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มะเร็งไฝ Melanoma

เป็นมะเร็งผิวหนังชนิดหนึ่งที่แพร่กระจายเร็วมาก เกิดจากเซลล์สร้างสีผิว melanocyte การที่จะเข้าใจโรคนี้ท่านจะต้องเข้าใจโครงสร้างของผิวหนัง

โครงสร้างของผิวหนัง 

  • ผิวหนังเป็นอวัยวะที่ห่อหุ้มร่างกายทำหน้าที่ป้องกัน ความร้อน แสง การติดเชื้อ ควบคุมอุณหภูมิของร่างกาย และสร้างวิตามินดีผิวหนังประกอบด้วยเซลล์สองชั้น
  • ชั้น epidermis เป็นชั้นนอกสุดประกอบด้วยชั้นบนสุดเป็น squamous เซลล์รองลงมาได้แก่ basal cell โดยมี melanocyte อยู่ใต้ subcutaneous
  • ชั้น dermis เป็นชั้นที่อยู่ของต่อมขน ต่อมเหงื่อ ต่อมไขมัน หลอดเลือด
Melanocyte และ ไฝ Mole

melanocyte เป็นตัวสร้างสีผิว melanin เมื่อผิวถูกแสงทำให้สีผิวเข็มขึ้น ไฝเป็นกลุ่มของ melanocyte ที่อยู่รวมกันมักเกิดในช่วงอายุ 10-40 ปี อาจจะแบน หรือนูน สีอาจเป็นสีชมพู หรือสีน้ำตาล รูปร่างกลม หรือวงรีไฝมักจะไม่เปลี่ยนแปลงขนาดหรือสีตัดออกแล้วไม่กลับเป็นซ้ำ

Melamoma

เป็นมะเร็งที่เกิดจากเซลล์ melanocyte ที่แบ่งตัวนอกเหนือการควบคุมของร่างกาย ถ้าเกิดที่ผิวหนังเรียก cutaneous melanoma เกิดที่ตาเรียก ocular melanoma โดยทั่วไปเกิดบริเวณลำตัว ขา ถ้าคนผิวดำมักเกิดที่เล็บ โดยทั่วไปมะเร็งแพร่กระจายไปยังต่อมน้ำเหลืองและอาจพบที่อวัยวะอื่นๆได้เรียก metastasis melanoma

ปัจจัยเสี่ยงของการเกิดมะเร็ง

อาการของมะเร็งไฝ

อาการเริ่มแรกมักเริ่มเกิดการเปลี่ยนแปลง ขนาด สี รูปร่าง ขอบ บางรายอาจมีอาการคัน มีขุยหากเป็นมากขึ้นอาจมีการเปลี่ยนแปลงของความแข็ง หากพบมะเร็งเริ่มต้นการรักษาจะหายขาด แต่หากรุกลามเข้าใต้ผิวหนังมะเร็งอาจแพร่กระจายไปยังอวัยวะอื่น

Asymmetry

รูปร่างไม่สมดุล

Border

ขอบไม่เรียบ เป็นรอยขรุขระ

Color

มีการเปลี่ยนของสี

Diameter

ขนาดใหญ่ขึ้น

การวินิจฉัย

หากแพทย์สงสัยว่าไฝที่เห็นว่าจะเป็นมะเร็งแพทย์จะตัดก้อนนั้นส่งพยาธิแพทย์ตรวจด้วยกล้องจุลทัศน์ หากก้อนนั้นใหญ่มากแพทย์จะตัดเพียงบางส่วนส่งตรวจ ถ้าพบเซลล์มะเร็งแพทย์จะตรวจพิเศษเพิ่มเพื่อตรวจดูว่ามะเร็งแพร่กระจายไปยังอวัยวะอื่นหรือยัง

การรักษา

หลังจากวินิจฉัยและทราบการแพร่กระจายของโรคแพทย์จะวางแผนการรักษา ก่อนการรักษาควรจดบันทึกคำถามเพื่อถามแพทย์ดังตัวอย่าง

วิธีการรักษา

  1. การผ่าตัด เป็นการรักษามาตรฐานแพทย์จะพยายามตัดเนื้อร้ายออกให้หมดร่วมทั้งต่อมน้ำเหลืองที่ใกล้เนื้อร้าย ถ้ามะเร็งแพร่กระจายไปอวัยวะอื่นแพทย์จะให้การรักษาอย่างอื่น
  2. เคมีบำบัด เป็นการให้สารเคมีเพื่อฆ่าเซลล์มะเร็งโดยอาจเป็นยากินหรือยาฉีด
  3. รังสีรักษาเป็นการฆ่ามะเร็งเฉพาะที่โดยเฉพาะมะเร็งที่แพร่กระจายไปยังอวัยวะอื่น เช่น สมอง ปอด ตับ
  4. การสร้างภูมิคุ้มกัน อาจให้ภูมิโดยการฉีด เช่นการให้ interferon หรือ interleukin โดยการกระตุ้นให้ร่างกายสร้างภูมิขึ้นมาเช่นการฉีดวัคซีน

ผลข้างเคียงของการรักษา

  1. การผ่าตัด อาจทำให้เกิดแผลเป็นบางรายเกิด keloid การตัดต่อมน้ำเหลืองอาจทำให้ขาหรือแขนบวม
  2. เคมีบำบัด การให้เคมีบำบัดอาจให้เกิดโลหิตจาง ติดเชื้อง่าย หรือเลือดออกง่าย ผมร่วง
  3. รังสีรักษา ทำให้ผมบริเวณที่ฉายรังสีร่วง อาจมีอาการอ่อนเพลีย
  4. การสร้างภูมิคุ้มกัน อาจมีอาการปวดเมื่อตามตัวเบื่ออาหาร ท้องร่วง

Risk Factors

When you're told that you have skin cancer, it's natural to wonder what may have caused the disease. The main risk factor for skin cancer is exposure to sunlight (UV radiation), but there are also other risk factors. A risk factor is something that may increase the chance of getting a disease.

People with certain risk factors are more likely than others to develop skin cancer. Some risk factors vary for the different types of skin cancer.

Risks for Any Type of Skin Cancer

Studies have shown that the following are risk factors for the three most common types of skin cancer:

  • Sunlight: Sunlight is a source of UV radiation. It's the most important risk factor for any type of skin cancer. The sun's rays cause skin damage that can lead to cancer.
  • Severe, blistering sunburns: People who have had at least one severe, blistering sunburn are at increased risk of skin cancer. Although people who burn easily are more likely to have had sunburns as a child, sunburns during adulthood also increase the risk of skin cancer.
  • Lifetime sun exposure: The total amount of sun exposure over a lifetime is a risk factor for skin cancer.
  • Tanning: Although a tan slightly lowers the risk of sunburn, even people who tan well without sunburning have a higher risk of skin cancer because of more lifetime sun exposure.

Sunlight can be reflected by sand, water, snow, ice, and pavement. The sun's rays can get through clouds, windshields, windows, and light clothing.

In the United States, skin cancer is more common where the sun is strong. For example, more people in Texas than Minnesota get skin cancer. Also, the sun is stronger at higher elevations, such as in the mountains.

Doctors encourage people to limit their exposure to sunlight. See the Prevention section for ways to protect your skin from the sun.

  • Sunlamps and tanning booths: Artificial sources of UV radiation, such as sunlamps and tanning booths, can cause skin damage and skin cancer.  Health care providers strongly encourage people, especially young people, to avoid using sunlamps and tanning booths. The risk of skin cancer is greatly increased by using sunlamps and tanning booths before age 30.
  • Personal history: People who have had melanoma have an increased risk of developing other melanomas. Also, people who have had basal cell or squamous cell skin cancer have an increased risk of developing another skin cancer of any type.
  • Family history: Melanoma sometimes runs in families. Having two or more close relatives (mother, father, sister, brother, or child) who have had this disease is a risk factor for developing melanoma. Other types of skin cancer also sometimes run in families. Rarely, members of a family will have an inherited disorder, such as xeroderma pigmentosum or nevoid basal cell carcinoma syndrome, that makes the skin more sensitive to the sun and increases the risk of skin cancer.
  • Skin that burns easily: Having fair (pale) skin that burns in the sun easily, blue or gray eyes, red or blond hair, or many freckles increases the risk of skin cancer.
  • Certain medical conditions or medicines: Medical conditions or medicines (such as some antibiotics, hormones, or antidepressants) that make your skin more sensitive to the sun increase the risk of skin cancer. Also, medical conditions or medicines that suppress the immune systemincrease the risk of skin cancer.

Other Risk Factors for Melanoma

The following risk factors increase the risk of melanoma:

  • Dysplastic nevus: A dysplastic nevus is a type of mole that looks different from a common mole. A dysplastic nevus may be bigger than a common mole, and its color, surface, and border may be different. It's usually wider than a pea and may be longer than a peanut. A dysplastic nevus can have a mixture of several colors, from pink to dark brown. Usually, it's flat with a smooth, slightly scaly or pebbly surface, and it has an irregular edge that may fade into the surrounding skin. A dysplastic nevus is more likely than a common mole to turn into cancer. However, most do not change into melanoma. A doctor will remove a dysplastic nevus if it looks like it might have changed into melanoma.
  • More than 50 common moles: Usually, a common mole is smaller than a pea, has an even color (pink, tan, or brown), and is round or oval with a smooth surface. Having many common moles increases the risk of developing melanoma.

Other Risk Factors for Both Basal Cell and Squamous Cell Skin Cancers

The following risk factors increase the risk of basal cell and squamous cell skin cancers:

Other Risk Factors for Squamous Cell Cancer

The risk of squamous cell skin cancer is increased by the following:

  • Actinic keratosis: Actinic keratosis is a type of flat, scaly growth on the skin. It is most often found on areas exposed to the sun, especially the face and the backs of the hands. The growth may appear as a rough red or brown patch on the skin. It may also appear as cracking or peeling of the lower lip that does not heal. Without treatment, this scaly growth may turn into squamous cell skin cancer.
  • HPV (human papillomavirus): Certain types of HPV can infect the skin and may increase the risk of squamous cell skin cancer. These HPVs are different from the HPV types that cause cervical cancer and other cancers in the female and male genital areas.

Symptoms of Melanoma

Often the first sign of melanoma is a change in the shape, color, size, or feel of an existing mole. Melanoma may also appear as a new mole. Thinking of "ABCDE" can help you remember what to look for:

  • Asymmetry: The shape of one half does not match the other half.
  • Border that is irregular: The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
  • Color that is uneven: Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
  • Diameter: There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea (larger than 6 millimeters or about 1/4 inch).
  • Evolving: The mole has changed over the past few weeks or months.

Melanomas can vary greatly in how they look. Many show all of the ABCDE features. However, some may show changes or abnormal areas in only one or two of the ABCDE features.

In more advanced melanoma, the texture of the mole may change. The skin on the surface may break down and look scraped. It may become hard or lumpy. The surface may ooze or bleed. Sometimes the melanoma is itchy, tender, or painful.

This photo shows an asymmetic melanoma with irregular and scalloped borders. The color varies from gray to brown to black. The melanoma is about 1.2 centimeters. This photo shows a dysplastic nevus with an arrow pointing to a new black bump that was not there 18 months earlier. The black bump is a melanoma that is about 3 millimeters.

Symptoms of Basal Cell and Squamous Cell Skin Cancers

A change on the skin is the most common sign of skin cancer. This may be a new growth, a sore that doesn't heal, or a change in an old growth. Not all skin cancers look the same. Usually, skin cancer is not painful.

Common symptoms of basal cell or squamous cell skin cancer include:

A lump that is small, smooth, shiny, pale, or waxy A lump that is firm and red
A sore or lump that bleeds or develops a crust or a scab A flat red spot that is rough, dry, or scaly and may become itchy or tender
A red or brown patch that is rough and scaly  

Diagnosis

If you have a change on your skin, your doctor must find out whether or not the problem is from cancer. You may need to see a dermatologist, a doctor who has special training in the diagnosis and treatment of skin problems.

Your doctor will check the skin all over your body to see if other unusual growths are present.

If your doctor suspects that a spot on the skin is cancer, you may need a biopsy. For a biopsy, your doctor may remove all or part of the skin that does not look normal. The sample goes to a lab. Apathologist checks the sample under a microscope. Sometimes it's helpful for more than one pathologist to check the tissue for cancer cells.

You may have the biopsy in a doctor's office or as an outpatient in a clinic or hospital. You'll probably have local anesthesia.

There are four common types of skin biopsies:

  • Shave biopsy: The doctor uses a thin, sharp blade to shave off the abnormal growth
  • Punch biopsy: The doctor uses a sharp, hollow tool to remove a circle of tissue from the abnormal area
  • Incisional biopsy: The doctor uses a scalpel  to remove part of the growth
  • Excisional biopsy: The doctor uses a scalpel to remove the entire growth and some tissue around it. This type of biopsy is most commonly used for growths that appear to be melanoma.

You may want to ask your doctor these questions before having a biopsy:

  • Which type of biopsy do you suggest for me?
  • How will the biopsy be done?
  • Will I have to go to the hospital?
  • How long will it take? Will I be awake? Will it hurt?
  • Will the entire growth be removed?
  • Are there any risks? What are the chances of infection or bleeding after the biopsy?
  • Will there be a scar? If so, what will it look like?
  • How soon will I know the results?
  • If I do have cancer, who will talk with me about treatment?

 

Staging

If the biopsy shows that you have skin cancer, your doctor needs to learn the stage (extent) of the disease to help you choose the best treatment.

The stage is based on:

  • The size (width) of the growth
  • How deeply it has grown beneath the top layer of skin
  • Whether cancer cells have spread to nearby lymph nodes or to other parts of the body

When skin cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if skin cancer spreads to the lung, the cancer cells in the lung are actually skin cancer cells. The disease ismetastatic skin cancer, not lung cancer. For that reason, it's treated as skin cancer, not as lung cancer. Doctors sometimes call the new tumor "distant" disease.

Blood tests and an imaging test such as a chest x-ray, a CT scan, an MRI, or a PET scan may be used to check for the spread of skin cancer. For example, if a melanoma growth is thick, your doctor may order blood tests and an imaging test.

For squamous cell skin cancer or melanoma, the doctor will also check the lymph nodes near the cancer on the skin. If one or more lymph nodes near the skin cancer are enlarged (or if the lymph node looks enlarged on an imaging test), your doctor may use a thin needle to remove a sample of cells from the lymph node (fine-needle aspiration biopsy). A pathologist will check the sample for cancer cells.

Even if the nearby lymph nodes are not enlarged, the nodes may contain cancer cells. The stage is sometimes not known until after surgery to remove the growth and one or more nearby lymph nodes. For thick melanoma, surgeons may use a method called sentinel lymph node biopsy to remove the lymph node most likely to have cancer cells. Cancer cells may appear first in the sentinel node before spreading to other lymph nodes and other places in the body.

Stages of Melanoma

These are the stages of melanoma:

  • Stage 0: The melanoma involves only the top layer of skin. It is called melanoma in situ.
  • Stage I: The tumor is no more than 1 millimeter thick (about the width of the tip of a sharpened pencil.) The surface may appear broken down. Or, the tumor is between 1 and 2 millimeters thick, and the surface is not broken down.
  • Stage II: The tumor is between 1 and 2 millimeters thick, and the surface appears broken down. Or, the thickness of the tumor is more than 2 millimeters, and the surface may appear broken down.
  • Stage III: The melanoma cells have spread to at least one nearby lymph node. Or, the melanoma cells have spread from the original tumor to tissues nearby.
  • Stage IV: Cancer cells have spread to the lung or other organs, skin areas, or lymph nodes far away from the original growth. Melanoma commonly spreads to other parts of the skin, tissue under the skin, lymph nodes, and lungs. It can also spread to the liver, brain, bones, and other organs.

Stages of Other Skin Cancers

These are the stages of basal cell and squamous cell skin cancers:

  • Stage 0: The cancer involves only the top layer of skin. It is called carcinoma in situ. Bowen disease is an early form of squamous cell skin cancer. It usually looks like a reddish, scaly or thickened patch on the skin. If not treated, the cancer may grow deeper into the skin.
  • Stage I: The growth is as large as 2 centimeters wide (more than three-quarters of an inch or about the size of a peanut).
  • Stage II: The growth is larger than 2 centimeters wide.
  • Stage III: The cancer has invaded below the skin to cartilage, muscle, or bone. Or, cancer cells have spread to nearby lymph nodes. Cancer cells have not spread to other places in the body.
  • Stage IV: The cancer has spread to other places in the body. Basal cell cancer rarely spreads to other parts of the body, but squamous cell cancer sometimes spreads to lymph nodes and other organs.

Treatment

Surgery Chemotherapy Photodynamic Therapy Biological Therapy Radiation Therapy

Treatment for skin cancer depends on the type and stage of the disease, the size and place of the tumor, and your general health and medical history. In most cases, the goal of treatment is to remove or destroy the cancer completely. Most skin cancers can be cured if found and treated early.

Sometimes all of the skin cancer is removed during the biopsy. In such cases, no more treatment is needed.

If you do need more treatment, your doctor can describe your treatment choices and what to expect. You and your doctor can work together to develop a treatment plan that meets your needs.

Surgery is the usual treatment for people with skin cancer. In some cases, the doctor may suggestchemotherapyphotodynamic therapy, or radiation therapy. People with melanoma may also havebiological therapy.

You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat skin cancer include dermatologists and surgeons. Some people may also need a reconstructive or plastic surgeon.

People with advanced skin cancer may be referred to a medical oncologist or radiation oncologist. Your health care team may also include an oncology nurse, a social worker, and a registered dietitian.

Because skin cancer treatment may damage healthy cells and tissues, unwanted side effects sometimes occur. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person. Before treatment starts, your health care team will tell you about possible side effects and suggest ways to help you manage them.

Many skin cancers can be removed quickly and easily. But some people may need supportive care to control pain and other symptoms, to relieve the side effects of treatment, and to help them cope with the feelings that a diagnosis of cancer can bring. Information about such care is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping and from NCI's Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and at LiveHelp (https://livehelp.cancer.gov/).

You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. See the Taking Part in Cancer Research section.

You may want to ask your doctor these questions before you begin treatment:

  • What is the stage of the disease? Has the cancer spread? Do any lymph nodes or other organs show signs of cancer?
  • What are my treatment choices? Which do you suggest for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • Will there be a scar? Will I need a skin graft or plastic surgery?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities?
  • Would a research study (clinical trial) be a good choice for me?
  • How often should I have checkups?

Surgery

In general, the surgeon will remove the cancerous growth and some normal tissue around it. This reduces the chance that cancer cells will be left in the area.

There are several methods of surgery for skin cancer. The method your doctor uses depends mainly on the type of skin cancer, the size of the cancer, and where it was found on your body.

Your doctor can further describe these methods of surgery:

  • Excisional skin surgery: This is a common treatment to remove any type of skin cancer. After numbing the area of skin, the surgeon removes the growth (tumor) with a scalpel. The surgeon also removes a border (a margin) of normal skin around the growth. The margin of skin is examined under a microscope to be certain that all the cancer cells have been removed. The thickness of the margin depends on the size of the tumor.
  • Mohs surgery (also called Mohs micrographic surgery): This method is often used for basal cell and squamous cell skin cancers. After numbing the area of skin, a specially trained surgeon shaves away thin layers of the tumor. Each layer is examined under a microscope. The surgeon continues to shave away tissue until no cancer cells can be seen under the microscope. In this way, the surgeon can remove all the cancer and only a small bit of healthy tissue. Some people will have radiation therapy after Mohs surgery to make sure all of the cancer cells are destroyed.
  • Electrodesiccation and curettage: This method is often used to remove a small basal cell or squamous cell skin cancer. After the doctor numbs the area to be treated, the cancer is removed with a sharp tool shaped like a spoon (called a curette). The doctor then uses a needle-shaped electrode to send an electric current into the treated area to control bleeding and kill any cancer cells that may be left. This method is usually fast and simple. It may be performed up to three times to remove all of the cancer.
  • Cryosurgery: This method is an option for an early-stage or a very thin basal cell or squamous cell skin cancer. Cryosurgery is often used for people who are not able to have other types of surgery. The doctor applies liquid nitrogen (which is extremely cold) directly to the skin growth to freeze and kill the cancer cells. This treatment may cause swelling. It also may damage nerves, which can cause a loss of feeling in the damaged area. The NCI fact sheet Cryosurgery in Cancer Treatment has more information.

For people with cancer that has spread to the lymph nodes, the surgeon may remove some or all of the nearby lymph nodes. Additional treatment may be needed after surgery. See the Staging section for information about finding cancer in lymph nodes.

If a large area of tissue is removed, the surgeon may do a skin graft. The doctor uses skin from another part of the body to replace the skin that was removed. After numbing the area, the surgeon removes a patch of healthy skin from another part of the body, such as the upper thigh. The patch is then used to cover the area where skin cancer was removed. If you have a skin graft, you may have to take special care of the area until it heals.

The time it takes to heal after surgery is different for each person. You may have pain for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

Surgery nearly always leaves some type of scar. The size and color of the scar depend on the size of the cancer, the type of surgery, the color of your skin, and how your skin heals.

For any type of surgery, including skin grafts or reconstructive surgery, follow your doctor's advice on bathing, shaving, exercise, or other activities.

You may want to ask your doctor these questions before having surgery:

  • What kind of surgery do you recommend for me? Why?
  • Will you remove lymph nodes? Why?
  • Will I need a skin graft?
  • What will the scar look like? Can anything be done to help reduce the scar? Will I need plastic surgery or reconstructive surgery?
  • How will I feel after surgery?
  • If I have pain, how will you control it?
  • Will I need to stay in the hospital? If so, for how long?
  • Am I likely to have infection, swelling, blistering, or bleeding, or to get a scab where the cancer was removed?
  • Will I have any long-term side effects?

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Drugs for skin cancer can be given in many ways.

Put directly on the skin

A cream or lotion form of chemotherapy may be used to treat very thin, early-stage basal cell or squamous cell skin cancer (Bowen disease). It may also be used if there are several small skin cancers. The doctor will show you how to apply the cream or lotion to the skin one or two times a day for several weeks.

The cream or lotion contains a drug that kills cancer cells only in the top layer of the skin:

  • Fluorouracil (another name is 5-FU): This drug is used to treat early-stage basal cell and squamous cell cancers.
  • Imiquimod: This drug is used to treat early-stage basal cell cancer.

These drugs may cause your skin to turn red or swell. Your skin also may itch, ooze, or develop a rash. Your skin may be sore or sensitive to the sun after treatment. These skin changes usually go away after treatment is over.

A cream or lotion form of chemotherapy usually does not leave a scar. If healthy skin becomes too red or raw when the skin cancer is treated, your doctor may stop treatment.

Swallowed or injected

People with melanoma may receive chemotherapy by mouth or through a vein (intravenous). You may receive one or more drugs. The drugs enter the bloodstream and travel throughout the body.

If you have melanoma on an arm or leg, you may receive drugs directly into the bloodstream of that limb. The flow of blood to and from the limb is stopped for a while. This allows a high dose of drugs in the area with the melanoma. Most of the chemotherapy remains in that limb.

You may receive chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
  • Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.

You may want to read the NCI booklet Chemotherapy and You.

You may want to ask your doctor these questions about chemotherapy:

  • Why do I need this treatment?
  • Which drug or drugs will I have?
  • How do the drugs work?
  • Do I need to take special care when I put chemotherapy on my skin? What do I need to do? Will I be sensitive to the sun?
  • When will treatment start? When will it end?
  • Will I have any long-term side effects?

Photodynamic Therapy

Photodynamic therapy (PDT) uses a drug along with a special light source, such as a laser light, to kill cancer cells. PDT may be used to treat very thin, early-stage basal cell or squamous cell skin cancer (Bowen disease).

The drug is either rubbed into the skin or injected intravenously. The drug is absorbed by cancer cells. It stays in cancer cells longer than in normal cells. Several hours or days later, a special light is focused on the cancer. The drug becomes active and destroys the cancer cells.

The side effects of PDT are usually not serious. PDT may cause burning or stinging pain. It also may cause burns, swelling, or redness. It may scar healthy tissue near the growth. If you have PDT, you will need to avoid direct sunlight and bright indoor light for at least 6 weeks after treatment.

The NCI fact sheet Photodynamic Therapy for Cancer has more information.

You may want to ask your doctor these questions about PDT:

  • Will I need to stay in the hospital while the drug is in my body?
  • Will I need to have the treatment more than once?

Biological Therapy

Some people with advanced melanoma receive a drug called biological therapy. Biological therapy for melanoma is treatment that may improve the body's natural defense (immune system response) against cancer.

One drug for melanoma is interferon. It's injected intravenously (usually at a hospital or clinic) or injected under the skin (at home or in a doctor's office). Interferon can slow the growth of melanoma cells.

Another drug used for melanoma is interleukin-2. It's given intravenously. It can help the body destroy cancer cells. Interleukin-2 is usually given at the hospital.

Other drugs may be given at the same time to prevent side effects. The side effects differ with the drug used, and from person to person. Biological therapies commonly cause a rash or swelling. You may feel very tired during treatment. These drugs may also cause a headache, muscle aches, a fever, or weakness.

You may find it helpful to read the NCI booklet Biological Therapy. You may also wish to read the NCI fact sheet Biological Therapies for Cancer.

You may want to ask your doctor these questions about biological therapy:

  • What is the goal of treatment?
  • When will treatment start? When will it end?
  • Will I need to stay in the hospital for treatment? If so, how long will I be in the hospital?

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. The radiation comes from a large machine outside the body. It affects cells only in the treated area. You will go to a hospital or clinic several times for this treatment.

Radiation therapy is not a common treatment for skin cancer. But it may be used for skin cancer in areas where surgery could be difficult or leave a bad scar. For example, you may have radiation therapy if you have a growth on your eyelid, ear, or nose. Radiation therapy may also be used after surgery for squamous cell carcinoma that can't be completely removed or that has spread to the lymph nodes. And it may be used for melanoma that has spread to the lymph nodes, brain, bones, or other parts of the body.

Although radiation therapy is painless, it may cause other side effects. The side effects depend mainly on the dose of radiation and the part of your body that is treated. It's common for the skin in the treated area to become red, dry, tender, and itchy. Your health care team can suggest ways to relieve the side effects of radiation therapy.

You may find it helpful to read the NCI booklet Radiation Therapy and You.

You may want to ask your doctor these questions about radiation therapy:

  • How will I feel after treatment?
  • Am I likely to have infection, swelling, blistering, or bleeding after radiation therapy?
  • Will I get a scar on the treated area?
  • How should I take care of the treated area?

 

Follow-up Care

After treatment for skin cancer, you'll need regular checkups (such as every 3 to 6 months for the first year or two). Your doctor will monitor your recovery and check for any new skin cancers. Regular checkups help ensure that any changes in your health are noted and treated if needed.

During a checkup, you'll have a physical exam. People with melanoma may have x-rays, blood tests, and scans of the chest, liver, bones, and brain.

People who have had melanoma have an increased risk of developing a new melanoma, and people with basal or squamous cell skin cancers have a risk of developing another skin cancer of any type. It's a good idea to get in a routine for checking your skin for new growths or other changes. Keep in mind that changes are not a sure sign of skin cancer. Still, you should tell your doctor about any changes right away. You'll find a guide for checking your skin in the How To Check Your Skin section.

Follow your doctor's advice about how to reduce your risk of developing skin cancer again.

You may find it helpful to read the NCI booklet Facing Forward: Life After Cancer Treatment. You may also want to read the NCI fact sheet Follow-up Care After Cancer Treatment.

Prevention

People with skin cancer are at risk of developing another skin cancer. Limit your time in the sun and stay away from sunlamps and tanning booths. Keep in mind that getting a tan may increase your risk of developing another skin cancer.

The best way to prevent skin cancer is to protect yourself from the sun:

Sunscreen lotions may help prevent some skin cancers. It's important to use a broad-spectrum sunscreen lotion that filters both UVB and UVA radiation. But you still need to avoid the sun during the middle of the day and wear clothing to protect your skin.

 

   

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