Skin Cancer

What is skin cancer?

A skin cancer occurs on the skin when the cells in the skin become abnormal.

There are non-melanoma skin cancers which include basal cell carcinomas and squamous cell carcinomas and there are melanoma skin cancers. These are very common cancers and are often caused by long-term sun exposure over your lifetime. 2 in 3 Australians will have a skin cancer by the time they are 70.

Certain people are at increased risks of developing a skin cancer including cricketers, surfers, golfers, gardeners, those with fair skin and people who work outdoors.

The importance of skin checks

A skin check is important to detect early skin cancer lesions. This enables management of smaller lesions and easier lesions to control before they become more dangerous, requiring surgical excisions. Skin cancer has a high cure rate when it is detected early.

A diagnosis of skin cancers requires years of training and clinical experience. There are many different types of skin cancers and they can look very different. In addition to an examination, often a biopsy is also performed.

Skin self-examination

Knowing your own skin is very important. Examining your own skin on a 3-monthly basis puts you in a unique position to be able to very quickly detect any changes with your skin. Your dermatologist will explain how to do this and there are some useful sites (www.aad.org) to assist you in your self-examination. Photographs are also a great resource. It is very easy these days to take photographs on a small phone or digital camera. You can then use these to compare your skin to previous photographs that have been taken.

A self-skin examination is very important, particularly if you have fair hair or over the age of 65, or have a past history of a melanoma.

How do I prevent a skin cancer?

The best ways to help limit your risk of developing a skin cancer is sun protection and avoidance.

Wearing a broad-brimmed hat, sunglasses, protective tight-weaved clothing and choosing to sit in the shade are all very important. Sunscreens are also important. A high SPF sunscreen should be applied in generous amounts 20 minutes prior to going out in the sun. It is also advised that these are reapplied every 2-3 hours and also if you have been swimming or in contact with water.

Importantly, please note that a moisturiser which contains a sunscreen applied in the morning will likely not be able to protect you at lunchtime.

Types of Skin Cancer

• BASAL CELL CARCINOMA

Basal cell carcinomas (BCCs) are the most common type of skin cancer in Australia. There are multiple types of basal cell carcinomas and these include superficial, nodular and sclerosing variants. The type that you are diagnosed with is important, as this will dictate the type of treatment that is appropriate for you. These treatments can include both nonsurgical and surgical options. The non-surgical options include creams such as imiquimod (Aldara). If these are untreated, they grow slowly over a number of months or years, and gradually invade the skin and down deeper into the fat and nerves.

• SQUAMOUS CELL CARCINOMA

Squamous cell carcinomas (SCCs) are another variant of non-melanoma skin cancers. There are also different types of squamous cell carcinomas and these include superficial and deeper variants. Some of these will arise from sunspots or actinic keratoses. As with basal cell carcinomas, the variant of squamous cell carcinoma will determine the appropriate treatment available. Again, this can include both surgical and non-surgical options.

• MELANOMA

Melanoma is the fourth most common cancer in Australia. Its incidence is increasing and, if diagnosed early, has a good survival rate. Melanoma is associated with sunlight exposure including sun beds. Other risk factors for the development of melanoma include fair skin type and family or personal history of melanoma. Ways to detect a melanoma skin cancer early are by self-examination and also having a skin check with your dermatologist or general practitioner.

It is helpful to keep in mind the ABCDE rule of changing moles. This involves the following:

A   Asymmetry
B   Border irregularity
C   Contour variation
D   Diameter over 6mm
E   Evolving or enlarging or changing

How do you treat skin cancer?

NON-MELANOMA SKIN CANCER TREATMENT

Non-melanoma skin cancers can be treated both non-surgically and surgically, depending on the variant of the skin cancer. Information is obtained from a biopsy and includes information such as the depth of the skin cancer, the presence of pigmentation or small finger-like projections indicating a sclerosing-type. If the skin cancer is amenable then creams can be used and these include imiquimod (Aldara) and 5-fluorouracil (Efudix). These are suitable for more superficial skin cancers. Photodynamic therapy can also be used. This involves the use of a cream and a red light that activates the cream. The advantage of this option is its ease of administration and also cosmetic outcome. Some skin cancers need to be surgically removed. The size and type of skin cancer will determine the type of surgical procedure and this can include a flap repair. This involves moving skin from site to another in order to obtain a good cosmetic outcome.

MELANOMA SKIN CANCER TREATMENT

Melanoma skin cancers need to be excised for an early stage melanoma. The margin around the melanoma is smaller than for a more advanced melanoma. Sometimes, with advanced melanoma, other procedures may need to be performed including CT scans, blood tests, and examination of local lymph nodes to detect the extent of the melanoma and treatment options.