Rufus R. Noble Western life expectancy has been increasing for many years thanks to a better standard of living, improved hygiene, and modern medicine. Cancer is one of those illnesses that continues to pose a challenge despite recent medical advances. According to the World Health Organization (WHO), skin cancer is the most common form of malignancy among white people. The first part of this paper provides a quick overview of recent information on skin cancer epidemiology, etiology, and diagnostics. The rest of the article focuses on modern treatments for skin cancer that highlight the use of nanotechnology. We focus on the latest nanotechnological treatments combined with chemotherapy. This field specializes in drug release control and real-time monitoring, with the goal of reducing unwanted side effects, their severity, and cost. Nanotechnology is rapidly evolving, as can be seen by the number of clinical trials that have already been approved or the new theranostic drugs that combine diagnostic and therapeutic modalities.
The following is a brief introduction to the topic:
Cancer treatment is still a challenge for many researchers around the world despite recent advances. Many new treatment options promise to improve treatment effectiveness, patient quality of life, and survival rates while reducing unwanted side effects.
This article provides an overview of the various types of cancers, their characteristics, and their prevalence. It also includes a discussion of current treatment methods that use nanotechnology. These methods are improving treatment options by utilizing the properties of nanoparticles and more effectively targeting cancer cells. Let’s conclude by looking at some prospects in the treatment of skin cancer.
Skin Cancer
The most common malignant condition is skin cancer, which occurs mainly in Caucasians. [ 1]. Each year, more than one million new cases of skin cancer are reported. The different types of skin carcinoma are named according to the type of cell they come from and how they behave. The three most common types of skin cancer are basal-cell carcinoma (BCC), squamous-cell carcinoma (SCC), and malignant melanoma.
2.1. Nonmelanocytic skin cancer
NMSC is one of the most common cancers in humans. Every year, 2-3 million new cases of NMSC are reported in the world. 1,3 million are only found in America [ 3]. The incidence of the disease is rising in Europe, Canada, the USA, and Australia by 3-8 percent per year [ 4]. Incidence rates are expected to double within the next 30 years [ 5]. UV light, ionizing radio waves, and chemical carcinogens are the most important etiological agents. Table 1 provides a more detailed summary.
Table 1: Risk factors for skin cancer
BCC is the most common type of skin cancer, representing 80-85%. BCC is the most common type of skin cancer in the USA. The incidence of BCC is increasing by 10% worldwide every year. This increases in men over 50, but also young women.
Skin cancer patients show signs of sun damage, such as collagenosis (collagenosis), irregular pigmentation, wrinkled skin, telangiectasia, and solar Keratosis. The most visible BCCs are red, slightly wrinkled, and scaled with small ulcerations. The border can be poorly defined, and it may have an oval or round shape. The center can be uniformly fibrous. The superficial BCC may appear clinically as chronic or subacute dermatitis.
SCC is the other type of NMSC. It represents 15-20% of all NMSCs. SCC’s growth shows local destruction and tissue invasion. SCC also causes more deaths than BCC. [ 4]. The incidence of SCC is on the rise, but it varies by region [ 8]. Risk factors for SCC can be classified as extrinsic and intrinsic. Outside risk factors include UVA, ionizing radio waves, HPV, chemical substances, and genetics. You can find more information in Table 1.
2.2. Malignant Melanoma
MM is a disease that affects the cells of the skin called melanocytes. These cells produce melanin pigment. In areas where there are a lot of light-skinned people, the incidence is on the increase. Since 2005, only Australia (with an incidence of 50-60/100000) has seen a slow decline in the rate [ 9]. In Europe, the incidence is 10-20/100000 residents. The USA has a rate of 20-30/100000. In 2012, the incidence in Slovenia was 23,1/100000 for males and 23,8/100000 for females. The yearly incidence for Slovenia is 700 new diagnoses [ 10].
MM is the most common cancer among men and women in Slovenia, even though it represents only 4% of all newly diagnosed cancers. In the rest of the world, MM is more prevalent in men than women.
A 2010 study found that 13200 [ 4] cases of MM were diagnosed annually. The incidence is 16 times higher in Caucasian populations than in Afro-Americans and 10 times higher in Latin Americans. In terms of etiology, the most important factors are UV light and constitutional factors [ 11](Table 1).
MM most commonly develops in melanocytes of the skin that are exposed intermittently to sun radiation. Rarer is the development of MM in the anogenital tract, the retina, or the gastrointestinal system. Multiple MM risk factors exist.
Skin type. Risks vary depending on skin type. It is higher in those with lighter skin (1:40) and lower in people with darker skin (1:1000) or Latin Americans (1/200). Dark-skinned people are more likely to develop the acral lentiginous MM, which is most commonly seen on the hands and soles of feet. There are six distinct skin types in Caucasians. The highest risk lies with skin types I and 2. Figure 1 shows a depiction of the six skin types.
Figure 1
Fitzpatrick & Sober’s Skin Types [ 12]. Type 1: always reddens; type 2: often reddens; type 3: mildly reddens; type 4 tans easily; type 5 tans easily; and type 6 – never reddens.
Sun radiation. MM/NMSC risk is dependent on skin type as well as UV exposure. UVA or UVB causes cancer, whether they are of artificial or natural origin. The UV rays are responsible for the tanning effect, vitamin D production, and immune system depressants. [2]. Most important is so-called “intermittent” sun exposure, as well as childhood and adolescent sun exposure. Chronic or professional sun exposure is the weaker risk, except for head and neck MM. Other risk factors are connected to UV exposure. The number of newly formed Naevi, sunburns, and the presence of actinic Keratosis are statistically related to an increased risk of this type of cancer.
Naevi. In addition to skin type, UV exposure, and the number of atypical naevi (dysplastic), the increased risk is also influenced by the number of these atypical naevi. Naevi with a diameter greater than 6 mm and an uneven color or shape are classified as dysplastic. Atypical Naevi Syndrome is a condition that occurs when we find more than 50 atypical or atypical-looking Naevi in a single person. This condition increases MM risks five-fold. Even when multiple atypical naevi are present, MM is most likely to develop in previously unaltered skin.
Age. The incidence of MM increases with age. However, the average age of a patient is 62. MM is one of the most common types of cancer in young adults [ 10].
Gender. In many countries, males are more susceptible to MM. The risk of death for men is 1.5 times greater than that for women. The incidence of MM in Slovenia is higher among women [ 10].
The immunosuppression. The immunosuppression also reduces patient survival.
Formerly removed MM. The risk of new MM in patients with MM is 3-7%.
Family history. Between 5 and 10% of MM occurs in families at “high risk”. A higher risk is associated with two or more relatives who have MM. These families are more susceptible to pancreatic cancer, retinal melanoma, and mesothelioma. The familial form of MM has been linked to genes with low and high penetrance. The most commonly identified penetrance gene is MC1R. The high penetrance genes so far are CDK4, CDKN2A POT1, TERT, and BAP1. CDKN2A is the most common mutation found in MM. It affects 2% of patients.
MM should be on the differential diagnosis list whenever a pigmented lesion or a stable nevus changes color, shape, or size. Changes in color, a larger radius, irregular borders, and even bleeding, itching, and pain can be seen [ 14]. The ABCDE acronym (asymmetry border color dimension and evolution) is a good way to remember these criteria.
2.3. Skin Cancer Diagnostics
A dermatological exam, medical history, and dermoscopy are all necessary to diagnose skin cancer. A surgical biopsy is also required, along with a pathohistological analysis. Dermoscopy, a noninvasive technique, uses a lens and a powerful light source to help distinguish skin cancer changes. Both MM and NMSC confirm the diagnosis with a skin biopsy and a histopathological examination. The biopsy involves the excision of up to 5 mm of healthy tissue and can be performed using either a punch biopsy or a shave biopsy. The anatomical location and size of tumors are taken into consideration when deciding on further therapy.
Protecting your skin from the sun is one of the best ways to care for it. Sun exposure over a lifetime can lead to wrinkles, age marks, and other skin issues — and even skin cancer.
The most comprehensive sun protection:
- Wear sunscreen. Choose a sunscreen that has an SPF of at least 15 and is broad-spectrum. Use sunscreen liberally and reapply it every two hours or more frequently if you are swimming or sweating.
- Find shade. Avoid sun exposure between 10 am and 4 pm, when sun rays are at their strongest.
- Protect your skin by wearing long sleeves, pants, and hats with wide brims. Consider using laundry additives that provide an extra layer of protection against ultraviolet rays for a limited number of washes or sun-protective clothing.
