Many cancers can affect the skin, which is the largest organ in our body and is made up of three layers: the epidermis (surface layer), the dermis (middle layer) and the subcutaneous tissue (deep layer).

The epidermis, in turn, is formed by several cells: melanocytes, which have the task of producing melanin, a pigment that protects from the harmful effects of sunlight, and keratinocytes, which represent the most numerous cells in this layer.

The keratinocytes present in the outer layer of the epidermis are called squamous cells and, when they undergo tumor transformation, they are called spinocellular carcinomas. The keratinocytes of the deepest layer are called basal cells and can give rise to basal cell carcinomas. Both are non-melanomatous skin cancers, i.e. skin cancers other than melanomas, which originate from melanocytes.

How widespread is it

Non-melanomatosis skin cancers are among the most common cancers: according to AIRTUM (Italian Association of Cancer Registers) records, they are in first place among men (15.2 percent of all cancers) and second among women after breast cancer (14.8 percent of all cancers).

In other words, on average every year there are about 120 cases of non-melanomatous skin cancer per 100,000 men and about 90 cases per 100,000 women.

Excluding melanomas, 8 out of 10 skin cancers are basal cell carcinomas, while the remaining 2 are spinocellular carcinomas.

Who is at risk

Basal and spinocellular carcinomas develop mainly in the parts of the body most exposed to the sun: face, ears, neck, scalp, shoulders and back. One of the main risk factors is exposure to ultraviolet rays (UVA and UVB), which derive mainly from the sun, but also from sunbeds and sunlamps, which must therefore be used with extreme care. Contact with arsenic and exposure to ionising radiation, some genetic anomalies and a failure of the immune system due to previous therapies, transplants or AIDS have also been identified as risk factors. In addition, smoking and some treatments for psoriasis may increase the risk of developing spinocellular carcinoma (especially at the lip level in smokers).

Having very clear skin, an advanced age and being a man are included among the so-called unchangeable risk factors, i.e. those on which no action can be taken.

How to care at The Aesthetics clinics of Geneva

Basal and spinocellular carcinomas, if treated in the early stages, heal in almost all cases and can often be treated completely by surgery or local treatments.

Surgery is generally the first choice treatment for these tumours. In some cases, surgery under local anesthesia, which is very similar to a simple skin biopsy, is sufficient to completely remove spinocellular carcinoma. This tumour, which involves the most superficial layers of the epidermis, can also be treated with curettage and electro-drying: the tumour is scraped off with a special tool and then the area is treated with an electric needle that destroys the remaining tumour cells. Mohs’s surgery, on the other hand, allows for the removal of very thin layers of tissue, which are then observed under a microscope: if there are cancer cells, another layer is removed, otherwise the procedure is stopped. This approach considerably improves the aesthetic appearance of the operation. Finally, laser surgery is used to vaporize the cells of spinocellular carcinoma and very superficial basal cell carcinoma.

Among the local therapies (also called topical therapies), cryotherapy is mainly used in early stage tumors and consists in burning tumor cells with cold, applying liquid nitrogen to the tumor. In some cases it is decided instead to apply directly on the tumor chemotherapy drugs such as 5-fluorouracil in the form of cream or ointment or drugs that stimulate the immune system against the tumor such as, for example, Imiquimod used especially in very early stage tumors.

Photodynamic therapy consists in applying a liquid drug to the tumour which, in a few hours, accumulates inside the cancer cells, making them sensitive to certain types of light. At this point, the affected area is hit with a special light, thus destroying the cancer cells.

Radiotherapy and systemic chemotherapy (to the whole body) are not very frequently used in skin carcinomas, while chemotherapy is useful in cases where the tumor has reached the lymph nodes.

In the very rare cases of advanced basal cell carcinoma or cancer that returns after an initial therapy, we can now also focus on targeted therapies that specifically act against the molecular mechanisms altered in many of these tumors.

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