May is skin cancer awareness month and it is worth bearing in mind that the biggest cause of skin cancer is too much exposure to UV light from the sun or sunbeds. All skin cancers present differently, their spread is different and are managed differently. There are 2 main categories of Skin cancer, Malignant Melanoma and non-melanoma.
Malignant melanoma is the most dangerous of the two as it is more aggressive and spreads easily. It can arise from an existing mole or start as a new mole. It is very important to diagnose and manage this cancer by a dermatologist or oncologist as it is likely to spread rapidly and need further treatment than simple excision depending on the stage of the disease. It is therefore crucial for early accurate diagnosis and treatment. In the NHS, if your GP suspects a malignant melanoma, you will be referred via the 2 week-wait cancer referral pathway.
Signs to look out for in Melanoma
We often talk about the ABCDEs of melanoma and here’s a detailed explanation of this common acronym used to identify signs of early melanoma.
Asymmetry – if a line is drawn in the middle, the right half and left half should match like mirror images and if it does not, it is asymmetrical.
Border – The edge of a benign mole is smooth whereas a melanoma has irregular edges.
Colour – Benign skin lesion has a uniform colour, often brown but if it has several shades of brown or black or even red or blue then it is suspicious.
Dimension – Benign lesions are usually small so if it is more than 5mm diameter it should be examined by a doctor.
Evolving – Benign moles remain the same over time but if there is a change in colour or shape or it starts bleeding, itching or crusting then you should seek medical advice.
Those with multiple moles, freckles and previous history are at highest risk. Any suspicious lesions are referred to a GP with a special interest in dermatology or Consultant Dermatologist for examination with a dermatoscope to fully assess the lesion or take a biopsy before treatment planning.
Non-Melanoma Skin Cancers
The non-melanoma skin cancers are more common and comprise of two types, Basal Cell Carcinoma (BCC) or rodent ulcer and Squamous Cell Carcinoma (SCC).
Basal Cell Carcinoma (BCC)
In the UK, Basal Cell Carcinoma is the most common form of skin cancer. It often looks like open sores that do not heal, shiny bumps, raised lesions with central visible capillaries or a central crater and grows very slowly. It is commonly found in sun-exposed areas in the face, scalp, neck and upper back. If diagnosed early, it is easily excised but may reoccur at the same site, close by or elsewhere. The larger the lesion, the more extensive the excision and sometimes a skin graft may be necessary. Your GP can diagnose a BCC or if in doubt, refer you to a Consultant Dermatologist for biopsy and excision. As it is a slow-growing tumour, it is referred routinely on the NHS.
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is the second most common type of skin cancer in the UK. It may look like scaly red patches, non-healing open sores, or raised growths with central depression which may crust or bleed. Although it can occur at any site on the body, sun-exposed areas are more prone.
It grows quickly but less likely to spread than melanoma. It is more serious than a BCC as it has a risk of spreading to other parts if left untreated. If your GP suspects SCC, you will be referred via the 2 week-wait cancer referral pathway. In hospital, the lesion will be excised, and further treatment initiated if there is any local spread.
These appear benign but if left untreated it can potentially develop into squamous cell carcinoma.
Actinic Keratosis or solar keratosis is a scaly, crusty growth that may feel like sandpaper when you run your finger over it. Actinic keratosis can be itchy and is caused by chronic exposure to UV radiation. If Your GP can treat this condition or refer you to your local dermatologist.
These are funnels shaped growths resembling a tiny horn. This may have a squamous cell carcinoma at its base.
This appears like a patch of dry skin which is red or crusty often in the elderly which does not heal. This could be a type of Squamous cell carcinoma.
Sun Awareness week 6th – 12th May 2019
All of the lesions I have described above are associated with UV radiation damage to the skin. According to the British Association of Dermatologists (BAD), surveys continue to show that a large number of Brits are still getting sunburnt in the UK and abroad. It goes without saying that using a tan bed is bad news for your skin. Banned in other countries it allows a concentrated exposure of UV radiation to the skin of often young individuals who are not fully informed of the dangers of their use. Melanoma UK launched a petition in 2018 to request the UK government to ban commercial sunbeds but unfortunately, the Committee has closed this petition in January 2019.
Be Sun safe
Protect yourself from the sun by practising safe sun whatever your skin colour
Avoid midday sun exposure between 11 am and 3 pm
Wear sunglasses to protect your eye area
Wear a wide-brimmed hat
Wear comfortable clothing
Stay in the shade where possible
Wear sufficient sun protection with at least an SPF 30 and reapply every 2 hours
Never let your skin burn
The main types of radiation from the sun are UVA, UVB and UVC. The UVC is stopped by the atmosphere so only UVA and UVB reaches us. UVA is present all year round, can penetrate glass and reach deeper layers of the skin and cause skin ageing. UVB causes sunburn and is associated with skin cancer. Sunscreens can contain chemical or physical filters, and, in the UK, SPF number refers to the ‘sunburn protection factor’ against UVB and 30 is accepted as satisfactory. UVA protection is denoted by the star system. So, a UVA rating of 4 or 5 stars is preferred. ‘Broad spectrum’ refers to protection from both UVA and UVB radiation. In terms of quantity, ‘more is better’ according to the British Association of Dermatologists while being mindful that sand can amplify the radiation level by up to 17% and water up to 5%. As we do not apply a sufficient amount, it is better to reapply every 2 hours and especially after getting wet or towel drying.
What about Vitamin D?
The skin manufactures Vitamin D with UV radiation as dietary sources are low. Exposure of forearms and hands for short periods are sufficient for vitamin D synthesis however there is no guidance on how long this short period needs to be. Contrary to popular belief, prolonged exposure does not lead to excess production of Vitamin D, instead, excess Vitamin D is destroyed while the risk of skin cancer is increased. The National Institute for Health and Care Excellence (NICE) recommends that all adults should take a daily supplement of Vitamin D especially in the winter months and regular monitoring with blood tests is not recommended. The Scientific Advisory Committee on Nutrition (SACN) recommends a daily supplement of 400IU per day for all aged 4 years and above.
I have come across many aesthetic clinics offering mole removal, but do they know how to diagnose malignant or pre-malignant skin lesions accurately?
Only doctors and nurses with experience in dermatology can diagnose and advise you accordingly. At Skin Enhance Clinic, I offer CryoPen cryotherapy for benign lesions but only after careful examination and diagnosis. It is best to get the diagnosis correct before embarking on treatments as even us doctors get caught out by some lesions.