The skin consists of different structural layers - epidermis, dermis, subcutis. Various types of cells such as the pigment cells (melanocytes) and glands (sweat glands) form part of the skin.
Skin Cancer is a group of abnormal cells that has developed from part of the skin. These cancerous cells have the potential to invade surrounding healthy tissues or spread to other parts of the body.
Skin Cancer can broadly be classified as melanoma or non-melanoma skin cancer (NMSC).
Common types of cancer in Singapore include NMSCs such as basal cell carcinoma, squamous cell carcinoma, and cutaneous melanoma.
Skin Cancers can also present in precancerous forms which lends themselves to early detection and treatment. Most Skin Cancers can be prevented by limiting or avoiding exposure to ultraviolet (UV) radiation and by paying attention to suspicious changes in your skin.
Skin Cancer develops primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. But it can also form on areas that rarely see the light of day such as your palms, beneath your fingernails, the spaces between your toes or under your toenails, and your genital area.
A cancerous skin lesion can appear suddenly or develop slowly. Its appearance depends on the type of cancer.
In the early stages of Skin Cancers, they are usually symptom-free. They may first appear as new-onset or enlarging pigmentation on the skin, persistent scaling, crust or erosion (broken skin) commonly over sun exposed areas, new pearly or red bumps on the skin.
Any mole (even longstanding) that has undergone a sudden change in color, size, shape or speed of growth can be considered suspicious.
This is the most serious form of Skin Cancer and the one responsible for most Skin Cancer deaths. Melanoma can develop anywhere on your body, in otherwise normal skin or in an existing mole that turns malignant. Melanoma most often appears on the trunk, head or neck of affected men. In women, this type of cancer most often develops on the arms or legs.
Warning signs of melanoma include:
Precancerous skin lesions, such as an actinic keratosis, can also develop into squamous cell Skin Cancer. Actinic keratoses appear as rough, scaly, reddish or dark-pink patches. They're most commonly found on the face, ears, lower arms and hands of people whose skin has been damaged by the sun.
If you notice any suspicious growth or change of the growth on your skin, consult your doctor right away. As with most cancers, early detection increases the chances of successful treatment.
Not all skin changes are cancerous. The only way to know for sure is to have your skin examined by your doctor or dermatologist.
At a specialist visit, the doctor may ask you about your family history and conduct a medical examination.
During the clinic visit, dermoscopy may be conducted to examine your skin closer. The doctor will use a dermatoscope, a handheld instrument to magnify the affected area for better visualisation.
Biopsy is a sampling of a small specimen of skin, that is recommended for histologic examination. This may take the form of a punch biopsy or an excision. Your doctor will discuss this in detail with you before the procedure.
Patient / Personal factors
Lifestyle factors
How can you prevent Skin Cancer?
The main treatment options are divided into surgery and non-surgical options. Treatment plans are tailored to the individual patient according to their medical profile. Most Skin Cancer treatments require only a local anesthetic and can be done in an outpatient setting. Sometimes no treatment is necessary beyond an initial biopsy that removes the entire growth.
Surgery is the most common form of treatment and usually definitive for certain forms of Skin Cancer. During the surgery, the cancer and surrounding tissue is removed. A follow-up procedure for skin coverage (skin graft or skin flap) may be necessary.
Surgical options include:
This procedure is for larger, recurring or difficult-to-treat Skin Cancers, which may include both basal and squamous cell carcinomas. Your doctor removes the skin growth layer by layer, examining each layer under the microscope, until no abnormal cells remain. This procedure allows cancerous cells to be removed without taking an excessive amount of surrounding healthy skin. Because it requires special skill, the surgery should be done only by specially trained doctors.
Certain early cancers may be treated by locally ablative procedures.
These procedures include:
Curettage and desiccation
After removing most of a growth, your doctor scrapes away layers of cancer cells using a circular blade (curette). An electric needle destroys any remaining cancer cells. This simple, quick procedure is common in treating small or thin basal cell cancers. It leaves a small, flat, white scar.
Cryotherapy
Your doctor may destroy actinic keratoses and some small, early Skin Cancers by freezing them with liquid nitrogen (cryosurgery). The dead tissue sloughs off when it thaws. The treatment may leave a small, white scar. You may need a repeat treatment to remove the growth completely.
Non-surgical options may be applicable for certain forms of cancer or patient profile. They include:
Topical agents
Radiation therapy
Radiation may be used to destroy basal and squamous cell carcinomas if surgery isn't an option.
Chemotherapy
In chemotherapy, drugs are used to kill cancer cells. For cancers limited to the top layer of skin, creams or lotions containing anti-cancer agents may be applied directly to the skin. Topical drugs can cause severe inflammation and leave scars. Systemic chemotherapy can be used to treat skin cancers that have spread to other parts of the body.
Targeted therapy/Immunotherapy for certain advanced skin cancers
Click here to access our Find A Doctor directory for a list of doctors treating this condition across our NUHS institutions.
