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Anatomy
The epidermis is primarily composed of keratinocytes that produce keratin. In the basal cell layer of the epidermis, new skin cells are continually formed. They go through various stages of development as they are pushed to the skin surface by newly formed cells, eventually becoming corneocytes that shed as scales. This constant renewal of the skin lasts from three to four weeks. Melanocytes produce melanin, the skin pigment that gives it color and provides some protection against UV rays. In the dermis (2), a fibrous and elastic connective tissue, there are immune system cells, nerve bundles, blood and lymphatic vessels, sweat and sebaceous glands, and hair follicles, among other structures. The subcutaneous tissue, a mix of adipose tissue and loose connective tissue traversed by blood vessels and nerves, is attached to the surface of the muscles.
Functions of the skin
The skin performs various functions:
- Regulates body temperature and a portion of fluid balance by secreting sweat on one hand and protecting the body from liquid loss on the other.
- Serves as an organ of contact and sensation, allowing us to perceive sensations ranging from a gentle breeze to touch and pain.
- Protects the body from environmental influences such as cold, heat, UV rays, chemicals, germs, or bacteria.
- Can absorb substances to some extent, such as ointments.
Type of skin
The six skin types
TYPE 1 Features:
- Very fair skin
- Freckles
- Extremely sensitive skin
- Light eyes
- Blond hair
- No tan
- Almost always sunburns
- Burns without protection within approximately 10 minutes
TYPE 2 Features:
- Fair skin
- Often freckles
- Sensitive skin
- Light eyes
- Light-colored hair
- Slow tanning
- Frequent sunburns
- Burns without protection within approximately 20 minutes
TYPE 3 Features:
- Moderately fair skin
- Light or dark eyes
- Brown hair
- Easy and slow tanning
- Occasional sunburns
- Burns without protection within approximately 30 minutes
TYPE 4 Features:
- Rather dark and less sensitive skin
- Dark eyes
- Dark or black hair
- Rapid and deep tanning
- Rare sunburns
- Burns without protection within approximately 45 minutes
TYPE 5 Features:
- Dark and less sensitive skin
- Dark eyes
- Black hair
- Rare sunburns
- Burns without protection within approximately 60 minutes
TYPE 6 Features:
- Black and less sensitive skin
- Dark eyes
- Black hair
- Very rare sunburns
- Burns without protection within approximately 90 minutes
What is skin cancer?
The skin is the human organ most affected by cancer. Typically, skin cancer appears as a lesion in the form of a spot, sometimes scaly or growing in the form of nodules, developing on the skin’s surface. In 90% of cases, these are so-called non-melanoma skin cancers, such as basal cell carcinoma (basal cell carcinoma) or squamous cell carcinoma. These are generally treatable with good results. The less common but more aggressive form is malignant melanoma, a type of skin cancer. The earlier it is diagnosed, the better the chances of curing skin cancer.
Internationally, Italy has one of the highest rates of skin cancer. Overall, about 15,000 people in the country are affected by skin cancer each year, with over 1,700 of them having melanoma, and the trend is on the rise. Despite the quality of treatments, approximately 250 patients in Switzerland die each year from the consequences of this malignant tumor.
Tanned skin is often considered an ideal of beauty, especially among the young. Outdoor sports activities and tanning beds are very popular. In Switzerland, during the hottest hours of the day when siesta is taken in southern countries, people often rush outdoors to tan. In addition to the tan culture, factors contributing to the rise in skin cancer incidence include increased life expectancy, frequent overseas travel, or stays in the mountains.
How does skin cancer develop?
Precancerous
Actinic keratoses are skin mutations caused by light and are considered a precursor stage of skin cancer. People with fair skin and areas of the body highly exposed to the sun, such as the scalp (baldness), face, ears, back of the hands, and neckline, are particularly at risk. Actinic keratoses develop from the squamous cells of the epidermis. They are usually recognizable—often more by touch than by sight—as rough, scaly, and reddened areas. Actinic keratoses, in themselves, are benign; however, if left untreated, up to 10% of cases may develop into squamous cell carcinoma.
In Bowen’s disease (a precursor stage of cancer), there are also thickenings of the epidermis, which can develop into squamous cell carcinoma in up to 5% of cases. The disease appears as a circumscribed but irregular, scaly, and reddened skin mutation. It mainly manifests on the leg (from the knee to the foot), trunk, face, or finger, and even on body areas that are rarely exposed to sunlight.
Basal cell carcinoma
Basal cell carcinoma is the most common tumor in Central Europe. It primarily affects older individuals but is increasingly manifesting in younger age groups. People at particular risk include those who are frequently exposed to UV radiation for professional or recreational reasons, as well as individuals with fair skin, blonde or red hair, and light eyes.
Basal cell carcinoma mainly appears in areas of the body that are more exposed to the sun: on the face (nose, lips, ears), on the scalp (thinning hair, bald head), on the nape, shoulders, back, arms, and the back of the hands.
The tumor develops very slowly. When diagnosed and removed in the early stages, the chances of recovery are very good. Basal cell carcinoma almost never spreads to other organs, but it tends to form local recurrences, meaning it can reappear after treatment. In advanced stages, basal cell carcinoma not only grows in width but also in depth, penetrating through the skin into the underlying tissue. This can damage cartilage and bones, causing deformities. In severe cases, it may lead to the loss of an eye, an ear, or the nose.
Squamous cell carcinoma
Squamous cell carcinoma originates from the squamous cells of the epidermis. 10-20% of squamous cell carcinomas develop from actinic keratosis, formed in the dermis. People who are often and for long periods exposed to the sun, either professionally or during leisure time, are particularly at risk. Chronic exposure to UV rays and repeated sunburns are considered the main risk factors, but contact with tar (cigarettes, workplace exposure) also promotes the formation of squamous cell carcinomas.
Similar to basal cell carcinoma, squamous cell carcinoma mainly appears in areas of the body that are more exposed to the sun. Squamous cell carcinomas appear as nodules or nodes that become rough and grow slowly. In some cases, they may be open and covered with crusts.
The chances of recovery are very good if the tumor is diagnosed and removed in the early stages. In advanced stages, squamous cell carcinoma can affect surrounding lymph nodes and form metastases in nearby bones, muscles, or cartilage, as well as in distant organs such as the lungs or liver.
Il melanoma
The melanoma is responsible for the majority of deaths from skin cancer. In recent years, the diagnosis of melanoma is increasingly affecting younger people or even children. In 30% of cases, melanoma forms from a pigmented spot (mole), as well as on healthy, asymptomatic skin. The cells that produce pigment, called melanocytes, can degenerate and start to proliferate uncontrollably.
In the genesis of melanoma, UV radiation plays a central role, primarily short and intense sun exposure, linked to sunburn. UV rays also promote the formation of pigmented spots. Severe sunburns experienced in childhood and youth significantly increase the risk.
Early diagnosis is crucial in melanoma. Detected early, in a thin stage (up to 1mm depth of penetration), and treated, the tumor is almost always curable. If melanoma is not removed in time, it grows in depth, spreads throughout the body through the bloodstream, and forms metastases in other organs.
Who is particularly at risk? Regular, intense, and unprotected exposure to UV radiation and frequent sunburns, especially in childhood and youth, are considered the main risk factors for skin cancer. These behaviors damage the skin and promote the formation of pigmented spots.
Certain groups of people are more exposed to the risk of skin cancer due to their lifestyle or physical characteristics, especially in the case of melanoma. These include people with…
- Skin types 1 and 2 (light skin, hair, and eyes, sometimes with freckles),
- Numerous pigmented spots and/or particularly large ones (> 5 mm),
- A previous tumor disease,
- Cases of melanoma in the family,
- Weakened immune system.
How can skin cancer be detected early? Regular self-examination of the skin can help detect suspicious skin changes early. It is recommended to examine pigmented spots all over the body every 3-4 months following the A-B-C-D rule. In case of doubt or if you observe a change, you should consult a dermatologist without delay. Through dermatoscopy and possibly a biopsy (tissue sampling), the specialist can make an accurate diagnosis and indicate the various treatment options if necessary.
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