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The Hunger Project Bolen Report
Ohm Society
Untitled
Skin Cancers Print E-mail
by Ron Kennedy, M.D., Santa Rosa, CA

Dr. Kennedy

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common form of skin cancer making up more than 90 percent of all skin cancer in the U.S. These cancers almost never spread to other parts of the body unless they are close to cartilage (like the ear) where they can slide down the surface of the cartilage and escape into the rest of hte body. They can, however, cause damage by growing and invading surrounding tissue. Light-colored skin and sun exposure are important factors in the development of BCC. About 20 percent of these skin cancers, however, occur in areas that are not sun-exposed, such as the scalp, chest, back, arms, and legs. The face is the most common location for BCC. Weakening of the immune system, whether by disease or medication, can also promote the risk of developing BCC as can the use of certain kinds of hair dyes. UV radiation from the sun is believed to be the main cause of skin cancer. Artificial sources of UV radiation, such as sunlamps and tanning booths also put one at risk. People who live in areas receiving high levels of UV radiation from the sun are more likely to develop skin cancer. In the U.S. skin cancer is more common in the South where the sunlight is generally more intense. The highest rates of skin cancer are found in Australia and South Africa, areas that receive high amounts of UV radiation. Also, skin cancer is related to lifetime exposure to UV radiation. Most skin cancers appear after age 50, but the sun's damaging effects begin at an early age. Therefore, protection should start in childhood in order to prevent skin cancer later in life.

Description

A basal cell carcinoma usually begins as a small, dome-shaped bump and is often covered by telangiectases (small, superficial blood vessels). The texture of such a spot is often shiny and translucent, sometimes referred to as "pearly." I biopsy is sometimes required to distinguish a basal cell carcinoma from a benign growth like a flesh-colored mole. Some BCCs contain melanin pigment, making them look dark rather than shiny. BCCs grow slowly, taking months or years to become sizable. Although spread to other parts of the body is very rare, a basal cell carcinoma can damage and disfigure the eye, ear, or nose if it grows nearby.

Diagnosis

Doctors usually remove all or part of the growth by performing a biopsy by injecting a local anesthesia and scraping a small piece of skin (referred to as a "shave biopsy"). The skin that is removed is examined under a microscope to check for cancer cells.

Treatment

The doctor's goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history. Curettage and desiccation consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is suited for small cancers in non-crucial areas such as the trunk and extremities. In more vulnerable areas, sush as the ear, the tumor is surgical excisied. Sometimes radiation treatments are used for skin cancer occurring in areas that are difficult to treat with surgery. With radiation, a good cosmetic result generally involves many treatment sessions, perhaps 25 to 30. Then there is cryosurgery which involves freezing the tumor. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.

Mohs Micrographic Surgery

Dr. Frederic Mohs developed the technique of removing skin cancer using a microscope. The surgeon carefully removes a small piece of the tumor and examines it under the microscope during surgery. This sequence of cutting and microscopic examination is repeated in a painstaking fashion so that the BCC can be mapped and taken out without having to estimate or guess the width and depth of the lesion thus removing as little of healthy normal tissue as possible. The cure rate is more than 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, forehead, ears, and the corners of the nose.

New and Better Treatment

In 1979 Dr. Bill Cham, Ph.D. of Western Australia became interested in a local legend that a plant called Devil's Apple (Solanum linnaeanum) could cure eye cancer in cattle. Over the next many years Dr. Cham managed to isolate the active compounds which turned out to be solasodine rhamnosyl glycosides (solosonine and solamargine). These compounds are most available in the common egg plant. To make a long story short, Dr. Cham has proven beyond any doubt that these compounds cure squamous cell and basal cell carcinomas without surgery. They act by being selectively absorbed by cancer cells (while not affecting normal cells) and inducing the cancer cells to destroy themselves by rupture of an intracellular structure called a lysosome. As the cancer cells die they are replaced by normal cells producing an almost perfect cosmetic result. This product is marketed in cream form and is called "Curaderm BEC5." Twelve weeks of twice daily application produces 100% cure of these two cancers.

Even more exciting is the possibility that these compounds may turn out to be a cure for all cancers. At least in the test tube they are extremely lethal to cancer cells, much more than any chemotherapy drug on the market. Also, these compounds have almost no toxicity to normal cells - which, of course, is the BIG problem with chemotherapy agents. Apparently, it is only a problem of getting these compounds to the cancer. In skin cancer it is simple - just rub it on. However, it is not yet clear how to bring these compounds into contact with internal cancers. This is undergoing intense research at this time.

Prevention

Avoiding sun exposure in is the best way to lower the risk for all types of skin cancer. Regular examinations of susceptible individuals, both by self-examination and regular physical exams by a dermatologist is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular checkups.

Squamous Cell Carcinoma

Squamous cells are found on the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Therefore, squamous cell carcinomas (SCCs) can arise in any of these tissues. SCCs of the skin occurs roughly 1/4 as commonly as basal cell carcinoma (BCC). Light-colored skin and sun exposure are even more important in predisposing to this kind of cancer than to basal cell carcinoma. Men are affected more often than women. Women, whose hair generally covers their ears, develop squamous cell carcinomas far less often in this location than do men. The most important factor in producing SCCs is sun exposure. Many such growths can develop from precancerous spots, called actinic or solar keratoses. These appear after years of sun damage on parts of the body, commonly on the forehead, cheeks, and backs of the hands. Sun damage takes many years to provoke skin cancer. It is therefore common for people who stopped being "sun worshipers" ealier in life to develop precancerous or cancerous spots decades later. Several rather uncommon factors may predispose to SCC in cluding exposure to arsenic, hydrocarbons, heat, or x-rays. Some squamous cell carcinomas arise in scar tissue. Suppression of the immune system by infection or drugs may also promote such growths. Unlike basal cell carcinomas which rarely spead to other locations, squamous cell carcinomas can metastasize. SCCs usually begin as firm, skin-colored or red nodules that begin within solar keratoses or on sun damaged skin. These are easier to cure and metastasize less often than those that develop in traumatic or radiation scars. One location particularly prone to metastatic spread is the lower lip. Therefore, a proper diagnosis in this location is very important.

Diagnosis

To make a proper diagnosis doctors perform a biopsy taking a sample after injecting local anesthesia by punching out a small piece of skin using a circular punch blade. This is referred to as a "punch biopsy." The skin that is removed is then examined under a microscope for cancer cells.

Treatment

Techniques for treating squamous cell carcinomas are similar to those for basal cell carcinoma. They include curettage and desiccation, a method dermatologists usually prefer scooping out the carcinoma by using a spoon like instrument called a curette. Desiccation involves the application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities. Doctors also sometimes surgically excise the tumor and stich up the remaining skin. Radiation treatments are used in areas difficult to treat with surgery. Good cosmetic result can involve many treatment sessions, up to 30. Some doctors are trained in cryosurgery, that is freezing the tumor. Liquid nitrogen is sprayed on to freeze and kill the abnormal cells.

New and Better Treatment

In 1979 Dr. Bill Cham, Ph.D. of Western Australia became interested in a local legend that a plant called Devil's Apple (Solanum linnaeanum) could cure eye cancer in cattle. Over the next many years Dr. Cham managed to isolate the active compounds which turned out to be solasodine rhamnosyl glycosides (solosonine and solamargine). These compounds are most available in the common egg plant. To make a long story short, Dr. Cham has proven beyond any doubt that these compounds cure squamous cell and basal cell carcinomas without surgery. They act by being selectively absorbed by cancer cells (while not affecting normal cells) and inducing the cancer cells to destroy themselves by rupture of an intracellular structure called a lysosome. As the cancer cells die they are replaced by normal cells producing an almost perfect cosmetic result. This product is marketed in cream form and is called "Curaderm BEC5." Twelve weeks of twice daily application produces 100% cure of these two cancers.

Even more exciting is the possibility that these compounds may turn out to be a cure for all cancers. At least in the test tube they are extremely lethal to cancer cells, much more than any chemotherapy drug on the market. Also, these compounds have almost no toxicity to normal cells - which, of course, is the BIG problem with chemotherapy agents. Apparently, it is only a problem of getting these compounds to the cancer. In skin cancer it is simple - just rub it on. However, it is not yet clear how to bring these compounds into contact with internal cancers. This is undergoing intense research at this time.

Prevention

Even more so than is the case with basal cell carcinoma, the key principles of prevention are minimizing sun exposure and getting regular checkups. It mekes sense to limiting recreational sun exposure, avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon), wear protective clothing, use high quality water proof UVA sunscreen of SPF 30 or higher, and have regular checkups bringing any suspicious lesions to the attention of your doctor.

Malignant Melanoma

Melanoma is the most serious type of skin cancer and begin in skin cells called melanocytes. These are the cells that make melanin, which gives skin its color. Melanin also protects the deeper layers of the skin from the sun's ultraviolet (UV) rays. When you spend time in the sun, melanocytes make more melanin which spreads out evenly resulting in a "tan." This also happens when skin is exposed to other forms of UV, such as in a tanning booth. If the skin receives too much ultraviolet light, the melanocytes may cancerous. This condition is called melanoma. The first sign of melanoma is often a change in the size, shape, or color of a mole. But a melanoma can also appear on the body where there was no leasion previously. In men, melanoma most often shows up on the upper body, between the shoulders and hips on the head and neck. In women, melanoma often develops on the lower legs. In dark-skinned people, melanoma often appears under the fingernails or toenails, on the palms of the hands, on the soles of the feet, in other words areas not protected by dark skin. Although these are the most common places on the body for melanomas to appear, they can appear anywhere on the skin. That's why it is important to always examine your skin to check for new moles or changes in moles. With early diagnosis and treatment, the chances of recovery are very good. The chance of getting melanoma increase with age, but melanoma can appear at any age. In fact, melanoma is one of the most common cancers in young adults. Each year, more than 50,000 people in the U.S. develop melanoma. Melanoma can become a life-threatening cancer. If found and treated in its early stages, chances of recovery are very good. If not found early, melanoma can grow deeper into the skin and spread to other parts of the body (metastasis). Once melanoma has spread to other parts of the body beyond the skin, it is difficult to treat.

Diagnosis

A mole that looks unusual or that has grown or changed color or shape in the last few months should receive the attention of your doctor. If your doctor also thinks the mole looks suspicious, you should be referred you to a dermatologist (a physician who specializes in diseases of the skin). The dermatologist may do a biopsy and remove a small piece of the mole or the entire mole. A pathologist (another specialty) looks at the sample under a microscope to check for cancer cells. If the mole turns out to be melanoma, your dermatologist will need to find out more about the disease, based on how thick the tumor is and, how far it may have spread. This is called staging. Staging the melanoma is a very important step as it may determine the choice of treatment.

To find out how thick the melanoma is, the doctor will remove the entire tumor along with some skin around it (if this wasn't already done during diagnosis). At the same time, or in a later step, the doctor may do a procedure called a sentinel lymph node (SLN) biopsy. This will help determine whether, and where, the melanoma has spread. Other tests may also play a role in staging. These include blood tests, chest x-rays, CT (computed tomography), MRI (magnetic resonance imaging), PET scan (positron emission tomography scan).

Treatment

If the melanoma has spread to the nearby lymph nodes, the affected lymph nodes may also be removed surgically. Surgery is usually the only treatment needed for people with early-stage melanomas (thinner melanomas that have not spread to the lymph nodes). However, these people still need regular follow-up visits to the doctor, to make sure the melanoma has not come back and that other moles do not need biopsies. Once a person has had melanoma, there is a higher chance of getting it again. After all traces of the tumor have been removed, you may be referred to an oncologist (cancer specialist). If the melanoma has spread to other areas or if there is a good chance the melanoma might come back, the oncologist may prescribe additional treatment such as immunotherapy (also called biochemical therapy or biotherapy) - a form of therapy that stimulates the immune system to kill or control cancer cells. Chemotherapy and/or radiation therapy may also be employed for melanoma which has metastisized. Melanoma that has spread to distant sites in the body, or to other organs (such as the lungs or liver) may not be curable, although one hears of miracle cures from time to time. In these cases, treatment usually focuses on relieving symptoms and keeping the patient as comfortable as possible.

Prevention

The main cause of melanoma is too much exposure to ultraviolet (UV) rays. The best way to prevent melanoma is to reduce the amount of time you spend in the sun, especially at certain times of the day, and to make sure you are well protected when you are in the sun. Childhood is an especially important time for sun protection. Protecting the skin during the first 18 years of life can reduce the risk of some types of skin cancer by up to 78%. Also do a skin self-exam every 6 to 8 weeks. This helps ensure that you find suspicious moles early and have them checked promptly by your doctor.



The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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