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Skin deep

by Simone McClenaughan | 09 Sep 2013

Australians are four times more likely to develop skin cancer than any other type of cancer, and two out of every three Aussies will develop it by the time they’re 70. It’s time to reduce your risks.

Skin cancer 101

Remember the good ol’ days when you spent the day at the beach, lathered up with baby oil to get the best bronzed skin? Many Australians hold these memories dear, and now they’re paying the price, with Australia having the highest skin cancer incidence in the world.

Accumulated unprotected exposure to ultraviolet (UV) radiation causes skin cancer, and the sun is the most common producer of these rays. “The older we are, the more time we have spent in the sun accumulating the damage to our cells that can develop into melanoma or other skin cancers,” says Rock.

There are two common types of skin cancer. Basal cell carcinoma (BCC) accounts for 70 per cent of skin cancers and tends to look like a pale or pink lump or scaly patch of skin. Squamous cell carcinoma (SCC) makes up the other 30 per cent and looks like a thick, red, scaly lump.

More than 430,000 Australians are treated for these two types of cancer each year. They tend not to be life threatening, however, it is possible for SCC to move to other parts of the body.

Then there is melanoma, which is the least common and the most dangerous. More than 11,500 cases of melanoma are diagnosed each year, causing more than 1540 deaths annually.

The best way to reduce your risk of all types of skin cancers is to cover up with long clothes, broad-brimmed hats and sunglasses, wear at least SPF30+ sunscreen, and stay in the shade during the middle part of the day when UV radiation levels are at their highest.

Melanoma 101

Melanomas are the types of skin cancer that you really have to be on the lookout for because they grow and spread quickly.

“Melanoma can penetrate lower into the skin until it reaches the blood vessels that transport it to other parts of the body such as the liver and brain,” explains

Vanessa Rock, Skin Cancer Prevention Manager at Cancer Council NSW.

Melanoma is an abnormal skin growth that develops from the pigment cells in your skin called melanocytes. Most melanomas are caused by ongoing exposure to UV rays and are most common in men over the age of 50.

“Men over the age of 50 are twice as likely to develop melanoma as women of the same age and are three times as likely to die from it,” warns Rock.

Besides colour and size, the other signs of melanoma are itching, bleeding, asymmetry, ragged edges and changes in a mole’s appearance. These are vital to look out for in skin checks, as the chances of successful treatment are much greater if melanoma is picked up early.

“Early detection and treatment is the key,” says Rock. “If melanoma is detected early and then removed surgically, the cure rate is high. If left unchecked, it’s likely to spread, which makes it harder to treat.”

Approximately 85 per cent of melanoma cases are treated successfully with surgery. Besides surgery, radiotherapy and chemotherapy may be used in some advanced cases. Radiotherapy may cause fatigue and localised burning and blistering, while chemotherapy may cause nausea, vomiting, fatigue and hair loss.

Tests

Skin cancers are initially detected via skin checks.  Evidence published in the Royal Australian College of General Practitioners’ (RACGP) Australian Family Physician journal (41.7, July 2012: 464-69) recommends doing a self-check every three months and getting checked by your doctor ever year if you have red hair, very fair skin and are over the age of 45, have a family or personal history of melanoma, and have lots of freckles or moles.

If you have blue eyes, relatively fair skin, are over 45 and have been sunburnt many times, then you should do a self-check every three to six months and see your doctor for a skin check every two years. Everyone else should check their skin annually, and everyone should take any concerns straight to a doctor.

“No matter who you are, if you’re worried about your skin or a potential skin cancer, visit your doctor immediately,” advises Dr Emily Farrell of the RACGP.  To make your self-checks work, it’s important to get to know what is and isn’t normal for your skin.  “While doing a skin-check, look for any changes to your skin or moles,” Dr Farrell says. “Taking digital photos can help you keep track. This way you have a record.”

When a doctor does check your skin, he or she will take a close look at your skin and discuss any concerns. “After doing a personal history run-through and checking if you have any concerns, your doctor will do a visual inspection with their naked eye,” explains Dr Farrell. “Then, if trained in using skin cancer detection aids such as a dermoscope, which is a special magnifying glass, your doctor will use that too. This is all non-invasive but he or she will need to see as much of your skin as possible, which will mean you’ll have to strip down to your underwear.”

Treatments

If something unusual catches your doctor’s eye, further assessments will be organised, such as a biopsy, where a sample of skin is taken. If the pathology comes back as cancerous, the lesion will be removed. In some cases, the biopsy may remove it all. However, if the cancer needs further removal, there are a number of ways this can be done.  It may be frozen off with liquid nitrogen in a technique called cryotherapy. This is generally done at the doctor’s surgery. The skin will be red, sore and blistered for a few days.

It may be cut out with minor surgery under a local anaesthetic or via another form of surgery, curettage and cautery, which is also performed under a local anaesthetic. The cancer is scooped out with a sharp spoon (a curette) and then an electric current (cautery) is applied to the area to kill any other dangerous cells. This may be quite sore for a few days afterwards. In some cases, the cancer can be treated with a special cream that is designed to destroy the cancerous cells.

In more severe cases where the cancer has penetrated the skin quite deeply, radiotherapy may be used to kill the tumour. Radiotherapy can leave the skin feeling burnt and very sore.

“Treatment depends on a number of factors such as the type and size of the cancer as well as its location.  Your GP will be able to determine which treatment is best for you,” says Rock.