Skin CancerBioethics and Biosafety

What is skin cancer?• Skin cancer is the uncontrolled growth of abnormal skin cells. • Occurs when unrepaired DNA damage to skin cells (most often caused

by ultraviolet radiation from sunshine or tanning beds) triggers mutations, or genetic defects, that lead the skin cells to multiply rapidly and form malignant tumors.

Actinic Keratosis• Actinic keratoses (AK), also called solar

keratoses• Scaly, crusty growths caused by damage

from the sun’s ultraviolet (UV) rays. • Appear on sun-exposed areas such as the

face, scalp, lips, and the back of the hands.• Become red, but some will be tan, pink,

and/or flesh-toned. • Second most common form of skin cancer

ATYPICAL MOLES • Are unusual-looking noncancerous

moles, also known as dysplastic nevi.• People who have them are at

increased risk of developing melanoma in a mole or elsewhere on the body. • Heredity appears to play a part in the

formation of atypical moles. They tend to run in families.

Basal Cell Carcinoma• Basal cell carcinoma (BCC) also known

as basalioma or basal cell cancer.• Most common skin cancer in the US.• While BCC has a very low metastatic risk, this

tumor can cause significant disfigurement by invading surrounding tissues

Melanoma• Most dangerous form of skin cancer.• Cancerous growths develop when

unrepaired DNA damage to skin cells most often caused by ultraviolet radiation from sunshine or tanning beds.• Lead the skin cells to multiply rapidly

and form malignant tumors

Merkel cell carcinoma• Merkel cell carcinoma is a very rare disease in

which malignant cells form in the skin.• Sun exposure and having a weak immune

system can affect the risk of Merkel cell carcinoma.• Merkel cell carcinoma usually appears as a

single painless lump on sun-exposed skin.• Tests and procedures that examine the skin

are used to detect (find) and diagnose Merkel cell carcinoma

Squamous cell carcinoma

• Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells.• SCCs often look like scaly red patches,

open sores, elevated growths with a central depression, they may bleed.

Common risk factors • Ultraviolet light exposure, either from the sun or from tanning beds. • Fair-skinned individuals, with hazel or blue eyes, and people with

blond or red hair are particularly vulnerable. • The problem is worse in areas of high elevation or near the equator

where sunlight exposure is more intense.• A chronically suppressed immune system from underlying diseases

such as HIV/AIDS infection or cancer.

• Exposure to ionizing radiation (X-rays) or chemicals known to predispose to cancer such as arsenic.

• Certain types of sexually acquired wart virus infections.• People who have a history of one skin cancer have a 20%

chance of developing a second skin cancer in the next two years.

• Elderly patients have more skin cancers.

Diagnosis of skin cancer

Diagnosis of skin cancer

People who have had cancer often talk about experiencing three feelings:

• Loss of control, • Unwanted aloneness• Loss of hope.

The American Academy of Dermatology and the American Cancer Society recommend that individuals perform monthly self-examinations.

• It is important to keep the ABCDE's • (Asymmetry, Border, Color, Diameter, Evolution) of

skin cancer in mind.

One half is unlike the other half.

Irregularity – edges are ragged or blurred

Varies from one area to another

Usually > 6mm when diagnosed, but can be smaller

A mole or skin lesion that looks different from the rest or is changing in size, shape or color.

If you notice anything on your skin changing, itching or bleeding, see a board-certified dermatologist.

Stages of skin cancer:• Stage I: The disease is localized to a primary tumor site. The majority of

diagnoses are during this stage.• Stage II: The disease is more developed, but remains localized to the

original site.• Stage III: The disease has spread regionally; doctors often examine the

number and location of invaded lymph nodes. • Stage IV: The melanoma has spread to distant organs.

New research:• 1 in 5 person dies from melanoma, the deadliest form of skin cancer, every hour.

• Skin cancer can occur anywhere on the body, even places where the sun doesn’t shine, such as the soles of the feet, or in the nose or mouth.

In fact, in people of color 30 to 40% of melanomas are diagnosed on the bottom of the foot.

• When detected early and treated properly, skin cancer is highly curable.

Radiotherapy

• Radiotherapy involves using low doses of radiation to destroy the cancer. • The level of radiation involved is perfectly safe. • However, your skin may feel sore for a few weeks after

radiotherapy.

Conti.. Radiotherapy is sometimes used to treat basal cell and squamous cell carcinomas if:

• surgery would be unsuitable• the cancer covers a large area• the area is difficult to operate on

Imiquimod cream

• Imiquimod cream is a treatment for basal cell carcinoma with a diameter of less than 2cm (0.8 inches). • Wash the cream off and contact your GP if

your skin blisters or you develop ulcers after using it.

Photodynamic therapy (PDT)• Photodynamic therapy (PDT) is

used to treat basal cell carcinoma, Bowen's disease and actinic keratoses. • It involves using a cream which

makes the skin highly sensitive to light.

cont…• After the cream has been

applied, a strong light source is shone onto the affected area of your skin, which kills the cancer. • PDT may cause a burning

sensation and around 2% of people who have this treatment will be left with some superficial scarring

Cryotherapy

• Cryotherapy uses cold treatment to destroy the cancer. • It is sometimes used for

non-melanoma skin cancers in their early stages.

Cont..

• Liquid nitrogen is used to freeze the cancer, and this causes the area to scab over.• After about a month, the scab

containing the cancer will fall off your skin. • Cryotherapy may leave a small white

scar on your skin

Surgical excision

• Surgical excision is an operation to cut out the cancer along with surrounding healthy tissue to ensure the cancer is completely removed.• It may be done in combination with a

skin graft, if it's likely to leave significant scarring.

Cont..

• A skin graft involves removing a patch of healthy skin, usually from a part of your body where any scarring cannot be seen, such as your back. It is then connected, or grafted, to the affected area.• In many cases, this operation is

enough to cure skin cancer.

PreventionsThe most important way to prevent skin cancer is to protect your skin from the harmful effects of the sun's rays

Sun and skin damageThere are two main types of damaging ultraviolet (UV) sunlight: • UVA UVA rays penetrate deeper into the skin, damaging the middle layer (the dermis). UVA rays therefore have the effect of ageing the skin and causing wrinkles. • UVBUVB rays are absorbed by the top layer of skin (the epidermis). This causes sun tanning but also burning

Do Not Burn or Tan• Avoid intentional tanning.• Avoid tanning beds.• Ultraviolet light from the sun and tanning beds causes

skin cancer and wrinkling

 Wear Protective Clothing• Long-sleeved shirt and pants.• A wide-brimmed hat and sunglasses.

Generously Apply Sunscreen• Use a broad spectrum sunscreen with Sun Protection

Factor• Apply 15 minutes before going outdoors and reapply

every two hours.

•Protect your child’s eyes by using plastic lens sunglasses •Children should have arms and legs covered when out in the sun. •They should wear hats which provides more sun protection. •When children are playing in the water, make sure to use waterproof sunscreen

Protect your childrens

Spot Check Your Moles

Examine your moles and freckles every month to check for any changes. See your health care provider immediately if you notice:•a mole or discoloration that appears suddenly or begins to change •a sore that does not heal areas of skin that are red and bumpy, bleed or are itchy

Protect your Eyes

Radiation from the sun can damage cells in the structures of your eyes. UV radiation from the sun may increase the risk of developing cataracts later in life. UV radiation can also contribute to the development of skin cancer on the eyelid or on the surface of the eye.

Case Study 1A Victorian County Court judge ruled that Eric Reeder’s skin cancer was serious and dangerous enough for him to sue his employer of 35 years. Mr. Reeder, a retired truck driver, had developed multiple skin cancers on his back, neck and shoulders, and had multiple malignant melanomas removed from his back. Mr. Reeder settled out of court with his employer, and died in 2007. His case has established a precedent in recognizing UV radiation as a workplace hazard.

Case Study 2

Basal Cell Carcinoma is a type of skin cancer which can be caused by UV exposure from the Sun as well as tanning beds. This particular post looks at a true case study of one women's fight against Basal Cell Carcinoma.

Conclusion The best cure for skin cancer remains early detection, prompt treatment, and follow-up preventive care measures. Recognize warning signs of a disease through regular skin self-examination. Even more important, however, is to protect yourself from the sun's rays. By avoiding the peak hours of ultraviolet radiation, and by wearing sunscreen and protective clothing, you can keep skin cancer from happening to you.