Thursday May 11, 2017
At London Doctors Clinic, our doctors are not only here to diagnose and treat diseases, but are able to advise on prevention and health education - two very important factors in the maintenance of good health! As part of Sun Awareness Week, we're helping raise awareness of skin cancer, and the risks associated with sun exposure...
To put the issue into perspective, we'll start with a little story:
Does the name Mack Horton sound familiar? You may recognise him from the news as an Olympic swimmer representing Australia. While winning a gold medal at Rio in the 400m men’s freestyle is certainly newsworthy, Mack was in the news for another reason – a cancer scare. One eagle-eyed fan had spotted that a mole on the swimmer’s chest appeared to be changing and advised him to get it checked. Luckily for Mack, this potentially life-saving advice meant that this mole – which did turn out to be a type of skin cancer – was surgically removed before it could cause any harm!
But we're not all fortunate to have millions of people monitoring our skin on our behalf! The first steps in skin cancer screening is educating yourself on what to look out for, and self-monitoring.
What Is Skin Cancer?
Cancer is a disease that involves a group of cells in the body that have mutated and have begun to start dividing uncontrollably. This unrestrained overgrowth of cells in cancer may lead to the formation of a tumour. The cancerous cells can come from any organ or body part; in the case of skin cancer, the cells come from one of the many layers of the skin.
The two broad groups of skin cancers are:
Melanoma is the least common type, with only 13,000 new cases a year in the UK. Unfortunately, it is also the most dangerous and carries the worse prognosis. Melanoma is a cancer of the melanocyte – the cell type that produces pigment and gives rise to skin colour. It usually presents as either a new mole or a change to a pre-existing mole.
Non-Melanoma Skin Cancers
Non-melanoma skin cancers are more common, with 100,000 new cases per year, and generally carry better outcomes than melanoma. Depending on which layer of skin the cancer resides in, they are divided into the two main sub-groups:
- Basal cell carcinoma (BCC)
- Squamous cell carcinoma (SCC).
BCCs represent 80% of non-melanoma skin cancers and are less severe. Both BCCs and SCCs can present in several different ways, and we will cover what to look out for later in this post.
How To Lower Your Risk of Skin Cancer
At this point, you may be wondering whether you are at risk of developing skin cancer. While skin cancer is the most common sort of cancer in the UK, there are many recognised risk factors that can be avoided.
There are a few factors that increase the risk of cancers in general. These are:
- Increased age
- Family history of cancer
- Skin type (people with fair skin tones are more at-risk than those with darker skin)
Obviously, you cannot change these! However, the main factor in skin cancer is one that you can do something about – sun exposure.
Exposure To Sun: UV Radiation
Sunlight naturally contains UV radiation which can damage skin cells, causing them to mutate and potentially become cancerous. Sustained sun exposure is an important factor to consider when looking at skin cancer risk.
Those who work in outdoor jobs, such as construction work, farming, and gardening, are at increased risk of developing this disease. Of course, it would be ridiculous to completely avoid the sun! Even from a medical perspective, enjoying the sunshine is necessary for healthy vitamin D production. However, it is important to enjoy spending time out in the sun responsibly and safely and especially take steps to avoid getting sunburn.
Those who work outside, for example in farming, are at an increased risk of developing skin cancer
Sun Safety Tips
The British Association of Dermatologists have published 5 top sun safety tips:
- Protect the skin with clothing, including a hat, t-shirt and UV protective sunglasses
- Spend time in the shade between 11am and 3pm, when it is most sunny
- Use a sunscreen of at least SPF 30 (SPF 50 for children or people with pale skin) which also has high UVA protection
- Keep babies and young children out of direct sunlight
- The British Association of Dermatologists also recommends that you tell your doctor about changes to a mole
These tips are particularly important for people with paler skin; fair-skinned people are at a higher risk of developing skin cancer. That’s not to say that dark-skinned people are not at risk – everyone should enjoy the sunshine responsibly!
Sunbeds and Skin Cancer
Another important step to take to reduce your cancer risk is to avoid tanning beds. While a golden tan is often associated with looking and feeling healthy, a sun tan does not protect your skin from the UV radiation found in sunlight and in tanning beds. Use of these beds is associated with an increased risk of all skin cancers, and in usage in under 35’s will double the lifetime risk of developing a melanoma.
What Does Skin Cancer Look Like?
The physical presentation of skin cancer depends on what sort of cancer is present.
BCCs and SCCs can appear in various different forms:
- Ulcers, etc.
They are particularly likely to develop on sun-exposed areas of the body, like the neck, shoulders, legs, and back. A new skin lump or sore – especially one that cracks, bleeds, or itches – that doesn’t heal within 4 weeks should be checked with your GP or private GP.
Melanomas are more likely to look like moles – either new ones or a change to a pre-existing one. Any moles displaying any of the following changes we would advise to have reviewed by a doctor:
- Changing shape or size
- Changing colour
- Itchy or sore
- Crusty or bleeding
Men are most likely to develop melanomas on their backs, while women are more likely to get them on their legs. You should book an appointment with your GP right away if you suspect that you have a melanoma.
If you're worried about a new or existing mole, it is best to seek advise from your GP
Skin Cancer Concerns: What Can A GP Do?
If you do see your GP about a possible skin cancer and your doctor shares your suspicion, you will be referred to a dermatologist – a specialist skin doctor. Most suspected skin cancer cases will require a biopsy, where a sample of the affected skin is taken to test for cancerous cells. If the test comes back as positive, treatment can be started. The exact treatment method will depend on the specific type of cancer that is present.
Treating Non-Melanoma Skin Cancers
For the vast majority of non-melanoma type cancers, treatment will involve surgical excision – where the cancer is surgically removed.
The outcomes for BCC treatment are excellent; this sort of cancer almost never spreads and there is no risk of death. Small BCCs may even be treated with topical creams, or freezing therapy.
SCCs are more concerning, although less common, than BCCs and do sometimes spread to nearby lymph nodes and other parts of the body. However, these can still be treated with combinations of surgery and radiotherapy or chemotherapy. Most people with BCCs and SCCs will be cured, and the surgery usually leaves little by way of permanent scarring.
Treating Melanoma Skin Cancer
Melanomas are more serious and difficult to treat than BCCs and SCCs, as they are more likely to spread to other parts of the body. Again, surgery is the main treatment option for this sort of cancer, with the possibility of additional radiotherapy or chemotherapy depending on the severity. While the outlook for melanoma depends on how much the cancer has spread, around 90% of people with melanoma will still be alive 10 years after their diagnosis.
Further Information and Support
While the statistics and treatment options around skin cancer can be quite confusing, it is important to remember that any difficult decisions that needs to be made will come with the advice of specialist doctors – no one is on their own! For more information on what you can do to stay safe in the sun and reduce your risk of skin cancer, check out the Cancer Research UK and British Association of Dermatologists websites. There you can also find more information on possible treatments.
If you are at all concerned about a suspicious-looking skin lesion - be it a pigmented mole, or a non-healing lesion - that you think may be skin cancer, do not hesitating in booking an appointment at any of our nine GP surgeries. As always, if you're looking to find a GP or London clinic, LDC is here for you.
By Ankit Mishra