The skin is the body’s largest organ and lies at the interface between the athlete and the sports milieu. In this series, Nella Grilo discusses dermatological conditions pertinent to athletes, such as traumatic injuries, environmental insults, infections, precancerous lesions, and skin cancer. In part IV, she uncovers non-melanoma skin cancer.
Non-melanoma skin cancer comprises basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and a host of rare tumors. Non-melanoma skin cancer is the most common malignancy among Caucasians, and its incidence continues to rise annually. Approximately one in five Americans will develop skin cancer during their lifetime, and 97% of these cancers will be NMSC(1). Athletes are at exceptionally high risk due to countless hours spent training and competing outdoors with extensive exposure to damaging UV rays. While NMSC is typically less dangerous than melanoma skin cancer, it can still cause significant health problems if left untreated, and clinicians must recognize lesions early.
The primary cause of NMSC is exposure to ultraviolet (UV) radiation from the sun or tanning beds. When the skin is exposed to UV radiation, it can cause DNA damage to keratinocytes and suppression of the inflammatory response. Over time, this damage can accumulate, leading to mutations in the skin cells that can result in cancer. People living in areas with high levels of sunlight or a history of frequent sunburns are at a higher risk of developing this type of skin cancer. Other risk factors include having fair skin, a weakened immune system, a family history of skin cancer, and exposure to certain chemicals or radiation.
1. Actinic keratosis (AK) presents as small, rough, scaly patches. Multiple clinical and subclinical lesions co-exist across large areas of sun-exposed skin, resulting in field cancerization (see figure 1). Lesions require treatment because of their potential to transform into invasive squamous cell carcinoma. Depending on the condition’s severity and the patient’s medical history, several treatment options are available for actinic keratosis. For example:
• Clinicians typically use topical medications to treat actinic keratosis. These medications work by destroying the abnormal cells in the affected area, leading to the formation of new, healthy skin cells.
• Cryotherapy involves freezing the affected area with liquid nitrogen. This destroys the abnormal cells, causing them to slough off and be replaced with new, healthy skin cells. Cryotherapy is a quick and relatively painless procedure done in a doctor’s office.
• Clinicians scrape off the affected area with a sharp instrument (curettage) and then use an electric current to destroy any remaining abnormal cells (electrodesiccation). This procedure is usually done under local anesthesia and may leave a scar.
• Photodynamic therapy (PDT) involves applying a special photosensitizing agent to the affected area, followed by exposure to a light source. The abnormal cells absorb the photosensitizing agent, making them more light-sensitive. Then, when exposed to the light, the abnormal cells are destroyed, and new, healthy skin cells develop.
• Laser therapy involves using a high-intensity laser beam to destroy abnormal cells. This is usually done under local anesthesia and may require multiple treatments(2).
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