Risk Factors, Diagnosis, Management, and Prevention of Skin Cancer - Essay Example

Risk factors, diagnosis, management, and prevention of skin cancer Skin cancer is the most common type of human cancer. It is approximated that over1 million cases of skin cancer occur yearly. The rate of skin cancer is increasing rapidly. Skin cancer is prevalent among most Americans. There are three important types of skin cancers, which include basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell carcinoma emanates in the basal cells which in turn form a cell within the skin that produces new skin cells. The other form of skin cancer is squamous cell carcinoma. It is uncontrolled growth of irregular cells arising in the squamous cells, which includes most of the skin’s upper layers. Lastly,Melanoma is produced from melanocytes so the tumor is usually brown or black (American Cancer Society 2010). Skin cancer develops on body parts such as the ears, chest, neck, hands, arms, lips, scalp, and face exposed to the sun. It is significant to note that it can also develop on parts that are rarely exposed to ultraviolet light such solar radiation. High cancer rate in young women is likely a reflection of the impact of tanning beds to skin cancer incidence. Skin melanoma is a rare cancer compared to basal and squamous cell skin cancers. However, it is associated with a much higher rate of metastases and mortality, and occurs more commonly in whites than other races (American Cancer Society 2010). The incidence of skin carcinomas is noted to be increasing in the past few years. At the current rate, it is predicted that 1 in 5 Americans will develop skin cancer in his/her lifetime. This increase has been linked to increasing solar radiation exposure associated with tanning behaviors. The use of artificial tanning beds has also been connected. Skin cancer can present as any kind of skin lesion such as an ulcer or lump, and can therefore be mistaken by the patient as a benign process. This often leads to a delay in diagnosis until the cancer has reached an advanced stage. Considering the significance of skin cancer and the significant research interest surrounding the strength of association between sun exposure and skin cancer. The objectives of this review are to discuss risk factors, diagnosis, management, and prevention of skin cancers. The young women demographic group, in particular, has the highest increase in cancer incidence noted. Melanoma is the second most common cancer in women ages 20 to 29 year old. Studies show no link between sex hormones and melanoma risk, and young women are the most common users of indoor tanning beds (American Cancer Society, 2010). Risk factors The ultraviolet (UV) component of solar radiation has traditionally been considered an important ‘carcinogen’. In the past few decades, the emergence of indoor tanning booths has emerged as another source of UV radiation exposure. Ultraviolet light has three components: UVA, UVB, and UVC. UVB is the most dangerous but also enhances vitamin D production in the skin . UVA is less carcinogenic, and UVC is not at all (Zhang et al., 2012). UV-induced DNA damage in keratinocytes can lead to pre-malignant changes in the skin such as actinic keratosis, solar lentigo, and dermatoheliosis. These lesions can develop into skin cancers. The tanning industry, which is evidently responsible at least in part for the severe rise in skin cancers, remains a multi-billion dollar industry worldwide. About 1 million American women use tanning beds regularly of which 70% are females between 16 to 45 years old. The number of women experiencing sun exposure for tanning is not known. Tanning beds were initially proclaimed non-carcinogenic as they emit mostly UVA. In addition, the tanning UV exposure was considered beneficial for promoting vitamin D production in the skin. However, studies demonstrated that tanning beds overall provided more UV radiation than the summer sun exposure. Fluorescent sunlamps were shown to provide up to 4 times as much UV radiation than the sun, for frequent tanners (Coelho et al, 2009). In 2009, it was reported that two female patients developed squamous cell cancer on the hands, after a long history of UV-light exposure to the hands for drying nail polish. Similar evidence was accumulating and this led to the World Health Organization declaring in 2009, that tanning bed exposure was carcinogenic. In addition,the increase in vitamin D levels by tanning devices was not found to be significant (Woo et al, 2010). The Food and DrugAdministration (FDA) issued tanning bed warnings for premature aging and increased risk of skin cancer. The American Cancer Society also recommends prevention of heavy sun exposure and tanning lamps as ways to prevent melanoma (American Cancer Society 2010). In order to provide even more evidence, Zhang et al (2012) conducted a study on 73,000 young females in the United States who were followed for sun exposure and tanning bed use, and the development of skin cancers. They reported that all three types of skin cancers were associated with tanning bed use of 4 times or more per year, and the association was stronger for patients who were exposed at a younger age. Basal cell carcinoma had the strongest association with UV exposure (Zhang et al, 2012). Ultraviolet radiation is known to induce DNA damage. It causes mutations in DNA at pyrimidine bases by inducing dimer formation. The tumor suppressor gene normally prevents cells with such mutations from dividing. However, the p53 gene can itself undergo mutation due to the UV exposure, making the cells apoptosisresistant and thus cause progression to cancer. The BRAF oncogene, as well as variations in the melanocortin 1 receptor gene (MC1R) are associated with increased risk of melanomas (American Cancer Society, 2010). Other risk factors for melanoma include moles (benign nevi), fair skin, freckling, a positive family history, and immunosuppression. The disease xerodermapigmentosum involves a defect in DNA repair after ultraviolet damage, and these patients develop skin cancers at a young age even with very mild skin exposure. Lack of circumcision is a risk factor for squamous cell carcinoma of the penis, and human papillomavirus (HPV) infection is a risk factor, particularly for squamous cell carcinoma in the genitourinary area (American Cancer Society, 2010). Other UV associated products are not fully explored for their health risks. UV light is also used to activate teeth whiteners, there is also a plastic mouthpiece that is marketed to be used by tanners while tanning, so that the tanning UV light can simultaneouslyactivate teeth whiteners. The potential effect of these teeth whitening procedures on oral cancers remains to be fully defined. Diagnosis A skin cancer is suspected when a patient reports an enlarging mole, or a non-healing skin ulcer. Melanomas arise from melanocytes with typically black or brown enlarging moles. Basal and squamous cell carcinomas arise from keratinocytes and appear as plaques, nodules, or ulcers (Riker et al, 2010). In order to make the diagnosis of skin cancer, a biopsy of the tissue and observation under the microscope is necessary. If a lesion is suspicious for melanoma, a full thickness complete excision of the lesion with a margin of surrounding normal tissue is needed. For basal and squamous cell cancers, a shave or punch biopsy to evaluate the lesion can be done first (Stulberg et al, 2004). Further tests and imaging may also be done to evaluate the presence of metastases. Management Most skin cancers are managed by surgical excision of the tumor, which may or may not be followed by radiation, photodynamic therapy, and systemic chemotherapy with antineoplastic drugs such as paclitaxel. Specific immunotherapy options, such as Ipilimumab (a monoclonal antibody) and interferon-alpha for melanoma, also exist. For basal cell carcinoma, targeted therapy is with Imiquimod (Stulberg et al, 2004). Targeted therapy for melanoma focuses on deactivating the BRAF gene, which is often involved in this cancer. After cancer treatment is completed, patients must undergo close follow up for recurrence of the tumor (American Cancer Society 2010). Radiation and surgery has been successful in treating skin cancer in that the layers that contain cancer are continuously removed until the cancer cells disappear. In addition, radiation is applied to kill cancerous cells and keep them from further growth. An individual who has once had squamous cell tumor has high chances of developing another cancer particularly in the same place. This is because the skin has suffered permanent sun harm. Such recurrences of cancer usually takes place within the first two years after radiation or surgery. Just like other cancers, survival rate for people with skin cancer is higher in younger women and men than in old men and women. This is because younger men and women have good health, undergo early diagnosis and more efficient in reaction to treatment (American Cancer Society, 2010). Prevention It is significant to note that the exposure to UV radiation with tanning continues to be popular despite health authority’s warnings against it, which demonstrates the increased need for patient education in this regard (Coelho et al, 2009). Using sunscreens, avoiding the sun during peak sun hours, using protective clothing and caps to protect the skin, and avoiding artificial sources of UV light, need to be promoted with prevention programs (Riker et al, 2010). Researchers have also recognized that current sunscreens are not maximally effective at protecting the skin against UV-induced cancer; therefore, new photo protective compounds are being investigated to develop effective sunscreens (Riker et al, 2010). The tanning industry continues to deny the strong association of tanning with skin cancers, while promoting the weak association between tanning and increased vitamin D levels. This misleading advertisement will have to be dealt with by the health authorities. Although tanning is permitted for those above 18 years age, parental permission in most states is sufficient for allowing younger adolescents and even children as young as 10 years, access to tanning beds. Stricter rules for age obedience and counseling that is more parental is necessary to reduce sun exposure at younger ages, since at young age, the exposure to sun can cause more damage (Riker et al., 2010). Some protection programs against skin cancer have already been tested and implemented: in Germany, a day care center was encouraged to practice hat wearing and sunscreen application, and the staff was educated about the risks of sun exposure (Stulberg et al, 2004). Such education by protection programs have had success in reducing skin cancer rates; increased awareness of adolescents for the risks of sun exposure have not significantly reduced tanning behaviors (Stulberg et al, 2004). All this evidence suggests that more severe measures will be needed to reduce skin cancer associated with risk behavior. The incidence of skin cancers has increased in the last few decades, and this increase is strongly associated with tanning practices. Protection from sun exposure and avoiding tanning could help reduce the rates of skin cancer; however, until now, education and prevention programs have failed to convince many adolescents that the health risks associated with UV exposure are greater than the benefits of improved appearance. The literature is yet to produce a highly effective skin cancer education and prevention program, which could effectively reduce the incidence of skin cancer. Other health effects of UV exposure, such as that with teeth whiteners, need further exploration to enhance our understanding of UV light as a hazard. In addition, it is vital to introduce measures such as encouraging day care center to practice hat wearing and sunscreen application, and the staff should be educated about the risks of sun exposure that can reduce skin cancers. Works Cited American Cancer Society. Skin Cancer Prevention and Early Detection.Learn About Cancer, 6 July 2010. Cafri, Guy. Investigating the Role of Appearance-Based Factors in Predicting Sunbathing and Tanning Salon Use." Journal of Behavioral Medicine 32.6 (2009): 532-44. Print. Coelho, Sergio G, and Vincent J Hearing. "Uva Tanning Is Involved in the Increased Incidence of Skin Cancers in Fair‐Skinned Young Women." Pigment Cell &Melanoma Research 23.1 (2009): 57-63. MacFarlane, Deborah F, and Carol A Alonso. "Occurrence of Nonmelanoma Skin Cancers on the Hands after Uv Nail Light Exposure." Archives of Dermatology 145.4 (2009): 447. Riker, Adam I, Nicolas Zea, and Tan Trinh. "The Epidemiology, Prevention, and Detection of Melanoma." The Ochsner Journal 10.2 (2010): 56-65. Stulberg, Daniel L, Blain Crandell, and Robert S Fawcett. "Diagnosis and Treatment of Basal Cell and Squamous Cell Carcinomas." American family physician 70.8 (2004): 1481. Woo, D. K., and M. J. Eide. "Tanning Beds, Skin Cancer, and Vitamin D: An Examination of the Scientific Evidence and Public Health Implications." Dermatol Ther 23.1 (2010): 61-71. Zhang M, Abrar A. Qureshi, Alan C. Geller, Lindsay Frazier, David J. Hunter, Jiali Han. "Use of Tanning Beds and Incidence of Skin Cancer." Journal of Clinical Oncology 30.14 (2012): 1588-93. Read More