exposure

Reporter Park Jeong-ryeol of Money Today | 2023.07.18 16:10

[박정렬의 신의료인]

Ultraviolet rays are one of the main causes of skin cancer. The longer and more frequently exposed to strong sunlight, the greater the risk of cancer. However, ‘malignant melanoma’, which is the most metastatic and virulent type of skin cancer, often appears on the extremities of the body where sunlight does not reach, such as the palms and soles of the feet. This is in contrast to the fact that Westerners tend to develop cancer on the face or arms and legs exposed to sunlight. As with other cancers, early diagnosis and treatment of skin cancer is important. Summer may be the ‘right time’ to discover malignant melanoma, which is normally hidden in socks, shoes, and clothes.

The three major skin cancers in Korea are basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. There are many patients in this order. According to the Central Cancer Registry, the number of newly diagnosed patients with skin cancer in 2020 was 7089, with women 1.25 times more than men. By age group, those in their 80s or older (32.4%), 70s (28.6%), and 60s (19.4%) accounted for about 80% of the total.

Among these, basal cell carcinoma is the most common cancer caused by mutations in the cells that make up the basal layer or hair follicle, which is the lowest layer of the skin (epidermis). It should be noted that the incidence rate is gradually increasing even among those under the age of 50. Kim Hye-seong, a professor of dermatology at Incheon St. Mary’s Hospital at the Catholic University of Korea, said, “The most important risk factor for basal cell carcinoma is exposure to ultraviolet rays. Radiation treatment, immune abnormalities, and genetic diseases also increase the risk of basal cell carcinoma.”

Squamous cell carcinoma is a cancer that originates from keratinocytes, the outer part of the epidermis. It occurs more often in men, and most develop into cancer from precancerous lesions that are prone to cancer, such as actinic keratosis (skin deformity caused by sunlight) or Bowen’s disease. As with basal cell carcinoma, exposure to ultraviolet rays and radiation are pointed out as risk factors, and are also associated with immune problems, resulting in organ transplant patients, AIDS (Acquired Immunodeficiency Syndrome), human papillomavirus (HPV) infection, smoking, and chronic skin conditions such as burns. The risk of developing it increases when there is damage.

Malignant melanoma is a malignant tumor arising from melanocytes that produce pigment. It mainly occurs in elderly people over 60 years of age, and patients under 40 are rare. Melanocytes determine the ‘color’ of the human body, such as pupils, hair, and skin. The difference in appearance between Westerners and Asians is due to differences in the composition of melanocytes. In Westerners, UV exposure, genetic factors, and giant congenital birthmarks are pointed out as important risk factors, but in the case of Koreans, it is estimated that pressure and friction have a greater effect on cancer incidence than UV rays.

/Pictures and tips = Incheon St. Mary’s Hospital Except for malignant melanoma, all other basal and squamous cell carcinomas appear most often on the ‘face’. Basal cell carcinoma is common in the central part of the nose, forehead, and eyelids, while squamous cell carcinoma is more common in the lips and cheeks. Basal cell carcinoma appears as black or dark brown dots (pigmented basal cell carcinoma) without symptoms such as pain or itching, but may appear as ivory-colored scars (sclerosing basal cell carcinoma) or ulcers (nodular basal cell carcinoma) warts (fibroepithelialoma). ) can appear in different forms depending on the type. Squamous cell carcinoma should be suspected when the skin becomes convex and hardened nodules or ulcers occur. Malignant melanoma is also not painful or itchy and looks like a black dot, with the border around the skin being ambiguous, and as the size grows, it is accompanied by ulcers and bleeding. At this time, cancer is confirmed through a biopsy.

Skin cancer is confirmed through a biopsy after identifying its shape with the naked eye or using a magnifying glass (dermoscopy). Treatment is usually applied surgically first. In particular, Mohs microschematic surgery (Mohs surgery), which first removes the surrounding area including the cancer, then inspects the tumor boundary area and traces and removes the root of the remaining cancer to the end, removes normal tissue. As it can be preserved as much as possible, it is evaluated as excellent cosmetically and functionally.

For malignant melanoma, which is highly metastatic and virulent, the primary treatment is surgery, which usually removes a larger area than non-melanoma skin cancer. If the tumor has deeply invaded the skin with a thickness of 1 mm, the surrounding lymph nodes are removed together considering the possibility of metastasis. In cases where surgery is not possible, anticancer drugs or radiation therapy are performed. Recently, immune anticancer drugs such as Keytruda, Opdivo, and Yervoy, or targeted anticancer drugs according to gene mutations are widely used for advanced malignant melanoma. Professor Kim said, “For the prevention of skin cancer, it is important to consult a dermatologist early if the size, color, or shape of a mole on the body, a black line on a nail, or a nodule on the face changes.”

[저작권자 @머니투데이, 무단전재 및 재배포 금지]

2023-07-18 07:10:00

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