Skin CancerProblem: Skin cancer is one of the most common types
of cancer in the UK. As a persons age increases so does their risk
of developing skin cancer. There has been a drastic increase in the
number of people diagnosed with skin cancer throughout the years
resulting in deaths. This represents a major public health
challenge.
Figure 1Cancer is a group of various diseases, there are over
200 different types.1Cancer develops when the DNA, containing
genetic information in a cell is damaged or changed; this produces
mutations which affects the growth and division of the cells.2In
unaffected cells- the cells divide in a controlled manner however,
in affected cells the body is not able to repair the damage so the
abnormal cells carry on dividing in an unregulated manner and
develop in to a tumour which can spread to other tissues in the
body.1(Figure 1 shows a skin cancer cell under an electron
microscope).
Figure 2When this process occurs in the skin, the malignant
cells can invade other tissues in the skin - leading to skin
cancer. Skin cancer is detectable in its early stages because the
tumour develops in cells in the epidermis (the outermost layer of
the skin). Therefore, these tumours can be easily detected. Early
detection and treatment is key to survival. 11 There are three main
types of skin cancers: Basal cell cancer, squamous cell cancer and
melanoma. These can be divided into two broad categories
non-melanoma and melanoma. Melanoma is much more dangerous than
non-melanoma, and causes the vast majority of skin cancer deaths.3
One in fifty five people will be diagnosed with melanoma in their
lifetime. The rate of many common cancers has been decreasing, but
melanoma has been increasing. Between the years 1997 to 2004 the
number of melanoma cases increased by 45% 21Skin cancer can be
caused by many factors; the most common being ultraviolet (UV)
light from the sun and sunbeds. Such rays are very powerful and are
able to damage the DNA in skin cells and if this causes specific
mutations it can lead to the build-up of cancerous cells in the
skin. UV light from the sun causes skin cancer over a long period
of time.To determine whether or not skin cancer has increased
dramatically throughout the years in the UK, epidemiological
studies have been performed. These studies use data from local and
national cancer registries and also from reporting of death
certificates. Therefore, data on the number of cases of skin cancer
that occur in the UK and the deaths they cause are gathered
together and presented in graphs and data tables. These results
allow epidemiologists to see trends in the incidence of skin
cancers and help them to inform the government and public health
bodies on the need for specific actions. For example, evidence on
an increase in melanoma in a population might lead to public health
campaigns warning of the risks of UV light exposure. 29
Figure 3.4
Figure 3 shows how the diagnosis of skin cancer (melanoma)
increases with age between the years 2006-2008. It shows data
specifically in the UK. This graph contains two different types of
information - Average number of cases per year which is represented
as a bar chart and Rates per 100,000 population which is
represented as a line graph.The Number of Cases per YearFigure 3
shows that between the ages of 0-14 there were no cases of skin
cancer for males and females - which shows that the younger a
person is the less likely he/she is to develop skin cancer. The
number of cases for males and females increased along with the age,
the number of female cases rapidly increased from the age group
30-34 to 35-39 where it increased by approximately 150 cases. The
number of male cases rapidly increased from the age groups of 55-59
to 60-64 where it increased by approximately 165 cases. The age
group for males 60-64 was the first time the number of cases per
year was higher than the females, this age group was also where the
graph had reached its highest value for both genders. After 60-64
the number of cases started to decrease for males and females as
the age of diagnosis increased, this trend continued for males
however for the females it decreased up until the age group 80-84
where the number of cases was just over 375, when the female age of
diagnosis was 85+ the value slightly increased to approximately
just over 400.Generally the bar chart showed that as a persons age
increases so does their risk of suffering from skin cancer but only
up to a certain age, in this case the trend continued till the age
group 60-64 which supported this conclusion however after that the
number of cases per year decreased.
Figure 4.5Figure 4 shows that skin cancer has increased rapidly
from 1975 to 2008. Females have the highest rate per 100,000
throughout the graph which suggests that they are more prone to
skin cancer. Rates have increased from approximately 4.5 to
16.5/100,000 which is a difference of 12 cases/100,000. The rate
per 100,000 for males remains much lower than for females. In 1975
males had a low figure - approximately 3/100,000 and by 2008 their
figure had increased to 16/100,000 which is a difference of 13
cases/100,000. It is clear that the curves for females and males
started off quite wide apart in 1975 but have come together by
2008, this may reflect different patterns of sun exposure in men
and women over this time period. Factors that might have increased
the risk of skin cancer include the use of sunbeds, greater
availability of foreign holidays and also the cultural wish to have
a sun tan.The overall trends for both genders show a steady
increase in the rate of skin cancers. However, between 1988 and
1993 there was an apparent dip in the rate of skin cancers in both
males and females. This might be a reflection of a period of
reduced sun exposure 20-30 years earlier or perhaps due to other
factors, such as a drop in the efficiency of cancer registries in
seizing the data on the incidence of skin cancers during this
period (e.g. because of economic cuts affecting jobs due to
recession). Figures 3 and 4 are taken from the Cancer Research UK
website. This is the worlds largest independent cancer research
charity22and is widely recognised for its authoritative and
reliable websites that provide valid information and statistics on
cancer. I feel that my data provided from this website is reliable
as it is a well known charity amongst the public.
Figure 5.15The map In Figure 5 shows the distribution of skin
cancer in Europe. The black arrow shows that the incidence of skin
cancer is greater the further a country is towards the North-West
of Europe. Citizens of those countries with high rates of skin
cancer (e.g. Scandinavia and UK) tend to have lighter skin colour
and are, therefore, more vulnerable to the harmful effects of UV
light than those people who live in the South of Europe (e.g. the
Mediterranean).
This information confirms the rapid increase in skin cancer in
the UK and highlights the potential problem it represents to the
people living here. Clearly, this problem requires a range of
possible solutions in order to prevent it from damaging peoples
health and threatening their lives.
SolutionsNew treatments for skin cancer have been developed
rapidly in recent years. Harpal Kumar, chief executive of Cancer
Research UK stated "There has been undeniable progress in the
treatment of skin cancer over the last 40 years and many more
people are surviving the disease. 13 There are many solutions to
treat skin cancer such as7: Surgery Photodynamic therapy
Chemotherapy
Effective solutions:
Figure 6.15Surgerythis type of treatment has different forms,
for example: Excision This form of surgery is the simplest which is
commonly used to treat small cancer- mainly melanoma. Figure 6
shows how the tumour is removed, it involves removing the lesion -
along with healthy looking skin known as the safety margin and also
tissue and fat from under the tumour. The healthy looking skin is
removed to ensure that the cancer has not spread anywhere else so
that this process can carry on.The tissue sample will be sent to
the laboratory to determine if any of the safety margin has been
affected which would lead to the surgery becoming unsuccessful,
which may result in further surgery to remove more tissue. This
form of surgical treatment has its own advantages: it provides an
opportunity to see if any other parts of your skin have been
affected, the process is done in one session unlike other cancer
treatments and also the cure rate is considerably high.8
Figure 7.15Mohs SurgeryThis form of surgery is very specialised,
it is the most effective type of surgery for the nonmelanoma group
(basal cell and squamous cell cancer). This process shown in figure
7, involves removing the lesion- piece by piece, each piece is then
examined under a microscope as soon as each layer of the skin has
been cut off. The layers are cut off till no sign of cancer has
been identified under the microscope. This procedure is similar to
excision however it aims to remove as little healthy skin as
possible.9 By using Mohs surgery, surgeons are able to spare more
of the healthy skin and this provides a superior cosmetic result.
23 The site at which the surgery has taken place will heal very
well - well enough that it is unnoticable in some cases.
Figure 8.15Photodynamic Therapy (PDT) Photodynamic therapy is
another form of effective treatment for skin cancer, but only for
the nonmelanoma group, it avoids the use of surgery and surgical
scars.14 This procedure shown in figure 8 uses a light sensitive
drug known as a photosensitising agent, an example of this is
Photofrin which is used to damage abnormal tissues; it usually has
no impact on normal tissues in the body. The drug is injected into
the cells; which is then absorbed by the cancer cells. Light is
shone on the affected area to activate the drug which then leads to
the cancer cells being destroyed.14 This form of treatment is an
alternative to surgery; however the process only works if the
cancer is not too deep in the skin because the light would not be
able to penetrate deep in the skin. PDT is a very effective
treatment and is preferred to the other form of treatments of skin
cancer, however after the treatment there are precautions, for
example, the cured area is more sensitive to strong light therefore
it should be protected for a couple of days. It may also cause
swelling in the cured area but is only temporary.
Figure 9.15Figure 9 shows the structure of the photosensitising
drug Photofrin. This drug is appropriate for the process because
the maximum absorbance of the wavelength is above 600nm therefore
it can absorb more light rather than haemoglobin.16
Figure 9.15
Advantages of PDT: The use of PDT has many advantages to treat
skin cancer, it is less destructive to the skin; unlike surgery, no
layers of the skin are being cut off, therefore no visible scars
will be produced in the process so people will feel more confident
about themselves. Photodynamic therapy is a fast, pain-free
procedure requiring as little sedation as possible; this procedure
has been proven to be relatively safe.24This process to cure the
cancer only takes about one to two sessions to complete therefore
it is a rapid procedure unlike any other treatment which is why
many people choose this form of treatment.Disadvantages of PDT: The
use of PDT also has its disadvantages, it an expensive procedure
and also has a lower cure rate compared to surgery. PDT can only
cure basal cell and squamous cell cancer- not melanoma.17 The
treatment contains side-effects: It may cause photosensitivity for
approximately 30 days because the photosensitising drug injected
during the procedure may still be present in the body so the
treated patients must avoid bright light or direct sunlight.
However if the patient is exposed to these lights it may cause
swelling and sunburn. The laser light used to shine on the skin to
activate the drug is unable to pass through more than 3cm of
tissue.12
Social ImplicationsEven though, these solutions are very
effective in curing skin cancer; they do have some social
implications. The main social implication from the use of surgery
is that it results in the creation of surgical scars on the skin
which could be very traumatic to the patient and may cause
emotional side-effects. People may start to feel conscious about
themselves which may harm their confidence and intervene with their
social life as they start to feel they are somewhat different from
others. Surgical scars also have a psychological effect- it can
affect relationship building with others and social withdrawal,
scars may lead the public to conjure unnecessary cruel comments
which can cause the treated patient to be paranoid and also create
social phobia, they may feel embarrassed and are not able look
people in the eye. Any form of treatment may make a patient feel
they are different from others.18Economic ImplicationsThe
occurrence of skin cancer and the effects of its treatment also
have economic implications. The cost of treating skin cancer varies
depending on its type. Basal cell and squamous cell cancers, which
are less dangerous than melanoma, may cost around 1000 to treat (by
surgery, PDT or radiotherapy). However, the large and increasing
number of cases is likely to place a significant strain on the
healthcare budget.19In contrast, melanoma, which is the deadliest
form of skin cancer, may require extremely complex treatment which
includes expensive drugs that may cost many thousands of pounds.
These treatments are often not affordable in the NHS and are not
approved by the National Institute of Health and Clinical
Excellence (NICE). Skin cancer can also have an impact on peoples
work life. Thus, sufferers may not be able to work meaning that
they have reduced financial income and may have to rely on
benefits. In addition, if they are not working, the government will
not receive tax from them and this reduces the money available to
fund schools and the National Health Service.19
Alternative SolutionsThere are alternative methods used to cure
skin cancer:
Radiotherapy
Figure 10.15Radio therapy is a good alternative solution for
skin cancer, it is particularly useful in areas where surgery may
be difficult to treat or may cause disfigurement, such as the
face.25 This procedure involves the use of high energy X- and Gamma
rays produced in specialised radiotherapy machines. These rays can
penetrate tissues and can be focussed on tumour containing areas.
The rays hit the DNA of cancer cells and cause breaks in the
double-stranded DNA helix. If sufficient damage is caused on the
tumour cells, they are unable to repair it and die.26 The key to
using this treatment effectively in treating skin cancer lies in
targeting the radiation selectively to sites where the cancer. In
addition, the normal tissues are better able than cancer cells to
repair DNA damage from the procedure, therefore the patient is more
likely to survive.This treatment is very effective because the high
energy X- and gamma rays shown in figure 10, used during the
procedure is aimed at the site of the tumour, thus, causes as
little damage as possible to the normal cells, however possible
side effects of this treatment are: sickness, itchy skin, weight
loss, and red soreness.27
New Drug TreatmentsIn the last 2 years there has been a
significant improvement in the treatment of melanoma by the use of
new drugs. Two drugs that have recently been approved for use in
Europe include vemurafenib and ipilimumab, these drugs can also be
used in the later stage of melanoma. The first of these drugs
(vemurafenib) targets a gene that is mutated and shuts off its
function. This has the effect of killing melanoma cells. Dr Antoni
Ribas, a professor of haematology /oncology expressed These results
tell us that this drug is having a very big impact, and this change
the way we treat metastatic melanoma.27
The second drug (ipilimumab) acts by waking up the immune system
to the presence of melanoma and allows the bodys own natural
defences to attack and destroy tumours. This drug can benefit
around 2,000 patients suffering from melanoma in the UK. Dr Paul
Lorigan, Senior Lecturer in Medical Oncology at NHS Foundation
Trust explained After years of no progress in the treatment of this
terrible illness, we have now made a stride forward. 28
The best known solution to skin cancer is by preventing it from
occurring. There are many techniques used nowadays that help
prevent skin cancer.Sunscreen: This is a lotion, gel or spray used
to prevent skin cancer. This type of method is the most common
solution in preventing cancerous cells from developing in the skin.
Sunscreen is applied to the skin that is exposed to the sun; it can
absorb the UV rays emitted and also reflect the harmful light
rays.20Less Exposure: This is another method used to prevent skin
cancer. The less skin exposed to the sun, the less likely a person
is going to develop the cancer.
Evaluation of References:Source 4: I used this source
(http://info.cancerresearchuk.org/cancerstats/types/skin/incidence/)
in order to find data on my problem. I believe that this source
provides valid and reliable information and data because it is from
the Cancer Research UK which is a well-known awareness charity
based organisation which was created in 2002. The purpose of this
organisation is to reduce the number of deaths due to cancer and is
also funded by the public. The source is reliable because it
contains data on the increase in skin cancer which also agrees with
other sources such as the BBC and other web sources therefore I
used this source to gain my data, and to also come up with
investigations (referred to in the text) as to why there were some
dips in the trend on the graph.Source 19: I used this source Phone
communication with a Specialist in Skin Cancer, Dr K. Harrington
from The Royal Marsden Hospital in order to gain knowledge about
the economical implications about the increase in the skin cancer
throughout the years as well as alternative solutions and to what
effect it has on the NHS and also on peoples lives. I believe that
this source is both reliable and valid because the information I
gained was from a Specialist in skin cancer, Dr. K. Harrington,
from the Royal Marsden Hospital who mainly specialises in
Radiotherapy. The Royal Marsden Hospital is a well-known cancer
treatment hospital and is one of the first NHS foundation trust
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