Soltalk June 2018 | Page 46

Doctor’s notes
Dr Rik Heymans is a general practitioner in Nerja and writes on developments in the world of medicine
Cutaneous squamous cell carcinoma
Exposure to cancer-promoting stressors and the response of
the body to those exposures (host response) promote the
development of cSCC. Well-known risk factors include the
following:
Cutaneous squamous cell carcinoma (cSCC) is the second most
common skin cancer and one of the most common cancers
overall in the United States. An estimated 3.5 million cases of
nonmelanoma skin cancers were diagnosed in the United
States in 2006; of those, approximately 80% were basal cell
carcinoma (BCC) and 20% were cSCC.
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Despite increased knowledge and public education regarding
the causes of skin cancer and modes of prevention, the
incidence of cSCC continues to rise worldwide. This increasing
incidence is likely multifactorial; the speculated causes for the
rise include: an aging population, improved detection, an
increased use of tanning beds, and environmental factors, such
as depletion of the ozone layer.
UV light exposure
Immunosuppression
Exposure to ionizing radiation or chemical carcinogens
Human papillomavirus (HPV) infection
Chronic UV exposure, such as through tanning beds, medical
UV treatments, or cumulative lifetime sun exposure, is the
most important risk factor for the development of cSCC.
Interestingly, a number of surrogate factors of chronic UVR
exposure from the sun are well known. Specifically,
epidemiologic evidence suggests that geographic proximity to
the equator, a history of precancerous lesions or prior skin
cancers, older age, and male sex predispose an individual to
the development of cSCC. Immunosuppression is also
increasingly recognized as a risk factor for the development of
skin cancer.
Although cSCC is not often fatal, it can cause significant
distress, especially when it involves the facial skin. Most cSCCs
are located in the head-and-neck region. Diagnosis of cSCC
begins with a careful history and physical examination, where
the typical appearance of this skin tumour is recognized. A
biopsy should be performed for any lesion suspected of being
a cutaneous neoplasm to rule out basal cell carcinoma and
other dermal lesions. These are things your family doctor
should be able to do.
Patients with precancerous lesions should avoid excessive UV
exposure by limiting outdoor activity to early morning and
late afternoon, using protective clothing, and wearing a broad-
brimmed hat to shade the face, head, and neck.
Daily application of a broad-spectrum sunscreen with a sun
protection factor (SPF) of at least 15 should also be encouraged.
The use of artificial tanning devices should be strongly
discouraged because this has been associated with a 2.5-fold
increase in the risk of developing cSCC. And it is important to
remember that lesions may recur even years after excision, so
patients should have routine examinations. In addition,
patients should get treatment of areas of chronic skin
inflammation or trauma with scarring to prevent the future
development of cSCC at those sites.
© Dr RIK HEYMANS
c/ Angustias 24, Nerja.
Tel: [phone]
44