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Skin Cancer

Skin Cancer is the most common type of cancer in the world. There are several types of non-melonoma skin cancers (NMSC):

  • Basal Cell Carcinoma – occurs in the lower most part of the surface of your skin. It usually develops in skin areas exposed to the sun. This cancer is very slow growing and usually does not spread to other parts of the body. About 75% of skin cancers are diagnosed as basal cell carcinoma.
  • Squamous Cell Carcinoma – occurs in the top layer of skin. The cancer is also slow growing but left untreated could spread. Squamous cell carcinoma accounts for about 20% of diagnosed skin cancers.

To read about other, rarer types of skin cancer, visit the MacMillan Cancer Support website.

Malignant melanoma is the 5th most common human malignancy and the most significant form of skin cancer. Annually over 13,000 melanoma patients are diagnosed in the UK. It is now the second most common cancer in people under the age of 50.

Symptoms of non-melanoma skin cancers can include a lump or area of skin that does not heal. Squamous cell carcinoma may appear as a flat, scab-like lesion that does not heal. For melanoma look for a mole that is enlarging, particularly with irregular edges, multi-coloured or one that is asymmetrical, itchy, crusted or painful, bleeding or looking inflamed.

Causes of skin cancer:
• A family history of skin cancer
• Sun damaged skin
• Having very fair skin (easily sun burned)
• Regular use of sunbeds or sunlamps
• Excessive number of moles or freckles.

If you have a sore or discoloured patch of skin that does not heal within 4 weeks, you should seek medical attention. If diagnosed and treated early, skin cancer is one of the easiest cancers to cure.

Malignant melanoma, skin screening and early diagnosis

Of a total population of around 60 million people in the UK, 13,000 are diagnosed with malignant melanoma every year. Excluding the other much more common forms of skin cancer, the so called non melanoma cancers, malignant melanoma is the 5th most common cancer in the UK and the second most common in people under the age of 50. Although melanoma comprises only around 5% of all skin cancers, it is responsible for 75% of all deaths caused by skin cancer.

The great majority of melanomata of course develop in the skin, the most accessible human organ. A legitimate question one might ask; “why we do not screen the population for skin cancers, particularly malignant melanoma?”. The answer of course is in the numbers. If we exclude children under the age of 15 who have very little risk for skin cancer development and are still in the process of developing new moles, we would have around 52 million people to screen. With annual screening this would mean over 50 million visits every year which of course would take a lot of time and resources and would be rather ineffective in terms of cost benefit ratio. Therefore the best way of picking up melanomas early is for people to know the signs and go to their doctors if they have them. Public education is therefore essential to let people know who is at risk of developing melanoma and the signs to look for.

People at higher risk of melanoma:

  • Previous history of malignant melanoma
  • Family history of malignant melanoma
  • Numerous moles
  • Immuno-suppression therapy such as organ transplant patients
  • Fair skinned, lots of freckles, red hair
  • Repeated or severe episodes of sunburn particularly in childhood
  • Fair skinned people born in hot countries such as Australia or Israel
  • Excess sun exposure both at home and abroad
  • Sun bed use, particularly before the age of 35

The following people are at a much higher risk of melanoma.

  • Those with more than one melanoma
  • Those who have two family members with melanoma and many abnormal moles
  • Those who have three or more people in the family diagnosed with melanoma or pancreatic cancer
  • Those born with very large moles (bigger than 20cm)

What to look for:

  • An enlarging mole
  • Changing shape, particularly getting an irregular edge
  • Changing colour
  • Getting darker, being multi shaded
  • Asymmetry (the two halves not looking the same)
  • Itchy or painful
  • Crusted or bleeding
  • Looking inflamed

Moles of three or more shades of brown or black are particularly likely to be melanoma.
In men the most common site for melanoma is the back and in women the legs.
A dark area under the nail that is enlarging and is not due to trauma should also be checked by a doctor.

So what is the advice?

  • Make sure you are familiar with the normal appearance of your skin and any moles you have.
  • This is very important if you are fair skinned, have many moles or a tendency to freckle or burn in the sun. Get your partner to look at areas of skin that you can’t easily see. If you think you have a mole that could be melanoma, go to your GP.
  • Not all melanomas develop from a pre-existing mole. In fact according to various studies, only 15-50% of histopathological samples of malignant melanoma show evidence of a pre-existing mole. The majority of melanomata therefore develop as a melanoma. Multiple mole removal as a preventative measure therefore is not recommended and by the same token UV protection is important for the entire exposed skin and not just for the moles.

Some sun smart advice from Cancer Research UK:

  • Spend time in the shade between 11am and 3pm
  • Wear a t shirt, hat and sun glasses
  • Use sun screen with at least sun protective factor (SPF) of 15 of course the higher the SPF the better with good UVA protection ie. total block. The SPF number gives you the amount of protection for UVB. For UVA protection we have star rating of up to 5 on UK sunscreens. The minimum recommended is 4 stars. Symbol of a circle with letters UVA inside is a European mark indicating good UVA protection.

Checking skin cancers:

  • It is important to make a habit of checking your own skin and your partner’s including difficult areas such as the back.
  • If you find any changes see your GP.

What about Technology?
Standard computerised systems are now becoming available for full body automated skin examination, photography and detection of melanomata. Total body photography with Dermatoscopy (close-up examination of an individual skin lesion using a specialist high resolution device) increases diagnostic accuracy for follow up, especially for those who are at a higher risk of development of malignant melanoma. Comparing the images taken with those taken previously is proving to be a highly effective approach, allowing for early diagnosis and in turn reducing the number of surgical procedures. This technology is advancing rapidly and will be a very helpful tool, helping early diagnosis of malignant melanoma.

Article Written By:
Dr SM Khorshid, Consultant Dermatologist.
Find out more about Dr Khorshid here.

14/04/17
Dr Khorshid is delivering a lecture available to the public on 27 April 2017 at The Hartswood Hospital in Brentwood, Essex. This lecture will be based on moles and melanomas, screening and prevention. If you would like to learn more about common skin conditions and how to identify an abnormal mole then this lecture is for you! For further information regarding interesting dermatological cases and research in this field please read our weekly updates on this news page.

​19/04/17
The Sunnex Dermatology website has been updated! Please visit www.sunnex.org/ for further enquires.

06/05/17
Clear change in mole documented on mole analysis system. Confirmed as in situ malignant melanoma in a 44 year old female patient.
Find out more about moles and melanoma here.

21/06/17
The sun and your skin
Know your skin type!  Your skin type can describe your tanning and burning responses to natural sunlight. 


Photoaging can be defined as the characteristic changes to skin, induced by chronic UVA (ultraviolet A) and UVB (ultraviolet B) exposure. UVB rays are a primary mutagen that can penetrate through the epidermal layer (the outermost layer) of the skin, resulting in mutations. UVA rays on the other hand can penetrate into deeper layers of the skin. Sun burn, a form of an acute inflammatory response is due to the penetrative nature of UVB, whereas UVA is more responsible for skin ageing. However, it is important to note that both UVA and UVB exposure can cause long term photoageing.
Skin types 1&2 (skin prone to burning and rarely tanning) are at the greatest risk and photoageing signs may be noticeable around the age of 40. Some common signs of photoageing include:  Coarse/ fine wrinkling, yellow discolouration of skin, scarring, erythema (superficial reddening of the skin, usually in patches) and telangiectasia (widening of the venules cause red lines/ patterns on the skin).
 
Why do we need to use sunscreen?
 
Sunscreens are able to block UVA, UVB and visible light. There are two types of sun screens.

  1. Physical sunscreens contain titanium dioxide or zinc oxide and can reflect UV radiation. These are often more effective and protective against skin cancer.  Physical sunscreens are often more thick and opaque but rub off more easily and must be frequently reapplied.
  2. Chemical sunscreens absorb UV radiation. The sun protection factor (SPF) indicates the UVB photo protection in the sunscreen or in other words, is a measure of the fraction of sunburn producing UV rays that reach the skin.

 
How do you know which SPF to use?
 
If your skin is prone to burning after 10 minutes, applying SPF 15 would allow you to stay in the sun without burning for around 150 minutes. This is an estimate and usually depends on your skin type, the intensity of sunlight exposure and how much sun screen you apply. SPF 30 or higher is recommended for the majority of patients. 

References
 
https://www.badgerbalm.com/s-30-what-is-spf-sunscreen-sun-protection-factor.aspx
 
Dermatology at a glance- Mahbub M.U. Chowdhury, Runwani P. Katugampola, Andrew Y. Finlay
 

23/06/17
Photodynamic Therapy (PDT)
To learn more about PDT please visit this recommended website published by the British Association of Dermatologists. 

www.bad.org.uk/shared/get-file.ashx?id=1990&itemtype=document