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Skin cancer is like any other kind of cancer – a few cells mutate and begin growing as cancerous tumours. Skin cancer is mostly located on the topmost layer of the skin – the epidermis. The epidermis can be further divided into a few parts by the types of cells that form it. Depending on the type of cell concerned with cancerous growth, the cancer is classified.
Skin cancer in the UAE is not as common as breast or colorectal cancer, but its appearance rate has increased by over 45% in the last decade. Melanoma, the deadliest kind of skin cancer, has risen by 50% in men and 35% in women, which is quite alarming. While people of colour are less prone to getting skin cancers, people of the UAE may have a high chance of developing them in peak summers. As specialists in the UAE put it, all you need is a few minutes under the scorching UAE sun to develop cancerous cells. The main reason behind this rise in skin cancer cases is the delay in diagnosis. Since skin cancers look a lot like generic skin conditions, they often go unnoticed until the later, lethal stages. But still, as compared to all other types of cancer, skin cancer is quite uncommon.
Skin cancers can be divided into two main categories – melanoma skin cancer and nonmelanoma skin cancer. Nonmelanoma skin cancers can be of several types, but three of those types are the most common. Given below is a rundown of all the major types of melanoma and nonmelanoma cancers.
You may know this type of skin cancer as the one that looks a lot like moles on our bodies. Melanoma is mostly found on the skin that has been damaged by the UV radiations from the sun and the cancerous growth looks a lot like moles. The key difference here is the colour, shape and size of these cancerous moles compared to the generic ones. Melanoma moles may be red or reddish-brown and may even change shape and size over time. They are generally not a perfect circle like most generic moles are. Melanoma develops in the melanocytes – the cells that produce pigments.
Basal Cell Carcinoma: Basal cell carcinoma develops in the basal skin cells of the skin’s topmost layer. It can look like a white/pink patch, a bump, a scar, an open sore, an alien growth that may itch or bleed, crust spots, or elevated growth with rolled edges. The shape and size of basal cell carcinoma may vary a lot, so you should see a doctor immediately if something unusual comes up.
Merkel Cell Cancer: This type of skin cancer is quite aggressive and grows at an alarming rate. Merkel cell carcinoma happens in the Merkel skin cells of the top layer of the skin. It may happen due to UV ray exposure as well as gene mutation. It is one of the most serious types of skin cancer but can be treated effectively with early detection. The growth of Merkel cell carcinoma looks a lot like a shiny pink, bluish or reddish bump that grows quickly.
Squamous Cell Carcinoma: This is the type of skin cancer can spread and has a high chance of growing in places that are generally never exposed to UV rays such as genitals. However, squamous cell carcinoma is very treatable. It often looks like a red scaly patch, a wart, a tough patch on the skin, or a raised skin growth but with depression. If treatment is delayed, it can spread to other body parts such as lymph nodes and bones.
Just like any other type of cancer, several small, big, unique and regular things may increase a person’s risk of getting the disease themselves:
UV Ray Exposure: Exposure to harmful ultraviolet radiation is the biggest risk factor for getting skin cancer. Living at higher altitudes and being exposed to sunlight a lot increases your risk of getting skin cancer. The same goes for people who have to spend a lot of time outside in the sun for work or other reasons. Type A UV rays are closer to increasing the risk of skin cancers like melanoma and squamous cell carcinoma than type B UV rays. Type A UV rays can even penetrate glass, increasing the risk several folds. The highest probability of skin cancer happening is on the face along with the head and neck as they are exposed to the sun.
Weak Immune System: People who have a weak immune system in general or due to a condition or treatment procedure like bone marrow transplants, organ transplants, HIV AIDS, etc. are at a higher risk of getting skin cancer. Their risk of getting squamous cell carcinoma is especially higher as compared to people who have a strong immune system. People who may be taking drugs to suppress or alter the functions of the immune system as part of a treatment plan have the same level of risk.
Artificial Tanning: Just like bathing in natural sunlight, the artificial methods of tanning and recreational sunbathing also increase the risk of getting skin cancer. And unlike natural sunbathing, there is no “healthy amount” of recreational sunbathing or artificial tanning one can do. Artificial tanning and sunbathing devices increase the risk of all types of cancers including melanoma, squamous cell carcinoma and basal cell carcinoma. Even the slightest exposure to these methods and activities can greatly increase the risk for you.
Having Fair Skin Tone: While all people, no matter their skin tone, are at risk of getting skin cancer, people with fairer skin tone may be more prone to getting it. Include factors like blonde or red hair, blue or green eyes, or having freckles to this list. In addition to that, people who are more prone to getting sunburns than tan are also more prone to getting skin cancer. The risk of developing melanoma is almost 20% higher for people with fairer skin tone or white people as compared to others.
Skin Conditions: Several skin conditions that are not cancerous themselves can later change into different types of cancer. For example, red or brown patchy and scaly skin is caused by actinic keratosis. If a person is already suffering from actinic keratosis, they have a higher chance of having it develop into squamous cell cancer. The more the patches, the higher the chances. Actinic keratosis is also caused by sun exposure, which means you can stay protected just by following a few preventive steps.
Merkel Cell Polyomavirus: Almost 80% of Merkel cell cancer patients have the Merkel Cell Polyomavirus present in their bodies. Several studies show that there is a link between the two, but not conclusive enough to relate what it is and how it is established. Merkel Cell Polyomavirus is quite common. However, it does not mean that everyone who has the virus will also have Merkel cell cancer.
Age and Gender: Men are more prone to getting certain types of skin cancer such as Merkel cell cancer. The stats of older white men developing skin cancer have increased in the past few years. Younger women with light skin tones have also been increasingly getting skin cancer. As far as age is concerned, older people are at a higher risk of developing skin cancers like basal cell cancer and squamous cell carcinoma. Fair skin, combined with genetic material, can result in younger people getting nonmelanoma skin cancer. Merkel cell cancer is the most commonly seen among people older than 70 years of age.
Fragile or Sensitive Skin: Naturally, people with sensitive skin are more prone to getting skin cancer. Skin or parts of the skin that have been sunburned or treated for a skin condition are more prone to developing skin cancers like squamous cell carcinomas and basal cell carcinomas.
Skin Cancer History: If you have been exposed to skin cancer already and treated for it, you have an almost 50% higher chance of getting the same or another type of skin cancer again. Almost half the people who have been diagnosed with basal cell carcinoma get another type of skin cancer within the next 5 years of their treatment. This makes follow up sessions and precautions all the more important.
Genetics: A few rare genetic conditions can increase the risk of developing certain skin cancers. For example, nevoid basal cell carcinoma syndrome aka Gorlin syndrome increases the risk of developing basal cell carcinoma. Albinism, dyskeratosis congenital, and epidermolysis bullosa simplex can increase the risk of getting squamous cell carcinoma. Cancers like melanoma can be passed down as information in the form of mutated genes. Genes like CDKN2A, P53, CDK4 and MITF can cause melanoma if inherited in mutated or changed form.
Medications: Some specific medicines containing steroids and other compounds can suppress the immune system and hence make the person more prone to developing skin cancer. These medicines make the skin sensitive and more prone to getting sunburned, which in turn increases the chances of getting squamous cell cancer. These medicines often create a growth pathway for mutated cells that turn into squamous cell carcinoma later on.
Radiation Therapy: This may take a lot of time if a patient has already received radiation therapy as a treatment procedure for other types of cancers.
Family History: People who have a family history of cancers like melanoma have a two or even three-times higher risk of developing it themselves. Almost 10% of melanoma patients turn out to be the ones with a family history of the same type of skin cancer. The risk is increased if family members living in different regions are diagnosed with melanoma, as it broadens the circle.
While there are several tests one can run when other types of cancer like breast, lung or prostate are concerned, there is only one way of diagnosing skin cancer for sure – a biopsy. Whether it is melanoma or nonmelanoma cancer we are talking about, a biopsy is the only sure-shot way of identifying it. Since skin cancer looks a lot like basic skin conditions, other methods of diagnosis do not apply. In a biopsy, doctors take a sample from the concerned area of the skin as well as a little bit of margin and run tests to check if the cells in the sample are cancerous. For skin cancers that are not very serious or have just started to appear, a biopsy sample may be enough to remove them completely. If not, further treatment is suggested.
Surgery: The surgery you go through depends on the type of cancer you have. Nonmelanoma cancers have a different set of surgeries than melanoma. Curettage and electrodesiccation are some of these surgeries. The cancerous growth is removed using a spoon-like tool known as a curette. The concerned area is then treated with electric current to kill the remaining cancer cells. Mohs micrographic surgery is used to treat larger or reappearing tumours. Cancer cells and a few surrounding cells are removed in this surgery until the area is clean again. Wide excision surgery removes the cancer cells along with a few other healthy cells. If the tumour is big, skin cells from other parts of the body may be used to treat the affected area. Sentinel lymph node biopsy, also used for other types of cancer that can spread to lymph nodes, is used to treat Merkel cell carcinomas in combination with other types of surgeries. For melanoma, lymph node biopsy, wide excision and lymph node dissection surgeries may be used. Lymph node dissection is used if cancer has spread further and lymph nodes are to be removed for treatment and not for observation.
Radiation Therapy: Radiation therapy uses high-energy x-rays or other kinds of particle rays to destroy cancerous cells. It is often used in places that are hard to treat with surgery such as eyelids. It may also be used to treat lymph nodes that may be involved in cancer. External beam radiation is the most common type of therapy for skin cancer. An external device is used to transfer beams in this method. Brachytherapy may also be used where a radiation-producing element is placed in the cancerous cells to slowly destroy them. People who have melanoma may also receive palliative radiation therapy.
Photodynamic Therapy: This treatment method is used for actinic keratosis that may cause squamous cell carcinoma. A medication is applied to the affected area and then exposed to a light-emitting device.
Cryotherapy: The cancerous cells are frozen and then destroyed in cryotherapy. Liquid nitrogen is used to destroy the cancer cells after freezing them. This may leave a scar, though.
Chemotherapy: Anti-cancer drugs and medication are given to patients in chemotherapy through the bloodstream or orally. Skin cancer can also be treated using topical medicines for chemotherapy. Chemo is generally used to treat skin cancer on the face as it does not leave a scar.
Targeted Therapy: This type of treatment is used to target the specific genes or proteins that may be causing cancer growth. A few tests may be required to determine the cause. It is also used for advanced basal cell cancer. Medicines are used in this form of treatment as well.
Immunotherapy: This type of skin cancer treatment uses drugs like Cemiplimab or Pembrolizumab to target the functioning of the immune system. It aims to restore the natural action plan of the immune system and kills the cancer cells by disabling the checkpoints used by cancer cells.
The very first thing you need to do is prevent or decrease your exposure to harmful UV rays from the sun. Since these rays are at their worst from 10 am to 4 pm, try and avoid stepping out during these hours.
Wear a broad-spectrum sunscreen if and when you have to step out in the sun. Anything higher than SPF 30 should be the minimum goal to chase.
If you are going to a place like a beach, make sure you use sunscreen every hour or two. Cover your exposed body entirely with at least an ounce of sunscreen and repeat it after staying in water for long or heavy sweating.
Recreational sunbathing should be avoided as much as possible.
The same goes for artificial tanning instruments like sun lamps, tanning salons and tanning beds.
Make sure you undergo preventive skin examinations regularly, especially if you are at an increased risk of getting skin cancer.
Take advice from your doctor before taking any supplements.
Since skin cancer of the face is pretty common, make sure you apply sunscreen regularly on the face.
Both critical illness insurance and basic health insurance plans may cover skin cancer. When covered by basic health insurance plans, skin cancer may be covered under the dermatology section of the plan. A waiting period of 6 months to 2 years may apply. In the case of a critical illness plan, a waiting period of 90 days may apply as well as a survival period of 15 to 30 days. Critical illness plans will offer you a lump sum amount to cover the expenses of the treatment. Basic health insurance plans may cover the surgery costs, pre- and post-hospitalisation expenses, and medicine costs as per the scope of the plan. Deductibles, copayment and coinsurance may apply.
Even if skin cancer statistics are not as bad as other types of cancers in the UAE, ignoring it for a long time can result in lethal outcomes. Skin cancer is completely treatable with full recovery in most cases – up to 99% – which is quite staggering. But this is applicable only when it is identified in the early stages. So, make sure that you get regular screenings and get anything suspicious on your skin checked out. Keep a good health insurance plan handy and stay aware of the recent trends and risk factors.