exposure between 10 am and 4 pm
- Avoiding tanning for a long time, avoiding sun burns
- Avoiding the use of solarium
- Use of sun protective clothing/accessories (hat, sunglasses etc.)
- Use of broad-spectrum sunscreen with at least 15 SPF all year long
- Application of at least two tablespoons of sunscreen with at least 30 SPF to whole body at least half an hour prior to sun exposure, re-application of sunscreen every two hours, re-application of sunscreen immediately after swimming or excessive sweating
- Protecting babies from sun (sunscreen can be used in babies older than 6 months)
- Performing body examination of your own body monthly
- Annually being examined by a dermatologist or a plastic surgeon for full skin examination
It is important to mention that unfortunately due to the misbelief in our country that suggests “if a knife touches the lesion, it will become cancerous”, many patients delay treatment and only consult a doctor at later stages, although perhaps they can be fully cured in the early stages. This misperception sometimes causes the disease to progress rapidly and unfortunately even causes the loss of the patient.
The treatment of skin cancers is surgical removal of the lesion or lesions. In advanced types of malignant cancers such as squamous cell carcinoma and malignant melanoma, it is necessary to clear spreading sites of the lesion as well.
Of course, the most important step in the treatment of skin cancers is the clearance of cancerous masses. However, repairing the damaged tissue that remains after tumor surgery in the most aesthetic way is as important to the plastic surgeon as cancer surgery itself, since it will help the patient both physically and psychologically.
The damaged tissue after cancer surgery is generally large and it is repaired by making tissue transfer from a neighboring or a faraway tissue. Such tissue repair is called “reconstruction” and the “reconstructive surgery” term in our department’s name comes from this field. Since such surgeries require both good tumor surgery and successful reconstruction surgery, the best outcome will be achieved by doctors who have a special interest and knowledge on this subject.
