Skin Cancer
What is Skin Cancer?
Skin cancer is the uncontrolled growth of abnormal skin cells. It occurs when damaged skin cells do not replicate correctly during the normal course of repair.
These new irregular cells can trigger DNA mutations or genetic defects that multiply rapidly and form malignant tumors.
Who can Skin Cancer Affect?
Skin cancers account for around 80% of all newly diagnosed cancers. Approximately, 66% of Australians will be diagnosed with skin cancer, this almost three times the rate seen in the US or the UK.
Annually, over 750,000 people are treated for non-melanoma skin cancers in Australia. These non-melanoma skin cancers are twice as common in men.
Melanoma skin cancer affects over 12,000 Australians annually, it is the most common cancer among Australian between 15-44 years.
Types of the Skin Cancer
There are six types of skin cancer, these are:
- Actinic Keratoses
- Atypical Moles
- Basal Cell Carcinomas
- Squamous Cell Carcinoma
- Melanoma
- Merkel Cell Carcinoma
Actinic Keratoses
Actinic keratoses (AK) also called solar keratoses, are scaly, crusty growths (lesions) caused by damage from the sun’s ultraviolet (UV) rays.
They typically appear on sun-exposed areas such as the face, bald scalp, lips, and the back of the hands, and are often elevated, rough in texture, and resemble warts.
Most become red, but some will be tan, pink, and/or flesh-toned. If left untreated, up to ten percent of AKs develop into squamous cell carcinoma (SCC), the second most common form of skin cancer. In rarer instances, AKs may also turn into basal cell carcinomas (BCC), the most common form of skin cancer.
Atypical Moles
Atypical Moles are unusual-looking benign (noncancerous) moles, also known as dysplastic nevi (the plural of “nevus,” or mole). Atypical moles may resemble melanoma, and people who have them are at increased risk of developing melanoma in a mole or elsewhere on the body.
The higher the number of these moles someone has, the higher the risk. Those who have 10 or more have 12 times the risk of developing melanoma
compared with the general population.
Basal Cell Carcinomas
Basal Cell Carcinomas (BCC) are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars and are usually caused by a combination of cumulative and intense, occasional sun exposure.
Basal Cell Carcinomas almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening. It shouldn’t be taken lightly, though: it can be disfiguring if not treated promptly.
Basal Cell Carcinomas are the most common form of all cancers. It is also known as a non-melanoma skin cancer.
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis).
SCCs often look like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed. They can become disfiguring and sometimes deadly if allowed to grow.
SCC is mainly caused by cumulative exposure to the sun’s ultraviolet (UV) radiation over the course of a lifetime.
SCCs may occur on all areas of the body including the mucous membranes and genitals, but are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, balding scalp, neck, hands, arms and legs. Often the skin in these areas reveals telltale signs of sun damage, including wrinkles, pigment changes, freckles, “age spots,” loss of elasticity, and broken blood vessels.
Squamous cell carcinoma is also known as a non-melanoma skin cancer.
Melanoma
Melanoma is the most dangerous form of skin cancer, these cancerous growths develop when unrepaired DNA damage to skin cells triggers mutations (genetic defects) that lead the skin cells to multiply rapidly and form malignant tumors.
These tumors originate in the pigment-producing melanocytes in the basal layer of the epidermis. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white.
Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease.
If melanoma is recognized and treated early, it is almost always curable, but if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal.
While it is not the most common of the skin cancers, it causes the most deaths. Melanoma kills about one in six patients.
Merkel Cell Carcinoma
Merkel Cell Carcinoma (MCC) is a rare, aggressive skin cancer that is at high risk of recurring and spreading (metastasizing) throughout the body, with most recurrences taking place within two years after diagnosis of the primary tumor. While the disease very rare, it results in death in 30% of patients.
MCC most often arises on sun-exposed areas in fair-skinned individuals over age 50. Its name comes from the similarity of these cancer cells to normal Merkel cells in the skin that are thought to be associated with touch sensation.
Risk Factors for Skin Cancer
Every Australian is at risk of skin cancer, though the risk increases as you get older.
Prior Diagnosis
People who have had a skin cancer previously are at risk for developing others over the years, either in the same area or elsewhere on the body.
For these patients regular screening and full body mapping should be routine so that not only the site(s) previously treated are monitored, but the entire skin surface can be examined and compared for changes.
Skin cancers on the scalp and nose are especially troublesome, with recurrences typically taking place within the first two years following surgery.
Exposure to Sunshine
Both long-term sun exposure over your lifetime and occasional extended, intense exposure (typically leading to sunburn) combine to cause damage that can lead to skin cancer.
Almost all skin cancers occur on parts of the body excessively exposed to the sun — especially the face, ears, neck, scalp, shoulders, and back.
Age
The risk of skin cancer increases with age both as a result of cumulative sun exposure and the degenerative nature of aging.
The incidence increases for both males and females over 50 years old, but as the number of new cases has increased sharply each year in the last few decades, the average age of patients at onset has steadily decreased.
Genetic Factors
The tendency to develop can also be inherited, people who are at highest risk have the following genetic features:
- fair skin
- blond or red hair
- blue, green, or grey eyes
- family history of skin cancer
Rarer Factors
Skin tumors can develop
- contact with arsenic,
- exposure to radiation,
- open sores that resist healing,
- chronic inflammatory skin conditions, and
- complications of burns, scars, infections, vaccinations, or tattoos are contributing factors.
It is not possible to pinpoint a precise, single cause for a specific tumor, especially one found on a sun-protected area of the body.
The disease is rarely seen in children, but occasionally a teenager is affected.
Causes of Skin Cancer
The greatest causes of skin cancer is overexposure to ultraviolet (UV) radiation from the sun.
Sunburn
Sunburn causes 95% of melanomas, the most deadly form of skin cancer.
In Australia, on an average summer weekend, many people get sunburnt when they are taking part in watersports and activities at the beach or a pool, as well gardening or having a barbeque, etc.
Sunburn is also common on cooler or overcast days, as many people mistakenly believe UV radiation is not as strong. This is untrue – you can still be sunburnt when the temperature is cool.
Sun exposure that doesn't result in burning can still cause damage to skin cells and increase your risk of developing skin cancer. Evidence suggests that regular exposure to UV radiation year after year can also lead to skin cancer.
Skin Cancer Symptoms
Become familiar with the look of your skin, so you pick up any changes that might suggest a skin cancer.
Look for:
- any crusty, non-healing sores
- small lumps that are red, pale or pearly in colour
- new spots, freckles or any moles
- changing in thickness or shape over a period of weeks to months
- changing in colour, especially those dark brown to black, red or blue-black
Frequently, two or more of these features are present in one tumor.
In addition, skin cancers can resemble non cancerous skin conditions such as psoriasis or eczema. A trained melanographer or skin cancer specialist can decide for sure.
If you observe any of the warning signs or some other worrisome changes in your skin, consult your Cotton Tree immediately.
The sooner a skin cancer is identified and treated, the better your chance of avoiding surgery or, in the case of a serious melanoma or other skin cancer, potential disfigurement or even death.
It is also a good idea to talk to our doctors about your level of risk and for advice on early detection.
Screening for Skin Cancer
There is currently no formal screening program for skin cancers in Australia. It is recommended that people become familiar with their skin. If you notice any changes consult your doctor.
More information about early detection is available in Cancer Council's position statement on screening and early detection of skin cancer.
Diagnosis for Skin Cancer
It is important to check your skin regularly and check with your doctor if you notice any changes.
Your doctor may perform a biopsy (remove a small sample of tissue for examination under a microscope) or refer you to a specialist if he/she suspects a skin cancer.
Treatment for Skin Cancer
Skin cancers are almost always removed. In more advanced skin cancers, some of the surrounding tissue may also be removed to make sure that all of the cancerous cells have been taken out.
Common skin cancers can be treated with ointments or radiation therapy. They can also be removed with surgery (usually under a local anaesthetic), cryotherapy (using liquid nitrogen to rapidly freeze the cancer off), curettage (scraping) or cautery (burning).
For more detailed information about skin cancer please phone Cancer Council 13 11 20 or talk to your GP.
Treatment Team
Depending on your treatment, your treatment team may consist of a number of medical staff, such as:
- General Practitioner
- Dermatologist – a doctor who specialises in preventing, diagnosing and treating skin diseases
- Plastic Surgeon – trained in complex constructive techniques, including surgery if the cancer has spread
Prognosis for Skin Cancer
It is not possible for a doctor to predict the exact course of a disease. However, your doctor may give you the likely outcome of the disease. If detected early, most skin cancers are successfully treated.
In 2013, 2209 people died from skin cancer in Australia, 1617 from melanoma and 592 deaths from non-melanoma skin cancers.
The five-year relative survival rate for melanoma is 89% for Australian men and 94% for Australian women.
Skin Cancer Prevention
Protect your skin.
For best protection, we recommend a combination of sun protection measures:
- Slip on some sun-protective clothing – that covers as much skin as possible
- Slop on broad spectrum, water resistant SPF30+ sunscreen. Put it on 20 minutes before you go outdoors and every two hours afterwards. Sunscreen should never be used to extend the time you spend in the sun.
- Slap on a hat – that protects your face, head, neck and ears
- Seek shade
- Slide on some sunglasses – make sure they meet Australian standards.
Be extra cautious in the middle of the day when UV levels are most intense.
SunSmart UV Alert
The SunSmart UV Alert is reported in the weather section of daily newspapers and on the Bureau of Meteorology website. It can also be view on the Cancer Council Australia website, or as a free app on mobile devices.
Issued by the Bureau when they forecast a UV Index for the day of three or above, the SunSmart UV Alert identifies times during the day when sun protection will be needed.
Applying Sunscreen
Apply sunscreen liberally – at least a teaspoon for each limb, front and back of the body and half a teaspoon for the face, neck and ears. Most people don’t apply enough sunscreen resulting in only 50-80% of the protection stated on the product.
Sun Protection and Babies
Evidence suggests that childhood sun exposure contributes significantly to your lifetime risk of skin cancer. Cancer Council Australia recommends keeping babies out of the sun as much as possible for the first 12 months.
Where this is not possible, parents and carers should minimise exposure by:
- Planning the day’s activities outside the middle of the day when UV levels are most intense.
- Covering as much skin as possible with loose fitting clothes and wraps made from closely woven fabrics.
- Choosing a hat that protects the baby’s face, neck and ears.
- Making use of available shade or create shade for the pram, stroller or play area. The material should cast a dark shadow. The baby will still need to be protected from scattered and reflected UV radiation.
- Keeping an eye on the baby’s clothing, hat and shade to ensure they continue to be well-protected.
- Applying a broad spectrum, water resistant sunscreen to small areas of the skin that cannot be protected by clothing, such as the face, ears, neck and hands, remembering to reapply the sunscreen every two hours or more often it is wiped or washed off.
There is no evidence that using sunscreen on babies is harmful, although some babies may develop minor skin irritation. Try sunscreen milks or creams for sensitive skin which are less likely to irritate the skin. As with all products, use of any sunscreen should cease if any unusual reaction occurs.
