Report on Skin Cancer by AskDocWeb

Skin Cancer

This article covers the etiologies of keratosis, BCC and SCC, with their currently available treatments.

Keratosis and sunspots most often occur on people with fair skin. They can be identified as a discreet slightly raised, red lesion, commonly located on sun exposed areas of the skin. Both keratosis and sunspots are classified as precancerous growths. These spots are almost as common as pimples. If sunspots and Keratosis are left untreated, approximately 20% of actinic keratosis develop into squamous cell carcinoma and that can become deadly. Up to 60% of those over 40 years old have at least one sunspot.

Getting just one sunburn before the age of 18 years can increase your risk of solar Keratosis. The number of people getting sunspot are increasing at an alarming rate, especially in people ages 20 to 40 years old. Skin Cancer Rates have more than doubled in the USA, Europe, South Africa and Australia since 1987.

To detect Sun Spots and Keratosis, look for a change in your skin such as:

  • Dry skin
  • Patchy areas of skin
  • Reddening irritated spots

If any of these changes occur to your skin, it is recommended you see your medical practitioner so that you can find out if it is a Sunspot or Keratosis and assess the risk and/or possible treatment.

It is fashionable to have a suntan and people feel that exposing their skin to the sun is a healthy, pleasant thing to do. Most of the time this is true but the sun also has a down side in that, the ultraviolet part of the sunlight, in particular U.V.-B (290-320nm), is responsible for producing long-term solar skin damage (keratosis) and skin cancers. In fact, skin cancers are the most common malignancy in humans.

Keratosis

An overgrowth of the epidermis forms a scaly layer on the skin. The start of this lesion is usually a small patch of dilated capillaries several millimeters in diameter. Then a dry, rough, adherent yellow or dirty brown scale forms, which may bleed if picked off. It may eventually become thick and horny, with a sharp, clear division between the keratosis and normal skin. Solar keratoses occasionally regress if sun exposure is stopped before they become too established. Although non-malignant, they are potentially malignant and can develop into cancer.

Basal Cell Carcinoma (BCC)

A BCC is a malignant tumor that rarely spreads to distant sites (metastases). It starts in the basal layer of cells, between the basement membrane and the subsequent layer of cells and grows upwards from these. It consists of immature cells and has an organized complex of supportive tissue around it. The primary cause of BCC is sunlight exposed onto sensitive skin. Contributory causes are radiation damage, exposure to arsenic, burn scars and vaccination marks. BCCs are the most common malignant skin tumors in humans; they do not spread by metastases, but they erode tissue, and if not treated may eventually kill.

BCCs may appear in a variety of guises and on first appearance, they are commonly small, rounded lumps with a pearly edge, and a thin surface covering with a few superficial transparent blood vessels. BCCs may also appear as ulcers, or as bleeding or non-healing lesions. Occasionally they appear as flat diffuse crusting or scaling red lesions. BCC tumors usually grow slowly but in a relentless manner. They then ulcerate and the ulcer will follow the spreading tumor, causing further damage, (for this reason they are also known as rodent ulcers).

Squamous Cell Carcinoma (SCC)

An SCC is a malignant tumor arising from the cells above the basal layer of the epidermis (prickle layer), usually after many years of exposure to sunlight. The cells in the prickle layer are maturing towards keratin formation and the cancer occurs when they accelerate in growth and breakthrough the basement membrane into the dermis. Although sunlight is the most common cause of SCC, any cancer-producing substance (carcinogen) may initiate its development.

SCCs often arise from precancerous conditions such as solar keratoses. SCCs may also develop from skin ulcers, scar tissues, and x-ray damaged tissues, if this occurs then the chance of metastasis increases to approximately 20%. In addition, some 40% of transplant patients who are on immunosuppressive drugs develop SCCs within 5-years post-transplantation. This skin cancer is a serious problem and is potentially deadly.

The first sign of an SCC is usually a thickening, with the lesion feeling firm, and the limits are not discrete. In the early stages there may be a crust that may later shed to show an ulcer. It may also form as a crack (fissure) or a small ulcer on the lip, which fails to heal and bleeds recurrently. The SCC may metastasize with an incidence of generally less than 5%.

Old Established Treatments

Surgery: There are various surgical techniques available to treat skin cancer in its various forms. Surgical excision of a tumor has the advantage, that if done correctly, removes the affected area virtually completely. This treatment is extensive, requires anesthesia and depending on the tumor, may require skin grafting with its accompanying cosmetic limitations. The risks of surgical intervention are well known and excision of BCCs or SCCs from the facial area often involves reconstructive surgery, which can be both time consuming and costly.

Radiotherapy, more so prior to the 1950’s than now, has been used to treat most skin cancers. The disadvantage of this mode of treatment is the resulting scar tissue, which may be depressed, depigmented and may also undergo degenerative and malignant changes at a later date.

Dermatological treatment consists of curettage and diathermy/cauterization, cryotherapy, chemosurgery and chemotherapy, and is generally used for superficial skin cancers. With curettage and diathermy, the tumor is scraped out and the bleeding stopped by cauterization, (application of heat) by an electric current (diathermy).

Cryotherapy, possibly the most widely used method, involves an intensely cold probe, cooled by liquid nitrogen, which is applied to the lesion. When the lesion thaws, there is pain in the treated area, followed by blister formation.

Chemosurgery involves chemical fixation of the lesion and the fixed tissue is shaved off in layers. Chemotherapy with 5-fluorouracil (5-FU), which is an anti-metabolite and inhibits RNA and protein syntheses leading to cell death, is used to treat superficial lesions, but it is not specific for cancer cells. 5-FU is supplied as an ointment and requires considerable care in its application under medical supervision.

All of the above methods (surgery, radiotherapy and dermatological) have their own individual limitations. However, the limitations common to all of these methods are:

  • Formation of scar tissue
  • Lack of normal tissue regrowth
  • High rate of recurrence
  • Unacceptable appearance
  • Limited access to the lesion if it is deep within the skin

New Treatment

It is now well established that specific glycoalkaloids from the Solanum family have anticancer properties. The specific glycoalkaloids consist of BEC, which is a standardized mixture of triglycosides, solasonine and solamargine and their corresponding di- and mono-glycosides.

Curaderm-BEC5, is a topical cream preparation of a mixture of the glycoalkaloids solasodine glycosides (BEC). BECs are present in some solanaceous plants, including edible plants such as Solanum melongena (otherwise known as eggplant or aubergine). BEC was first introduced in Australia and is now trying for worldwide availability.

For comments on Curaderm see the Curaderm forum.

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