Skin cancer

Skin cancers are common in the head and neck because these are commonly sun-exposed areas that can result in chronic damage. They can common affect the forehead, nose and neck. Although they are usually slow growing and restricted to the skin, aggressive variants have the potential to spread to lymph nodes in the neck and distant organs like liver, lung and bones. The common types of skin cancer are cutaneous squamous cell carcinoma, basal cell carcinoma and malignant melanoma. Rare types include sebaceous carcinoma, Merkel cell carcinoma and adnexal carcinoma. 

How common is it?

They are relatively uncommon in the Indian population as the melanin (pigment) in their skin presents ultraviolet ray related skin damage. However awareness is important because if detected early they can be treated appropriately with excellent results and minimal treatment-related side effects.

What are the symptoms?

When arising in an area of skin that was previously discoloured or abnormal, the signs of cancerous transformation are remembered as A to E: Asymmetry, Border irregularity, Colour change, Diameter larger than a pea and Evolving (recent changes or alternation). New lesions can be raised, scaly, itchy, reddish, bleeding on touch, dark or pigmented, or appear like a lump on the skin. Any of these symptoms when lasting longer than two weeks need to be evaluated by a doctor. 

What causes it?

Most commonly chronic sun damage is the cause of these cancers. Patients on immunosuppressants following transplant surgery are also predisposed to skin cancers. Familial syndromes like xeroderma pigmentosum also result in multiple skin cancers, however these are not common. 

How do you diagnose it?

Skin cancers can often be identified by visual inspection, however confirmation occurs by biopsy of the lesion. Imaging in the form of CT, MRI or PET is performed only when the skin cancer appears clinically advanced or if there is suspicion of spread to the neck lymph nodes or other organs like the lung or liver. 

How do you treat it?

Most skin cancers can be removed by surgery. The goal of surgery is to completely remove the cancer with a rim of uninvolved tissue (known as a ‘margin’). Lymph nodes, when involved, need to be removed as well. Skin cancers on the face may also need removal of the parotid gland on the same side as it may be involved by spread. When the area removed is large, reconstruction is indicated, with skin grafts, local, regional or microvascular flaps. This is vital for good healing and the best possible cosmetic outcome. Certain cancers may be candidates for initial radiotherapy rather than surgery. Advanced cancers may require additional radiotherapy or chemotherapy. Patients with very advanced cancers that have spread to other organs may be candidates for newer immunotherapy agents that have shown promise in recent clinical trials. 

Is it curable? 

The type of cancer is a major determinant of survival in these patients. Basal cell carcinoma often causes local invasion with very low chance of spread to nodes; hence when completely removed these have an excellent prognosis. Squamous cell carcinoma has a higher risk of nodal spread while malignant melanoma has a high risk of spread by blood to other organs. Early stage and low-grade cancers that are removed completely have a high likelihood of cure. Advanced stage cancers have a high risk of recurrence and lower chance of cure. However each patient is different; it does not mean that patients with advanced disease do not survive. To maximize chances of survival, early diagnosis and appropriate and complete treatment from qualified specialists are of vital importance.

What does the road to recovery look like?

The extent of your treatment will determine how long it takes you to recover. Surgery for an early tumour may take two weeks to recover from while a major surgery following by radiotherapy and chemotherapy may take months to completely recover from. It is important to think of your treatment as a marathon rather than a sprint, and take help from those around you, whether they are medical professionals, or friends and family. Follow-up after treatment is crucial – this is to not only assess your recovery, but also to check for recurrence or new cancers; patients who develop sun damage related skin cancers have a high risk of developing new cancers subsequently.