With a surface area of approximately 2 m², our skin is the body’s largest organ. We classify cancers of this organ—which ensures our survival by protecting our bodies from all kinds of external threats—into malignant melanoma and non-melanoma skin cancers. Non-melanoma skin cancers are the most common cancers among the white population, with basal cell carcinoma and squamous cell carcinoma accounting for the vast majority of these cases. The most significant factor contributing to the development of skin cancers is the ultraviolet radiation present in sunlight.
Basal cell carcinoma
This type of cancer, which typically presents as slow-growing lumps on the face that tend to bleed following trauma and have a central depression, has become widely recognised both in our country and around the world following the news that the famous actor Hugh Jackman underwent six operations for this condition.
Although this type of cancer does not usually spread beyond the area where it originates, it can, albeit rarely, be fatal, particularly in patients with very advanced-stage disease.
As with all forms of skin cancer, the main risk factor for this type of cancer is exposure to sunlight. Although this type of cancer, which arises as a result of the cumulative effects of sun exposure over many years, is most commonly seen in older people, it should not be forgotten that it can also occur in younger people.
Furthermore, the use of sunbeds increases the risk of developing all the types of skin cancer mentioned in our article due to the effects of ultraviolet radiation.
In patients who have had basal cell carcinoma once, the likelihood of developing a new basal cell carcinoma is significantly increased. Red hair, a young age and the cancer occurring particularly on the nose, eyelids and ears are factors that increase the likelihood of recurrence.
Squamous cell carcinoma
Squamous cell carcinoma, which is the second most common form of skin cancer, is a type of cancer that tends to be more aggressive than basal cell carcinoma; it can spread throughout the body and may be fatal in advanced stages.
As with basal cell carcinoma, the most significant risk factor is exposure to sunlight. In addition, having fair skin, being an albino, having a compromised immune system, certain genetic disorders and the HPV virus also increase the likelihood of developing the cancer.
They typically appear in sun-exposed areas as crusted lesions that are sunken in the centre, slightly raised at the edges, and may bleed intermittently.
As with basal cell carcinoma, the likelihood of the disease recurring is significantly higher in patients who have been diagnosed with squamous cell carcinoma.
Malignant Melanoma
As this type of cancer—which is the most common cause of death from skin cancer—can almost always be cured if detected at an early stage, it is extremely important to raise awareness of this disease.
It is known that ultraviolet rays influence the development of malignant melanoma through various mechanisms. These mechanisms include suppressing the skin’s immune system, increasing the division of melanocytes—the cells that give the skin its colour—increasing the production of harmful by-products of metabolism known as free radicals, and damaging the DNA of melanocytes.
In addition to ultraviolet radiation, viruses and certain chemicals also play a role in the development of malignant melanoma.
Malignant melanoma is a disease that particularly affects the white population; it is more common in people with fair or red hair, those with freckles, and those who burn very easily in the sun.
Furthermore, a history of severe sunburn, particularly during childhood (sunburn that heals with blistering), significantly increases the risk of malignant melanoma.
The incidence of malignant melanoma is on the rise both globally and in our country.
People with risk factors need to be particularly aware and vigilant regarding malignant melanoma. It should not be forgotten that every individual must, first and foremost, be their own doctor. The main risk factors include: the presence of moles that are changing in appearance; having more than 50 moles larger than 2 mm; a family history of malignant melanoma; a personal history of malignant melanoma; and the presence of congenital giant moles.
If any coloured lesion on the body becomes asymmetrical, if the edges of the lesion become irregular, if the lesion contains different shades of colour, if the lesion is large in diameter, or if the lesion is growing, this must be taken seriously. If one or more of these signs are observed, it is essential to consult a plastic surgeon without delay.
From a public health perspective, the most important duty of us doctors is to prevent people from contracting diseases, rather than simply treating them. For this reason, the primary aim of this article is to explain what needs to be done to protect against skin cancer. Let us briefly outline the preventive measures in bullet points:
- Avoid the sun between 10 am and 4 pm
- Avoid spending long periods in the sun to prevent a tan, and avoid sunburn
- Not using a sunbed
- Wearing sun-protective clothing (hats, sunglasses, etc.)
- Use broad-spectrum sunscreens with an SPF of at least 15 all year round
- At least an hour before going out in the sun, apply 2 tablespoons of sunscreen with an SPF of at least 30 to your whole body; reapply every 2 hours, and reapply immediately after swimming or excessive sweating
- It is essential to protect babies from the sun (sunscreen can be used on babies over 6 months old).
- Carrying out our own monthly body checks
- Have a full-body skin examination by a dermatologist or plastic surgeon once a year.
We must also point out that, unfortunately, due to the misconception in our country that ‘if a scalpel touches it, it becomes cancer’, many patients delay seeking treatment and only consult a doctor at much more advanced stages, even though their condition could have been detected at the earliest stage and successfully treated. This misconception, leading to the disease progressing, can unfortunately sometimes even result in the loss of our patient.
Treatment for skin cancers involves the surgical excision of the lesion or lesions with wide margins. In advanced forms of cancers that can spread, such as squamous cell carcinoma and malignant melanoma, it is necessary to remove not only the lesion but also the surrounding areas where the cancer has spread.
In the treatment of skin cancers, the most important step is, of course, the removal of the cancer. However, for the plastic surgeon, treating the patient both physically and psychologically by repairing the tissue defect resulting from tumour surgery in the most aesthetically pleasing way is just as important as the cancer surgery itself.
Due to the extensive nature of tissue defects resulting from cancer surgery, these defects are repaired by transferring tissue from an area adjacent to the defect or from a more distant part of the body. We refer to these repair procedures as ‘reconstruction’, and the term ‘reconstructive surgeon’ in our specialism derives from this. As this type of surgery requires both skilful tumour surgery and aesthetically pleasing, successful reconstructive surgery, the best outcomes are achieved when the treatment is carried out by surgeons with specialised knowledge and expertise in this field.