A Silent Epidemic Under the Sun

For this month of May we highlight skin cancer, a malignant transformation of skin cells, represents the most common form of cancer globally. With millions of new cases diagnosed annually, it poses a major public health challenge. Despite its high prevalence, awareness and preventive measures remain underutilized. Skin cancer is not just a cosmetic concern; it can lead to significant morbidity and even mortality, particularly when diagnosed late.

Classification and Characteristics
Skin cancer is broadly categorized into three primary types: Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and Melanoma. BCC, the most common but least aggressive, arises from basal cells of the epidermis. It often presents as a pearly nodule and rarely metastasizes, but can cause local tissue destruction. SCC originates from keratinocytes and is more likely to invade deeper tissues and spread, especially in immunocompromised individuals. The most serious form is melanoma, derived from melanocytes, which is highly invasive and prone to early metastasis. It is characterized by asymmetry, irregular borders, color variation, and progressive changes in size or shape—the hallmarks of the ABCDE criteria.

Etiology and Risk Factors
The principal environmental cause of skin cancer is excessive exposure to ultraviolet (UV) radiation, primarily from sunlight and artificial sources like tanning beds. Other risk factors include fair skin, a family or personal history of skin cancer, chronic sunburns, immunosuppressive states, and certain genetic syndromes such as xeroderma pigmentosum. Prolonged UV exposure causes DNA damage, which, if unrepaired, can lead to oncogene activation and tumor suppressor gene inactivation, culminating in carcinogenesis.

Diagnosis and Clinical Evaluation
Diagnosis begins with a thorough skin examination and the use of dermoscopy to evaluate suspicious lesions. Definitive diagnosis is achieved through skin biopsy, which provides histopathological confirmation. Clinicians must maintain a high index of suspicion, especially in patients with evolving skin lesions or those with risk factors.

Management and Treatment Options
Treatment strategies depend on the type, size, location, and stage of the tumor. Surgical excision remains the cornerstone of treatment for most skin cancers. Mohs micrographic surgery is especially effective for high-risk or facial lesions, offering tissue-sparing precision. Non-surgical options include radiation therapy, topical chemotherapeutics, and cryotherapy. Advanced melanomas may require systemic therapy, such as immunotherapy (e.g., checkpoint inhibitors) or targeted therapy for BRAF-mutant tumors.

Prevention and Public Health Implications
Preventive strategies are crucial to reduce the burden of skin cancer. These include sun protection behaviors, such as wearing broad-spectrum sunscreen, avoiding peak sun hours, wearing protective clothing, and avoiding indoor tanning. Public education campaigns and routine dermatologic screenings, particularly for high-risk groups, can greatly enhance early detection and improve outcomes.

Skin cancer, though preventable and often treatable in early stages, remains a significant cause of morbidity and mortality worldwide. Its rising incidence highlights the need for heightened awareness, effective preventive strategies, and timely medical intervention. As future clinicians and medical professionals, we must prioritize patient education, regular screenings, and a proactive approach to reduce the impact of this prevalent disease.