ZOOLOGY 100 NOTES (3).

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SKIN CANCER AND THE ENVIRONMENT
SKIN CANCER
• The most common types of skin cancers are:
1. Basal Cell Carcinoma
2. Squamous Cell Carcinoma
3. Melanoma
• different skin cancer symptoms:
a. changes in the skin that do not heal
b. ulcers in the skin
c. discoloration
d. changes in existing moles.
SKIN CANCER
• - a malignant growth on the skin, w/c develops on the epidermis
- fastest growing type of cancer in:
1. U.S.A.: most commonly diagnosed malignancy, surpassing the lung,
breast, colorectal, & prostate cancer
- melanoma is the least common cancer, but the most potentially serious
2. U.K.: 8,000 cases/year, 1,800 deaths
- has 20-30 years latency period
- many skin cancer in older individuals today can be traced to behaviors as
young adults in the 70s & early 80s
- deep tans at that time were routinely spoken of as “healthy”

RISKS OF SKIN CANCER

- associated with chronic inflammation of the skin:
1. overexposure to UV-radiation either through:
a. natural/sun UV exposure: direct DNA
damage mechanism (caused by: UVA &UVB)
b. artificial UV exposure (tanning saloon):
indirect DNA damage mechanism
- is also associated with malignant
melanoma type of skin cancer since sunbeds cause
indirect DNA damage
i) UVA rays: affect the skin at the deeper
level, reaching through the epidermis, dermis, &
hypodermis (C.T. & blood vessels are present)
- EPIDERMIS: activates the melanin
causing changes in the
pigmentation, loss of elasticity of
the skin (contributing to: premature wrinkling, sagging, &
aging of the skin )

ii) UVB rays: primarily affect the epidermis causing sunburn, redness,
& blistering of the skin
- melanin is also activated, but the effects are longer lasting
with pigmentation continuing 24 hours

2. chronic non-healing wounds: esp. burns/Marjolin’s ulcer

- can develop into squamous cell carcinoma
3. Genetic predisposition: congenital melanocytic nevi syndrome (CMNS)
 - presence of mole of varying size that appear at or within 6 months of birth
- nevi larger than 20 mm (3/4”) in size has higher risk of being cancerous
4. human Papilloma virus (HPV): assoct’d w/ squamous cell carcinoma of the
genital, anal, oral, pharynx, & fingers
5. UV germicidal irradiation

SKIN CANCER
1.Basal cell carcinoma (BCC): by UVB via direct damage
- most common, rarely causes death
- present on sun exposed area of the skin (FACE)
- looks like a raised, smooth, pearly bump on the sun-exposed skin of the head,
neck or shoulders.
- Sometimes small blood vessels can be seen within the tumor.
- Crusting and bleeding in the center of the tumor frequently develops.
- It is often mistaken for a sore that does not heal.
- TREATMENT: surgery or radiation
2.Squamous cell carcinoma (SCC): by UVB via direct damage (EAR,FACE,LIP of fair-
skinned Caucasians)
- common, but less common than BCC
- is a red, scaling, thickened patch on sun-exposed skin.
- Ulceration and bleeding may occur.
- when not treated, it may develop into a large mass.
3. melanomas: by indirect damage by free radicals and reactive oxygen species
- sunscreen ingredients into the skin combined with 60 minutes exposure to UV,
leads to an increase of free radicals to the skin
- least frequent skin cancer, but deadly once spread
- are brown to black looking lesions.
- Signs that might indicate a malignant melanoma:
- change in:
a. size b. shape
c. color or elevation of a mole.
- The appearance of a new mole during adulthood, or new pain, itching,
ulceration or bleeding.
What Causes Skin Cancer?
1. Sunburn and Sunlight (UV light)
a. Total amount of sun received over the years
b. overexposure resulting in sunburn
- Most people receive 80% of their lifetime exposure to the sun by 18 years of age.
- Tanning is your skin's response to UV light.
- It is a protective reaction to prevent further injury to your skin from
the sun, but it does not prevent skin cancer.
- Remember, skin cancer is very slow to develop.
- The sunburn you receive this week may take 20 years or more to become skin
cancer.
2. Heredity
- If there is a history of skin cancer in your family, you are probably at a
higher risk.
- People with fair skin, with a northern European heritage appear to be most
susceptible.
- Multiple nevi (moles) or atypical nevi
3. Environment
a. The level of UV light today is higher than it was 50 or 100 years ago, due to a
reduction of ozone in the earth's atmosphere (the Ozone Hole).
• Ozone serves as a filter to screen out and reduce the amount of UV
light that we are exposed to.
- With less atmospheric ozone, a higher level of UV light reaches the earth's
surface.
b. Other influencing factors
i) elevation
ii) latitude
- The rays of the sun are strongest near the equator
- But even in Antarctica, Chile, and New Zealand, the UV level
is much higher than normal especially in the springtime
due to the ozone hole in the southern hemisphere.
iii) cloud cover
- Climates and micro-climates with regular cloud cover may have a 50%
lower level of UV light due to the actual amount is affected by the density of
the clouds.
 iv) occupational exposure: coal tar, pitch, creosote, arsenic compounds, or radium

Are there precautions that will reduce my risk?

The following six (6) steps (recommended by the American Academy of
Dermatology and the Skin Cancer Foundation to help reduce the risk of
sunburn and skin cancer): (M.A.R.W.A.P.)
Minimize your exposure (esp. in early years) to the sun at midday and between the hours
of 10:00AM and 4:00PM.
Apply sunscreen with at least a SPF-15 or higher, to all areas of the body which are
exposed to the sun.
Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming
or perspiring.
Wear clothing that covers your body and shades your face. (Hats should provide
shade for both the face and back of the neck.)
Avoid exposure to UV radiation from sunlamps or tanning parlors.
Protect your children. Keep them from excessive sun exposure when the sun is strongest
(10:00AM and 3:00PM), and apply sunscreen liberally and frequently to children 6
months of age and older.
Do not use sunscreen on children under 6 months of age. Parents with children
under 6 months of age should severely limit their children's sun exposure.

TREATMENT
- Depends:
1. type of skin cancer 2. age of the patient
3. if the cancer is primary or recurrence
TYPE OF SKIN CANCER:
- To determine the correct treatment required
- Example:
a. basal cell cancer on the cheek of a young man:
- Moh’s surgery:
- treatment w/ the best cure rate
- technique used to remove the cancer w/ the least amount of
surrounding tissue & the edges are checked immediately to see if the
tumor is found
- provides the opportunity to remove the least amount of tissue
- provides the best cosmetically favorable results
- important in areas where excess skin is limited (FACE)
b. elderly frail man w/ multiple complicating medical conditions, difficult
to excise basal cell cancer:
- radiation therapy (slightly slower cure rate) or topical
chemotherapy (for large superficial basal cell carcinoma for good cosmetic
outcome)
- imiquimod or 5-fluorouracil (chemotherapy), freezing the cancer off
(cryotherapy) = can provide adequate control of the disease, but both have
lower cure rates than surgery

PATHOLOGY
- In squamous cell carcinoma/malignant epithelial tumor (w/c originates
in epidermis, squamous mucosa):
- MICROSCOPICALLY:
- tumor is elevated, fungating, or may be ulcerated with irregular
borders
 - tumor cells destroy the basement membrane & form a sheet or
compact masses w/c invade the subjacent C.T. (dermis)
- in well differentiated carcinomas, tumor cells are
atypical/pleomorphic resembling normal keratinocytes from pricke
layers (large, polygonal, with abundant eosinophilic (pink)
cytoplasm and central nucleus)
- their disposal is similar to that of normal epidermis: immature/basal cells at the
periphery, becoming more mature to the center of tumor masses
- tumor cells transform into keratinized squamous cells & form round nodules w/
concentric, laminated layers or cell nests/epithelial keratinous pearls
- the surrounding stroma is reduced & contains inflammatory nfiltrates (lymphocytes)