What Is Keratin Cancer and How Is It Treated?

Keratin is a tough, fibrous protein that forms the primary structural component of our skin, hair, and nails. While “keratin cancer” is not a formal medical term, it commonly refers to cancers that originate from keratinocytes, the most abundant cell type in the epidermis, the outermost layer of the skin. These cancers represent a significant portion of all skin cancer diagnoses.

Understanding Keratinocyte Skin Cancers

Keratinocytes are specialized cells making up approximately 90% of the epidermal skin cells. Their main function is to create a protective barrier against environmental damage, including harmful UV radiation, heat, and water loss. They continuously replenish from epidermal stem cells in the basal layer of the skin, differentiating as they migrate upwards. This differentiation involves producing keratin proteins, which provide strength and maintain the skin’s barrier function.

The two most common types of skin cancer arising from keratinocytes are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Basal cell carcinoma originates in the basal cells, the deepest layer of the epidermis, and is the most frequently diagnosed skin cancer. These cancers typically grow slowly and rarely spread to other parts of the body. Squamous cell carcinoma, the second most common type, develops from squamous cells, which are flat cells found in the outer part of the epidermis. While usually curable when detected early, SCC has a higher likelihood of growing deeper into the skin or spreading compared to BCC.

Recognizing Signs and Causes

Recognizing potential changes in the skin is important for early detection. Basal cell carcinomas often appear as a shiny, pearly, or translucent bump (skin-colored, pink, red, or brown to black, especially on darker skin tones). These bumps may have tiny visible blood vessels, or look like a persistent sore that bleeds, oozes, or crusts and does not heal, or heals and then reappears. They can also manifest as a flat, scar-like area that is white, yellow, or waxy, sometimes with poorly defined borders.

Squamous cell carcinomas typically present as a firm bump or a scaly sore. They can appear as thick, rough, scaly red patches that may crust or bleed, or as open sores that do not completely heal. Some SCCs may also resemble warts, or present as elevated growths with a central depression that may bleed. These growths can be itchy, painful, or cause no discomfort.

The primary cause of both basal cell and squamous cell carcinomas is repeated, unprotected exposure to ultraviolet (UV) radiation from sunlight and artificial sources like tanning beds. UV rays can damage the DNA within skin cells, leading to genetic changes that promote uncontrolled cell growth. Other risk factors include fair skin that freckles or burns easily, a history of sunburns, increasing age, and a weakened immune system. Individuals with a previous history of skin cancer also face an increased risk of developing new lesions.

Diagnosis and Treatment Approaches

The diagnostic process for keratinocyte skin cancers begins with a thorough visual examination by a dermatologist. If a suspicious lesion is identified, a biopsy is performed to confirm the diagnosis. Common biopsy techniques include shave, punch, or excisional biopsy. The tissue sample is then examined under a microscope by a dermatopathologist to identify cancer cells.

Treatment approaches for basal cell carcinoma and squamous cell carcinoma vary based on the cancer’s type, size, location, and the patient’s overall health. Surgical removal is a common primary treatment option. Mohs micrographic surgery is often used for high-risk tumors or those in sensitive areas, allowing for precise removal of cancerous tissue while preserving healthy skin. Other surgical methods include excisional surgery, which removes the tumor with a surrounding margin of healthy tissue, and curettage and electrodesiccation, where the cancer is scraped away and remaining cells are destroyed with an electric current.

Non-surgical treatments are also available, particularly for superficial or low-risk lesions. These include radiation therapy, topical creams applied directly to the skin, and photodynamic therapy, which involves applying a photosensitizing drug followed by exposure to a special light. For advanced cases, targeted therapy or immunotherapy may be considered, which work by specifically attacking cancer cells or boosting the body’s immune response against the cancer.

Prevention and Outlook

Preventing keratinocyte skin cancers largely revolves around minimizing exposure to harmful UV radiation. Seeking shade, especially during peak sun hours (typically 10 AM to 4 PM), is recommended. Wearing protective clothing (long-sleeved shirts, pants, wide-brimmed hats, UV-blocking sunglasses) provides a physical barrier against the sun’s rays. Regular use of broad-spectrum sunscreen with an SPF of 30 or higher is advised; apply it about 30 minutes before sun exposure and reapply every two hours, or more frequently after swimming or sweating. Avoiding tanning beds and sun lamps is important, as they emit UV radiation that increases skin cancer risk.

Early detection through regular skin self-examinations and annual professional skin checks by a dermatologist is important. Prompt identification and treatment of suspicious lesions can prevent the cancer from growing larger or spreading. The outlook for basal cell carcinoma and squamous cell carcinoma is generally very good, with high cure rates when detected and treated early. Basal cell carcinomas rarely spread and are almost always curable, while squamous cell carcinomas, though with a slightly higher chance of spreading, are still highly treatable. Ongoing follow-up is often necessary due to the risk of recurrence or developing new skin cancers.

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