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What is Skin Cancer?

Skin Cancer are frequent cancers.The two main types of skin cancers are:

* The cancers épithéliaux with 80 to 800 new cases per year for 100 000 inhabitants according to the countries;

* The shrewd melanomas with 4 to 6 new cases for 100 000 inhabitants in France every year.

The cutaneous carcinomas (épithéliomas baso and spino-cellular)

What is Skin Cancer?

One distinguishes:

* The épithéliomas basocellulaires to merely local evolution;

* The épithéliomas spinocellulaires, capable to be invasifs and métastatiques.

These are the most frequent cutaneous cancers at people of Caucasian type.

They develop themselves among subjects to risks that can be identified, what permits a prevention and a precocious detection.

The prognosis depends on the forwardness of the diagnosis.

Skin Cancer The populations to risk

The factors of environment are primordial.

The sun is the main enemy of skin. The solar exhibitions are especially harmful than they are prolonged, intense and that they concern the light-skinned patients (phototype 1, II or III).

Some toxic factors also intervene.

The poisoning to the arsenic is of professional origin (viticulture etc.), medicinal (liqueur of Fowler used once in the treatment of the psoriasis) or very rarely food.

The manipulation of toxic such the aromatic polycyclic hydrocarbons, tars, can be at the origin of cutaneous carcinomas.

Tobacco in association with the sun plays an important role in the development of the cancers of the lower lip.

Of the medicinal reasons (iatrogènes) are possible:

Some cancers of skin are led by the radiotherapy. This therapeutic, indispensable in the treatment many cancers, is quit on the other hand in some indications: angiomes, burrs, chronic dermatose...

The puvathérapie is a treatment very used in case of psoriasis. He/it associates the oral hold of a psoralène (méladinine) to the exhibition in the UVA. The consequences long-term of such a treatment, especially if he/it is prolonged, are a risk increased of carcinoma spinocellulaire.

The treatments immunosuppresseurs (AZT notably) increase the risk of cutaneous cancers also.

Some cutaneous states are factors of risk: scars, burns, chronic ulcerations, inflammatory dermatoses etc

Some rare domestic dermatoses is also factors of risk: xeroderma pigmentosum, épidermodysplasie verruciforme, nævomatose basocellulaire, albinism...

The tumor drifts of the cells basales of the epidermis.

Several factors encourage their intervening:

* The exhibition in the sun and to the ionizing radiations; * The treatments to basis of arsenic; * The big age and the Caucasian type; * The existence of precancerous cutaneous lesions that is the solar kératoses: small red plates dry squameuses in the exposed in the sun zones.

The apparition of these cancers gets used in general to the level of the zones exposed in the sun. It is necessary to be attentive as soon as the present skin of the photo ageing signs leads. These signs are especially clean to the level of the face, of the neckline, of the back of the hands and forearms. Skin is fine, irregularly pigmented, wrinkled, dry, browsed of télangiectasies and sometimes of papules or sallow plates corresponding to zones of élastose. The patient or the physician must worry before all lesion persist papuleuse, érythémateuse (red) or color of the normal, scabby or ulcerated skin.

The clinical aspects are very variable. The pearl épithéliomateuse is typical. It is about small translucent grains of 1 to 5 mm of diameter, opaline, farms, recovered to the periphery of the lesion.

The cutaneous biopsy permits the histological diagnosis.

The spontaneous evolution is slowly extensive in surface, without invasion of the neighboring cloths nor metastasis. Under treatment, the evolution is favorable. Some local recidivisms can occur if the treatment is badly conducted.

The precocious treatment rests on the surgical exérèse completes the lesion or, for the small tumors, the destruction, liquid, or laser nitrogen.

A regular surveillance is then necessary (every 6 months or every year) because of the risks to see to develop itself/themselves of other cutaneous carcinomas.

These rarer tumors drift of the kératinocytes of the epidermis.

Clinically, the lesion can take various aspects: bud, ulceration saignotante or insignificant lesion. The biopsy imposes itself to the least doubt.

The extension is local, regional (ganglia) and general (metastases).

The treatment is the large surgical exérèse, associated if need to the clearing-out ganglionnaire. The radiotherapy and the chemotherapy have their indications.

The reasons are identical to those of the épithéliomas basocellulaires but some supplementary factors are possible:

* Shrewd degeneration of former scars of burns for example or of chronic wounds as an ulcer of leg;

* Degeneration of a kératose or an illness of Bowen.

The actinic kératoses is therefore precancerous cutaneous lesions. These lesions are very frequent and nearly all light-skinned aged topics having lived and having worked in the sun have some.

They are often associated to the signs of chronic solar exhibition (wrinkles, élastose, télangiectasies, pigmented stains).

They present themselves as plates, of variable size, érythémateuses and kératosiques. Their rough surface is characteristic to the touch. Some of these kératoses are hyperkératosiques (cutaneous horn). When an infiltration, an erosion or an erythema marked exist, a transformation in spino-cellular épithélioma must be suspected.

These actinic kératoses must be distinguished of the warts séborrhéiques.

The illness of Bowen is rarer. She presents herself under the shape of a plate well limited érythémato-squameuse of some mm to several cm capable to sit where. An eczema, a psoriasis is sometimes evoked but the fixity of the lesion imposes a histological exam. The risk of transformation in carcinoma spinocellulaire is important.

The treatment is urgent and rest on the surgical exérèse or the électrocoagulation.

The prognosis depends on the forwardness of the diagnosis.

Skin Cancer Prevention

Some preventive measures are simple: sun protection, treatment of the actinic kératoses etc