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OVERVIEW

image SUMMARY

  • Skin cancer is the most common cancer worldwide. Genetic predispositions, chemical carcinogens, and environmental factors can all contribute to the development of skin cancer.

image DON’T FORGET

  • Diseases such as xerodermapigmentosum, Gorlin syndrome, familial atypical multiple mole melanoma syndrome, albinism, epidermodysplasia verruciformis, bowenoid papulosis, discoid lupus erythematosus, and chronic inflammation have been associated with skin cancer.

  • Chemical carcinogens such as arsenic, creosote, cigarette smoke, and psoralen plus ultraviolet light A (PUVA) lead to an increased chance of developing skin cancer.

  • Environmental and artificial exposure to UV radiation is a leading cause of skin cancer.

image CLINICAL PEARLS

  • Genetic predispositions, if suspected, should be addressed early on. Patients with a family history of skin cancer should be checked periodically.

image PATIENT EDUCATION POINTS

  • Patients should be educated on proper sun protection methods, especially those patients with fair skin and light eyes. However, all skin types are prone to the deleterious effects of UV exposure, and thus patients should be counseled properly on daily sunscreen use.

  • Patients with occupational exposure should be counseled on safety measures to avoid cumulative contact. Risks should be evaluated in a timely manner, especially if they present with other underlying conditions.

INTRODUCTION

Skin cancer is the most commonly diagnosed cancer in the United States,1 and one of every three cancers diagnosed globally is skin cancer, according to the World Health Organization. Although the majority of reported skin cancers are melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC), there are a variety of other skin cancers that have equal importance. Genetic predispositions exist for skin cancer, but most are caused by environmental factors that can be modified, such as ultraviolet (UV) exposure from sun or tanning booths or the use of barrier contraceptives during sexual intercourse to modify the risk for SCC of the genital area. Skin cancer is also a well-documented consequence in organ transplant patients.2

This chapter will outline the etiologies of skin cancer. From molecular genetics to environmental triggers, different pathogeneses can result in the same malignancy. Diseases, chemical carcinogens, occupational exposures, and environmental factors are listed in Table 4-1. Being aware of the variety of exposures and family histories can help clinicians make earlier diagnoses and decrease the morbidity and mortality of skin cancer for their patients.

TABLE 4-1Etiology of Skin Cancer Listed by Diseases or Disorders, Chemical and Occupational Carcinogens, and Environmental and Lifestyle Factors

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