About Skin Cancer

Cancer itself is a cell disease where abnormal cells multiply and form tumours. Cells are the body’s building blocks, constantly replacing old tissue.

Normally, cells multiply and die in an orderly manner, but sometimes abnormal cells persist and develop into cancer.

Benign tumours grow slowly and rarely spread, while malignant tumours invade nearby tissues and can spread through the bloodstream or lymph vessels. New cancer seeds that form elsewhere in the body from cancer spread are called metastases.

Basal cell carcinoma (BCC) is the most common skin cancer, accounting for approximately 66% of cases. It originates in the basal cells of the skin. BCC typically exhibits slow growth over months or even years, and rarely spreads to new sites in the body. However, if left untreated, some BCCs can erode deep into the skin, and surrounding tissue making treatment more difficult.

Squamous cell carcinoma (SCC) is the second most common skin cancer, making up 33% of cases. It originates in the squamous cells of the skin. SCCs have the potential to grow rapidly over a span of several weeks or months. If left untreated, SCC can become invasive, and spread to other parts of the body, particularly if they begin at special sites like the lips.

Melanoma which arises from melanocyte cells, comprises only 1-2% of all skin cancers. Melanoma is considered the most serious form of skin cancer due to its higher potential for spreading to other parts of the body, leading to serious illness and death. Because melanomas may have no symptoms initially, and may resemble harmless moles at a glance, early detection through specialist skin examination is essential.

• A spot that differs in appearance and texture compared to other spots on your skin.
• A spot that has undergone changes in size, shape, colour, or texture.
• A skin sore or ulcer that fails to heal within a few weeks.
• An itchy or bleeding skin sore

It is important not to ignore a skin lesion or mole that is changing. Seek medical advice for any skin lesion whose appearance is changing, or which is causing new symptoms.

UV radiation primarily originates from the sun, but it can also come from artificial sources like arc welders, glue curing lights (e.g., used for artificial nails), and tanning beds. In Australia, commercial use of tanning beds (solariums) has been banned due to the significant risk of developing skin cancer associated with their use.

Most regions in Australia have consistently high levels of UV radiation throughout the year. UV radiation is not visible or temperature dependent. It can result in sunburn, premature skin aging, and damage to skin cells, ultimately leading to skin cancer.

Sun damage to the skin may not always be immediately visible and can accumulate over time. Understanding how to protect your skin from the sun and prevent skin cancer is crucial.

• Having pale or freckled skin, especially if it is prone to burning rather than tanning.
• Having red or fair hair and light-coloured eyes (blue or green).
• Experiencing unprotected exposure to UV radiation, particularly in the form of intermittent intense sun exposure and sunburns, such as during weekends and holidays.
• Engaging in active tanning or using tanning beds (solariums).
• Working outdoors or being exposed to arsenic.
• Having a weakened immune system, which can result from conditions like leukemia or lymphoma or from using immunosuppressive medications (e.g., for rheumatoid arthritis, other autoimmune diseases, or organ transplants).
• Having numerous moles or moles with irregular shapes and uneven colours (dysplastic naevi).
• Having a previous history of skin cancer or a family history of the disease.
• Having certain skin conditions, such as sunspots. It’s worth noting that individuals with olive or very dark skin have a higher level of natural protection against UV radiation due to increased melanin production compared to those with fair skin. However, they can still develop skin cancer.

Australia has one of the highest rates of skin cancer globally. It is estimated that around two out of three Australians will receive a skin cancer diagnosis before reaching the age of 70. Non-melanoma skin cancer is the most frequently diagnosed cancer in Australia. Each year, over one million treatments are administered for non-melanoma skin cancers. While basal cell carcinoma (BCC) can develop in younger individuals, it is more commonly observed in those over the age of 40. Squamous cell carcinoma (SCC) primarily affects people over the age of 50.

Skin cancer is initially diagnosed visually by a dermatologist, who has years of experience in recognising the various forms of skin cancer. Your dermatologist will often use a specialised device called a dermatoscope (which uses magnification and polarised light) to aid in the initial diagnosis.

After a skin cancer has been identified, the diagnosis is often confirmed by a biopsy procedure. This is typically a simple procedure, performed under local anaesthetic. The biopsy involves taking a small sample of tissue from the abnormal area, or (for suspected melanomas) removal of the entire pigmented lesion.

The sample is sent to the lab, where it is examined under a microscope and the diagnosis is verified.

Treatments include

Cryotherapy

Cryotherapy uses liquid nitrogen to freeze sunspots and certain early non-melanoma skin cancers. The treatment may cause a temporary burning or stinging sensation that lasts for a few minutes. Afterwards, the treated area may be sore and appear red. A blister may develop within a day, followed by the formation of a crust on the wound a few days later followed by re-growth of new healthy skin.

Topical treatments

Topical treatments are medicated creams or gels that can be applied directly to the skin to treat certain skin spots and superficial skin cancers. These treatments are only used in specific cases, such as to treat patches of sunspots or non-melanoma skin cancers. They make the treated area red and irritated for a period of time as they work, and often come with a requirement to avoid UV exposure.

Surgery

The treatment of many skin cancers requires surgery. Skin cancer surgery is typically considered minor surgery, and can be completed as an oupatient, or as a day-case procedure.

During surgery, the doctor will surgically remove the cancerous tissue and close the wound using stitches, under local anaesthetic. For larger wounds, the doctor may perform a flap or graft procedure, using skin from another part of the body to cover the wound.

Mohs surgery is a specific type of surgery reserved for complex skin cancers on sensitive areas (nose, eyelids etc.) Mohs involves removing layers of cells and examining them under a microscope in real-time.

Curettage and electrodesiccation, also known as cautery, involve the removal of cancer using a small, sharp instrument called a curette, followed by the application of heat to stop bleeding and destroy any remaining cancer cells

Radiotherapy and Chemotherapy

More serious or more advanced skin cancers may need to be treated by a medical oncologist, a radiation oncologist, or a specialist cancer surgeon. A dermatologist is hihgly trained to identify the rare cases in which this more intensive form of treatment is needed.

Sun protection advice

• Cover up

Wear clothing that covers your shoulders, neck, arms, legs, and body. Opt for closely woven fabric or fabric with a high ultraviolet protection factor (UPF) rating in a dark colour.

• Wear a sun hat

Choose a hat that shades your face, neck, and ears, such as legionnaire, broad-brimmed, or bucket hats. Ensure that the hat meets the Australian Standard and has a close weave that doesn’t allow light to pass through. Note that baseball caps and sun visors do not provide sufficient protection.

• Use sunscreen

Use a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. Apply it 20 minutes before going outdoors and reapply every two hours after swimming, sweating, or any activity that may cause it to rub off. For an adult, the recommended amount is 1 teaspoon for each arm, each leg, the front and back of the body, and the face, neck, and ears – totalling 7 teaspoons of sunscreen for full-body coverage.

• Wear sunglasses

Wear sunglasses that meet the Australian Standard, preferably with a wraparound style. It’s important to protect both the eyes and the delicate skin around them. Sunglasses should be worn year-round.

• Seek shade

Utilise shade from trees, umbrellas, buildings, or any form of canopy. Remember that UV radiation can reflect off surfaces like concrete, water, sand, and snow, so shade alone may not provide complete protection. If you can see the sky through the shade, it means that the shade will not fully shield you from UV rays.

• Avoid Solariums

Refrain from using solariums, also known as tanning beds or sun lamps. These devices emit artificial UV radiation and are banned for commercial use in Australia.