It turned out that it was skin cancer.

It is easy to be mistaken for a stitch, but it is characterized by asymmetry and uneven outlines
Complete excision is essential to prevent recurrence and skin reconstruction is also important for quality of life

[이데일리 이순용 기자] Although skin cancer is considered a rare cancer in Korea, it is actually one of the most common cancers. According to data from the Central Cancer Registry, 7,174 cases of skin cancer occurred among men and women in 2019, accounting for 2.8% of all cancers. This is by no means a small number. Furthermore, skin cancer ranks first among all cancers in the West and the incidence rate continues to increase worldwide along with the aging of the population. With the help of Professor Soonhyo Kwon from the Dermatology Department of Kyunghee University Hospital in Gangdong, we will learn about the reality of skin cancer, treatment and prevention.

◇ Skin cancer continues to increase due to an aging population

In the case of Westerners, skin cancer is the most common cancer of all cancers. Compared to Asians, the melanin pigment that protects against UV rays is relatively low, so the risk of skin cancer is high. However, as the population ages, the incidence of skin cancer has more than doubled in any country, and Korea is no exception. According to the National Health Insurance Review and Assessment Service, the number of patients who have visited skin cancer hospitals in the past five years has increased by 40% (29.83 in 2017 → 29,459 in 2021). UV rays accumulate and the onset of skin cancer increases.

◇ Cancer caused by continuous exposure to UV rays

Continued exposure to UV light damages DNA that contains genetic information, causing mutations in cells. UV rays are largely divided into UV rays A, B and C. Among them, A and B are the ones that have a negative effect on the onset of skin cancer.Generating free radicals, not just aging skin , but also indirect DNA damage, increasing the possibility of carcinogenesis.

There are various benign and malignant tumors on the skin and knowing how to distinguish them can greatly help in the early detection and treatment of skin cancer. Malignant tumors include basal cell carcinoma, squamous cell carcinoma, malignant melanoma, Kaposi’s sarcoma, Paget’s disease, and mycosis fungoides, but the first three are the most common. Of all skin cancers, basal cell carcinoma and squamous cell carcinoma (including Bowen’s disease) account for about 85% and malignant melanoma for about 10%. Malignant melanoma has a relatively high death rate among skin cancers due to its high rate of metastasis. On the other hand, basal cell carcinoma or squamous cell carcinoma has a low rate of metastasis and has little effect on the survival rate. According to data from the Central Cancer Registry, 5-year relative survival rates for skin cancer from 2015 to 2019 were 63.9% for malignant melanoma, 103.3% for basal cell carcinoma and cancer. ’89, 3% for squamous cell carcinoma.

◇ Malignant melanoma often occurs on the hands, toes, soles of the feet and face

Basal cell carcinoma is characterized mainly in the face, particularly on the face, nose and cheeks. The problem is that basal cell carcinoma doesn’t just happen on the face. 20-30 out of 100 people develop it on areas other than the face exposed to UV rays. It can also occur on the bald scalp. It occurs mainly in the elderly, but sometimes occurs in people in their fifties. Squamous cell carcinoma commonly occurs on the face, back of the hands, arms, lower lip, and auricle. It can take many forms, such as lumps, warts, and ulcers.

On the other hand, melanoma tends to invade the hands, toes, soles of the feet, face, back and shins. Vertical black streaks appear on the nail, especially if they occur under the nail. In the case of melanoma, it should be noted that there are a lot of them in the 30s and 40s.

◇ It looks like a dot, but it is asymmetrical and has rough edges

In general, seborrheic keratosis, that is, age spots, there are many people who come to worry if it is skin cancer. However, skin cancer has its own characteristics. Basal cell carcinoma and squamous cell carcinoma are markedly different from the general ones. The tumor looks like an ulcer, bruised, bleeding, or oozing at the site of the tumor. If these ulcers do not heal well despite treatment, a professional diagnosis is imperative. They also grow in size or have a grayish-blue color if you look closely.

Also, if it is mistaken for a spot and recurs after laser removal, skin cancer should be suspected. Malignant melanoma is a different type of skin cancer. It looks like a spot or lump, similar to a blackhead, but the lesion is not symmetrical and the edges are uneven. If the color is varied and the diameter is 0.6 cm or more, the area with the spot is itchy and there is a high possibility of melanoma. In particular, if the original shape becomes larger or other spots are present, an accurate diagnosis must be obtained.

◇ Complete excision and reconstruction of the skin are also important to prevent recurrence.

Skin cancer is confirmed by biopsy. Although the pathology department primarily checks the tissue, the dermatologist also checks the tissue to further diagnose the histological subtype of skin cancer and the depth of invasion. Treatment mainly consists of the surgical removal of the cancerous tissue. In this case, two things must be satisfied. The first is to completely remove the cancer so that it does not recur, and the second is to completely reconstruct the skin aesthetically and functionally. In addition to surgery, there are cauterization with electricity, curettage, cryotherapy, radiation therapy, and imiquimod ointment. Although it is mainly performed when the surgery is difficult, there is a limitation in that the cancer cells are not completely removed. However, for malignant melanoma, radiotherapy and chemotherapy are mobilized in addition to surgery. In the initial stage, it is okay to simply remove it, but if the thickness of the tumor is more than 1 mm, the surrounding lymph nodes can be removed or anticancer drugs can be used in consideration of the possibility of metastasis.

◇ Reducing exposure to UV rays is essential, sun protection is essential

Ultraviolet rays are classified as Class 1 carcinogens by the World Health Organization (WHO). So, first of all, you need to reduce your UV exposure. Since you can’t avoid outdoor activities, you need to use sunscreen when you go out. UV rays build up on the skin, so it’s good to get in the habit of using sunscreen from an early age. Also, ultraviolet A with a long wavelength can affect the skin even on cloudy days, so you shouldn’t be relieved.

Professor Kwon Soon-hyo said: “Especially men who don’t care about their skin should pay attention to UV rays. For early detection of skin cancer, you should always pay attention to your own skin. We recommend that you check your skin for ulcer-like spots or dark spots in hard-to-reach places, such as the soles of your feet or nails. For any cancer, early diagnosis is the most reliable treatment ”.