skin cancer

関

specific types

WordNet

1. bruise, cut, or injure the skin or the surface of; "The boy skinned his knee when he fell" (同)scrape
2. a persons skin regarded as their life; "he tried to save his skin"
3. a bag serving as a container for liquids; it is made from the hide of an animal
4. an outer surface (usually thin); "the skin of an airplane"
5. a natural protective body covering and site of the sense of touch; "your skin is the largest organ of your body" (同)tegument, cutis
6. strip the skin off; "pare apples" (同)peel, pare
7. type genus of the family Cancridae (同)genus Cancer
8. the fourth sign of the zodiac; the sun is in this sign from about June 21 to July 22 (同)Cancer the Crab, Crab
9. (astrology) a person who is born while the sun is in Cancer (同)Crab
10. a small zodiacal constellation in the northern hemisphere; between Leo and Gemini
11. any malignant growth or tumor caused by abnormal and uncontrolled cell division; it may spread to other parts of the body through the lymphatic system or the blood stream (同)malignant neoplastic disease
12. move along on skis; "We love to ski the Rockies"; "My children dont ski"
13. narrow wood or metal or plastic runners used in pairs for gliding over snow
14. a sport in which participants must travel on skis

PrepTutorEJDIC

1. 〈U〉〈C〉(人・動物の)『皮膚』,肌 / 〈C〉〈U〉(動物からはいだ)『皮』,『毛皮』;皮製品,皮袋 / 〈C〉(果物・野菜の)皮 / 〈U〉〈C〉(液体の表面にできる)薄い膜,上皮 / 〈C〉(枠組み・表面などを覆う)外皮,外被,外板 / 〈動物・果物など〉‘の'皮をはぐ(むく) / 〈手・脚など〉‘を'擦りむく / 《話》(金などを)〈人〉‘から'巻き上げる《+『名』〈人〉+『of』+『名』》 / 〈傷口などが〉皮で覆われる《+『over』》
2. 〈U〉〈C〉『がん』 / 〈U〉〈C〉害悪 / 《Cancer》(星座の)カニ座
3. 『スキー』 / 『スキーで滑走する』 / …‘を'スキーで滑る / スキーの,スキー用の
4. (スポーツとしての)『スキー』;スキー術

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/26 10:50:55」(JST)

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[Wiki en表示]

Skin cancer
A basal-cell carcinoma. Note the pearly appearance and telangiectasia.
Classification and external resources
Specialty	Oncology and dermatology
ICD-10	C43-C44
ICD-9-CM	172, 173
ICD-O	8010-8720
MedlinePlus	001442
eMedicine	article/276624, article/870538, article/1100753, article/1965430
NCI	Skin cancer
MeSH	D012878

Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. There are three main types: basal-cell cancer (BCC), squamous-cell cancer (SCC) and melanoma. The first two together along with a number of less common skin cancers are known as nonmelanoma skin cancer (NMSC). Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or result in death. It often appears as a painless raised area of skin, that may be shiny with small blood vessel running over it or may present as a raised area with an ulcer. Squamous-cell cancer is more likely to spread. It usually presents as a hard lump with a scaly top but may also form an ulcer. Melanomas are the most aggressive. Signs include a mole that has changed in size, shape, color, has irregular edges, has more than one color, is itchy or bleeds.

Greater than 90% of cases are caused by exposure to ultraviolet radiation from the Sun. This exposure increases the risk of all three main types of skin cancer. Exposure has increased partly due to a thinner ozone layer. Tanning beds are becoming another common source of ultraviolet radiation. For melanomas and basal-cell cancers exposure during childhood is particularly harmful. For squamous-cell cancers total exposure, irrespective of when it occurs, is more important. Between 20% and 30% of melanomas develop from moles. People with light skin are at higher risk as are those with poor immune function such as from medications or HIV/AIDS. Diagnosis is by biopsy.

Decreasing exposure to ultraviolet radiation and the use of sunscreen appears to be effective methods of preventing melanoma and squamous-cell cancer. It is not clear if sunscreen affects the risk of basal-cell cancer. Nonmelanoma skin cancer is usually curable. Treatment is generally by surgical removal but may less commonly involve radiation therapy or topical medications such as fluorouracil. Treatment of melanoma may involve some combination of surgery, chemotherapy, radiation therapy, and targeted therapy. In those people whose disease has spread to other areas of their bodies, palliative care may be used to improve quality of life. Melanoma has one of the higher survival rates among cancers, with over 86% of people in the UK and more than 90% in the United States surviving more than 5 years.

Skin cancer is the most common form of cancer, globally accounting for at least 40% of cases. It is especially common among people with light skin. The most common type is nonmelanoma skin cancer, which occurs in at least 2-3 million people per year. This is a rough estimate, however, as good statistics are not kept. Of nonmelanoma skin cancers, about 80% are basal-cell cancers and 20% squamous-cell cancers. Basal-cell and squamous-cell cancers rarely result in death. In the United States they were the cause of less than 0.1% of all cancer deaths. Globally in 2012 melanoma occurred in 232,000 people, and resulted in 55,000 deaths. Australia and New Zealand have the highest rates of melanoma in the world. The three main types of skin cancer have become more common in the last 20 to 40 years, especially in those areas which are mostly Caucasian.

Classification

There are three main types of skin cancer: basal-cell carcinoma (BCC), squamous-cell carcinoma (SCC) and malignant melanoma.

Cancer	Description	Illustration
Basal-cell carcinoma	Note the pearly translucency to fleshy color, tiny blood vessels on the surface, and sometime ulceration which can be characteristics. The key term is translucency.
Squamous-cell carcinoma	Commonly presents as a red, crusted, or scaly patch or bump. Often a very rapid growing tumor.
Malignant melanoma	The common appearance is an asymmetrical area, with an irregular border, color variation, and often greater than 6 mm diameter.

Basal-cell carcinomas are present on sun-exposed areas of the skin, especially the face. They rarely metastasize and rarely cause death. They are easily treated with surgery or radiation. Squamous-cell carcinomas (SCC) are common, but much less common than basal-cell cancers. They metastasize more frequently than BCCs. Even then, the metastasis rate is quite low, with the exception of SCC of the lip, ear, and in people who are immunosuppressed. Melanomas are the least frequent of the 3 common skin cancers. They frequently metastasize, and could potentially cause death once they spread.

Less common skin cancers include: dermatofibrosarcoma protuberans, Merkel cell carcinoma, Kaposi's sarcoma, keratoacanthoma, spindle cell tumors, sebaceous carcinomas, microcystic adnexal carcinoma, Paget's disease of the breast, atypical fibroxanthoma, leiomyosarcoma, and angiosarcoma.

The BCC and the SCCs often carry a UV-signature mutation indicating that these cancers are caused by UV-B radiation via the direct DNA damage. However the malignant melanoma is predominantly caused by UV-A radiation via the indirect DNA damage.The indirect DNA damage is caused by free radicals and reactive oxygen species. Research indicates that the absorption of three sunscreen ingredients into the skin, combined with a 60-minute exposure to UV, leads to an increase of free radicals in the skin, if applied in too little quantities and too infrequently. However, the researchers add that newer creams often do not contain these specific compounds, and that the combination of other ingredients tends to retain the compounds on the surface of the skin. They also add the frequent re-application reduces the risk of radical formation.

Signs and symptoms

There are a variety of different skin cancer symptoms. These include changes in the skin that do not heal, ulcering in the skin, discolored skin, and changes in existing moles, such as jagged edges to the mole and enlargement of the mole.

Basal-cell carcinoma

Basal-cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin of the head, neck or shoulders. Sometimes small blood vessels (called telangiectasia) can be seen within the tumor. Crusting and bleeding in the center of the tumor frequently develops. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly and with proper treatment can be completely eliminated, often without scarring.

Squamous-cell carcinoma

Squamous-cell carcinoma is commonly a red, scaling, thickened patch on sun-exposed skin. Some are firm hard nodules and dome shaped like keratoacanthomas. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous-cell is the second most common skin cancer. It is dangerous, but not nearly as dangerous as a melanoma.

Melanoma

Most melanomas consist of various colors from shades of brown to black. A small amount of melanomas are pink, red or fleshy in color; these are called amelanotic melanomas which tend to be more aggressive. Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or pain, itching, ulceration, redness around the site, or bleeding at the site. An often-used mnemonic is "ABCDE", where A is for "asymmetrical", B for "borders" (irregular: "Coast of Maine sign"), C for "color" (variegated), D for "diameter" (larger than 6 mm—the size of a pencil eraser) and E for "evolving."

Other

Merkel cell carcinomas are most often rapidly growing, non-tender red, purple or skin colored bumps that are not painful or itchy. They may be mistaken for a cyst or another type of cancer.

Causes

Ultraviolet radiation from sun exposure is the primary cause of skin cancer. Other factors that play a role include:

• Smoking tobacco
• HPV infections increase the risk of squamous-cell carcinoma.
• Some genetic syndromes including congenital melanocytic nevi syndrome which is characterized by the presence of nevi (birthmarks or moles) of varying size which are either present at birth, or appear within 6 months of birth. Nevi larger than 20 mm (3/4") in size are at higher risk for becoming cancerous.
• Chronic non-healing wounds. These are called Marjolin's ulcers based on their appearance, and can develop into squamous-cell carcinoma.
• Ionizing radiation, environmental carcinogens, artificial UV radiation (e.g. tanning beds), aging, and light skin color. It is believed that tanning beds are the cause of hundreds of thousands of basal and squamous-cell carcinomas. The World Health Organization now places people who use artificial tanning beds in its highest risk category for skin cancer.
• The use of many immunosuppressive medications increases the risk of skin cancer. Cyclosporin A, a calcineurin inhibitor for example increases the risk approximately 200 times, and azathioprine about 60 times.

Pathophysiology

Micrograph of melanoma. FNA specimen. Field stain

A malignant epithelial tumor that primarily originates in the epidermis, in squamous mucosa or in areas of squamous metaplasia is referred to as a squamous-cell carcinoma.

Macroscopically, the tumor is often elevated, fungating, or may be ulcerated with irregular borders. Microscopically, tumor cells destroy the basement membrane and form sheets or compact masses which invade the subjacent connective tissue (dermis). In well differentiated carcinomas, tumor cells are pleomorphic/atypical, but resembling normal keratinocytes from prickle layer (large, polygonal, with abundant eosinophilic (pink) cytoplasm and central nucleus).

Their disposal tends to be similar to that of normal epidermis: immature/basal cells at the periphery, becoming more mature to the centre of the tumor masses. Tumor cells transform into keratinized squamous cells and form round nodules with concentric, laminated layers, called "cell nests" or "epithelial/keratinous pearls". The surrounding stroma is reduced and contains inflammatory infiltrate (lymphocytes). Poorly differentiated squamous carcinomas contain more pleomorphic cells and no keratinization.

Prevention

Sunscreen is effective and thus recommended to prevent melanoma and squamous-cell carcinoma. There is little evidence that it is effective in preventing basal-cell carcinoma. Other advice to reduce rates of skin cancer includes avoiding sunburning, wearing protective clothing, sunglasses and hats, and attempting to avoid sun exposure or periods of peak exposure. The U.S. Preventive Services Task Force recommends that people between 9 and 25 years of age be advised to avoid ultraviolet light.

The risk of developing skin cancer can be reduced through a number of measures including decreasing indoor tanning and mid day sun exposure, increasing the use of sunscreen, and avoiding the use of tobacco products.

There is insufficient evidence either for or against screening for skin cancers. Vitamin supplements and antioxidant supplements have not been found to have an effect in prevention. Evidence for a benefit from dietary measures is tentative.

Treatment

Treatment is dependent on type of cancer, location of the cancer, age of the person, and whether the cancer is primary or a recurrence. Treatment is also determined by the specific type of cancer. For a small basal-cell cancer in a young person, the treatment with the best cure rate (Mohs surgery or CCPDMA) might be indicated. In the case of an elderly frail man with multiple complicating medical problems, a difficult to excise basal-cell cancer of the nose might warrant radiation therapy (slightly lower cure rate) or no treatment at all. Topical chemotherapy might be indicated for large superficial basal-cell carcinoma for good cosmetic outcome, whereas it might be inadequate for invasive nodular basal-cell carcinoma or invasive squamous-cell carcinoma.. In general, melanoma is poorly responsive to radiation or chemotherapy.

For low-risk disease, radiation therapy (external beam radiotherapy or brachytherapy), topical chemotherapy (imiquimod or 5-fluorouracil) and cryotherapy (freezing the cancer off) can provide adequate control of the disease; all of them, however, may have lower overall cure rates than certain type of surgery. Other modalities of treatment such as photodynamic therapy, topical chemotherapy, electrodesiccation and curettage can be found in the discussions of basal-cell carcinoma and squamous-cell carcinoma.

Mohs' micrographic surgery (Mohs surgery) is a technique used to remove the cancer with the least amount of surrounding tissue and the edges are checked immediately to see if tumor is found. This provides the opportunity to remove the least amount of tissue and provide the best cosmetically favorable results. This is especially important for areas where excess skin is limited, such as the face. Cure rates are equivalent to wide excision. Special training is required to perform this technique. An alternative method is CCPDMA and can be performed by a pathologist not familiar with Mohs surgery.

In the case of disease that has spread (metastasized), further surgical procedures or chemotherapy may be required.

Treatments for metastatic melanoma include biologic immunotherapy agents ipilimumab, pembrolizumab, and nivolumab; BRAF inhibitors, such as vemurafenib and dabrafenib; and a MEK inhibitor trametinib.

Reconstruction

Currently, surgical excision is the most common form of treatment for skin cancers. The goal of reconstructive surgery is restoration of normal appearance and function. The choice of technique in reconstruction is dictated by the size and location of the defect. Excision and reconstruction of facial skin cancers is generally more challenging due to presence of highly visible and functional anatomic structures in the face.

When skin defects are small in size, most can be repaired with simple repair where skin edges are approximated and closed with sutures. This will result in a linear scar. If the repair is made along a natural skin fold or wrinkle line, the scar will be hardly visible. Larger defects may require repair with a skin graft, local skin flap, pedicled skin flap, or a microvascular free flap. Skin grafts and local skin flaps are by far more common than the other listed choices.

Skin grafting is patching of a defect with skin that is removed from another site in the body. The skin graft is sutured to the edges of the defect, and a bolster dressing is placed atop the graft for seven to ten days, to immobilize the graft as it heals in place. There are two forms of skin grafting: split thickness and full thickness. In a split thickness skin graft, a shaver is used to shave a layer of skin from the abdomen or thigh. The donor site, regenerates skin and heals over a period of two weeks. In a full thickness skin graft, a segment of skin is totally removed and the donor site needs to be sutured closed.

Split thickness grafts can be used to repair larger defects, but the grafts are inferior in their cosmetic appearance. Full thickness skin grafts are more acceptable cosmetically. However, full thickness grafts can only be used for small or moderate sized defects.

Local skin flaps are a method of closing defects with tissue that closely matches the defect in color and quality. Skin from the periphery of the defect site is mobilized and repositioned to fill the deficit. Various forms of local flaps can be designed to minimize disruption to surrounding tissues and maximize cosmetic outcome of the reconstruction. Pedicled skin flaps are a method of transferring skin with an intact blood supply from a nearby region of the body. An example of such reconstruction is a pedicled forehead flap for repair of a large nasal skin defect. Once the flap develops a source of blood supply form its new bed, the vascular pedicle can be detached.

Prognosis

The mortality rate of basal-cell and squamous-cell carcinoma are around 0.3%, causing 2000 deaths per year in the US. In comparison the mortality rate of melanoma is 15–20% and it causes 6500 deaths per year. Even though it is much less common, malignant melanoma is responsible for 75% of all skin cancer-related deaths.

Epidemiology

Age-standardized death from melanoma and other skin cancers per 100,000 inhabitants in 2004

  no data

  <0.7

  0.7–1.4

  1.4–2.1

  2.1–2.8

  2.8–3.5

  3.5–4.2

  4.2–4.9

  4.9–5.6

  5.6–6.3

  6.3–7

  7–7.7

  >7.7

Skin cancer result in 80,000 deaths a year as of 2010; 49,000 of which are due to melanoma and 31,000 of which are due to non-melanoma skin cancers. This is up from 51,000 in 1990.

In the US in 2008, 59,695 people were diagnosed with melanoma, and 8,623 people died from it. In Australia more than 12,500 new cases of melanoma are reported each year, out of which more than 1,500 die from the disease. Australia has the highest per capita incidence of melanoma in the world.

More than 3.5 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in that country. According to the Skin Cancer Foundation, one in five Americans will develop skin cancer at some point of their lives. The most common form of skin cancer is basal-cell carcinoma, followed by the squamous cell carcinoma. Although the incidence of many cancers in the United States is falling, the incidence of melanoma keeps growing, with approximately 68,729 melanomas diagnosed in 2004 according to reports of the National Cancer Institute.

Skin cancer (malignant melanoma) is the fifth most common cancer in the UK (around 13,300 people were diagnosed with malignant melanoma in 2011), and the disease accounts for 1% all cancer deaths (around 2,100 people died in 2012).

The survival rate for people with melanoma depends upon when they start treatment. The cure rate is very high when melanoma is detected in early stages, when it can easily be removed surgically. The prognosis is less favorable if the melanoma has spread to other parts of the body.

Australia and New Zealand exhibit one of the highest rates of skin cancer incidence in the world, almost four times the rates registered in the United States, the UK and Canada. Around 434,000 people receive treatment for non-melanoma skin cancers and 10,300 are treated for melanoma. Melanoma is the most common type of cancer in people between 15–44 years in both countries. The incidence of skin cancer has been increasing. The incidence of melanoma among Auckland residents of European descent in 1995 was 77.7 cases per 100,000 people per year, and was predicted to increase in the 21st century because of "the effect of local stratospheric ozone depletion and the time lag from sun exposure to melanoma development."

References

External links

• Skin cancer at DMOZ
• Skin cancer procedures: text, images and videos

UpToDate Contents

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• 1. ダーモスコピーによる皮膚癌の治療優先順位決定のアルゴリズム dermoscopic algorithms for skin cancer triage
• 2. 皮膚扁平上皮癌の治療および予後 treatment and prognosis of cutaneous squamous cell carcinoma
• 3. 黒色腫のスクリーニングおよび早期発見 screening and early detection of melanoma
• 4. 皮膚扁平上皮癌（SCC）の臨床的特徴および診断 clinical features and diagnosis of cutaneous squamous cell carcinoma scc
• 5. 実質臓器移植レシピエントに生じる皮膚癌の予防とマネージメント prevention and management of skin cancer in solid organ transplant recipients

English Journal

• Late-onset dysphagia caused by severe spastic peristalsis of a free jejunal graft in a case of hypopharyngeal cancer.

• Imai T1, Goto T2, Matsumoto K3, Kurosawa K2, Asada Y4, Saijo S4, Matsuura K4.
• Auris, nasus, larynx.Auris Nasus Larynx.2016 Dec;43(6):693-7. doi: 10.1016/j.anl.2016.03.011. Epub 2016 Apr 8.
• Free jejunal transfer is the main technique used for reconstructing a circumferential defect caused by total pharyngo-laryngo-cervical-esophagectomy in certain cancer cases. We report a rare case of severe late-onset dysphagia caused by autonomous spastic peristalsis, which led to complete obstructi
• PMID 27068782

• Electrical stimulation towards melanoma therapy via liquid metal printed electronics on skin.

• Li J1, Guo C2, Wang Z1, Gao K3, Shi X3, Liu J4.
• Clinical and translational medicine.Clin Transl Med.2016 Dec;5(1):21. doi: 10.1186/s40169-016-0102-9. Epub 2016 Jun 23.
• BACKGROUND: We proposed a method of using electrical stimulation for treatment of malignant melanoma through directly spray-printing liquid metal on skin as soft electrodes to deliver low intensity, intermediate frequency electric fields.METHODS: With patterned conductive liquid metal components on
• PMID 27339426

• Cancer stem cell as therapeutic target for melanoma treatment.

• Alamodi AA1, Eshaq AM2, Hassan SY3, Al Hmada Y4, El Jamal SM4, Fothan AM2, Arain OM5, Hassan SL3, Haikel Y6,7, Megahed M3, Hassan M4,7,8.
• Histology and histopathology.Histol Histopathol.2016 Dec;31(12):1291-301. doi: 10.14670/HH-11-791. Epub 2016 Jun 15.
• Human malignant melanoma is a highly aggressive skin tumor that is characterized by its extraordinary heterogeneity, propensity for dissemination to distant organs and resistance to cytotoxic agents. Although chemo- and immune-based therapies have been evaluated in clinical trials, most of these the
• PMID 27301538

Japanese Journal

• 肉眼的に明らかな腫瘤性病変を認めなかった陰窩腺由来肛門管癌のPagetoid spreadの1例

• 日本大腸肛門病学会雑誌 69(1), 20-26, 2016
• NAID 130005116774

• Cordycepin Suppresses Thymic Stromal Lymphopoietin Expression via Blocking Caspase-1 and Receptor-Interacting Protein 2 Signaling Pathways in Mast Cells

• Biological and Pharmaceutical Bulletin 39(1), 90-96, 2016
• NAID 130005116499

• 人工真皮を用いた皮膚悪性腫瘍の治療 (特集 人工真皮の現況と展望)

• 形成外科 58(12), 1343-1350, 2015-12
• NAID 40020670716

Related Links

• The Skin Cancer Foundation - SkinCancer.org

The leading skin cancer prevention and information organization. Physician-approved medical information on symptoms and treatments, as well as photos. ... The Skin Cancer Foundation is the only international organization devoted ...

• Skin Cancer: MedlinePlus - National Library of Medicine ...

Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands, and arms. Another type of skin ...

Related Pictures

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★リンクテーブル★

リンク元	「皮膚癌」「skin neoplasm」「cancer of the skin」「皮膚がん」「skin carcinoma」
関連記事	「cancer」「skin」

「皮膚癌」

　　[★]

英

skin cancer, cutaneous carcinoma

ラ

carcinoma cutis

関

• 上皮性悪性腫瘍

• 表皮癌

• 扁平上皮癌
• 有棘細胞癌
• 基底細胞癌

• 表皮付属器癌
• 汗腺癌、脂腺癌

「skin neoplasm」

　　[★]

皮膚腫瘍、皮膚新生物

関

cancer of the skin、skin cancer、skin tumor

「cancer of the skin」

　　[★]

皮膚癌、皮膚がん

関

skin cancer、skin carcinoma、skin neoplasm

「皮膚がん」

　　[★]

英

[[]]

同

skin cancer

関

[[]]

同

skin cancer

「skin carcinoma」

　　[★]

皮膚癌

関

cancer of the skin、skin cancer

「cancer」

　　[★]

同

癌腫

関

tumor

　 　

「skin」

　　[★]

• n.

• 皮膚