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Skin cancer

Also listed as: Cancer - skin

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Following Up
• Supporting Research

Skin cancer is generally a result of too much exposure to the sun. While skin cancer is the most common form of cancer, many types are both preventable and treatable. Skin cancer is classified into five different types:

• Basal cell carcinoma (BCC) is the most common form and accounts for 90% of all skin cancers. It originates in the basal cells, at the bottom of the epidermis (outer skin layer), and is caused by long-term exposure to sunlight.
• Squamous cell carcinoma (SCC) is the second most common type. It originates in the epidermis, eventually penetrating the underlying tissue if not treated. In a small percentage of cases, this cancer spreads (metastasizes) to other parts of the body.
• Malignant melanoma (MM) is a form of skin cancer that currently is affecting an more and more people. Each year, more than 53,000 cases are diagnosed in the U.S. MM is a very serious type of skin cancer, but the cure rate is quite good if it is diagnosed and removed early. Melanoma originates in moles or other growths on normal skin.
• Paget's disease (PD) is a rare type of skin cancer. It generally appears on the nipple, and is associated with an underlying breast cancer. It may also appear in the groin or near the anus, possibly originating in the sweat glands.
• Kaposi's sarcoma (KS) is caused by a virus in the herpes family. An aggressive AIDS-related form affects about one third of AIDS patients. A more slow growing form occurs in elderly men of Italian or Jewish ancestry.

Signs and Symptoms

Skin cancer is accompanied by the following signs and symptoms:

• A new skin lesion or open sores that bleed, ooze, or crust, and fail to heal in an expected time frame
• Enlargement of an existing skin lesion
• Change in color, size, shape or texture of a mole
• A new mole
• Reddish patch or irritated area, frequently occurring on the chest, shoulders, arms, or legs
• Shiny bump that is pearly or translucent
• Poorly defined borders of a skin lesion

What Causes It?

Exposure to ultraviolet (UV) radiation from the sun is the primary cause of skin cancer. A virus causes Kaposi's sarcoma, while Paget's disease is related to underlying breast cancer.

Who's Most At Risk?

People at risk for developing skin cancer may have the following conditions or characteristics:

• Light skin color
• Spend a lot of time outdoors in work or leisure activities
• History of severe sunburn
• Family history of skin cancer
• Large dark-colored birthmark known as congenital melanocytic nevus
• Certain non-cancerous skin conditions, such as actinic keratosis, which can predispose a person to skin cancer
• HIV (human immunodeficiency virus) -- a risk for Kaposi's sarcoma specifically

What to Expect at Your Provider's Office

Your health care provider will examine your skin for new, changed, or unusual moles. This may involve the use of a dermatoscope, which is used for close examination of skin growths. Your health care provider will take a biopsy of any growths that appear cancerous. This involves removing a small piece of skin for microscopic examination. A biopsy can confirm whether or not you have skin cancer.

Treatment Options

Prevention

Skin cancer is a preventable disease. If you are at high risk, avoid sun exposure. When you have to be in the sun, protect yourself by covering up, wearing a hat, and applying sunscreen with an SPF of at least 30. You should also have regular skin cancer screenings with your primary health care provider or a skin specialist (dermatologist).

Treatment Plan

The primary goals of treatment are to remove the cancerous growth and stop the spread of the disease.

Drug Therapies

Melanoma that is deep or has spread and AIDS-related Kaposi's sarcoma may be treated with chemotherapy.

Surgical and Other Procedures

• Most skin cancer can be surgically removed.
• When surgery is not possible, cryotherapy (freezing), topical chemotherapy, or radiation may be used. If the cancer is on or close to the skin's surface, photodynamic therapy (laser) may be used.
• Paget's disease of the nipple usually requires mastectomy (removal of breast tissue).

Complementary and Alternative Therapies

Alternative treatments are focused on preventing rather than treating skin cancer. In addition, some CAM treatments may reduce the side effects of conventional treatments. Finally, while many CAM treatments have not yet undergone rigorous scientific research, evidence suggests that some treatments may be useful when applied along with conventional treatments for skin conditions, including skin cancer. You should never rely on alternative therapies alone for treating skin cancer.

Nutrition

Eating certain foods or following therapeutic diets may help prevent skin cancer. It is hard to test the role of nutrients in protecting against various forms of skin cancer, but several studies have investigated the role of antioxidants (including vitamin C, vitamin E, beta-carotene, zinc, and vitamin A), folic acid, fats and proteins, and a variety of whole foods. While results are not absolutely clear, there may be some protective effect from antioxidants. There may also be a protective effect from foods such as fish, beans, carrots, chard, pumpkin, cabbage, broccoli, and vegetables containing beta-carotene and vitamin C. Studies on animals suggest that lignans, substances found in foods such as soy and flaxseed, may also help fight cancer in general, including the spread of melanoma from one part of the body to another.

Other substances found in plants may help protect the skin from sun-related damage. These include

• Apigenin, a flavanoid in vegetables and fruits, including broccoli, celery, onions, tomatoes, apples, cherries and grapes, and in tea and wine
• Curcumin, in the spice turmeric
• Resveratrol, in grape skins, red wine, and peanuts
• Quercetin, a flavanoid in apples and onions

Selenium has been touted as an antioxidant that might help prevent skin cancer. One study, however, suggests that selenium might actually increase the risk of developing squamous cell cancer.

Therapeutic diets may also help with skin cancer. An example the Gerson diet, which is customized for each patient. This diet may enhance treatment of melanoma. It strives for a low-fat, low-salt diet, hourly feedings of highly concentrated raw fruit and vegetable juice nutrients, and strategies to speed up metabolism (the breakdown and use of food), such as exercise, taking supplements, and restricting calories. Castor oil, administered every other day for several weeks, and coffee enemas given as frequently as every 4 hours over a 24-hour period, are thought to alleviate pain and improve nutritional status.

Herbs

Naturopathic doctors and botanists recommend a number of herbs and herbal combinations to prevent and treat cancer in general. To identify appropriate herbs to use in your treatment for skin cancer, see a trained herbalist, who will consider your condition and may prescribe herbs to support your care.

Green tea ( Camellia sinensis ) contains polyphenols, compounds that are potent antioxidants. Antioxidants eliminate free radicals, harmful by-products of cells' metabolism that are thought to play a role in cancer. The main polyphenol in green tea is epigallocatechin gallate (EGCG). Scientific studies suggest that EGCG and green tea polyphenols may prevent the onset and growth of skin tumors.

Other herbs with antioxidant and skin-protecting effects include bilberry (Vaccinium myrtillus), ginkgo ( Ginkgo biloba ), milk thistle ( Silybum marianum ), ginger ( Zingiber officinale ), and hawthorn ( Crataegus laevigata ).

For Kaposi's sarcoma, some naturopaths recommend a paste made from lemon balm ( Melissa officinalis ) cream, several drops of Hoxsey-like formula (a mixture of herbs and potassium iodide thought to be effective against cancer), and powdered turmeric applied to lesions twice a day.

An animal study conducted in China investigated the effects of Cordyceps sinensis on natural killer cells. These are white blood cells that attack cancer and other harmful substances in the body. The study found that Cordyceps sinensis was effective against malignant melanoma by promoting natural killer activity and inhibiting tumor formation.

You should remember that certain herbs and nutrients can alter the way medications, including chemotherapy, act in your body. Make sure you keep your conventional and alternative health care providers informed about all the supplements, therapies, and medications you are using.

Homeopathy

Homeopathy is widely used among patients with melanoma, and warrants scientific investigation. An experienced homeopath considers your individual case and recommends treatments that address both your underlying condition andany symptoms you may be having.

Acupuncture

While acupuncture is not used as a treatment for cancer itself, evidence suggests it can be a valuable therapy for cancer-related symptoms (particularly nausea and vomiting that often accompanies chemotherapy treatment). Some studies have indicated that acupuncture may help reduce pain and shortness of breath.

Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness. Acupressure is technique that patients can learn and use to treat themselves.

Some acupuncturists prefer to work with a patient only after they have completed conventional medical cancer therapy. Others will provide acupuncture or herbal therapy during active chemotherapy or radiation. Acupuncturists treat cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer-related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.

Massage

Massage is generally not recommended for those who have been diagnosed with skin cancer.

Prognosis/Possible Complications

Prognosis varies depending on the type of skin cancer:

• Basal cell carcinoma: generally excellent.
• Squamous cell carcinoma: excellent for small lesions removed early and completely.
• Malignant melanoma: 5-year survival is almost 100 percent for very superficial lesions removed early. However, thick lesions and melanoma that has spread to other organs have poor prognosis.
• Paget's disease: depends on the extent and cell type of the underlying breast cancer.
• Kaposi's sarcoma: good for superficial lesions of the slow-growing form in the elderly of Italian or Jewish ancestry. The course of AIDS-related Kaposi's sarcoma depends on the status of the person's immune system.

Following Up

See your provider regularly for screenings to check for a recurrence of skin cancer.

Supporting Research

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• Review Date: 6/15/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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