Itch And Pain In Nonmelanoma Skin Cancer: Pain As An Important Feature Of Cutaneous Squamous Cell Carcinoma
Pain is a common feature of cancer with an estimated prevalence rate between 52% and 77%. Itch is the most common dermatologic symptom and is also a common feature of lymphoma. However, no studies have been performed examining the prevalence rates of pain and itch in common skin cancers. Squamous cell carcinoma and basal cell carcinoma are the 2 most common types of nonmelanoma skin cancer . They have a rapidly increasing incidence in the United States, with nearly 4 million new cases of NMSC diagnosed each year. The purpose of the present study was to assess the prevalence and intensity of pain and itch among the 2 most common skin cancers.
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Basal Cell Nevus Syndrome
This rare inherited condition, which is also known as Gorlin syndrome, increases your risk of developing basal cell cancer, as well as other types of tumors. The disease can cause clusters of basal cell carcinoma, especially on areas like your face, chest, and back. You can learn more about basal cell nevus syndrome here.
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When Should Itchy Skin Raise A Red Flag
Itching per se is not dangerous. As we have mentioned there are numerous reasons for an itchy skin. But when should itchy skin be associated with a cancer symptom?
Basically, patients complain of multiple lesions that are itchy or painful as well as suspicious-looking should raise some confers for non-melanoma skin cancers. According to studies, more than one-third of skin cancer lesions are itchy with fewer than 30 percent being described as painful. Some patients report their lesions are being both painful as well as itchy.
The type of skin cancers mostly associated with itching as skin cancer symptom is basal cell carcinomas and squamous cell carcinomas, whereas melanoma lesions were least likely to be associated with any kind of painfulness or itchiness. Even though melanomas are less common than basal cell carcinomas or squamous cell skin cancers, they are however far more dangerous.
Although itchy skin alone does not indicate skin cancer, there are a number of other features associated with the lesions that should be noted as being associated with any kind of skin cancer. These include:
- The emergence of new moles
- Moles that increase in size
- Irregular outlines of moles
- Change in color from brown to black
- A spot that becomes raised over time
- Moles with an irregular, rough or ulcerated surface
- Moles that tend to easily bleed
- Spots that look different from others
- Any ulcer or broken down part of the skin which does not heal within 4 weeks
How Common Is Skin Cancer
Skin cancer is the commonest type of cancer in the United States. The skin is the largest organ in the body with a surface area of around 2 sq ft in an average adult. It acts as a protective barrier against several types of harmful agents, including heat, injuries, light, and infections. Because of the crucial protective functions that the skin performs, it is vulnerable to various conditions, such as allergies, infections, burns, and even cancer.
Depending on the cell from which it originates, skin cancer can be of several types. The most common types of skin cancers are basal cell carcinoma and squamous cell carcinoma. These two types of skin cancers are curable unlike the third most common skin cancer called melanoma. Melanoma is the most dangerous skin cancer, causing many deaths. Even curable skin cancers can cause significant disfigurement to the affected person. Other types of skin cancers include lymphoma of the skin, Kaposi sarcoma, and Merkel cell skin cancer. Knowing the type of skin cancer is crucial for your doctor to decide your treatment.
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Skin Cancer Diagnosis Always Requires A Skin Biopsy
When you see a dermatologist because youve found a spot that might be skin cancer, your dermatologist will examine the spot.
If the spot looks like it could be a skin cancer, your dermatologist will remove it all or part of it. This can easily be done during your appointment. The procedure that your dermatologist uses to remove the spot is called a skin biopsy.
Having a skin biopsy is essential. Its the only way to know whether you have skin cancer. Theres no other way to know for sure.
What your dermatologist removes will be looked at under a microscope. The doctor who examines the removed skin will look for cancer cells. If cancer cells are found, your biopsy report will tell you what type of skin cancer cells were found. When cancer cells arent found, your biopsy report will explain what was seen under the microscope.
How Common Are Painful Skin Cancer Lesions
A study completed at Wake Forest University Baptist Medical Center in 2010 and 2011, found that of 268 patients who had confirmed skin cancer lesions, more than 1/3 reported itchiness and approximately 30 percent reported them as being painful.
Painful lesions were also found to be more likely in non-melanoma skin cancer lesions than in melanoma lesions. Pain prevalence was reported as greatest in squamous cell carcinoma at 42.5%, with pain prevalence in basal cell carcinoma at 19.9% and only 3.7% in melanoma.
In another study published in the Archives of Dermatology, the prevalence of pain in squamous cell carcinoma was found to be 39.8% and 17.7% in basal cell carcinoma.
So while these numbers may not represent the majority of lesions, they nevertheless show that there is a significant chance that skin cancer lesions will be painful.
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In What Ways Can An Itchy Mole Be Treated
If you notice changes to color, size, or shape of any moles, you should have them checked by a doctor. If you have a mole that bleeds, itches, feels tender, or its painful, its important to see a doctor as soon as possible. Most moles that are itchy, painful, large or have a potential for being cancerous are typically removed.
Study Shows That Pain And Itch May Be Signs Of Skin Cancer
Asking patients if a suspicious skin lesion is painful or itchy may help doctors decide whether the spot is likely to be cancerous, according to a new study headed by Gil Yosipovitch, chair of the Department of Dermatology and director of the Temple Itch Center at Temple University School of Medicine.
The study, published online byJAMA Dermatology, involved 268 patients who had 339 laboratory-confirmed skin cancer lesions and found that nearly 37 percent of skin cancer lesions are accompanied by itching, while 28 percent involve pain. Nonmelanoma skin cancersspecifically, basal cell carcinoma and squamous cell carcinomaare more likely than melanoma to involve itch or pain.
The study highlights the importance of a simple bedside evaluation for the presence and intensity of pain or itch as an easily implementable tool for clinicians in evaluating suspicious skin lesions, concluded the researchers.
Yosipovitch said the findings are important because skin cancer is the most common cancer in the U.S., with more than 3.5 million nonmelanoma skin cancers diagnosed in 2 million people annually.
Patients sometimes have multiple lesions that are suspicious looking, and those that are itchy or painful should raise high concerns for nonmelanoma skin cancers, he said.
When the researchers compared the patients responses, they found that:
The prevalence of itch was greatest in squamous cell carcinoma , followed by basal cell carcinoma and melanoma .
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Is Skin Cancer Itchy
An itchy skin rash could be a warning sign of skin cancer. But, itching is very common and can occur for many reasons other than cancer. Some possible explanations include dry skin, eczema, contact dermatitis, an insect bite or an allergic reaction to a medication, cosmetic or poison ivy.
Due to the wide range of potential causes, itchy skin alone is usually not a reason to be overly concerned. Unless the itching is very bothersome or lasts beyond a few days, home remedies such as applying an anti-itch cream, moisturizer or cool compress may be all that is needed to improve comfort until the itching resolves on its own.
Is Cancer Causing The Itching
Itching related to cancer is sometimes identical to itching related to skin conditions or other benign causes, but there are some characteristics that may differ.
Signs of cancer-related itching may include:
- Itching in response to water, which is called aquagenic pruritus
- Lack of any rash or hives
- The presence of other symptoms such as a yellowish discoloration of the skin , and the B symptoms, which are body-wide symptoms of lymphoma including fever, weight loss, and drenching night sweats
In addition, itching associated with cancer may feel the worst on the lower legs and chest and may be associated with a burning sensation.
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What Are The Signs That A Mole Might Be Malignant
The ABCDE method sums up the signs that your mole might be melanoma:
- Asymmetry: One half of the mole doesnt match the other half.
- Border: The mole has irregular, blurred, or ragged borders.
- Color: The mole has two or more different colors.
- Diameter: Its larger than ¼ inch across.
- Evolving/Elevating: The mole is changing size, shape, or color, or its becoming raised above the rest of the skin.
Signs And Symptoms Of Non
Non-melanoma skin cancer usually starts as an abnormal area or change on any part of the skin. How non-melanoma skin cancer looks often depends on the type of cancer. Other health conditions can also look like non-melanoma skin cancer. See your doctor if you have any changes on your skin.
The following are common signs and symptoms of basal cell carcinoma and squamous cell carcinoma , the most common types of non-melanoma skin cancer.
Basal cell carcinoma usually develops on areas of skin exposed to the sun, especially the head, face and neck. It can also develop on the central part of the body . BCC may appear on the skin as:
- a sore that doesnt heal or comes back after healing
- pale white or yellow flat areas that look like scars
- raised and scaly red patches
- small, smooth and shiny lumps that are pearly white, pink or red
- a pink growth with raised edges and indents in the centre
- a growth that has small blood vessels on the surface
- a sore that bleeds
- a growth or area that is itchy
Squamous cell carcinoma usually develops on areas of skin exposed to the sun, but it can also be found on the skin around the genitals and anus. It can occur on the skin of scars, sores, ulcers and burns. SCC may appear on the skin as:
- a sore that doesnt heal or comes back after healing
- rough or scaly red patches with irregular borders
- raised lumps that indent in the centre
- a growth that looks like a wart
- a sore that is crusty or bleeds easily
- a growth or area that is itchy, irritated or sore
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If skin cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place . Certain parts of the body, such as the ears and lips, are more prone to develop recurrent skin cancers. In addition, people whose immune system is suppressed due to a medication or disease are also at higher risk for skin cancer recurrence.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
How To Diagnose Skin Cancer
First, a doctor will examine a personâs skin and take their medical history. They will usually ask the person when the mark first appeared, if its appearance has changed, if it is ever painful or itchy, and if it bleeds.
The doctor will also ask about the personâs family history and any other risk factors, such as lifetime sun exposure.
They may also check the rest of the body for other atypical moles and spots. Finally, they may feel the lymph nodes to determine whether or not they are enlarged.
The doctor may then refer a person to a skin doctor, or dermatologist. They may examine the mark with a dermatoscope, which is a handheld magnifying device, and take a small sample of skin, or a biopsy, and send it to a laboratory to check for signs of cancer.
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Dark Lines On The Fingernails Or Toenails
The appearance of a dark area under a fingernail or toenail that appears without an obvious injury should always be investigated. Melanoma of the nail bed often presents when a pigmented streak of the nail involves the cuticle . These cancers are most common on the thumb and big toe but may occur on any nail.
While subungual melanomas are uncommon in whites, accounting for only around 1% of melanomas, they are the most common form of melanoma found in dark-skinned individuals.
Real Red Flag For Doctors And Patients
Most cases of skin cancer begin their development as an unusual looking skin lesion. A persistent lesion that has been particularly itchy and bothersome should be a red flag for patients and doctors alike.
Patients sometimes have multiple lesions that are suspicious looking, and those that are itchy or painful should raise high concerns for non-melanoma skin cancers,stated Dr. Yosipovitch, Director of the Temple Itch Center.
The research team ranked the three most common forms of skin cancer by order of which tends to be itchiest:
- Squamous cell carcinoma
- Basal cell carcinoma
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Types Of Skin Malignancies:
- Melanoma the least common form of skin cancer, but responsible for more deaths per year than squamous cell and basal cell skin cancers combined. Melanoma is also more likely to spread and may be harder to control.
- Nonmelanoma malignancies:
- Squamous cell cancer the second-most common skin cancer. It’s more aggressive and may require extensive surgery, depending on location and nerve involvement.
- Basal cell cancer the most common form of skin cancer. It is rarely fatal but can be locally aggressive.
These skin malignancies are typically caused by ultraviolet radiation from exposure to the sun and tanning beds.
Staging For Merkel Cell Cancer
Doctors use the TNM system to describe the stage of Merkel cell cancer. Doctors use the results from diagnostic tests and scans to answer these questions:
Tumor : How large is the primary tumor? Where is it located?
Node : Has the tumor spread to the lymph nodes? If so, where and how many?
Metastasis : Has the cancer spread to other parts of the body? If so, where and how much?
The results are combined to determine the stage of Merkel cell cancer for each person.
There are 5 stages: stage 0 and stages I through IV . The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
Stage 0: This is called carcinoma in situ. Cancer cells are found only in the top layers of the skin. The cancer does not involve the lymph nodes, and it has not spread.
Stage I: The primary tumor is 2 centimeters or smaller at its widest part. The cancer has not spread to the lymph nodes or to other parts of the body.
Stage IIA: The tumor is larger than 2 cm and has not spread to the lymph nodes or other parts of the body.
Stage IIB: The tumor has grown into nearby tissues, such as muscles, cartilage, or bone. It has not spread to the lymph nodes or elsewhere in the body.
Stage III: The cancer has spread to the lymph nodes. The tumor can be any size and may have spread to nearby bone, muscle, connective tissue, or cartilage.
Stage IV: The tumor has spread to distant parts of the body, such as the liver, lung, bone, or brain.
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