Everything classification of skin cancer

1. SKIN CANCER (SC)

2. What is skin?
 The skin, which is the human body's largest
organ, has several functions. It prevents the body
from losing water and other fluid, stores fat, cools
the body when sweat evaporates, and makes
vitamin D. The skin also protects the body from
infection, light, and injury
 There are three layers of skin:
 Epidermis - the outer layer of skin
 Dermis - the middle layer of the skin; contains
nerves, blood vessels, sweat glands, hair follicles,
and oil-producing cells that keep the skin from
drying out
 Fatty layer - the deep layer of skin

3. What is skin?
 Skin cancer begins in the epidermis, the outer
layer of skin. The epidermis has three kinds of
cells.:
 Squamous cells - are cells that progressively
flatten and fill with protective keratin (a tough,
insoluble protein that makes skin almost
completely waterproof) to form the outmost
surface of the skin.
 Basal cells - are small cells located at the base of
the epidermis that serve as a reservoir for
squamous cells shed from the skin.
 Melanocytes - are cells that produce a dark
material, or pigment, that gives the skin its color.

4. What Is Skin Cancer?
 Skin cancer is a disease in which skin
cells lose the ability to divide and
grow normally. Healthy skin cells
normally divide in an orderly way to
replace dead cells and grow new
skin. Abnormal cells can grow out of
control and form a mass or 'tumor'.
When abnormal cells originate in the
skin, the mass is called a skin tumor

5. Epidemiology
 Skin cancer - one of the most common cancer in
the world.
 WHO – III place to mortality
 Central Asia SC – Uzbekistan – 34%
 Iran – 28%
 Pakistan – 23-25%
 Kyrgyzstan – 11,6%
 The correlation Skin Cancer between Women/Men
– 1:2

6. Epidemiology
 The two most common types are basal cell
cancer and squamous cell cancer. They
usually form on the head, face, neck,
hands and arms.
 Another type of skin cancer, melanoma, is
more dangerous but less common.

7. Causes Skin Cancer
 Ultraviolet (UV) radiation from the sun is
the main cause of skin cancer. Energy from
the sun actually is a form of radiation. It
consists of visible light and other rays that
people can't see. Invisible infrared
radiation, for instance, makes sunlight feel
hot. UV also is invisible, and causes
sunburn and sun tan.

8. Risk factors for skin cancer
 Fair skin
 Age 50 or older, although the damage from
excess sun exposure starts in childhood and
accumulates through out life
 Living in the South where the sun is more
intense
 Regularly outside during the midday sun (10 am
to 4 pm) when the sun exposure is most intense
 Skin is usually unprotected when exposed to
the sun
 Family history of melanoma
 History of severe sunburn in childhood
 Have many moles and freckles

9. Benign skin tumors
 papilloma
 seborrheic wart
 keratoakantoma
 pigmented mole
 dermatofibroma (fibroma)
 angioma
 lipoma

10. Precancerous diseases skin
 actinic keratosis (solar keratosis)
 Bowen's disease

11. Types Of The Skin Cancer
 Basal cell carcinoma (75- 80%)
 Squamous cell carcinoma (20 – 25%)
 malignant melanoma

12. Types of skin cancer

13. TNM Classification and Stage
Grouping of SC
TNM Classification Stage Grouping
T1 2 cm Stage 0 Tis No M0
T2 2 to 5 cm Stage I T1 N0 Mo
T3 5 cm Stage II T2 N0 M0
T4 Deep extradermal structures T3 N0 Mo
(cartilage, sceletal muscule, Stage III T4 N0 M0
bone) Any T N1 M0
N1 Regional Stage IV Any T Any N M1

14. Levels of invasion of Clark
melanoma
 I
 II
 III
 IV
 V
 Tumor growth within the
epidermis
 Tumor penetrates the
papillary dermis
 Tumor within the papillary
dermis, does not penetrate
the mesh layer of the dermis
 Tumor penetrates the mesh
layer of the dermis
 Invasion of subcutaneous fat

15. Breslow thickness:
 Breslow thickness: an additional method for
determining the stage of the tumor. It is for
measuring the depth of invasion in mm.
 - Low risk of metastasis - tumor 1, 2, 3 levels
of Clark and depth of invasion of less than
0.76 mm.
 - High risk of metastasis - tumor levels 4.5
Clark and depth of invasion more than 1.5
mm.

16. Types of skin cancer
metastasis
1. Нematogenous way - when tumor cells
invade the blood vessel and transfer to the
blood stream to other organs (lungs, liver,
bones, etc.).
2. Lymphogenous way - when tumor cells
invade the lymphatic vessel and lymph flow
is transferred to the next (regional) or distant
lymph nodes.

17. Types of Melanoma metastasis:
1. Нematogenous way
2. Lymphogenous way
3. Intracellular way :
 Erythematous form - may appear with nodular
skin eruptions, located under the skin and inside
the skin or having the form of a plurality of
entities and bleeding exophytic

18. Types of Melanoma metastasis
 Thrombophlebitis form - she reminds picture
thrombophlebitis. In the thick skin a few centimeters from the
primary tumor there are painful, seal around them with
hyperemia. Can be extended superficial veins. These seals
gradually increase in size and ulcerate. These metastases are
more frequently found at the location of the primary melanoma
on the lower extremities.
 The satellite form - characterized by the occurrence near the
primary tumor or scar after the removal of the melanoma
lesions of multiple small, dark or black colorSlightly raised above
the skin and resemble specks of mascara or ink. Satellites are
often found at the location of the primary melanoma on the
trunk and extremities

19. Types Of The Skin Cancer
 Basal cell carcinoma - is the most
common kind of skin cancer. More than 90
per cent of all skin cancers in the United
States are basal cell carcinomas.
Fortunately, basal cell carcinoma also is
the least serious kind of skin cancer. That's
because it grows slowly and rarely
spreads. It spreads in less than 1 out of
every 1,000 patients.

20. Types Of The Skin Cancer
 Squamous cell carcinoma - is more
serious because it does spread to vital
organs inside the body. Spread occurs in a
few cases in every 100. It does so slowly.
At first cancer cells tend to spread only as
far as the nearest lymph nodes structures,
which filter out and trap the cancer cells.
If spread has occurred, the affected lymph
nodes can be removed before cancer
spreads to vital organs.

21. Types Of The Skin Cancer
 Malignant melanoma - is the most
serious kind of skin cancer because it
may spread quickly from the skin
through the lymph nodes or blood, to
internal organs.

22. Skin Phototype
 The risk of developing skin cancer among other
factors highly depends on your skin type. In
1975, Fitzpatrick, a respected dermatologist
created a standard for classifying individuals
according to their skin color and burning and
tanning responses to sun light exposure.
Basically a low number means a higher risk.
 However, there are people with skin type 3
who develop skin cancer and even people with
naturally dark skin can also develop skin
cancer.

23. Skin Phototype

24. Symptoms of Skin Cancer
 A new growth on the skin.
 A change in an existing skin
growth.
 A sore that does not heal.

25. ABCDEs of melanoma skin cancer

26. Diagnosis
 Inspection (Dermatoscopy - inspection
using dermatoscope - microscope
 Biopsy
 Ultrasound examination
 X-rays study (lung)
 Magnetic resonance imaging and
computed tomography (bone, brain, liver)
 Blood tests: Determination of tumor
marker in the blood - the antigen S - 100
 Determination of monoclonal the antibodies S-
300

27. Diagnosis
 Two types of biopsy are done for most skin cancers:
 An excisional biopsy excises, or cuts away, the entire
visible growth. For small nonmelanoma skin cancer,
an excisional biopsy may also be the only treatment
necessary, whereas other cancers like malignant
melanoma generally require additional removal of a
wider margin of normal tissue around the site.
 An incisional biopsy, or core biopsy, removes only a
sample of the growth. Further treatment is necessary
if the microscopic examination reveals cancer cells.
This is the most common type of biopsy

28. Examples of skin cancer

30. Detecting skin cancer
Skin cancer warning signs:
 A new growth or a sore that doesn't heal in two weeks.
 A smooth shiny, pale, or waxy lump.
 A firm red lump, sometimes with bleeding or a crusty
surface.
 A flat, red spot that is rough, dry, or scaly.
 A mole that has one half shaped differently from the
other half.
 A growth with an irregular border and/or containing
colors that can include black, tan, blue, white, or red.
 A growth that is larger than six millimeters (the size of a
pencil eraser).

31. How Is Skin Cancer Treated?
 Treatment depends on the
 type of skin cancer
 its stage and location and the
 individual's age and overall health

32. Cancer treatment
 Surgery: Taking out or destroying the
cancer.
 Chemotherapy: Giving drugs to kill
the cancer cells.
 Radiation therapy: Using powerful
energy from x-rays or other sources
to destroy the cancer cells.

33. Surgery treatment
 Simple excision involves cutting out the tumor
with a margin of surrounding normal skin to be
sure it is completely removed.
 Cryosurgery (cryo = "cold") freezes and kills the
cancer cells. It uses liquid nitrogen, which has a
temperature of 196 degrees below zero
centigrade. Cryosurgery is used mainly for small
or superficial skin cancers, and to remove
precancerous growths.
 Laser surgery uses the highly focused beam of
light from a laser to destroy cancer cells. It is
seldom used for cancers that have not grown
beyond the outer layer of the skin

34. Surgery treatment
 Modern ways of doing surgery reduce the amount of
scar tissue that forms afterward. Nonetheless, skin
cancer surgery will leave a visible scar. Its size usually
depends on the size of the cancer and the amount of
tissue removed during surgery.
 Cryosurgery for a small tumor usually leaves a faint,
white scar that is barely visible.
 Treatment of large cancers may require a skin graft to
close the defect. Grafting involves removing skin from
another part of the body and moving it to the area
where the cancer was removed. Scars often fade and
become less visible with time.

35. Chemotherapy
 Chemotherapy - means treatment with anti-
cancer drugs. Systemic chemotherapy also may
be given in a pill, injected into a muscle, or
intravenous form through a needle in a vein. This
body-wide, or systemic, chemotherapy can kill
cancer cells that have spread outside the skin. It
may cause nausea and other side effects in some
individuals. Side effects are common, but can
generally be controlled. This treatment is generally
used only for metastic cancer.

36. Radiation therapy
 Radiotherapy - uses a special kind of energy
carried by invisible rays or particles to kill
cancer cells, or keep them from growing. X-
rays are the kind of radiation often used to kill
skin cancer. The amounts are much higher
than those used in an ordinary mammogram
or chest x-ray. This therapy often is used for
cancers that occur in areas difficult to treat
with surgery, especially in the very elderly,
who may be unable to safely undergo surgery.
These include cancers on the ears, eyelids, and
tip of the nose.

37. Other Treatments
 Biological therapy - tries to use the body's
own natural defenses to attack and
destroy cancer cells. It sometimes is called
biological response modifier (BRM)
therapy or immunotherapy. It is available
in clinical trials, studies conducted in
medical centers to determine its safety
and effectiveness.

38. How Can Skin Cancer Be
Prevented?
 Sun Block
 Reduce your Exposure of the Sun
 Protective Clothing
 Self Exam
 Dermatology visits
 Education and Awareness

39. Strategies for preventing skin
cancer
 Limit exposure (ограничьте кожу) of the
skin to intense, midday sun (10 am to 4
pm)
 When in bright sun wear protective
clothing (hat, long sleeves –длинные
рукава) and wear sun block (SPF 15-30).
Pay special attention to your head, a bald
spot, top of your ears, nose, hands, and
arms. You may need to reapply sunscreen
occasionally if it washes off or wears off
with activity or swimming.