Skin cancer

by DR GEORGIA PAGE MBBS, FRACGP, BSc (Biomedical)

Australia has one of the highest rates of skin cancer in the world
and accounts for 80% of all cancers. Two in three Australians will be diagnosed with skin cancer by the time they are 70. For this reason prevention and early detection is so important. Protecting yourself from the sun can reduce your risk of developing skin cancer and having regular skin checks means skin cancers can be found and treated early. 

Types of Skin Cancer 
There are 3 main types of Skin Cancer

  • Melanoma – is the most serious type of skin cancer. It is the third most common cancer diagnosis in Australia with 1 in 13 men and 1 in 21 women diagnosed in their lifetime. In can arise anywhere in the body – most commonly sun exposed areas such as the back, legs and face, however it can rarely occur in parts of the body where the sun doesn’t shine such as soles of your feet and between your toes. The first sign of melanoma can be a change in an existing mole or appearance of a new spot. This change could be an increase in size, shape, colour, itchy, bleeding or raised. Only 20–30% of melanomas come from a pre-existing mole which is why it is important for any new moles or lesions, especially in adulthood, need to be checked. If left untreated it can spread to other parts of the body. 
  • Squamous Cell Carcinoma (SCC) – Are more common than melanoma and are more likely to occur in people over the age of 50. They usually occur in sun exposed areas such as the head, neck, hands, forearms and lower legs. They can grow quickly over a few weeks or months and are often red, scaly and tender to touch. Although less likely to spread through the body compared to melanoma, some have the potential to spread to the lymph nodes. 
  • Basal Cell Carcinoma (BCC)– are the most common type of skin cancer but are the least dangerous and less likely to spread. They tend to grow a bit slower, in areas that get high sun exposure such as the head, face, neck, shoulders and back. They can appear as a pearly pink lumps that are sometimes itchy or bleed. 

Risk factors
The risk of skin cancer is increased with exposure to UV radiation. This risk is higher with;

  • Episodes of unprotected sun exposure
  • History of childhood sunburn or tanning 
  • Use of other sources of UV radiation such as solariums.

Some people are more susceptible to skin cancer than others and includes those with;

  • Skin types with a tendency to burn such as pale skin with freckles and light or red hair
  • Family history of melanoma, SCC or BCC. 
  • Previous history of skin cancer (those with a previous history of BCC or SCC have a 50% chance of having another one in the next 3 years) 
  • Low immune system.
  • Increased number of moles and freckles
  • Increasing age (more common in those over 50 however melanoma is the most commonly diagnosed cancer in the 15–29 age group). 
  • Male gender. 

Symptoms
If you have a spot or mole that is Sore, Changing, Abnormal or New (S.C.A.N your skin) please get it looked at by a doctor. 

  • Sore – scaly , itchy, tender, bleeding and doesn’t heal within 6 weeks
  • Changing – changing in size , shape and colour 
  • Abnormal – looks different and stands out to other spots and moles – ‘the ugly duckling’
  • New – any new mole or spot should be checked especially if you are over 40. 

Prevention
Protect your skin from UV radiation from the sun. Do you remember the ‘slip slop slap’ campaigns of the 80’s? Now skin cancer prevention campaigns have added a few more sun protection measures to make it the 5 S’s. 

  • Slip – on sun protecting clothing covering as much skin as possible
  • Slop on sunscreen (preferably water resistant , SPF 30) before you go outside in the sun and reapply regularly. This especially applies when UV levels are more intense in the middle of the day. 
  • Slap on a hat (with broad brim which covers your head, neck and ears) 
  • Seek Shade 
  • Slide on some sunglasses. 

Early detection – skin checks
Skin checks can be with done by your GP, skin cancer accredited doctor or dermatologist. If you are at higher risk of skin cancer you should have your skin checked at least every year. 

However let’s not forget self-skin checks. It is important to get to know your skin and what is normal for you. If you are at high risk of skin cancer you should ‘SCAN your skin’ every 3 months. As discussed previously look for any spots or moles that are Sore, Changing, Abnormal or New. Look out for that “ugly duckling” or stand out spot. Partners or friends can help too by looking at your back, back of neck, tops of ears and scalp. Don’t forget to look where the sun doesn’t shin such as the soles of feet, between toes and under toe nails. If you notice a change please see your doctor who will examine the lesion and if it looks suspicious will perform a biopsy or excision to confirm if it is a skin cancer. 

Treatment of skin cancer 
If you are diagnosed with a skin cancer, treatment depends on what type of skin cancer it is.

Non melanoma skin cancers such as BCC’s and SCC’s are usually excised or cut out. If it only affects the outer layers of the skin it could be removed using cryotherapy (liquid nitrogen to freeze the cancer off) or using a special cream. In larger or more difficult to treat skins cancers radiotherapy is sometimes used. 

Treatment of melanoma depends on what stage it is found. Early stage melanoma can be treated by removing it and the surrounding skin with a larger excision or cut. If it is a deeper melanoma and has spread to lymph nodes or other parts of the body treatment can include surgery, radiotherapy, targeted therapy and immunotherapy. 

Summary 
When it comes to skin cancer, prevention and early detection is so important. Protect yourself from the sun by following the 5 S’s – slip, slop, slap, seek and slide. ‘SCAN’ your skin frequently and if you notice a change in a mole or freckle , the appearance of a new spot, or a sore that hasn’t healed please see your doctor. If you are at high risk of skin cancer and have had a history of skin cancers you should have regular skin checks with a doctor. 

Resources 
www.scanyourskin.org/
www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/
check-for-signs-of-skin-cancer

Georgia enjoys all aspects of general practice and has been working at Your Family Doctors at Erina for the last 12 years. The practice has a fabulous team and they pride themselves on delivering good quality health care, with that special personal touch. For more information call 43654999, check the website www.yourfamilydoctors.com.au or like them on facebook. 

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