Skin Cancer

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Skin cancer is the most common type of human cancer. Its rate has been increasing in recent years, mainly because of the mutation-causing effects of the ultraviolet rays in sunlight.

Malignant melanoma results from an overgrowth of melanocytes, the pigment-producing cells in the epidermis. It is the most dangerous form of skin cancer because of its tendency to metastasize. This cancer appears as a lesion that is variable in color with an irregular border (Fig. 21-5). It may spread superficially for up to 1 or 2 years before it begins to invade the deeper tissues of the skin and to metastasize through blood and lymph. The prognosis for cure is good if the lesion is recognized and removed surgically before it enters this invasive stage.

Squamous cell carcinoma and basal cell carcinoma are both cancers of epithelial cells. Both appear in areas exposed to sunlight, such as the face. Squamous cell carcinoma appears as a painless, firm, red nodule or plaque that may develop surface scales, ulceration, or crusting (Fig. 21-6). This cancer may invade underlying tissue but tends not to metastasize. It is treated by surgical removal and sometimes with x-irradia-tion or chemotherapy.

Basal cell carcinoma constitutes more than 75% of all skin cancers. It usually appears as a smooth, pearly papule (Fig. 21-7). Because these cancers are easily seen and do not metastasize, the cure rate after excision is greater than 95%.

Kaposi sarcoma, once considered rare, is now seen frequently in association with AIDS. It usually appears as distinct brownish areas on the legs. These plaques become raised and firm as the tumor progresses. In those with weakened immune systems, such as AIDS patients, the cancer can metastasize.

Skin Medical Terminology

FIGURE 21-5. Characteristics of malignant melanoma. (A) Shows asymmetry. (B) Shows irregular borders. (C) Shows variation in color, a diameter greater than 6 mm, and elevation. (Courtesy of The American Cancer Society; American Academy of Dermatology.)

Skin Medical Terminology

FIGURE 21-6. Squamous cell carcinoma shown on the face and the back of the hand, sun-exposed areas that are commonly affected. (Reprinted with permission from Bickley LS. Bate's Guide to Physical Examination and History Taking. 8th Ed. Philadelphia: Lippincott Williams & Wilkins, 2003.)

FIGURE 21-7. Basal cell carcinoma. An initial translucent nodule spreads, leaving a depressed center and a firm, elevated border. (Reprinted with permission from Bickley LS. Bate's Guide to Physical Examination and History Taking. 8th Ed. Philadelphia: Lippincott Williams & Wilkins, 2003.)



Key Clinical Terms



atopic dermatitis

Hereditary, allergic, chronic inflammation of the skin with pruritus;

a-TOP-ik der-ma-TI-tis


basal cell carcinoma

An epithelial tumor that rarely metastasizes and has a high cure rate

with surgical removal


Removal of dead or damaged tissue, as from a wound



Splitting or bursting, as when the layers of a wound separate



Inflammation of the skin, often associated with redness and itching;


may be caused by allergy, irritants (contact dermatitis), or a variety of



Study of the skin and diseases of the skin



Instrument for cutting thin sections of skin for skin grafting



A general term for an inflammation of the skin with redness, lesions,


and itching; atopic dermatitis


Removal of scab tissue (eschar) resulting from burns or other skin




Protrusion of internal organs (viscera) through an opening, as


through a wound


Material, which may include fluid, cells, pus, or blood, that escapes


from damaged tissue

Kapo si s arcoma

Cancerous lesion of the skin and other tissues seen most often in pa-


tients with AIDS

lupus erythematosus (LE)

A chronic, inflammatory, autoimmune disease of connective tissue

LU-pus er-i-the-ma-TO-sis

that often involves the skin; types include the more widespread systemic lupus erythematosus (SLE) and a discoid form (DLE) that involves only the skin

malignant melanoma

A metastasizing pigmented tumor of the skin


An autoimmune disease of the skin characterized by sudden, inter-


mittent formation of bullae (blisters); may be fatal if untreated

pressure ulcer

An ulcer caused by pre ssure to an area of the body, as from a bed or chair; decubitus (de-KU-bi-tus) ulcer, bedsore, pressure sore

psor iasis

A chronic hereditary dermatitis with red lesions covered by silvery



rule of nines

A method for estimating the extent of body surface area involved in a burn by assigning percentages in multiples of nine to various regions of the body

sclero derma

A chronic disease that is characterized by thickening and tightening


of the skin and that often involves internal organs in a form called progressive systemic sclerosis (PSS)

squamous cell carcinoma

An epidermal cancer that may invade deeper tissues but tends not to metastasize


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