Prof. Indra Dev Sharma was our teacher in the Department of
Surgery in King George’s Medical College, Lucknow. He was the first qualified
Breast surgeon of Lucknow, trained in leading breast care centres of the U.S,
U.K, Sweden and Austria. He was responsible for sensitizing the state
government about the seriousness of early detection of cancers in the breast
and the government sanctioned a thermography unit to the Department of Surgery
on hos insistence. He got it installed in the Experimental Surgery building and
personally performed the investigation in all his patients. His training in
Karolinska Institute of Sweden and several other Breast units in Europe shaped
the researcher in him. His record keeping was meticulous and he regularly
published his work and presented them in national and international
conferences. He had 84 publications and was an extremely sought after thesis guide
because the research often got published. I remember he authored a chapter in
Recent Advances in Medical Thermology in 1984, when we were appearing for our
M.S examinations.
Dr. Sharma joined the Department of Surgery in 1973, became a
Reader in 1984. Though the clinical and research work in Surgical Oncology was
started by Prof. N.C. Misra long time back, but he was a member of the
undivided Department of Surgery, of which he was the Head of the Department
when he retired. The Department of Surgical Oncology was created by the
Government of Uttar Pradesh on 3rd September 1998 with Prof. ID Sharma as the
Head of Department. He remained at the helm of the department till his
retirement in January 2009.
After my M.Ch in Plastic Surgery he and Prof. Misra thought
that I should spend some time in Tata Memorial Hospital, Mumbai and learn
reconstructive oncology under Dr. Kavrana. The six months that I spent in TMH
was time extremely well spent because the volume of work was of a developing
country and the quality of work was world class. After returning from T.M.H I became a useful member of their team, doing all the reconstruction after they had done the surgical ablation.
Dr. Sharma belonged to a family of doctors. His father, Dr.
D.N. Sharma, an alumnus of KGMC, was at the helm of medical administration of
the state of Uttar Pradesh and his twin brother Prof. Vishnu Dev Sharma was
Professor of Orthopedics in KGMC. Both brothers were very mild mannered
gentlemen and they all lived as a joint family in Niralanagar opposite
Vivekananda Hospital.
Prof. Sharma had a very busy practice both at home and at
Neera Hospital. I had the privilege of assisting him in Neera Hospital for the
longest period of time. He was a very generous teacher and would let me operate
most of his cases. All his modified radical mastectomies were reconstructed by
me and we had a very large series of breast reconstruction patents which we
published in journals and presented in conferences. I did my first breast
augmentation, breast reduction and correction of breast ptosis in his patients.
We also operated oral cancers, skin cancers, soft tissue tumours and bone
tumours in Neera Hospital and he would keenly go through the Chemotherapy
journals and design his own chemotherapy programme for his patients because the
city had no medical oncologist then.
His clinic at home would attract patients from all over the
state, neighboring states and Nepal. Many of them would reach early in the
morning on working days and he could not deny them the early morning darshan.
This often resulted in him getting late in reaching the Surgery department in
the morning. On other days this would go unnoticed, but on Thursdays we had a
morning case conference in the New Surgical Block auditorium, and it was
attended by surgeons from all over the city – Balarampur Hospital, Civil
Hospital, Command Hospital, and all surgical departments. In this conference
his absence could be felt, so he devised an ingenious plan. He would come late,
slip into his room, which was next to the auditorium, change into his OT dress,
powder his hands and walk into the auditorium dusting his hands so that people
would get the impression that he was coming from O.T. His senior consultant in the Unit, Prof. G.P.
Agarwal knew all about this but he was a very kind hearted person and never
revealed his secret to anyone.
When the Government of Uttar Pradesh planned to establish a
Cancer Institute in Lucknow, Prof. I.D. Sharma was one of the advisors to the
government. He was decorated with many awards and two of them Vidya Ratan Award
and Guru Shreshtha Award come to my mind.
Prof. I.D. Sharma’s lectures were all very well planned. He
was never in the habit of confusing the MBBS students with unnecessary details.
He would teach exactly what was adequate for them, and no more. He would finish
his topic in 40 minutes and then revise it all ove again so that the message
was clear to everyone. Today, I have recovered my class notes on Early
Detection of Skin Cancers, which I am sharing with you all.
Although skin cancers that are detected early are almost
always curable, things can become a lot more serious when they evade detection,
to the point where they can become deadly. Here are 9 subtle signs of skin
cancer:
1.
Repeatedly getting a sore in the same place
A sore that doesn’t heal may be a sign of basal or squamous
cell carcinoma, which are the two most common types of skin cancer. They often
develop in the men’s beard areas and are associated with pain during shaving.
If such a sore hasn’t healed within a month, then you must visit a doctor.
2. Pearly
bump on the skin
Basal cell carcinomas can often look like unassuming “pearly
bumps”. They can be pink, red, white, tan, black or brown in color. Other signs
to look out for include irritated red spots, pink growths crusted, indented
centers; the aforementioned sores; and white, yellow, waxy areas that look like
scars.
3. A red,
scaly patch that just won’t quit
Both basal and squamous cell carcinomas can show up as scaly
red patches. Squamous cell carcinomas, in particular, can be a little tender to
the touch. Furthermore, both carcinomas can feel like “irregular sandpaper”
when touched. Squamous cell carcinomas can also present as sores that won’t
heal – wart-like growths or elevated growth with indented centers that bleed.
4. A
change in one of your moles
Although melanoma is less common than the other forms of
cancer, it’s by far the most lethal. It can show up either as a new sport, or
it can arise within an existing mole. Always be on the lookout for a mole that
has changed in size, shape or color. A suspicious mole can also be identified
by multiple or unusual colors, such as red, white, blue or black.
Use this acronym to track mole changes:
•
A stands
for asymmetry. In melanoma, two sides of a mole often don't match.
•
B stands
for borders. A melanoma usually has irregular borders, rather than clearly
defined ones.
•
C stands
for colour. Melanomas are usually uneven in color.
•
D stands
for diameter. An increase in a mole's size, or diameter, could indicate
melanoma.
•
E stands
for evolving. Watch out for moles that change over time.
5. Getting
a new mole after 55 years of age
It’s uncommon for new moles to grow once you’re over the age
of 55. If you’re over that age and experience a new one growing, be sure to
head to a surgeon to have it biopsied.
6. Moles
itching or bleeding for no apparent reason
If you have a mole that just starts bleeding without you
having any recollection of injuring yourself, or if it itches persistently,
then you should definitely get it checked. These should be biopsied.
7.
Suspicious spot on a part of your body not exposed to the sun
Melanomas can present on parts of the body that are almost
never exposed to the sun, and most people aren’t aware of this fact. Sun
exposure does, in fact, increase the risk of developing melanoma, however, it
can occur in the most surprising of places, such as a man’s penis or a woman’s
vulva. A melanoma can even present on the bottom of your foot. Make sure you
check your entire body when doing a skin check, including parts of it that
aren’t exposed.
The key to the successful treatment of skin cancer is to catch it early. Even if a spot you’re concerned about turns out to be benign, it’s much better to have it checked out early rather than waiting six months only to find that the matter is actually malignant.
Skin cancer starts when skin cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.
The cancer cells can invade and destroy healthy body tissue.
In time, cancer cells can break away and spread to other parts of the body.
When cancer spreads, it's called metastatic cancer.
Risk factors
Factors that may increase the risk of skin cancer include:
- Skin that
sunburns easily. Anyone of
any skin color can get skin cancer. But the risk is higher in people with
skin that sunburns easily. The risk of skin cancer also is higher in
people who have blond or red hair, light-colored eyes or freckles.
- Light from the
sun. Ultraviolet
(U.V) light from the sun increases the risk of skin cancer. Covering the
skin with clothes or sunblock / sunscreen can help lower the risk.
- Light from U.V.
Lamps. People who
use indoor tanning beds with U.V lamps have an increased risk of skin
cancer. The lights used in tanning beds give off harmful ultraviolet
light.
- A history of
sunburns. Having had
one or more sunburns that raised blisters increases the risk of developing
skin cancer. If the sunburns happened during childhood, they increase the
risk of getting skin cancer as an adult even more.
- A history of skin
cancer. People
who've had skin cancer once are much more likely to get it again.
- A family history
of skin cancer. If a blood
relative, such as a parent or sibling, had skin cancer, you may be more
likely to get skin cancer.
- Staying in Ozone
layer depleted zones.
The ozone layer prevents harmful wavelengths
of ultraviolet light from passing through the Earth's
atmosphere. In places like Australia and in the South Pole this layer is
depleated and so incidence of skin cancer are high
- A weakened immune system. If the body's germ-fighting
immune system is weakened by medicine or disease, there might be a higher
risk of skin cancer. Patients on Chemotherapy, Steroids etc. have
compromised immunity.
Prevention
Most skin cancers can be prevented by protecting oneself from
the sun. To lower the risk of skin cancer you can:
- Stay out of the
sun during the middle of the day. The sun's rays are strongest between about 10 a.m.
and 3 p.m. Plan outdoor activities at other times of the day. When
outside, stay in shade as much as possible.
- Wear sunscreen
year-round. Use a
broad-spectrum sunscreen even on cloudy days. Apply sunscreen generously.
Apply again every two hours, or more often if you're swimming or sweating.
- Wear protective
clothing. Wear dark,
tightly woven clothes that cover your arms and legs. Wear a wide-brimmed
hat that shades your face and ears. Don't forget sunglasses.
- Check your skin
often and report changes to your healthcare professional. Look at your skin often for new
growths. Look for changes in moles, freckles, bumps and birthmarks. Use
mirrors to check your face, neck, ears and scalp.
The most common skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma, with basal and squamous cell cancers being the most prevalent.
We will discuss about these three cancers in our subsequent classes.
With this Dr. I.D. Sharma’s class
ended. He took the next 10 minutes to revise all that he had taught that day
and then walked out towards his car.
