Types of Skin Cancer

The location of the disease's origin determines the sort of skin cancer a person will develop. If the disease develops in skin cells known as basal cells, the individual has basal cell skin cancer. Melanoma occurs when the pigment-producing cells of the skin become malignant. 

The most prevalent form of skin cancer is basal cell carcinoma (BCC). ⁽¹⁾ BCC is common in individuals with fair skin. This skin cancer also affects those with darker skin tones. BCC often appears as flesh-coloured growths, pearl-like bumps, or pinkish patches of skin and often forms after years of sun exposure or indoor tanning. However, they may occur anywhere on the body, including the chest, abdomen, and legs. BCC should be diagnosed and treated as soon as possible. BCC may invade the deeper tissues. If allowed to develop, it may invade the nerves and bones. 

Squamous skin cell carcinoma (SCC) is the second most prevalent kind of skin cancer. ⁽¹⁾ Usually appears as a red, hard lump, scaly patch, or a sore that heals and then reopens. People with fair skin are more susceptible to developing SCC. This skin cancer also occurs in persons with darker skin tones. SCC often manifests as a red, hard lump, scaly patch, or a sore that cures and then reopens. SCC often develops on frequently sun-exposed skin, such as the ear rim, face, neck, arms, chest, and back. SCC may penetrate deeply into the skin, causing injury and deformity. Early detection and treatment may prevent SCC from becoming invasive and spreading to other parts of the body. 

Melanoma is the most lethal kind of skin cancer. ⁽¹⁾ Usually develops in a mole or abruptly arises as a new dark area on the skin. It is commonly referred to as "the most severe kind of skin cancer" due to its proclivity to spread. Melanoma may grow inside an existing mole on the skin or show unexpectedly as a different-looking dark area. Early detection and treatment are critical. Knowing the ABCDE warning signals of melanoma may assist in early detection. ⁽²⁾

Other skin cancer types:

• Cutaneous T-cell lymphoma ⁽³⁾
• Dermatofibrosarcoma protuberans (DFSP) ⁽⁴⁾
• Merkel cell carcinoma ⁽⁵⁾
• Sebaceous carcinoma ⁽⁶⁾

These cancers most frequently appear on the most heavily sun-exposed areas of the body, including the forehead, hands, ear and nose. 

Causes and Diagnosis of Skin Cancer

Skin cancer is caused by DNA mutations in skin cells. The mutations cause the cells to proliferate uncontrollably and create a mass of cancer cells. Skin cancer originates in the outermost layer of the skin (epidermis). ⁽⁷⁾ The epidermis is a thin layer that offers a protective layer of skin cells that are continuously lost by the body. The epidermis has three primary cell types: 

• Located just under the epidermis, squamous cells serve as the skin's inner lining. 
• The basal cells, which create new skin cells, are located underneath the squamous cells. 
• Melanocytes, which create melanin, the pigment that gives skin its typical colour, are situated in the bottom portion of the epidermis. When exposed to sunlight, melanocytes create more melanin to protect the deeper layers of skin. 

Where skin cancer develops impacts its form and treatment choices. 

The majority of DNA damage in skin cells is caused by ultraviolet (UV) radiation from sunshine and tanning beds. However, sun exposure cannot explain the development of skin malignancies in the skin that is not typically exposed to sunlight. This suggests that additional variables, such as exposure to hazardous chemicals or a disease that impairs the immune system, may contribute to your chance of developing skin cancer. 

The following factors increase the risks of developing skin cancer: ⁽⁷⁾

• Having less pigment (melanin) in the skin gives less protection against UV rays (someone with darker skin is less likely to acquire skin cancer). 
• Sunburns in the past. 
• Excessive exposure to the sun, particularly if their skin is not covered by sunscreen or clothes. Tanning, particularly exposure to tanning lights and beds, is also dangerous.
• Sunny or high-altitude conditions. 
• Moles or atypical moles (dysplastic nevi) These aberrant moles, which seem irregular and are often bigger than normal moles, are more likely to develop malignancy than others.
• Precancerous skin lesions (actinic keratoses).
• Family history of skin cancer.
• Personal history of skin cancer. 
• Compromised immune system. This covers persons living with HIV/AIDS and those receiving immunosuppression after organ transplants. 
• Radiation exposure for skin problems (eczema, acne). 
• Exposition to certain chemicals (arsenic). 

Stages of Skin Cancer

BCC & SCC

Rarely is it necessary to determine the stage of BCC since these malignancies are nearly always curable before they spread to other regions of the body. ⁽⁸⁾ On the other hand, SCCs are more likely to spread (although this risk is still low); therefore, defining the stage might be more crucial, especially in those at a greater risk. ⁽⁸⁾ This includes organ transplant recipients and individuals afflicted with HIV, the virus that causes AIDS. Head-and-neck squamous cell skin cancers have a greater risk of recurrence and metastasis than those in other areas. 

The American Joint Commission on Cancer (AJCC) TNM method is most often used to determine the stage of basal and squamous cell skin malignancies. ⁽⁸⁾ The 2018 edition applies solely to squamous and basal cell skin malignancies of the head and neck (lip, ear, face, scalp and neck). The stage is based on three essential pieces of information:

• The size of the tumour (T) and if it has invaded neighbouring structures or tissues, such as a bone. 
• If the malignancy has spread to neighbouring lymph nodes (N) 
• If the cancer has moved to distant areas of the body, it has metastasized (M)

Following T, N, and M with numbers or letters provides further information on each of these elements. Higher values indicate a more advanced stage of cancer. Once a person's T, N, and M categories have been identified, they are merged in a procedure called stage grouping to determine their overall stage. 

Stage 0 is the earliest stage of skin cancer (also called carcinoma in situ, CIS). The remaining phases span from I through IV. Generally, the smaller the number, the less the cancer has spread. A higher number, such as stage IV, indicates that the cancer has progressed further. If you think you have head and neck skin cancer, see a physician as soon as possible. Ask your healthcare provider to explain cancer staging.

Melanoma 

Melanoma is classified into phases using five Roman numerals (0-IV) and up to four letters (A-D) that indicate a greater risk within each stage. The stage is mostly defined by particular information regarding the tumour and its development, which are tallied using the TNM method. ⁽⁹⁾ There are five stages of melanoma, ranging from 0 to IV. Some stages have subgroups, which are represented by the letters A through D. The greater the number and letter, the more widespread the illness and (usually) the worse the prognosis. For instance, Stage II is more severe than Stage I, while Stage IIIC is more severe than Stage IIIB. 

In Stage 0 melanoma (in situ), the malignant tumour is still localised to the epidermis. The cancer cells have not spread deeper than the epidermis (into the dermis). ⁽⁹⁾ The melanoma is in situ, which is Latin for "in place." There is no sign that the malignancy has progressed to lymph nodes or other tissues (metastasis). 

In Stage I melanoma (localised tumour), cancer cells are present in both the epidermis and dermis. ⁽⁹⁾ Stage I melanoma is up to 2mm thick (known as the Breslow thickness ⁽¹⁰⁾ ) and may or may not have ulceration. There is no sign that the malignancy has progressed to lymph nodes or distant places (metastasis). There are two subtypes of Stage I melanoma: IA and IB. 

Tumour thickness and ulceration identify Stage II melanoma (localised tumour). ⁽⁹⁾ Both the epidermis and dermis contain cancerous cells. There is no sign that the malignancy has progressed to lymph nodes or distant places (metastasis). Stage II has three subgroups: IIA, IIB, and IIC. 

The extent of lymph node involvement and ulceration indicates Stage III Melanoma (regional spread). In Stage III melanoma, the disease has progressed to one or more regional lymph nodes or has formed an in-transit or satellite metastasis in the skin or dermis along the lymphatics before reaching a lymph node. ⁽⁹⁾ There is no sign that the malignancy has spread to distant places (metastasis). There are four subtypes of stage III melanoma: IIIA, IIIB, IIIC, and IIID. 

In Stage IV melanoma (metastasis beyond regional lymph nodes), the melanoma has migrated beyond the initial tumour site and regional lymph nodes to more distant parts of the body. ⁽⁹⁾ The most frequent locations of metastasis are distant skin and lymph nodes, followed by lungs, liver, brain, bone, and/or intestines. Serum levels of an enzyme called lactate dehydrogenase (LDH) may or may not be high. Brain metastases, a subtype of Stage IV melanoma, are one of the most prevalent and difficult-to-treat consequences of melanoma. In terms of risk factors, diagnosis, and therapy, they vary from all other types of metastases.

Treatments for Skin Cancer on the Nose

Surgery

Options for treating nasal skin cancer vary depending on the kind of cancer, its stage of development, and other variables such as age and general health. Because skin cancer seldom spreads beyond its initial location, surgery is a typical therapy. 

Electrodesiccation and Curettage is a frequent kind of surgery for skin cancer, including scraping or burning away the tumour. ⁽¹¹⁾ It is used to treat skin cancer lesions as well as benign growths. The physician injects numbing medicine into and around the lesion before scraping it out, using cauterisation to halt bleeding. Depending on the magnitude of the lesion, this operation may need to be repeated. There is no substantial difference in cure rates for skin malignancies treated with curettage and electrodesiccation and those treated with excisional surgery, according to research. 

The Mohs surgical procedure involves the meticulous removal of tiny layers of malignant cells. ⁽¹¹⁾ This method aids in the preservation of the surrounding tissue and may take many hours to complete. When cancer is diagnosed in the skin folds around the nose, Mohs surgery is more likely to be performed. The risk of recurrence after Mohs surgery is less than 5%, the lowest of all therapeutic options. 

During an excisional surgery procedure, your physician will remove the skin cancer growth as well as some surrounding healthy tissue. ⁽¹¹⁾ Typically, after numbing the region with a topical anaesthetic, sutures are necessary. If the growth is substantial, a skin transplant may be required. Excisional surgery carries a risk of scarring, which is often treatable with reconstructive surgery. The excisional surgical cure rates for early skin cancer are 95% for BCC and 92% for SCC. 

Surgical laser technology is to destroy cancer cells; laser surgery involves putting a laser beam directly on the skin. ⁽¹¹⁾ It is often used to treat precancerous growths such as actinic keratosis or as subsequent therapy for skin cancer. ⁽¹¹⁾

Cryosurgery, commonly known as cryotherapy, is often used to treat precancerous or extremely tiny cancerous growths. ⁽¹¹⁾ In this procedure, liquid nitrogen is used to freeze skin cancer development. This destroys cancer cells and produces blistering and crusting of the skin. It may need to be repeated many times within the same appointment visit. The blister should heal within one to two months, leaving a scar.

Medication

Topical Pharmaceuticals 

With topical chemotherapy, it is feasible to treat both BCC and SCC. These treatments are often available as a cream or ointment that may be administered directly to the malignant growth: 

• 5-FU (5-fluorouracil) may be used to eliminate cancer cells on the surface of the skin, but it cannot be absorbed deeply into the skin. ⁽¹¹⁾ It is intended to treat both precancerous lesions and skin cancer in its early stages. 
• Solaraze (diclofenac) is an anti-inflammatory drug that is nonsteroidal. ⁽¹¹⁾ Two to three months of twice-daily application may be utilised to treat precancerous lesions. 
• Zyclara (imiquimod) is a modulator of the immune response in the form of a cream that enhances the immune system's reaction to skin cancer. ⁽¹¹⁾ It may be used to treat precancerous lesions and BCC in its earliest stages. 
• To enhance the immune response, interferon may be administered directly to the malignant skin growth. ⁽¹¹⁾ Typically, it is considered when surgery is not possible. 
• Another topical chemotherapeutic drug is Picato (ingenol mebutate). ⁽¹¹⁾ It is allowed for the treatment of precancerous lesions, but not SCC or BCC. 

Oral Pharmaceuticals 

Skin cancer rarely reaches advanced stages, but when it does, oral treatments may be effective. Besides chemotherapy, targeted medicines may be utilised to treat advanced skin cancer. ⁽¹²⁾ Targeted treatment is a medicine that may specifically target cancer cells without harming healthy cells. This can assist to prevent treatment-related negative effects. 

Vismodegib (Erivedge) and sonidegib (Odomzo) are inhibitors of the hedgehog pathway that impede the growth and spread of cancer cells. ⁽¹¹⁾ After surgery or other therapies, the capsules are taken once a day. These drugs have several potential negative effects and should never be used during pregnancy since they may inhibit foetal development. 

Cetuximab (Erbitux) is an EGFR inhibitor that inhibits the spread of SCC. Its potential adverse effects include skin infections, diarrhoea, mouth sores, and appetite loss. ⁽¹¹⁾

Intravenous Immunotherapy 

Keytruda (pembrolizumab) is licenced for the treatment of locally advanced non-curable cutaneous squamous cell carcinoma (cSCC), head and neck squamous cell carcinoma (HNSCC), Merkel cell carcinoma (MCC), and melanoma. ⁽¹¹⁾ This therapy is neither chemotherapy nor radiotherapy. It is a pharmacological treatment that utilises the immune system to combat some types of cancer. Sometimes, Keytruda's adverse effects might be so severe or life-threatening that they can cause death. 

Opdualag (nivolumab, relatlimab) is licensed for the treatment of melanoma that has spread or cannot be surgically removed. ⁽¹¹⁾ Muscle and bone discomfort, diarrhoea, exhaustion, and skin rash are the most common adverse effects. 

Radiation therapy

When a skin cancer tumour is very big or cannot be surgically removed, radiation treatment may be an option. ⁽¹¹⁾ During treatment, high-energy rays or particles are employed to destroy cancer cells. Radiation has been shown to cure BCC and SCC in their early stages. It may also help reduce advanced cancers and cure metastases. Radiation therapy is often combined with other therapies. For instance, your doctor may offer radiation therapy following surgery to ensure that all cancer cells are eliminated. This may lessen the likelihood of recurrence. 

Photodynamic therapy

Photodynamic therapy has been shown to effectively cure precancerous lesions, but it is not yet an authorised treatment for skin cancer. ⁽¹³⁾ It includes applying a gel to the affected area, which is then absorbed by the skin. This medication makes cancer cells highly photosensitive. The lesion is then immediately illuminated with a specific laser, which destroys the malignant cells. Photodynamic treatment may make the skin highly photosensitive. ⁽¹¹⁾ Consult with your dermatologist regarding sun protection following treatment.

Preventing Skin Cancer on the Nose

Avoiding UV radiation from the sun and tanning beds is the greatest strategy to prevent skin cancer on the nose (or anyplace else on the body).  ⁽¹⁴⁾  Avoid indoor tanning beds at all costs, and use sun protection while outside. Among the sun protection methods are:

• Applying a high-quality sunscreen with an SPF of 15 or higher is recommended. 
• Wearing a hat, sunglasses, and lightweight, high-coverage clothes. 
• Being in the shadow.

Summary

Although the majority of therapies for skin cancer are quite successful, they might have negative effects. Scarring and possibly disfigurement are the most typical side effects of treating nasal skin carcinoma. Even if cancer is cured, these side effects may be quite uncomfortable. If necessary, discuss plastic surgery with your oncologist or dermatologist. Any surgery will result in scarring, but a plastic surgeon may assist in lessening it while minimising its extent and impact. Early detection of skin cancer is the best method to decrease scarring and avoid disfigurement. Make yearly dermatologist checkups and undertake monthly self-examinations of skin.