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The skin is the largest organ in
our body. It provides protection against heat, cold, light,
and infection. The skin is made up of two major layers
(epidermis and dermis) as well as various types of cells.
The top (or outer) layer of the skin - the epidermis -
is composed of three types of cells: flat, scaly cells
on the surface called squamous cells; round cells called
basal cells; and melanocytes, cells that provide skin
its color and protect against skin damage. The inner layer
of the skinóthe dermisóis the layer that contains the
nerves, blood vessels, and sweat glands.
What is skin cancer?
Skin
cancer is a disease in which cancer (malignant) cells
are found in the outer layers of your skin. There are
several types of cancer that originate in the skin. The
most common types are basal cell carcinoma (70 percent
of all skin cancers) and squamous cell carcinoma (20 percent).
These types are classified as nonmelanoma skin cancer.
Melanoma (five percent of all skin cancers) is the third
type of skin cancer. It is less common than basal cell
or squamous cell skin cancer, but potentially much more
serious. Other types of skin cancer are rare.
Basal
cell carcinoma is the most common type of skin
cancer. It typically appears as a small raised bump that
has a pearly appearance. It is most commonly seen on areas
of the skin that have received excessive sun exposure. These
cancers may spread to the skin around the cancer but rarely
spread to other parts of the body.
Squamous
cell carcinoma is also seen on the areas of the
body that have been exposed to excessive sun (nose, lower
lip, hands, and forehead). Often this cancer appears as
a firm red bump or ulceration of the skin that does not
heal. Squamous cell carcinomas can spread to lymph nodes
in the area.
Melanoma
is a skin cancer (malignancy) that arises from
the melanocytes in the skin. These cancers typically arise
as pigmented (colored) lesions in the skin with an irregular
shape, irregular border, and multiple colors. It is the
most harmful of all the skin cancers, because it can spread
to other sites in the body. Fortunately, most melanomas
have a very high cure rate when identified and treated
early.
Who gets skin cancer?
Skin cancer is a disease that has shown a steady increase over the past 20 years. Fortunately, with early diagnosis and treatment, it remains a very curable disease. A variety of factors have been identified that place a person at a higher risk to develop skin cancer (see "Am I at risk?").
How is skin cancer diagnosed?
The
vast majority of skin cancers can be cured if diagnosed
and treated early. Aside from protecting your skin from
sun damage, it is important to recognize the early signs
of skin cancer.
- Skin
sores that do not heal,
- Bumps
or nodules in the skin that are enlarging, and
- Changes
in existing moles (size, texture, color).
If
you notice any of the factors listed above see your doctor
right away. If you have a spot or lump on your skin, your
doctor may remove the growth and examine the tissue under
the microscope. This is called a biopsy. A biopsy can
usually be done in the doctor's office and usually involves
numbing the skin with a local anesthetic. Examination
of the biopsy under the microscope will tell the doctor
if the skin lesion is a cancer (malignancy).
How is skin cancer treated?
There
are varieties of treatments available, including surgery,
radiation therapy, and chemotherapy, to treat skin cancer.
Treatment for skin cancer depends on the type and size
of cancer, your age, and your overall health.
Surgery
is the most common form of treatment. It generally consists
of an office or outpatient procedure to remove the lesion
and check edges to make sure all the cancer was removed.
In many cases, the site is then repaired with simple stitches.
In larger skin cancers, your doctor may take some skin
from another body site to cover the wound and promote
healing. This is termed skin grafting. In more advanced
cases of skin cancer, radiation therapy or chemotherapy
(drugs that kill cancer cells) may be used with surgery
to improve cure rates.
Am I at risk?
People
with any of the factors listed below have a higher risk
of developing skin cancer and should be particularly careful
about sun exposure.
- long-term
sun exposure
- fair
skin (typically blonde or red hair with freckles)
- place
of residence (increased risk in Southern climates)
- presence
of moles, particularly if there are irregular edges,
uneven coloring, or an increase in the size of the mole
- family
history of skin cancer
- use
of indoor tanning devices
- severe
sunburns as a child
- nonhealing ulcers or nodules
in the skin
Early
identification of skin cancer can save your life.
How can I lower my risk?
The single most important thing you can do to lower your risk of skin cancer is to avoid direct sun exposure. Sunlight produces ultraviolet (UV) radiation that can directly damage the cells (DNA) of our skin. People who work outdoors (farming, construction, boating, outdoor sports) are at the highest risk of developing a skin cancer. The sun's rays are the most powerful between 10 am and 2 pm, so you must be particularly careful during those hours.
If you must be out during the day, wear clothing that covers as much of your skin as possible, including a wide-brimmed hat to block the sun from your face, scalp, neck, and ears. In addition to protective clothing, the use of a sunscreen can reflect light away from the skin and provide protection against UV radiation. When selecting a sunscreen, choose one with a Sun Protection Factor (SPF) of 15 or more. Sunscreen products do not completely block the damaging rays, but they do allow you to be in the sun longer without getting sunburn.
In addition to being sun-smart, it is critical to recognize early signs of trouble on your skin. The best time to do self-examination is after a shower in front of a full-length mirror. Note any moles, birthmarks, and blemishes. Be on the alert for sores that do not heal or new nodules on the skin. Any mole that changes in size, color, or texture should be carefully examined. If you notice anything new or unusual, see your physician right away. Catching skin cancer early can save your life.
Ultraviolet Index: What you need to know
The new Ultraviolet (UV) Index provides
important information to help you plan your outdoor activities
and avoid overexposure to the damaging rays of the sun.
Developed by the National Weather Service and the Environmental
Protection Agency, the UV Index is issued daily as a national
service.
The UV Index gives the next day's amount of exposure to UV rays. The Index predicts UV levels on a 0-10+ scale (see chart below).
Always take precautions against
overexposure, and take special care when the UV Index
predicts exposure levels of moderate to above (5 - 10+).
|
Index
Number Exposure Level
|
| 0
- 2 |
|
Minimal |
| 3
- 4 |
|
Low |
| 5
- 6 |
|
Moderate |
| 7
- 9 |
|
High |
| 10+
|
|
Very
High |
More than 55,000 Americans will
develop cancer of the head and neck (most of which is
preventable) this year; nearly 13,000 of them will die
from it.
Find it early and be cured
Tobacco
is the most preventable cause of these deaths. In the
United States, up to 200,000 people die each year from
smoking-related illnesses. The good news is that this
figure has decreased due to the increasing number of Americans
who have quit smoking. The bad news is that some of these
smokers switched to smokeless or spit tobacco, assuming
it is a safe alternative. This is untrue-they are merely
changing the site of the cancer risk from their lungs
to their mouth. While lung cancer cases are down, cancers
in the head & neck app ear to be increasing. Cancer of
the head and neck is curable if caught early. Fortunately,
most head and neck cancers produce early symptoms. You
should know the possible warning signs so you can alert
your doctor to your symptoms as soon as possible. Remember-successful
treatment of head and neck cancer can depend on early
dectecfion. Knowing and recognizing the signs of head
and neck cancer can save your life.
Here's what you should watch for:
A
lump in the neck...Cancers that begin in the
head or neck usually spread to lymph nodes in the neck
before they spread elsewhere. A lump in the neck that
lasts more than two weeks should be seen by a physician
as soon as possible. Of course, not all lumps are cancer.
But a lump (or lumps) in the neck can be the first sign
of cancer of the mouth, throat, voicebox (larynx), thyroid
gland, or of certain lymphomas or blood cancers. Such
lumps are generally painless and continue to enlarge steadily.
Change
in the voice...Most cancers in the larynx cause
some change in voice. Any hoarseness or other voice change
lasting more than two weeks should alert you to see your
physician. An otolaryngologist is a head and neck specialist
who can examine your vocal cords easily and painlessly.
While most voice changes are not caused by cancer, you
shouldn't take chances. If you are hoarse more than two
weeks, make sure you don't have cancer of the larynx.
See your doctor.
A
growth in the mouth...Most cancers of the mouth
or tongue cause a sore or swelling that doesn't go away.
These sores and swellings may be painless unless they
become infected. Bleeding may occur, but often not until
late in the disease. If an ulcer or swelling is accompanied
by lumps in the neck, be very concerned. Your dentist
or doctor can determine if a biopsy (tissue sample test)
is needed and can refer you to a head and neck surgeon
to perform this procedure.
Bringing
up blood...This is often caused by something
other than cancer. However, tumors in the nose, mouth,
throat or lungs can cause bleeding. If blood appears in
your saliva or phlegm for more than a few days, you should
see your physician.
Swallowing
problems...Cancer of the throat or esophagus
(swallowing tube) may make swallowing solid foods difficult.
Sometimes liquids can also be troublesome. The food may
"stick" at a certain point and then either go through
to the stomach or come back up. If you have trouble almost
every time you try to swallow something, you should be
examined by a physician. Usually a barium swallow x-ray
or an esophagoscopy (direct examination of the swallowing
tube with a telescope) will be performed to find the cause.
Changes
in the skin...The most common head and neck cancer
is basal cell cancer of the skin. Fortunately, this is
rarely a major problem if treated early. Basal cell cancers
appear most often on sun-exposed areas like the forehead,
face, and ears, although they can occur almost anywhere
on the skin. Basal cell cancer often begins as a small,
pale patch that enlarges slowly, producing a central "dimple"
and eventually an ulcer. Parts of the ulcer may heal,
but the major portion remains ulcerated. Some basal cell
cancers show color changes. Other kinds of cancer, including
squamous cell cancer and malignant melanoma, also occur
on the skin of the head and neck. Most squamous cell cancers
occur on the lower lip and ear. They may look like basal
cell cancers and, if caught early and properly treated,
usually are not much more dangerous. If there is a sore
on the lip, lower face, or ear that does not heal, consult
a physician. Malignant melanoma classically produces dense
blue-black or black discolorations of the skin. However,
any mole that changes size, color, or begins to bleed
may be trouble. A black or blue-black spot on the face
or neck, particularly if it changes size or shape, should
be seen as soon as possible by a dermatologist or other
physician.
Persistent
Earache...Constant pain in or around the ear
when you swallow can be a sign of infection or tumor growth
in the throat. This is particularly serious if it is associated
with difficulty in swallowing, hoarseness or a lump in
the neck. These symptoms are best evaluated by an otolaryngologist.
Identifying high risk of head and neck cancer
As
many as 90 percent of head and neck cancers arise after
prolonged exposure to specific factors. Use of tobacco
(cigarettes, cigars, chewing tobacco or snuff) and alcoholic
beverages are closely linked with cancers of the mouth,
throat, voice box and tongue. (In adults who neither smoke
nor drink, cancer of the mouth and throat are nearly nonexistent.)
Prolonged exposure to sunlight is linked with cancer of
the lip and is also an established major cause of skin
cancer.
What you should do...All of the symptoms and signs described here can occur with no cancer present. In fact, many times complaints of this type will be due to some other condition. But you can't tell without an examination. So, if they do occur, see your doctor and be sure.
REMEMBER: When found early, most cancers in the head and neck can be cured with relatively little difficulty. Cure rates for these cancers could be greatly improved if people would seek medical advice as soon as possible. So play it safe. If you think you have one of the warning signs of head and neck cancer, see your doctor right away.
BE SAFE: See your doctor early! And practice health habits which will make these diseases unlikely to occur.
Fine Needle Aspiration up^
What is FNA?
Fine
needle aspiration (FNA) is a technique that allows a biopsy
of various bumps and lumps. It allows your otolaryngologist
to retrieve enough tissue for microscopic analysis and
thus make an accurate diagnosis of a number of problems,
such as inflammation or even cancer.
FNA is used for diagnosis in:
- Neck
lymph nodes
- Neck
cysts
- Parotid
gland
- Thyroid
gland
- Inside
the mouth
- Any
lump that can be felt
Why is it important?
A
mass or lump sometimes indicates a serious problem, such
as a growth or cancer*. While this is not always the case,
the presence of a mass may require FNA for diagnosis.
Your age, sex, and habits, such as smoking and drinking,
are also important factors that help diagnosis of a mass.
Symptoms of ear pain, increased difficulty swallowing,
weight loss, or a history of familial thyroid disorder
or of previous skin cancer (squamous cell carcinoma) may
be important as well.
*
When found early, most cancers in the head and neck
can be cured with relatively little difficulty. Cure
rates for these cancers are greatly improved if people
seek medical advice as soon as possible. So play it
safe. If you have a lump in your head and neck area,
see your otolaryngologist right away.
What are some areas that can be biopsied in this fashion?
FNA
is generally used for diagnosis in areas such as the neck
lymph nodes or for cysts in the neck. The parotid gland
(the mumps gland), thyroid gland, and other areas inside
the mouth or throat can be aspirated as well. Virtually
any lump or bump that can be felt (palpated) can be biopsied
using the FNA technique.
How is it done?
Your
doctor will insert a small needle into the mass. Negative
pressure is created in the syringe, and as a result of
this pressure difference between the syringe and the mass,
cellular material can be drawn into the syringe. The needle
is moved in a to and fro fashion, obtaining enough material
to make a diagnosis. This procedure is generally accurate
and frequently prevents the patient from having an open,
surgical biopsy, which is more painful and costly. The
procedure generally does not require anesthesia. It is
about as painful as drawing blood from the arm for laboratory
testing (venipuncture). In fact, the needle used for FNA
is smaller than that used for venipuncture. Although not
painless, any discomfort associated with FNA is usually
minimal.
What are the complications of this procedure?
No medical procedure is without risks.
Due to the small size of the needle, the chance of spreading
a cancer or finding cancer in the needle path is very small.
Other complications are rare; the most common is bleeding.
If bleeding occurs at all, it is generally seen as a small
bruise. Patients who take aspirin, Advil®, or blood
thinners, such as Coumadin®, are more at risk to bleed.
However, the risk is minimal. Infection is rarely seen.
Sean
Marsee of Ada, OK, lifted weights and ran the 400 meter
relay. By the time he was 18 years of age, he had won
28 medals. To keep his body strong, he did not smoke or
drink. But he did use smokeless tobacco, because he thought
it wasn't harmful to his health.
When oral cancer was discovered, part
of Sean's tongue was removed. But the cancer spread. More
surgeries followed, including removal of his jaw bone. In
his last hours, Sean wrote - he could no longer speak -
a plea to his peers; "Don't dip snuff". He died at age 19.
Three percent of American adults are smokeless tobacco users. They run the same risks of gum disease, heart disease, and addiction as cigarette users, but an even greater risk of oral cancer. Each year about 30,000 Americans are diagnosed with oral and pharyngeal cancers, and more than 8,000 people die of these diseases. Despite the health risks associated with tobacco use, consumers continue to demand the product. In 2001, the five largest tobacco manufacturers spent $236.7 million on smokeless tobacco advertising and promotion.
What is smokeless tobacco?
There are two forms of smokeless tobacco: chewing tobacco and snuff. Chewing tobacco is usually sold as leaf tobacco (packaged in a pouch) or plug tobacco (in brick form). Both are placed between the cheek and gum. Users keep chewing tobacco in their mouths for several hours to get a continuous high from the nicotine in the tobacco.
Snuff is a powdered tobacco (usually sold in cans) that is put between the lower lip and the gum. It is also referred to as “dipping.” Just a pinch is all that’s needed to release the nicotine, which is then swiftly absorbed into the bloodstream, resulting in a quick high.
The chemicals contained in chew or snuff are poisonous and addictive. Every time smokeless tobacco is used, the body adjusts to the amount of tobacco needed to get a high. Consequently, the next time tobacco is used, the body will need a little more tobacco to get the same feeling. Holding an average-sized dip or chew in the mouth for 30 minutes gives the user as much nicotine as smoking four cigarettes.
Is smokeless tobacco less harmful than cigarettes?
In 1986, the U.S. Surgeon General declared that the use of smokeless tobacco “is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous conditions and can lead to nicotine addiction and dependence.” Also since 1991, the National Cancer Institute has recommended that the public avoid the use of all tobacco products due to their high levels of nitrosamines.
In a recent study, cancer researchers found that oral tobacco products including lozenges and moist snuff are not a good alternative to smoking, since the levels of cancer-causing nitrosamines in smokeless tobacco and lozenges are very high. Some smokeless products contain the highest amounts of nicotine that can be readily absorbed by the body.
What are the ingredients in smokeless tobacco?
- Polonium 210 (nuclear waste)
- N-Nitrosamines (cancer-causing)
- Formaldehyde (embalming fluid)
- Nicotine (addictive drug)
- Cadmium (used in batteries and nuclear reactor shields)
- Cyanide (poisonous compound)
- Arsenic (poinsonous metallic element)
- Benzene (used in insecticides and motor fuels)
- Lead (nerve poison)
Who are the most common smokeless tobacco users?
According to the 2000 National Household Survey on Drug Abuse conducted by the Substance Abuse and Mental Health Services Administration, young adults between the ages of 18-25 are the most common smokeless tobacco users. This trend may be influenced by innovative marketing tactics targeted at a younger audience.
Smokeless tobacco manufacturers are marketing flavored smokeless tobacco. A 2005 American Legacy Foundation and National Cancer Institute study noted, “Tobacco companies are using candy-like flavors and high tech delivery devices to turn a blowtorch into a flavored popsicle, misleading millions of youngsters to try a deadly product.”
What are the physical and mental effects of smokeless tobacco use?
Cancer. Smokeless tobacco is a cancer-causing agent or carcinogen. Cancers are most likely to develop at the site where tobacco is held in the mouth, but it may also include the lips, tongue, cheek, and throat.
Leukoplakia. Smokeless tobacco users may develop a condition in which white spots form on the gums, inside of the cheeks and sometimes tongue. It can be caused by the irritation from the tobacco juice. The disorder can be considered pre-cancerous. Therefore, if a white patch does not heal within one week, a doctor should be consulted.
Heart disease. The stimulating effects of nicotine, an organic compound made out of carbon, hydrogen, nitrogen, and sometimes oxygen, increase the heart rate and blood pressure and may trigger irregular heart beats.
Gum and tooth disease. Smokeless tobacco permanently discolors teeth, causes halitosis (bad breath), and may contribute to tooth loss. Smokeless tobacco contains a lot of sugar which forms and acid that may eat away the tooth enamel causing cavities and mouth sores. Also, its direct and repeated contact with the gums may cause them to recede.
Social effects. Bad breath, discolored teeth.
What are some early warning signs of oral cancer?
- A sore that bleeds easily and does not heal
- A lump or thickening anywhere in the mouth or neck
- Soreness or swelling that does not go away
- A red or white patch that does not go away
- Trouble chewing, swallowing, or moving the tongue or jaw
Tips to quit using smokeless tobacco for a lifetime
- Write down a list of reasons to quit. For example:
- Don’t want to risk getting cancer.
- Family members find it offensive.
- Don’t like having bad breath after chewing and dipping.
- Don’t want stained teeth or no teeth.
- Don’t like being addicted to nicotine.
- Want to start leading a healthier life.
- Pick a quit date and throw out all chewing tobacco and snuff.
- Remember daily of the decision to stop chewing tobacco.
- Ask friends and family to help stay committed to the decision to quit by giving support and encouragement.
- Find alternatives to smokeless tobacco, such as sugarless gum, pumpkin or sunflower seeds, apple slices, raisins, or dried fruit.
- Engage in recreational activities to keep the mind off of smokeless tobacco.
- Develop a personalized plan that works best; set realistic goals.
- Reward successes.
Reprinted from the American Academy of Otolaryngology-Head
and Neck Surgery Web site with permission of the American Academy
of Otolaryngology-Head and Neck Surgery Foundation, copyright
© 2003.
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