1️⃣Basal Cell Carcinoma (BCC)
Overview
BCC is the most common human cancer and arises from basal cells of the epidermis. It is locally invasive but rarely metastasizes. Early detection ensures nearly 100% cure.
Causes & Risk Factors
● Chronic ultraviolet (UV-B) exposure
● Fair skin, light eyes, blonde/red hair
● Immunosuppression or transplant history
● Genetic syndromes (Gorlin, xeroderma pigmentosum)
● Ionizing radiation or arsenic exposure
Symptoms / Signs
● Pearly or translucent nodule with rolled edges
● Central ulcer (“rodent ulcer”)
● Non-healing crusted patch or scar-like lesion
● Usually on face, neck, scalp, or hands
Diagnosis & Investigations
● Dermatoscopy and skin biopsy (punch/shave/excisional).
● Histologic subtypes: nodular, superficial, infiltrative, morpheaform, micronodular.
● Imaging (CT/MRI) only for large or recurrent lesions.
Treatment
Prognosis & Follow-Up
Cure rate > 95 %. Recurrence ≈ 5 %. Dermatologic review every 6–12 months.
2️⃣Cutaneous Squamous Cell Carcinoma (cSCC)
Overview
Second most common skin cancer; arises from keratinocytes. Unlike BCC, it can metastasize to lymph nodes or distant sites if neglected.
Risk Factors
● UV exposure, chronic scars, burns, or ulcers
● Immunosuppression (transplant patients)
● HPV infection (esp. β-HPV)
● Tobacco / arsenic
Clinical Features
● Scaly, indurated papule or plaque
● May ulcerate or bleed
● Commonly on sun-exposed sites, lips, ears
Diagnosis & Staging
● Excisional or incisional biopsy.
● AJCC 8ᵗʰ TNM staging considers tumour thickness, perineural invasion, nodal status.
● Imaging (PET/CT) for high-risk or advanced cases.
Treatment
● Surgery: mainstay; 4–6 mm margin for low-risk, ≥ 1 cm for high-risk.
● Mohs surgery: for recurrent or facial lesions.
● Adjuvant RT: for positive margins or perineural spread.
● Systemic therapy:
o Cisplatin + 5-FU or Taxane for advanced disease.
o PD-1 inhibitors (Cemiplimab, Pembrolizumab) → ≈ 45–50% response.
Prognosis
Localized cure ≈ 90–95%; node-positive ≈ 60%; metastatic ≈ 30%.
3️⃣Melanoma (Cutaneous & Uveal)
Overview
Melanoma arises from melanocytes and is the deadliest skin cancer, yet curable when caught early. Uveal melanoma affects the eye but shares molecular pathways.
Risk Factors
● Intermittent intense UV exposure & sunburns
● Multiple or atypical moles
● Family history of melanoma (CDKN2A, BRAF mutations)
● Fair skin, light eyes
● Immunosuppression
Symptoms
Use ABCDE rule:
● A – Asymmetry
● B – Border irregularity
● C – Colour variation
● D – Diameter > 6 mm
● E – Evolving appearance
Uveal melanoma → blurred vision, floaters, pupil distortion.
Diagnosis & Work-up
● Excisional biopsy preferred.
● Breslow thickness and ulceration = prognostic keys.
● Sentinel node biopsy if > 0.8 mm or ulcerated.
● Molecular testing: BRAF, NRAS, KIT, GNAQ/GNA11 (uveal).
● PET-CT / MRI for staging.
Stage-Wise Treatment
Immunotherapy
● Anti-PD-1 (Pembrolizumab, Nivolumab) – 1L standard.
● Dual IO (Nivolumab + Ipilimumab) → ↑ CR rate (~ 20%).
Targeted Therapy
● BRAF V600E → Dabrafenib + Trametinib or Encorafenib + Binimetinib.
● KIT mutant → Imatinib.
● NRAS → Binimetinib.
● Uveal melanoma → Tebentafusp (T-cell receptor therapy) + IO.
Adjuvant / Neoadjuvant Immunotherapy
Now standard for Stage IIB–IV resected cases.
Surveillance & Prognosis
Stage 5-year Survival
Regular dermatology and PET/CT follow-up every 3–6 months.
4️⃣Merkel Cell Carcinoma (MCC)
Overview
An aggressive neuroendocrine skin cancer often linked to Merkel cell polyomavirus or chronic UV damage.
Risk Factors
● Age > 60 years
● Fair skin
● Immunosuppression
● Prior cancer or radiation
Clinical Clues
“AEIOU” mnemonic: Asymptomatic, Expanding rapidly, Immunosuppressed, Older than 50, UV-exposed site.
Diagnosis
● Biopsy with IHC (CK20 dot pattern, Synaptophysin+, Chromogranin+).
● PET/CT for staging.
Treatment
1. Surgery: Wide excision + sentinel node biopsy.
2. Adjuvant RT: Improves local control.
3. Systemic therapy: PD-1/PD-L1 inhibitors → Avelumab, Pembrolizumab (60% response).
4. Chemotherapy: Cisplatin + Etoposide for IO-ineligible.
5. Clinical trials: IO + radiation combos under study.
Prognosis
5-year OS ≈ 70% (localized), 40% (node+), 20% (distant). Regular PET/CT monitoring recommended.
5️⃣Primary Cutaneous Lymphomas (PCL)
Overview
A diverse group of lymphoid neoplasms confined to the skin at diagnosis. Most are T-cell origin (Cutaneous T-Cell Lymphoma – CTCL); others are B-cell.
Main Types
Diagnosis
● Skin biopsy + IHC (CD3, CD4, CD8, CD20, CD30, CD56) and flow cytometry.
● Staging via PET/CT and blood Sézary cell count.
Treatment Strategy
● Early stage: Skin-directed (topical steroids, phototherapy, RT).
● Advanced: Systemic Retinoids, HDAC inhibitors (Vorinostat, Romidepsin), Interferon-α.
● Targeted: Brentuximab (CD30+), Mogamulizumab (CCR4+).
● Allogeneic HSCT: Curative option for fit patients with advanced CTCL.
● Emerging: CAR-T and bispecific antibodies for CD30/CD19 skin lymphomas (early trials 2025).
Recent Advances (2024 – 2025)
● IO expansion → Cemiplimab and Pembrolizumab approved for metastatic BCC/SCC.
● Tebentafusp for uveal melanoma extends OS > 24 months.
● CAR-T for CTCL and Merkel cell carcinoma under trial.
● AI-based dermatoscopic tools improving early diagnosis.
● Combination IO + radiotherapy boosts response in advanced melanoma and MCC.
Our Expertise @ Coimbatore Cancer Clinic
● Advanced dermatoscopic evaluation and image-guided biopsy.
● Access to Imiquimod, Vismodegib, Pembrolizumab, BRAF/MEK inhibitors.
● Partnership with oculoplastic surgeons for uveal melanoma.
● PD-L1 testing and molecular profiling for targeted therapy selection.
● Multidisciplinary tumour board for complex or recurrent cases.
● Cosmetic reconstruction and rehabilitation post-excision.
When to Consult
Any non-healing ulcer, new pigmented mole, rapidly growing skin nodule, or bleeding
lesion that persists > 4 weeks should be evaluated by a qualified oncologist or
dermatologic surgeon.
FAQs
Is all skin cancer caused by sun exposure?
Mostly yes (UV radiation is major), but genetic and immune factors also contribute.
Can advanced skin cancer be treated without surgery?
Yes—modern immunotherapy and targeted agents achieve long-term control even in metastatic cases.
Does immunotherapy cause severe side effects?
Usually manageable and reversible with timely monitoring and steroids.
Are treatments available locally in India?
Yes – all standard and newer IO/TKI agents are accessible through national programs and our affiliated centres.
Disclaimer
Educational content only; not a substitute for personalised medical advice
