Cover me! Understanding dermatology in Sports and Exercise Medicine – part IV

      2.   The presence of red, scaly patches on the skin characterizes Bowen’s disease. It is also known as squamous cell carcinoma in situ. Bowen’s disease also affects areas of the body exposed to the sun. The condition is more common in older individuals and those with a weakened immune system. The cause of Bowen’s disease is unclear, but it may be related to sun damage, chronic skin inflammation, and certain genetic factors. If left untreated, Bowen’s disease can progress to invasive squamous cell carcinoma, which can spread to other body parts and become life-threatening.

Treatment options for Bowen’s disease depend on the size, location, and severity of the lesion, as well as the patient’s overall health. Surgery is the most common treatment, as often it is a large, isolated lesion. However, clinicians can use all the treatment options mentioned for actinic keratosis.

      3.   Actinic cheilitis, or "Sailor’s Lip," is a precursor of SCC found on the lips. It is very similar to actinic keratosis as it is a premalignant lesion caused by chronic sun exposure. It is most common on the lower lip along the vermillion border. Given SCC on the lips is considered a high-risk form of skin cancer with an 11% chance of metastasis compared to 1% for other body locations, it is essential to recognize and appropriately manage these potentially malignant precursory lesions. Treatment options are the same as for actinic keratosis⁽³⁾. 

Non-Melanoma Skin Cancer

There are two main types of non-melanoma skin cancer; basal cell carcinoma and cutaneous squamous cell carcinoma. Basal cell carcinoma (BCC) is the most common malignancy overall, not just the most common skin malignancy, and the incidence is rising. It has low mortality but can cause significant morbidity primarily through local destruction. The interplay between environmental and patient-derived characteristics is linked to pathogenesis. It typically develops on skin areas exposed to the sun, such as the face, neck, and ears.

Moreover, BCC usually appears as a small, pearly, or flesh-colored bump that may bleed or form a scab. Several subtypes exist, but superficial spreading and nodular variants are the most common. It may also have visible blood vessels on the surface.

Basal cell carcinoma rarely spreads to other parts of the body but can cause damage to surrounding tissues if left untreated. There are multiple therapeutic modalities, and appropriate selection requires knowledge of complications, cosmetic outcomes, and recurrence rates⁽⁴⁾. The available data suggest that surgical methods remain the gold standard in BCC treatment, with Mohs micrographic surgery typically utilized for high-risk lesions. Alternate treatment options for appropriately selected primary low-risk lesions may include PDT, cryotherapy, topical imiquimod, and 5-FU. Radiotherapy is a suitable alternative to surgical methods for treatment in older patient populations. Electrodesiccation and curettage (ED&C) is a common primary treatment option for low-risk lesions. Furthermore, new hedgehog pathway inhibitors are promising for managing advanced BCC⁽⁵⁾. 

Cutaneous squamous cell carcinoma represents 20% of all skin cancers, resulting in one million cases in the United States annually. The lifetime risk of developing squamous cell carcinoma continues to increase annually and will likely continue to increase because of the aging population. It may appear as a scaly, red, or pink patch of skin, a raised bump with a central depression, or a wart-like growth. It can also form an ulcer that doesn’t heal. Cutaneous squamous cell carcinoma has a higher risk of spreading to other body parts than BCC, especially if left untreated. Most cutaneous squamous cell carcinoma is treated locally, with a subset leading to recurrence, metastasis, and death⁽⁶⁾.

Treatment options include surgical excision such as Mohs micrographic surgery. Surgery produces excellent cure rates and spares the maximal amount of tissue. Other modalities include electrodesiccation and curettage, cryosurgery, radiotherapy, topical medications, photodynamic therapy, and systemic therapy. Management and follow-up depend on individual lesions’ risk stratification⁽⁷⁾.

Table 1: Less common types of non-melanoma skin cancer

Conclusion

Non-melanoma skin cancer is almost entirely preventable if athletes take proper precautions against sun damage from early childhood. Athletes must protect their skin from the sun’s harmful rays, including wearing protective clothing, using sunscreen with a high SPF, and seeking shade during peak sun hours. Athletes should also monitor their skin for changes or irregularities and seek medical attention if they notice suspicious growths or lesions. Furthermore, clinicians should be aware of these precancerous and cancerous lesions, as early detection will significantly reduce the morbidity associated with these conditions. By taking proactive measures, athletes can reduce their risk of developing NMSC and stay healthy and active for years.

References

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2.      J Eur Acad Dermatol Venereol. 2014 Sep;28(9):1141-9

3.      J Eur Acad Dermatol Venereol. 2021 Apr;35(4):815-823

4.      Hematol Oncol Clin North Am. 2019 Feb;33(1):13-24

5.      Am J Clin Dermatol 2014 Jul;15(3):197-216

6.      Hematol Oncol Clin North Am. 2019 Feb;33(1):1-12

7.      Int J Dermatol. 2015 Feb;54(2):130-40