Roentgen-Ray Treatment of Skin Cancer

Abstract

Listen

Translate article

CANCER of the skin usually begins in abnormal tissue, such as a wart fissure, old scar, thickened skin, and from prolonged irritation due to dirt, dust, or wind. It is frequently found in elderly patients whose skin is thickened and in those individuals who have led lives exposed to the weather, as well as in persons living in rural districts who seldom use warm water and soap for cleansing purposes. If these pre-cancerous lesions are cured, no carcinoma will develop. Cancer of the skin is very often ignored as it causes very little discomfort. It is an appalling fact that four thousand deaths occur in the United States each year from skin cancer. I have noted with surprise that in certain rural communities skin cancer is permitted to reach the advanced stage before medical aid is sought. This is partly due to ignorance on the part of the patient who does not realize the gravity of the condition. This type of patient will treat a skin lesion with ointments and salves. He has no way of knowing that the irritating effect of such treatment aggravates his lesion. A few years ago I saw a patient with one-half of his face eaten away with carcinoma before he even consulted a physician. The case was so far advanced that it was impossible to do anything for him. If such cases are treated early, from 95 to 98 per cent can be cured permanently. Chronic irritation is recognized as probably the most important factor in the stimulation of abnormal cell growth. As the proliferation continues, the vitality of the part decreases and in the older center cells necroses and ulceration are produced. Ninety per cent of skin cancers develop on the face, neck, and hands. Areas not protected by clothing are especially vulnerable. About two-thirds are basal-cell type and one-third are squamous-cell carcinoma. Basal-cellcancer usually occurs in persons beyond middle age. It may begin as a papillomatous lesion, the so-called rodent ulcer which is slow in destruction of the surrounding tissues. The characteristic lesion is ulcerative, with a raised pearly border, and is common on the face, especially above the lip line. However, it may occur on the neck, arms, back, chest, legs, buttocks, and perineum. Basal-cell cancers seldom metastasize, but if they are of long standing, may develop to such an extent as to become incurable. Squamous-cell carcinoma is differentiated from the basal-cell carcinoma in that it forms prickle cells and epithelial cells with protoplasmic processes between them. There is a mixed cell type which has some basal and some squamous cells, which occurs in a small percentage of the cases. One method of grading malignancy of the skin cancer is based on the number of malignant cells or the amount of tumor cells as they approach the normal. As a rule, the more embryonic or lower cells present in the tumor or specimen, the quicker the response to radiation.