What is Skin Cancer?
Skin cancer — the abnormal growth of skin cells — most often develops on skin exposed to the sun. But this common form of cancer can also occur on areas of your skin not ordinarily exposed to sunlight.
There are three major types of skin cancer — basal cell carcinoma, squamous cell carcinoma and melanoma.
You can reduce your risk of skin cancer by limiting or avoiding exposure to ultraviolet (UV) radiation. Checking your skin for suspicious changes can help detect skin cancer at its earliest stages. Early detection of skin cancer gives you the greatest chance for successful skin cancer treatment.
About Iranian Surgery
Iranian surgery is an online medical tourism platform where you can find the best Surgeons to treat your Skin cancer in Iran. The price of treating a Skin Cancer in Iran can vary according to each individual’s case and will be determined by the type of treatment you have and an in-person assessment with the doctor.
For more information about the cost of Skin Cancer Treatment in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number 0098 901 929 0946. This service is completely free.
Before Skin Cancer Treatment
Where skin cancer develops
Skin cancer develops primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it can also form on areas that rarely see the light of day — your palms, beneath your fingernails or toenails, and your genital area.
Skin cancer affects people of all skin tones, including those with darker complexions. When melanoma occurs in people with dark skin tones, it's more likely to occur in areas not normally exposed to the sun, such as the palms of the hands and soles of the feet.
Basal cell carcinoma signs and symptoms
Basal cell carcinoma usually occurs in sun-exposed areas of your body, such as your neck or face.
Basal cell carcinoma may appear as:
. A pearly or waxy bump
. A flat, flesh-colored or brown scar-like lesion
. A bleeding or scabbing sore that heals and returns
Squamous cell carcinoma signs and symptoms
Most often, squamous cell carcinoma occurs on sun-exposed areas of your body, such as your face, ears and hands. People with darker skin are more likely to develop squamous cell carcinoma on areas that aren't often exposed to the sun.
Squamous cell carcinoma may appear as:
. A firm, red nodule
. A flat lesion with a scaly, crusted surface
Melanoma signs and symptoms
Melanoma can develop anywhere on your body, in otherwise normal skin or in an existing mole that becomes cancerous. Melanoma most often appears on the face or the trunk of affected men. In women, this type of cancer most often develops on the lower legs. In both men and women, melanoma can occur on skin that hasn't been exposed to the sun.
Melanoma can affect people of any skin tone. In people with darker skin tones, melanoma tends to occur on the palms or soles, or under the fingernails or toenails.
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Melanoma signs include:
. A large brownish spot with darker speckles
. A mole that changes in color, size or feel or that bleeds
. A small lesion with an irregular border and portions that appear red, pink, white, blue or blue-black.
. A painful lesion that itches or burns
. Dark lesions on your palms, soles, fingertips or toes, or on mucous membranes lining your mouth, nose, vagina or anus.
Signs and symptoms of less common skin cancers
Other, less common types of skin cancer include:
. Kaposi sarcoma. This rare form of skin cancer develops in the skin's blood vessels and causes red or purple patches on the skin or mucous membranes.
Kaposi sarcoma mainly occurs in people with weakened immune systems, such as people with AIDS, and in people taking medications that suppress their natural immunity, such as people who've undergone organ transplants.
Other people with an increased risk of Kaposi sarcoma include young men living in Africa or older men of Italian or Eastern European Jewish heritage.
. Merkel cell carcinoma. Merkel cell carcinoma causes firm, shiny nodules that occur on or just beneath the skin and in hair follicles. Merkel cell carcinoma is most often found on the head, neck and trunk.
. Sebaceous gland carcinoma. This uncommon and aggressive cancer originates in the oil glands in the skin. Sebaceous gland carcinomas — which usually appear as hard, painless nodules — can develop anywhere, but most occur on the eyelid, where they're frequently mistaken for other eyelid problems.
When to see a doctor
Make an appointment with your doctor if you notice any changes to your skin that worry you. Not all skin changes are caused by skin cancer. Your doctor will investigate your skin changes to determine a cause.
Skin cancer occurs when errors (mutations) occur in the DNA of skin cells. The mutations cause the cells to grow out of control and form a mass of cancer cells.
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Cells involved in skin cancer
Skin cancer begins in your skin's top layer — the epidermis. The epidermis is a thin layer that provides a protective cover of skin cells that your body continually sheds. The epidermis contains three main types of cells:
. Squamous cells lie just below the outer surface and function as the skin's inner lining.
. Basal cells, which produce new skin cells, sit beneath the squamous cells.
. Melanocytes — which produce melanin, the pigment that gives skin its normal color — are located in the lower part of your epidermis. Melanocytes produce more melanin when you're in the sun to help protect the deeper layers of your skin.
Where your skin cancer begins determines its type and your treatment options.
Ultraviolet light and other potential causes
Much of the damage to DNA in skin cells results from ultraviolet (UV) radiation found in sunlight and in the lights used in tanning beds. But sun exposure doesn't explain skin cancers that develop on skin not ordinarily exposed to sunlight. This indicates that other factors may contribute to your risk of skin cancer, such as being exposed to toxic substances or having a condition that weakens your immune system.
Factors that may increase your risk of skin cancer include:
. Fair skin. Anyone, regardless of skin color, can get skin cancer. However, having less pigment (melanin) in your skin provides less protection from damaging UV radiation. If you have blond or red hair and light-colored eyes, and you freckle or sunburn easily, you're much more likely to develop skin cancer than is a person with darker skin.
. A history of sunburns. Having had one or more blistering sunburns as a child or teenager increases your risk of developing skin cancer as an adult. Sunburns in adulthood also are a risk factor.
. Excessive sun exposure. Anyone who spends considerable time in the sun may develop skin cancer, especially if the skin isn't protected by sunscreen or clothing. Tanning, including exposure to tanning lamps and beds, also puts you at risk. A tan is your skin's injury response to excessive UV radiation.
. Sunny or high-altitude climates. People who live in sunny, warm climates are exposed to more sunlight than are people who live in colder climates. Living at higher elevations, where the sunlight is strongest, also exposes you to more radiation.
. Moles. People who have many moles or abnormal moles called dysplastic nevi are at increased risk of skin cancer. These abnormal moles — which look irregular and are generally larger than normal moles — are more likely than others to become cancerous. If you have a history of abnormal moles, watch them regularly for changes.
. Precancerous skin lesions. Having skin lesions known as actinic keratoses can increase your risk of developing skin cancer. These precancerous skin growths typically appear as rough, scaly patches that range in color from brown to dark pink. They're most common on the face, head and hands of fair-skinned people whose skin has been sun damaged.
. A family history of skin cancer. If one of your parents or a sibling has had skin cancer, you may have an increased risk of the disease.
. A personal history of skin cancer. If you developed skin cancer once, you're at risk of developing it again.
. A weakened immune system. People with weakened immune systems have a greater risk of developing skin cancer. This includes people living with HIV/AIDS and those taking immunosuppressant drugs after an organ transplant.
. Exposure to radiation. People who received radiation treatment for skin conditions such as eczema and acne may have an increased risk of skin cancer, particularly basal cell carcinoma.
. Exposure to certain substances. Exposure to certain substances, such as arsenic, may increase your risk of skin cancer.
Complications of skin cancer
Potential complications of skin cancer include:
. Recurrence, where your cancer comes back
. Local recurrence, where cancer cells spread to surrounding tissues
. Metastasis, where cancer cells spread to muscles, nerves, or other organs in your body
If you’ve had skin cancer, you’re at heightened risk of developing it again in another location. If your skin cancer recurs, your treatment options will depend on the type, location, and size of the cancer, and your health and prior skin cancer treatment history.
Most skin cancers are preventable. To protect yourself, follow these skin cancer prevention tips:
. Avoid the sun during the middle of the day. For many people in North America, the sun's rays are strongest between about 10 a.m. and 4 p.m. Schedule outdoor activities for other times of the day, even in winter or when the sky is cloudy.
You absorb UV radiation year-round, and clouds offer little protection from damaging rays. Avoiding the sun at its strongest helps you avoid the sunburns and suntans that cause skin damage and increase your risk of developing skin cancer. Sun exposure accumulated over time also may cause skin cancer.
. Wear sunscreen year-round. Sunscreens don't filter out all harmful UV radiation, especially the radiation that can lead to melanoma. But they play a major role in an overall sun protection program.
Use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Apply sunscreen generously, and reapply every two hours — or more often if you're swimming or perspiring. Use a generous amount of sunscreen on all exposed skin, including your lips, the tips of your ears, and the backs of your hands and neck.
. Wear protective clothing. Sunscreens don't provide complete protection from UV rays. So cover your skin with dark, tightly woven clothing that covers your arms and legs, and a broad-brimmed hat, which provides more protection than a baseball cap or visor does.
Some companies also sell photoprotective clothing. A dermatologist can recommend an appropriate brand.
Don't forget sunglasses. Look for those that block both types of UV radiation — UVA and UVB rays.
. Avoid tanning beds. Lights used in tanning beds emit UV rays and can increase your risk of skin cancer.
. Be aware of sun-sensitizing medications. Some common prescription and over-the-counter drugs, including antibiotics, can make your skin more sensitive to sunlight.
Ask your doctor or pharmacist about the side effects of any medications you take. If they increase your sensitivity to sunlight, take extra precautions to stay out of the sun in order to protect your skin.
. Check your skin regularly and report changes to your doctor. Examine your skin often for new skin growths or changes in existing moles, freckles, bumps and birthmarks.
With the help of mirrors, check your face, neck, ears and scalp. Examine your chest and trunk, and the tops and undersides of your arms and hands. Examine both the front and back of your legs, and your feet, including the soles and the spaces between your toes. Also check your genital area and between your buttocks.
To diagnose skin cancer, your doctor may:
. Examine your skin. Your doctor may look at your skin to determine whether your skin changes are likely to be skin cancer. Further testing may be needed to confirm that diagnosis.
. Remove a sample of suspicious skin for testing (skin biopsy). Your doctor may remove the suspicious-looking skin for lab testing. A biopsy can determine whether you have skin cancer and, if so, what type of skin cancer you have.
Determining the extent of the skin cancer
If your doctor determines you have skin cancer, you may have additional tests to determine the extent (stage) of the skin cancer.
Because superficial skin cancers such as basal cell carcinoma rarely spread, a biopsy that removes the entire growth often is the only test needed to determine the cancer stage. But if you have a large squamous cell carcinoma, Merkel cell carcinoma or melanoma, your doctor may recommend further tests to determine the extent of the cancer.
Additional tests might include imaging tests to examine the nearby lymph nodes for signs of cancer or a procedure to remove a nearby lymph node and test it for signs of cancer (sentinel lymph node biopsy).
Doctors use the Roman numerals I through IV to indicate a cancer's stage. Stage I cancers are small and limited to the area where they began. Stage IV indicates advanced cancer that has spread to other areas of the body.
The skin cancer's stage helps determine which treatment options will be most effective.
During Skin Cancer Treatment
Skin cancer types
Two main types of skin masses exist, keratinocyte carcinoma and melanoma. However, several other skin lesions are considered part of a larger skin cancer umbrella. Not all of these are skin cancer, but they can become cancerous.
. Actinic keratosis: These red or pink patches of skin are not cancerous, but they’re considered a form of precancer. If left untreated, these skin masses may develop into squamous cell carcinoma.
. Basal cell carcinoma: The most common form of skin cancer, basal cell carcinomas account for 90 percent of all cases of skin cancer. They’re slow-growing masses that most often show up on the head or neck.
. Squamous cell carcinoma: This type of skin cancer develops in the outer layers of your skin, and it’s typically more aggressive than basal cell carcinoma. It may show up as red, scaly lesions on your skin.
. Melanoma: This type of skin cancer is less common, but it’s the most dangerous type of skin cancer. In fact, melanoma makes up just one percent of skin cancers, but it causes the majority of skin cancer-related deaths each year. Melanoma forms in the melanocytes, the skin cells that create pigment.
Skin cancer stages
To determine a skin cancer’s stage or severity, your doctor will factor in how large the tumor is, if it has spread to your lymph nodes, and if it has spread to other parts of the body.
Skin cancers are divided into two primary groups for staging purposes: nonmelanoma skin cancer and melanoma.
Nonmelanoma skin cancers include basal cell and squamous cell cancers.
. Stage 0: The abnormal cells have not spread beyond the outermost layer of skin, the epidermis.
. Stage I: The cancer may have spread to the next layer of skin, the dermis, but it is no longer than two centimeters.
. Stage II: The tumor is larger than two centimeters, but it has not spread to nearby sites or lymph nodes.
. Stage III: The cancer has spread from the primary tumor to nearby tissue or bone, and it is larger than three centimeters.
. Stage IV: The cancer has spread beyond the primary tumor site to lymph nodes and bone or tissue. The tumor is also larger than three centimeters.
Melanoma stages include:
. Stage 0: This noninvasive type of skin cancer has not penetrated below the epidermis.
. Stage I: The cancer may have spread to the second layer of skin, the dermis, but it remains small.
. Stage II: The cancer has not spread beyond the original tumor site, but it is larger, thicker, and may have other signs or symptoms. These include scaling, bleeding, or flaking.
. Stage III: The cancer has spread or metastasized to your lymph nodes or to nearby skin or tissue.
. Stage IV: The most advanced stage of melanoma. Stage IV is an indication the cancer has spread beyond the primary tumor and is showing up in lymph nodes, organs, or tissue distant from the original site.
When cancer comes back after treatment, it’s called recurrent skin cancer. Anyone who has been diagnosed with and treated for skin cancer is at risk for a recurrence of the cancer. That makes follow-up care and self-examinations even more important.
Your treatment options for skin cancer and the precancerous skin lesions known as actinic keratoses will vary, depending on the size, type, depth and location of the lesions. Small skin cancers limited to the surface of the skin may not require treatment beyond an initial skin biopsy that removes the entire growth.
If additional treatment is needed, options may include:
. Freezing. Your doctor may destroy actinic keratoses and some small, early skin cancers by freezing them with liquid nitrogen (cryosurgery). The dead tissue sloughs off when it thaws.
. Excisional surgery. This type of treatment may be appropriate for any type of skin cancer. Your doctor cuts out (excises) the cancerous tissue and a surrounding margin of healthy skin. A wide excision — removing extra normal skin around the tumor — may be recommended in some cases.
. Mohs surgery. This procedure is for larger, recurring or difficult-to-treat skin cancers, which may include both basal and squamous cell carcinomas. It's often used in areas where it's necessary to conserve as much skin as possible, such as on the nose.
During Mohs surgery, your doctor removes the skin growth layer by layer, examining each layer under the microscope, until no abnormal cells remain. This procedure allows cancerous cells to be removed without taking an excessive amount of surrounding healthy skin.
. Curettage and electrodesiccation or cryotherapy. After removing most of a growth, your doctor scrapes away layers of cancer cells using a device with a circular blade (curet). An electric needle destroys any remaining cancer cells. In a variation of this procedure, liquid nitrogen can be used to freeze the base and edges of the treated area.
These simple, quick procedures may be used to treat basal cell cancers or thin squamous cell cancers.
. Radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy may be an option when cancer can't be completely removed during surgery.
. Chemotherapy. In chemotherapy, drugs are used to kill cancer cells. For cancers limited to the top layer of skin, creams or lotions containing anti-cancer agents may be applied directly to the skin. Systemic chemotherapy can be used to treat skin cancers that have spread to other parts of the body.
. Photodynamic therapy. This treatment destroys skin cancer cells with a combination of laser light and drugs that makes cancer cells sensitive to light.
. Biological therapy. Biological therapy uses your body's immune system to kill cancer cells.
After Skin Cancer Treatment
What is the outlook for people with skin cancer?
Nearly all skin cancers can be cured if they are treated before they have a chance to spread. The earlier skin cancer is found and removed, the better your chances for a full recovery. Ninety percent of those with basal cell skin cancer are cured. It is important to continue following up with a doctor to make sure the cancer does not return. If something seems wrong, call a doctor right away.
Recovery time for Mohs surgery
Recovery is usually very easy and uneventful. Overall, resting as much as possible the first few days after surgery is helpful.
Stitches (sutures) are usually removed at the surgeon's office anywhere from four to 14 days from the date of surgery. Your physician will let you know what date to return for stitch removal.
Most patients report minimal discomfort after surgery and require minimal or no pain medication.
If there is pain, many patients find that they prefer to take something for pain at the first hint of discomfort instead of waiting until the pain builds up to an unbearable level. If you have mild or moderate pain, your doctor may advise you to take acetaminophen (Tylenol) or another pain reliever over the counter. Aspirin or aspirin-containing pain relievers may cause increased bleeding. Rarely, prescription pain medications may be required for severe pain.
Your physician will let you know what pain medications are recommended for your specific condition.
Most patients are able to return to work or school the next day after Mohs. Avoiding heavy lifting, straining, or strenuous exercise for seven to 21 days may be required depending on the area of surgery. Your physician will need to let you know what activity precautions are required based on the area and size of your procedure.
You may go out in the sun with sunscreen and protective hats and clothing. Excess sun exposure has been linked to skin cancer. Use of sunscreen or other cover-up on the scar is very helpful for at least six months after surgery to help minimize scarring. It is important to follow your own physician's instructions for wound care and sun protection.
How do I take care of my surgical area after Mohs surgery?
It is recommended to check with your surgeon for specific postoperative wound care instructions. Often, you will be asked to go home and take it easy for the rest of the day. A few patients like to return to work and resume their work the day after surgery. It may be advisable to avoid heavy lifting and exercise, especially the first 24-48 hours after surgery.
Your physician will usually give you more detailed instructions depending on the area and size of the surgery. You will have usually have a bulky "pressure" dressing on the surgery area for one day. You may be asked to keep the area dry for 24 hours. Swimming pools, oceans, and Jacuzzis are usually not permitted while the stitches are in. These may increase your chance of infection. Many physicians allow you to shower the next day after surgery. Wound care may require cleaning the wound with soap or hydrogen peroxide two to three times a day and applying petroleum jelly to the area.
Mild swelling is not uncommon the first day or two after surgery and can be lessened by use of an ice-bag application, ice cubes or chips in a small Ziploc baggie, or frozen peas in the bag. Leaving the dressing in place, use cold pack application every five to 15 minutes every hour for the first eight to 24 hours after surgery. Swelling is more common for surgeries around the eyes or lips. Sleeping propped up on a few pillows or in a reclining chair may help decrease swelling after surgery of the head and face area.
The surgical area may ooze a little blood or clear liquid especially in the first few hours after surgery; activity may aggravate this. Hot drinks or bending over at the waist can also initiate or worsen bleeding of face wounds. If bleeding occurs, firm pressure applied directly to the site for 10-15 minutes may be helpful. Most bleeding will stop if you apply enough pressure. Your surgeon should be notified if bleeding persists. Rarely, a visit to the hospital emergency room may be necessary for severe bleeding.
Your surgeon will need to know if pain is increasing after one to two days after your surgery or if you are having fever or other concerning symptoms. In such cases, you may need to be seen at the surgeon's office. The surgical area may need to be checked for bleeding or infection. Limiting hot foods, hot drinks, and heavy chewing for 48 hours may help decrease the chances of postoperative bleeding for wounds around the mouth or cheek areas. Your physician will explain recommended wound care.
Most patients are advised to try to avoid applying makeup or powder directly on a fresh wound unless the surface is fully healed. Skin-colored tape strips called Steri Strips are available to minimize wound leakage and help cover up a visible wound. It is important to follow your physician's instructions for wound care.