Prevent and diagnose it early
Susan Biali, MD
Learn how to prevent skin cancer, and recognize the signs of melanoma, squamous cell carcinoma and basal cell carcinoma.
It’s National Skin Cancer Action Week from November 16 to 22. Most of us don’t think much about skin cancer, though it’s all too common. What seems like a harmless small growth has the potential to spread, and the effects can be devastating. Skin cancer is preventable, and unlike many cancers you may be able to recognise the first signs.
Melanoma, the most serious form of skin cancer, has a higher incidence in Australia than anywhere else in the world. According to the Melanoma Institute Australia, more than 12,500 Australians are diagnosed with melanoma every year. Skin cancer accounts for more than 80 per cent of all new cases of cancer diagnosed each year. And an estimated 434,000 Australians are treated for one or more non-melanoma skin cancers each year.
Before we discuss the most common types, here are some general risk factors that predispose people to skin cancer.
UV radiation in sunlight is the number one risk factor. The more lifetime sun exposure you have, the higher the risk.
If you have even one severe, blistering sunburn, it increases your risk. The most damaging sunburns happen in childhood, but adult burns are still risky. Even if your skin tans easily, tanning increases lifetime sun exposure and risk.
Artificial UV radiation is very damaging, particularly to younger people. Solariums produce stronger radiation than sunlight, and if used before age 35 the risk of skin cancer may be increased by up to 75 per cent. The World Health Organization has classified tanning beds as carcinogenic to humans, and the Cancer Council Australia recommends all state and territory governments commit to a complete ban on solariums.
Currently, the governments in New South Wales, South Australia, Victoria, the ACT and Queensland have announced forthcoming bans. In other states and territories: Tasmania bans those aged under 18 and people with very fair skin, Northern Territory solarium owners are strictly licensed and Western Australia has increased its safety provisions.
If you have light skin that burns easily or freckles, you are more vulnerable to developing skin cancer. Fair skin has less melanin pigment, which protects against UV radiation. People with blue or green eyes, or red or blonde hair, are also more at risk.
Exposure to radiation
If you have had radiation therapy for cancer, you have a greater likelihood of developing non-melanoma cancer in the area that was treated, even many years later.
The three most common types of skin cancer
Melanoma is a cancer of the melanocytes, the cells that give our skin its pigmentation. It can occur on any skin surface; in men it is often on the head or neck, or between the shoulders and hips, and in women it is often on the lower legs or between the shoulders and hips.
The darker your skin, the less likely you’ll get melanoma. When melanoma does occur in dark-skinned people, it shows up in more unusual places, such as under the toenails, on the palms or the soles of the feet.
Melanoma is the most dangerous of all skin cancers and spreads aggressively. Once it has spread beyond the skin, the potential for a cure drops dramatically.
Melanomas often develop out of existing moles, and if you have more than 50 “common” moles on your body, you are at increased risk and should have a doctor check your skin annually.
The first sign of melanoma is often a change in the shape, size, colour or texture of an existing mole. Please see the accompanying sidebar on the “ABCDE” approach to diagnosing melanoma.
2. Squamous cell carcinoma
This skin cancer is the most strongly linked to lifetime sun exposure and childhood overexposure. It can occur in both light- and dark-skinned people and most commonly is found in fair-skinned people in sun-exposed areas such as the head, face, ears, neck and backs of hands. In dark-skinned people it is more likely to occur in areas less exposed to the sun such as the legs and feet.
As fair-skinned people age, they often develop flat, scaly brown or red patches on sun-exposed areas such as their face and backs of hands. These growths, called actinic keratoses, can develop into squamous cell skin cancers and need to be watched closely.
Signs of a squamous cell cancer include a new hard spot or lump on your skin, often with a rough, scaly or crusty surface. It can also appear as a sore that won’t heal.
3. Basal cell carcinoma
Basal cell skin cancer is the most common skin cancer in fair-skinned people. It occurs primarily in sun-exposed areas, most commonly the face, but also on the scalp, ears, hands, shoulders and the back. It is the least dangerous skin cancer, as it rarely spreads to other parts of the body and usually only causes local damage as it grows.
This cancer often appears like a shiny, smooth lump or nodule. It may crust, itch, bleed and fail to heal.
Get to know your skin well so you will notice anything new. Do a regular skin self-exam of your entire body using a mirror. Whenever you see changes to an existing lesion or find a new one that’s acting differently or doesn’t heal, show it to your doctor.
How to protect yourself from skin cancer
The ABCDEs of melanoma warning signs
|A||asymmetry||the shape of one half of a mole no longer matches the other half|
|B||border irregularity||ragged or blurred edges; pigment spreading into surrounding skin|
|C||colour is uneven||new shades of black, brown, tan or other colours|
|D||diameter||the size of the mole increases; some tmelanomas are very small but most are larger than the head of a pencil eraser|
|E||evolving||the mole has changed in weeks or months|
Any time you have a mole that is changing, or a new mole that looks unusual or is growing quickly, show it to your medical doctor.