Looking after your skin in the sun and skin cancer
15 July 2010
How skin damage occurs
When we exposure our skin to the sun, ultraviolet light causes damage to the genetic material in skin after just a few minutes. This DNA damage is repaired by the immune system.
However, repeated exposure, sunbathing, and sunburn; can lead to permanent damage that takes many years to become obvious. As we age, this is represented by: fine lines/wrinkles, flat pigmented ‘age spots’, scaly red ‘solar keratosis’ and skin cancer.
What causes Skin Cancer?
Skin cancer is due to a number of factors and the risk increases significantly in people with a fair skin, red hair, and history of sun-exposure. Burning in childhood and early adolescence may be a significant risk factor and we also see skin cancer develop in some families. The age of onset is typically after the age of 50-years. However, we increasingly see skin cancer in younger patients and in patients with signs of sun-damage and actinic keratosis.
Types of skin cancer
Skin cancer is becoming increasingly common in the UK. There are three main types:
Basal cell carcinoma (80%)
Basal Cell Carcinoma (BCC) is the most frequent type of skin cancer and frequently develops on the central face, chest/back and lower leg. It is a slow-growing type of skin cancer and does not normally spread to other body tissues or lymph glands. It usually presents as a small raised pearly nodule or a red plaque on the skin that may bleed or ulcerate. Whilst slow-growing, it can cause significant tissue destruction if left untreated. We always recommend treatment except in very elderly patients with small superficial tumors. Treatment depends on the site of the skin cancer and how deep it is in the skin. Superficial BCC's may be treated by topical creams, scraping (curettage), photodynamic therapy (PDT), or skin surgery. Deeper invasive BCC requires skin surgery or radiotherapy X-Ray treatment.
An example of variegated pigmentation in a carcinoma
Squamous cell carcinoma (15%)
This is more frequently seen in sites of high intensity sun exposure including the scalp, face, ears and back of the hands. It usually presents as a rapidly growing skin nodule that may bleed and ulcerate. Treatment is essential as the skin cancer can spread to lymph glands. Skin surgery or radiotherapy is normally recommended to remove the abnormal skin.
A melanoma on a persons toe.
Malignant melanoma (5%)
This is the most dangerous type of skin cancer and is due to the abnormal growth of pigmented cells called Melanocytes. Melanocytes produce brown pigment in the skin and are responsible for moles. When these cells grow abnormally they produce change in a pre-existing mole or development of a new mole that has irregular features. It is important to have any moles checked if they increase in size (more than 6mm in diameter), lose symmetry, change in colour (develop dark black pigment), or produce symptoms (redness, bleeding or itching). A mole scanner could be used to confirm or assist the diagnosis of skin Cancer by a consultant Dermatologists who are experts in diagnosing skin cancer.
An example of a skin cancer on a persons back.
Younger people are now victims of skin cancer.
Malignant melanoma is the now the second most common cause of death in the 25-35 year age group. Over 50% of patients referred to a dermatologist in the UK are for the diagnosis or treatment of a skin cancer. 1 in 20 people aged over 60 years now develop a non-melanoma skin cancer.
Most skin cancer is treatable if caught early
The good news is that most skin cancers can be treated if caught early. Protection and awareness of the sun can help you to stay cancer free.
Key advice to protect yourself and to avoid skin cancer:
- Protection from the sun is the best medicine, particularly when sun exposure accounts for more than 90 percent of all skin cancers.
- Avoid the sun as much as possible between 10 a.m. and 3 p.m.
- Wear sunscreen of at least SPF 15 year-round and a sunscreen of SPF 30 or higher if you are fair-skinned.
- For additional protection, wear wide-brimmed hats and clothing made of dark, tightly woven fabrics.
- Purchase sunscreens and sunglasses that block both UVA and UVB rays. Use SPF formula lip protectants.
- Be aware that sand, snow and water can reflect 85 percent of the sun's rays.
- And avoid getting a "base tan" using a tanning bed. There is no evidence that indoor tanning prevents sunburn. In fact, any change of skin color is a sign of damage and increases the risk of premature skin aging and skin cancer.
And finally:
- Regularly check for changes on your skin.
Skin cancer may appear as a growth that changes in color, size or shape. This is most often seen in warts, moles and birthmarks, but also can be associated with sores that do not heal.
Melanoma usually looks like a flat, brown or black mole that has irregular, uneven borders. It can develop in an existing mole or other mark on the skin, but often arises in an area of unmarked skin.
Growths may be lumpy or rounded, become crusty, ooze, or bleed. Look in areas of your body that get the most sun, such as your head, neck, back, chest, shoulders, arms and legs. Men tend to develop skin cancer on the neck and upper back, and women tend to develop it most on their legs. The most common site of all is the nose.
What to do if you see any unusual changes in your skin?
If you do notice changes in your skin, talk to your GP or ask to be referred to a skin specialist, a consultant Dermatologist. Once seen, a skin biopsy may be performed to determine if a growth is cancerous and to confirm a clear diagnosis and then plan your treatment. If Skin Cancer is discovered you will need guidance about what you should do next. Consultant Dermatologists are the experts best placed to advice you and guide you through the process of what is the correct treatment for your diagnosis.
Potential treatments could include:
Skin Cancer Surgery
Skin Cancer surgery is usually performed after injection of a local anaesthetic into the skin.
Topical Imiquinod Immunotherapy
Imiquinod can be used to treat superficial BCC's and works by stimulating the immune system to react and destroy abnormal pre-cancerous and cancerous skin cells. It is applied once daily for 5-days per week for a total of 6-weeks. Activation of the immune system produces a strong reaction in the skin causing redness, weeping and mild irritation.
Photodynamic Therapy (PDT)
Superficial BCC can be treated by a new technique called PDT. A special cream is applied to the skin cancer and left in contact for 3-hours under an occlusive plastic dressing. A special lamp with an intense red light is then applied to the area and the skin cancer cells are selectively destroyed. This is because the abnormal cells absorb the cream and convert it into a photoactive substance.
Radiotherapy X-Ray Therapy
Radiotherapy can be used in elderly patients or in extensive tumours that are not readily treated by other modalities.
The good news is that most skin cancers are treatable but early detection is the key.
About the author
Dr Russell Emerson - Consultant Dermatologist & Dermatological Surgeon FRCP, DM, MB ChB
Dr Emerson is Lead Skin Cancer Clinician for The Sussex Community Dermatology Service and was former Chair of the Sussex Skin Cancer Network. Dr Emerson is a recognised laser expert and lecturer in cosmetic dermatology. He is trained in all forms of non-surgical cosmetic procedures including dermal fillers, botulinum therapy, laser therapy, minor surgery and cancer surgery. Dr Emerson is also the founder of the Hove Skin Clinic a leading private Dermatology and Plastic surgery clinic in the South East of England.
Hove Skin clinic website: http://www.hoveskinclinic.co.uk/
Telephone number: (01273)719834 Fax: (01273) 733891
Email address:info@hoveskinclinic.co.uk
Hove Skin Clinic is providing a Mole Scanning service for YourDoc Medical Clients. Please go to YourDoc Medicals shop to purchase this service.
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Everyone on one side of my family has had moles removed, now my aunt is potentially very unwell. I am red headed, with freckles, very few moles - should I be extra vigilant? |
| Yes, there is an increased risk with a fair skin type. It is advisable to be extra vigilant and go and see your GP if you have any concerns. |
