SKIN CANCER AWARENESS

The opinions and views of Dr Dylan Naidoo

04-04-2011

The focus is on  MELANOMA,    “The killer moles”

AUTHOR: DR Dylan Naidoo, Specialist Dermatologist,

240 Manning road, Glenwood, Durban

Ph:031 2061020 Fax: 2061094

skindoctor@mwebbiz.co.za  for e mail questions, enquiries, appointments and emergency skin cancer and mole scanning appointments.

The problem:

Medical authorities are reporting an increasing incidence of skin cancers in South Africa.  It is an established fact that skin cancer can be diagnosed early and subsequently treated or surgically removed to result in complete cure from the cancer. 

Please note that prevention is better than treatment and cure.  The incidence of skin cancer and pre- cancer lesions increases especially after the age of 50.  The peak incidence is around 50-95 years of age.  At this stage in your life there is generally no surplus finance for the treatment and surgery for your cancers. All cancer treatments are very expensive.  Please prevent this future expenditure.  Some families and skin types have a higher incidence of skin cancers.  These families need to start skin checking and self examination at the age of 20.

Some skin cancers are locally invading diseases with a limited potential for spread to other organs and complete surgical removal can therefore guarantee a complete cure.  It is important to bear in mind the other skin cancers or melanoma skin cancer can spread to distant sites in the body if they are not diagnosed and treated at an early stage.  The incidence of melanoma skin cancers is steadily increasing, and most large studies suggest that in all parts of the world it is doubling over a ten-year period. 

The treatment options have not changed dramatically in the past 20 years, but the proportion of melanoma skin cancers in the early curable stages has increased. The increased early recognition and treatment of these cancers is the result of intensive public awareness campaigns. Doctors and other related medical personnel are trained to recognize the warning signs of early or established cancers.  This article seeks to inform the public about skin cancer, cancer prevention, early recognition of cancer and the treatment of skin cancer. 

How does one develop cancer?

There are genes present in the human body and human skin that are actively involved in the suppression of cancer development and the potential to form cancers. These cancer-suppressing genes undergo transformation and they lose their potential to suppress cancer development.  This is scientifically termed the inactivation or loss of cancer suppressor genes.  One of the genes identified by scientists is called the p53 cancer suppressor gene.  Various factors affect the behavior of these genes and these include the environmental factors, the depletion of the ozone layer and chemical agents like arsenic.  One of the established factors that contribute to cancer formation is sunlight.

Signs of chronic sun-damage that may lead to cancer:

Solar or actinic keratoses are the result of long-term exposure to sunlight seen especially in those people that have been outdoor workers or those who enjoyed recreational activities like sailing, surfing or simply tanning excessively. These are small scaly rough patches on the sun-exposed areas of the body. Some people may have numerous keratoses on their skins.  Some of these keratoses will develop into skin cancers

The 3 major types of skin cancer:

1.      Basal cell carcinomas  “or rodent ulcers”

They are also called rodent ulcers because of the manner in which they destroy the skin as the tumour spreads.  They are often raised above the surface of the skin and the raised area may have a shiny see-through appearance.  A crust may cover them and they bleed easily. If left unattended they will eventually form an ulcer.  They usually occur on the face but they are also found on other body surface areas.

2.      Squamous cell carcinomas                                                                                                                    These are usually hard, raised, pink or red tumours or red scaly  patches.  These cancers often occur on the sun-exposed surfaces of the body.

3.      Malignant Melanomas

These are usually small, brownish to blackish, multicolored slightly raised areas with an irregular outline.  They may form a crust or bleed on the surface.  Some of these cancers may arise from older moles or pigmented birthmarks or so called beauty spots. These are the most lethal of the skin cancers.

Education about cancers:

There is no doubt that education about cancers, and it’s prevention is the best way to eradicate death from skin cancer and the associated deformity or disfiguring scars arising from extensive cancer surgery if it is diagnosed too late.  The education programs must target the scholars so that skin safety is practiced from a very early age.  

“The best and most cost effective treatment of skin cancer is prevention  AND EARLY DETECTION AND SKIN EXAMINATIONS”

Advise to children: The main cause of skin cancers in fair skins is sunlight exposure. It has been scientifically proven that more than 80% of the sun-related damage to skin occurs before the age of 20.  It is NEVER too late to educate the high-risk people about how to prevent cancer ALTHOUGH 80% of the damage has been done. 

It is therefore imperative that the education programs are aimed primarily at the scholars.   Let them appreciate that a beautiful skin means a sun-protected skin.  The skin is a garment you have to respect because it is the only permanent cover you have to wear for life.  Take care of it and it will last the distance.  The most important tip is to protect yourself from direct sunlight especially if you are fair-skinned. 

Cancers that arise from chronic sun-exposure are usually more common in older people.  After the age of 60, people are generally unemployed and they are attending special government run clinics for those that cannot afford private care.  Generally these patients do not have money freely available and they have no access to medical aid schemes and private care.  They are usually attending clinics with limited budgets and these clinics usually attend to other life threatening medical disorders.  Skin care is the least of their priorities.   This predicament can be avoided.

Some important sayings for children and adults to learn:

“Kids cook quick”

“Fry now and pay later”

“Between 11 and 3 slip under a tree”

“Pick up a spade and plant some shade”

Which are the likely sites for the development of cancer ?

All sun-exposed areas

The face of those people 65 years and older

Females: especially the leg between the knee and ankle

Feet and  nails in the pigmented races 

Who are the high-risk groups ?

People with a fair complexion and a tendency to sunburn

Red haired, blonde haired and fair skinned people

Women with a tendency to freckle

People with a large number of “moles”  (naevi or birthmarks) on their body

Those who have had frequent severe sunburns

People with a past history of skin cancer

People with a family history of melanoma skin cancer

Frequent sunbathers and sun-bed tanners

Those with outdoor jobs

Those who enjoy sunny vacations without appropriate sun-protection

Those with marked freckling of upper half of the back

People who have experienced 3 or more blistering sunburns before the age of 20

Those who have had 3 or more years with outdoor summer jobs during the teen years

People with a history of excessive sun-exposure in the first ten years of life

History of severe sunburns in childhood and adolescence

Those who have principally indoor occupations with intermittent intense sun-exposure due to outdoor recreational habits

People of European decent who have spent time spent in a tropical and subtropical environment.

“Identifying the dangerous moles” or melanoma 

The following features are helpful in suspecting the development of a cancer:  

The changing mole, Rapidly growing mole

A strange, angry looking or bizarre mole suddenly noticed by close friend or partner  

Change in the shape of the mole  (the two halves of the mole do not match), Irregular border or margins of the mole.

Colour changes: The common safe mole has one colour usually a single shade of brown or black.  Suspect danger when there are uneven mixtures of red black brown and blue

Size changes: A sudden increase in size greater than 6 mm. The scaly, bleeding, painful or itchy mole. The mole that disappears with an irregular pattern.

Yearly mole checks, OR MOLE MAPPING

Those people with multiple moles or what is labeled medically as dysplastic naevi need yearly mole checks to be done by a doctor who monitors the behavior of the moles and then decides if the suspicious lesions need surgical removal.  This process can be assisted by photographic documentation AND SPECIAL MOLE MAPPING TECHNIQUES.

It is advisable to get a second opinion if your doctor makes the following statements:

“I am not sure but I don’t think this one is dangerous”

“This is the least of your problems”

“If it is not troubling you then leave it alone”

“Ah!  This is just another skin spot you are getting”

“It is a new beauty spot and I think it looks quite cute”

Remember !!

You are entitled to tell your doctor that you suspect that a mole has changed.

You are also entitled to ask your doctor if he is absolutely sure that it is not a cancer.

Who is trained to identify these cancers

General practitioners, Dermatologists,  Surgeons  Oncologists and some nurses with special training.

What about skin self-examination ?

                  “You know you skin best after all you are wearing it daily”. 

Skin self examinations are possible if you can search for the warning signs as detailed above.  A family member can also be trained to examine those lesions or moles that you cannot see directly (those on your back). 

SKINSAFE  Tips for your Summer Vacations  (For holiday makers and sun-lovers)

You are entitled to enjoy your holiday or summer vacation but  protect  and respect your skin. It is compulsory to wear a sunscreen lotion especially if you are fair-skinned. A sunscreen lotion SPF (Sun Protection Factor) 15 is adequate for your protection. If you are swimming or playing any form of water-sport then it is important that you reapply sunscreen lotion every 2 to 3 hours. 

Do not forget  the following sun protection essentials:

Umbrella,

A broad brimmed that must shade the face,

Spare sunscreens lotions,

Wear a shirt (thick cotton or denim) when you are out of the water,

Beware blistering sunburns, or sudden intense bursts of direct sunlight,

“Go to the beach early…..   then between 11 and 3  slip under a tree or umbrella……  and  then come out again after 3”.

REMEMBER THE FAMOUS SAYING:           SLIP……SLOP…..SLAP

Slip on a shirt (preferably thick cotton or denim)

Slop on some sunscreen (and not suntan lotion)

Slap on a hat (broad brimmed to shade the face)

Important technical information with respect to the proper treatment of skin cancers:

Every tumour has a depth of growth and a lateral margin of growth, therefore it must be removed completely. A trained doctor with surgical skills can only do this procedure.  Only a trained pathologist can decide whether the tumour has been completely removed, therefore every specimen has to be sent to the pathology laboratory to assess whether the cancer has been completely excised or whether the surgeon has to repeat surgery to completely remove the tumour.  This is done to prevent recurrence of the cancer.