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Skin LesionsWith the harsh Australian sun constantly beaming down on us, skin cancer is the most common form of cancer in our society. In fact most of us, who have lived for some time in Australia, will have at least some dealings with a cancerous or precancerous skin lesion. As a plastic surgeon, Dr Kennedy specialises in removing any lesion with the minimum amount of scarring which is particularly important when these tumours are removed from areas such as the face. All skin lesion surgery is rebatable, so be sure to get a GP referral prior to consultation with Dr Kennedy.
In this animation, you will learn more about the different forms of skin cancer, what causes them and their treatment options. The cells in your body continuously divide, or proliferate, in order to grow as well as repair or replace damaged cells in the body. If the DNA that makes up these genes is damaged, or mutated, and not repaired properly, the genes may not function correctly. In contrast, cancerous or malignant tumours invade surrounding tissues and spread to other areas of the body. DNA damage can be caused by many different carcinogens, but UV radiation from the sun causes most of the damage that eventually leads to skin cancer.
Damage that occurs due to occasional sun exposure is usually repaired by built-in DNA repair mechanisms in your body. If this damage occurs in genes that are responsible for controlling the division of skin cells, these cells may begin to divide uncontrollably, which can result in skin cancer.
Skin cancer arises from cells within the epidermis, because they sustain the most damage from the sun. Skin cancer typically affects three different types of cells in the epidermis, known squamous cells, basal cells, and melanocytes.
Squamous cells are cells that have flattened as they progress from the basal cell layer toward the skin’s surface, where they are shed. Basal cells are the bottommost epidermal cells that lie along the junction between the epidermis and dermis. As these cells divide, they produce new cells that eventually become squamous cells, which constantly replace the dead skin cells that are shed at the skin’s surface. These cells are responsible for producing melanin, or pigment, which gives your skin and hair its colour. There are often warning signs that can indicate that you are at risk for developing skin cancer. Most common in people who are forty or older, solar keratoses are generally caused by long-term exposure to ultraviolet light from the sun. Ultraviolet light damages epidermal skin cells, which causes them to develop abnormal characteristics. Much like skin cancer, solar keratoses generally develop in areas that have been exposed to large amounts of sun such as the face, neck, ears, lips, forearms, and hands. Solar keratoses appear as rough, callous lesions, and vary in color from light beige tones to dark brown and range in size from a small dot to approximately an inch in diameter.
Basal cell carcinoma (or BCC) is by far and away the most common form of skin cancer in Australia. Basal cell carcinoma originates in basal cells and typically does not grow very rapidly, usually being cured by excision. Basal cell carcinoma tumours usually grow in a localised area and do not spread to other areas of the body.
Of all the skin cancers, it is this tumour that is most directly linked with sun-exposure; therefore it most commonly occurs on sun-exposed areas such as the face, ears, head, and chest. Squamous cell carcinoma originates in squamous cells, and like basal cell carcinoma has been linked to long-term, cumulative sun exposure. This type of cancer is more likely to spread to other areas of the body through the lymph nodes or bloodstream than basal cell carcinoma, making it more dangerous and difficult to treat. Like basal cell carcinoma, this form of cancer is often found on sun-exposed areas such as the face, ears, head, and chest. Although melanoma is the least common of the 3 main skin cancers, it is also the most dangerous. Unlike non-melanoma skin cancers, which are generally linked to the effects of long-term sun exposure, melanoma has been associated with periods of intense sun exposure such as sunburn, especially during childhood. This form of skin cancer originates in melanocytes and can quickly spread to other areas of the body. Melanoma may first resemble a mole on the back, legs, hands, fingers, soles of feet and toes, and the mucous membranes that line the nose and mouth.
Ultraviolet light plays a critical role in the development of skin cancer, and therefore protecting yourself from the sun is the best preventative step you can take. Avoid unnecessary sun exposure, and protect yourself by covering up with long sleeved shirts, pants, and wide brimmed hats when possible. If your skin will be exposed, we recommend an SPF 30+ sunscreen that protects against both UVA and UVB forms of sunlight.

More on these treatments can be found in the 3D Animation at the top of this page and Dr Kennedy will discuss your treatment options at the time of your consultation.
To understand basal and squamous cell skin cancers, it helps to know about the normal structure and function of the skin.
Cancers that develop from melanocytes, the pigment-making cells of the skin, are called melanomas. Skin cancers that are not melanoma are sometimes grouped together as non-melanoma skin cancers because they tend to act very differently from melanomas.
When seen under a microscope, these cancers share features with the cells in the lowest layer of the epidermis, called the basal cell layer. About 2 out of 10 skin cancers are squamous cell carcinomas (also called squamous cell cancers). Along with melanoma and keratinocyte cancers, there are some other much less common types of skin cancer. This uncommon type of skin cancer develops from neuroendocrine cells (hormone-making cells that resemble nerve cells in some ways) in the skin. These cancers are thought to be caused in part by sun exposure and in part by Merkel cell polyomavirus (MCV). Unlike basal cell and squamous cell carcinomas, Merkel cell carcinomas often spread to nearby lymph nodes and internal organs.
Lymphomas are cancers that start in lymphocytes, a type of immune system cell found throughout the body in the bone marrow (the soft inner part of some bones), lymph nodes (bean-sized collections of immune system cells), the bloodstream, and some internal organs. Most lymphomas start in lymph nodes or internal organs, but there are certain types of lymphoma that appear to begin mostly or entirely in the skin. These conditions may develop into skin cancer or may be very early stages in the development of skin cancer.
Actinic keratosis, also known as solar keratosis, is a pre-cancerous skin condition caused by overexposure to the sun. Even though most actinic keratoses do not become cancers, they are a warning that your skin has suffered sun damage. Squamous cell carcinoma in situ, also called Bowen disease, is the earliest form of squamous cell skin cancer. Like invasive squamous cell skin cancers, the major risk factor is overexposure to the sun. On the opposite, the dermis is composed of a relatively small number of cells and a well-developed extracellular matrix. The hypodermis is the deepest part of the skin and the thickest (up to 3 cm thick on the abdomen); it is an important depot of fat.
In direct contact with the external environment, the skin is a major sensory organ and the skin innervation is rich and complex with an afferent and an efferent limb, the three cutaneous compartments, namely, hypodermis, dermis and epidermis (with the exception of the horny layer) being innervated. Deeply embedded into the dermis are the epidermal appendages, such as the pilo-sebaceous follicles and the sweat glands.
There are approximately 2000 or more melanocytes per square millimeter in the exposed skin of the head, in the skin of the scrotum or in the foreskin and 1,000 to 1,500 melanocytes per square millimeter on the rest of the body in Caucasoids, Negroids and Mongoloids. The good news is that most skin cancers are completely curable with early treatment, which may involve surgical excision. In some cases, DNA damage to a gene that controls cell division may cause a cell to divide uncontrollably. Solar keratosis may be difficult to distinguish from skin cancer, but is typically easily treated if diagnosed early. While these changes do not cause the cells to become cancerous, they are considered precursors to skin cancer.
However, early detection and treatment will prevent the tumour from spreading into surrounding tissue and causing more localised damage. However, even this aggressive form of cancer can be treated successfully if diagnosed early.
As it is so aggressive, melanomas should be excised with larger margins than the other skin cancers. It will not only help in the prevention of cancers but also prevent your skin from premature aging. Treatment options include Cryosurgery, Mohs surgery, Surgical Excision, Curettage & Electrodessication, Chemotherapy, Chemical Peel and Radiation Therapy.
The basement membrane is an important structure because when a skin cancer becomes more advanced, it generally grows through this barrier.
They are called keratinocyte carcinomas or keratinocyte cancers because when seen under a microscope, their cells share some features of keratinocytes, the most abundant cell type of normal skin. It is very rare for a basal cell cancer to spread to nearby lymph nodes or to distant parts of the body. People who have had basal cell cancers are also more likely to get new ones elsewhere on the skin. They commonly appear on sun-exposed areas of the body such as the face, ears, neck, lips, and backs of the hands.

These cancers are also non-melanoma skin cancers, but they are quite different from keratinocyte cancers and are treated differently.
It is related to infection with Kaposi sarcoma herpesvirus (KSHV), also known as human herpesvirus 8 (HHV8). Benign (non-cancerous) adnexal tumors are common, but malignant (cancerous) ones, such as sebaceous adenocarcinoma and sweat gland adenocarcinoma, are rare.
Some actinic keratoses and other skin conditions that could become cancers may have to be removed. The dermo-epidermal junction is often the subject of specific studies; it is composed of an extracellular matrix, the constituents of which are produced by dermal and epidermal cells. The different compartments of the skinThe epidermis, is the outer layer of the skin in contact with the external environment; it is a pluristratified keratinised squamous non vascularised epithelium and is mainly composed of layers of keratinocytes (90 to 95%). The functions of the skinSkin fulfills several functions, the major one being a barrier function. Specific genes, which are coded in your DNA, are responsible for controlling cell division by communicating when to start and stop dividing. Benign tumours are generally localised to a specific area and do not invade surrounding tissue. The cells of the basal layer, called basal cells, continually divide to form new keratinocytes. It contains hair follicles, sweat glands, blood vessels, and nerves that are held in place by a protein called collagen. The subcutis helps the body conserve heat and has a shock-absorbing effect that helps protect the body's organs from injury. The most common types of keratinocyte cancer are basal cell carcinoma and squamous cell carcinoma. But if a basal cell cancer is left untreated, it can grow into nearby areas and invade the bone or other tissues beneath the skin. As many as half of the people who are diagnosed with one basal cell cancer will develop a new skin cancer within 5 years. Before the mid-1980s, this cancer was rare and found mostly in elderly people of Mediterranean descent.
The most common type of primary cutaneous lymphoma is cutaneous T-cell lymphoma (most of these are called mycosis fungoides). Several types of sarcoma can develop in the skin, including dermatofibrosarcoma protuberans (DFSP) and angiosarcoma (a blood vessel cancer).
Usually they develop on the face, ears, back of the hands, and arms of middle-aged or older people with fair skin, although they can arise on other sun-exposed areas. Your doctor should regularly check any that are not removed for changes that could indicate cancer. This is often related to sexually transmitted infection with human papilloma viruses (HPVs), the viruses that can also cause genital warts. Glabrous skin is observed on the palms, the soles, and glans penis and is characterised by a thick epidermis with dermatoglyphics (fingerprints).
Now it is also being seen in younger people, probably because they are spending more time in the sun with their skin exposed.
Kaposi sarcoma has become more common because it is more likely to develop in people with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). It is a dynamic and regenerating organ as keratinocytes of the outer layers are continuously shed and replaced by inner cells moving up to the surface. Epidermal and dermal cells and the immune cells in transit in the skin are also able to produce neuromediators and enzymes able to degrade them; they also express receptors specific for these neuromediators and are therefore sensitive to them. On the rest of the body, skin is hairy with a density and a structure of hairs that can vary from site to site. The skin is also a thermoregulator, an immune organ which detects and fights against infections, and a sensory organ which transmits information about temperature, touch, pain, itch and mechanical stimuli at every point of the body. When skin is exposed to the sun, melanocytes make more of the pigment, causing the skin to tan or darken. Their growth is often hard to predict, and many skin specialists consider them a type of squamous cell skin cancer. In a small percentage of people with this infection, changes in the virus' DNA can lead to this form of cancer. All these observations led to the concept of a neuro-immune-cutaneous-endocrine system (NICE) which would include the skin cells and the skin components of the nervous system and of the immune system.
This concept would allow to explain the influence of the psychism in the maintenance of the skin hoemeostasis and in the triggering of various dermatological disorders, such as psoriasis or eczema.

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Author: admin | 10.02.2016 | Category: Aluminum Sheds

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