10. PTC: Cancer Types: Skin

 

In 2016, the latest year for which incidence data are available, 82,476 NEW cases of Melanoma of the skin were reported, and 8,188 people died of Melanoma of the skin in the United States.  For every 100,000 people, 22 new Melanomas of the skin were reported and 2 died of cancer.
Cancer is the second leading cause of death in the United States, exceeded only by heart disease.  One of every four deaths in the United States is due to cancer.

BUT, early detection makes a difference:
99% is the survival rate for patients in the U.S. whose Melanoma is detected early.
The survival rate drops to 65% if the disease reaches the lymph nodes
and 25% if it spreads to distant organs.

 

"If you see something on your skin that is new, changing, not healing or doesn’t seem right, get it checked out as soon as possible"

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Scroll down or just click each to jump to that individual topic:

• What is skin cancer?
• What are my risks for skin cancer?
• What are the risk factors for skin cancer?
• Transplant drugs that can increase the risk of skin cancer
• How does skin cancer present?
• Overview
• Action Plan

  

                             What is skin cancer?

Skin cancer occurs when skin cells grow out of control, often caused by ultraviolet (UV) radiation from the sun and UV tanning machines. The skin is the largest organ in the body. Skin cancer can be treated successfully if found early. The two most common types of skin cancer after transplant are basal cell cancer (BSS) and squamous cell cancer (SCC), however, there are other types of skin cancer including melanoma and Merkel cell carcinoma (MCC).

According to the American Cancer Society (https://www.cancer.org/cancer/skin-cancer.html) Cancer can start at any place in the body. Sometimes, skin cancer cells can spread to other parts of the body, but this is not very common. When cancer cells spread to other places, it’s called metastasis. To doctors, the cancer cells in the new place look just like the ones from the skin. Cancer is always named based on the place where it starts. So if skin cancer spreads to another part of the body, it’s still called skin cancer.

Additional ACS Sources:

• https://www.cancer.org/cancer/melanoma-skin-cancer/about.html
• https://www.cancer.org/cancer/merkel-cell-skin-cancer/about/what-is-merkel-cell-carcinoma.html
• https://www.cancer.org/cancer/skin-lymphoma/about.html
• https://www.cancer.org/cancer/kaposi-sarcoma.html

 

                             What are my risks for skin cancer?

In an article by BAAKP member, Linda Umbach, the transplant patient skin cancer risk by cancer types are:

There are three main types of skin cancer: the most common non-melanoma type of cancer in the United States is Basal Cell Carcinoma. This cancer rarely spreads throughout the body and appears as a pink, waxy bump. This type of cancer can be protected against with the use of sunscreen and limited exposure to the Sun. By being a transplant patient, you are ten times more likely to contract this form of skin cancer.

Next is Squamous cell carcinoma. As a transplant patient, you are 65 times more likely to contract this type of cancer, and it is the most common type of skin cancer in pediatric and adult transplant patients. This skin cancer looks like large red bumps and can present as scaly-rough patches of skin. This type of cancer multiplies and is especially aggressive in transplant patients.

The third type is Melanoma; this is a skin cancer with dark coloration, and is asymmetrical, raised, and changes shape over time. Only 4% of diagnosed skin cancers are melanomas, but they cause 77% of skin cancer-related deaths.

                             What are the risk factors for skin cancer? 

All transplant patients are at increased risk to develop skin cancer. However, transplant patients with the following characteristics are at greater risk for skin cancer. These characteristics include:
• Older individuals
• Men
• Fair and easily burned skin
• Freckled skin
• Blue, green or hazel eyes
• Red and blonde hair
• People who have outdoor occupations or extensive exposure to the sun
• Family history of skin cancer
• Personal history of skin cancer

                             Transplant drugs that can increase the risk of skin cancer

While all our life-saving drugs are toxic to the kidneys, some result in more or less risk than others.  Here are the most common drugs ranked by their level of risk impact:

• Cyclosporin, Azathioprine — Highest Risk
• Tacrolimus, Cellcept, Mycophenolate — Middle Risk
• Sirolimus (rapamycin) — Lowest Risk

                             How does skin cancer present?

              What symptoms should patients be on the lookout for?

Skin cancer presents itself in different ways, but there are many common warning signs. Overall, you should be looking for a change in your skin such as new skin lesions like a mole, growth, dark spot, itchy dry spot or sore that develops and does not go away. However, not all lesions mean you have skin cancer. The CDC says that people should watch for these symptoms – a helpful way to remember them is to call them the A-B-C-D-E's of Melanoma : 

• Asymmetry: Does the spot or sore have two halves that are different shapes and sizes?
• Border: Does the spot or sore have irregular or uneven edges?
• Color: Does the spot or sore have an uneven color?
• Diameter: Is the spot or sore larger than the size of a pea, or one-quarter inch?
• Evolving: Is the spot or sore changing in size, color, or shape?

  What does skin cancer look like visually?

Note: For full versions of any of the INTRO video clips below, go to the full library of ONLINE resources at https://www.triowebptc.org/link/resource-library.html

 

                              Remember that the three most common types of skin cancer are Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma.

• Basal Cell Carcinoma: This cancer sometimes gets mistaken by people as a scar because they look really similar. This skin cancer is usually flat, and either flesh-colored, brown or yellow. This usually appears in places where you get a lot of sun like your face and neck. These can appear early on as a pearly or waxy bump with blue, brown or black areas.
• Squamous Cell Carcinoma: This skin cancer can look like a rough or scaly spot that can crust over or bleed. It could also look like a lump or growth that is flatter in the middle and raised around the outside. It could also look like an open sore that is oozy or crusty. It could also look more like a wart but with different colors than a usual wart. Remember, these can happen in your mouth too.
• Melanoma: This skin cancer can look like a large brown spot with darker spots inside of it. It is common for Melanoma to show up as a change in a mole you already have. This skin cancer could also look like a spot that has a border with a strange pattern. The border could be red, pink, blue, black or white. This skin cancer could feel like a spot that is itchy or burns, and it might only hurt when you scratch it.

How quickly does skin cancer develop after an organ transplant?

The majority of fair-skinned organ transplant patients will eventually develop skin cancer. After a transplant, there is generally a lag time of 3-7 years before skin cancers begin to develop. This period of time may vary depending upon individual risk factors. The longer a person takes immunosuppressant medications and the higher the dose, the greater the risk of skin cancer. In temperate climates, 40% of fair-skinned patients develop skin cancer within 20 years after transplantation. In warmer climates, up to 80% of fair-skinned patients develop skin cancer within 20 years after transplant.

Note: It is recommended that patients that are on the “waitlist” for a transplant find a Dermatologist who is knowledgeable about Post Transplant Skin Cancers and have them do a “pre-transplant” baseline study of their skin.  This way, the Doctors can look for changes with your “before transplant” records at hand!

For a quick photo introduction of what to look out for, link to this simple 7-slide view of skin cancer signs and symptoms (<-- just click here)

For more details, see the ITNS link below to their downloadable Skin Cancer booklet.

                     What are the treatments for skin cancer?
If caught early, skin cancers are almost always curable. Basal cell carcinomas and squamous cell carcinomas can be treated with a variety of methods including scraping and freezing for early skin cancers and surgical removal for more advanced cancers.

Melanoma is treated by surgically removing the growth. Mohs micrographic surgery is a special surgical procedure used to ensure the complete removal of a skin cancer, while sparing normal skin. Although the surgical removal of skin cancers inevitably leaves scars, appearance can usually be restored to a high degree after skin surgery.

There is more than one type of skin cancer

Skin cancer is simply an abnormal growth of skin cells and while they can all hurt your health, most aren't deadly, according to the American Academy of Dermatology.  Melanoma is the one people most often hear about but it's far more common to get actinic keratoses (AK) (a precancerous skin growth), basal cell carcinoma (BCC), or squamous cell carcinoma (SCC).

Melanoma is the number one cancer killer in young adults

 The other types aren't great for you either

Just because BCC, and SCC aren't normally deadly, doesn't mean you shouldn't worry about them. People with squamous cell carcinoma have a higher risk of death from any cause than the general population, according to the American Academy of Dermatology. About 4,140 people will die from skin cancers other than melanoma in the United States this year, they add.

How to spot skin cancer

Click on the image below to view this article by the American Cancer Society:

Your risk of getting it is almost entirely under your control

Skin cancer is the most preventable and yet the most ignored cancer, Dr. Barr says. In fact, taking a few simple preventive measures can lower your lifetime risk of getting any type of skin cancer by nearly 80 percent, according to the Prevent Cancer Foundation.

Reduce your risk for skin cancer
Protection from ultraviolet (UV) radiation is important all year round, not just during the summer or at the beach.  UV rays from the sun can reach you on cloudy and hazy days, as well as bright and sunny days.  UV rays raise also reflect off of surfaces like water, cement, sand and snow.
The CDC recommends easy options for protection from UV radiation:

• Stay in the shade, especially during the midday hours
• Wear clothing that covers your arms and legs
• Wear a hat with a wide brim to shade your face, head, ears and neck
• Wear sunglasses that wrap around block both UVA and UVB rays
• Use sunscreen with a sun protection factor (SPF) of 15 or higher, and both UVA and UVB broad spectrum) protection
• Avoid indoor tanning

Source: CDC.gov

 

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