AN OVERVIEW
Dr Jeet Garud MBBS, FRACGP, MMed(Skin Cancer)
Australia and New Zealand have the highest incidence of skin cancer in the world. 2 in 3 Australians will be diagnosed with skin cancer by the age of 70.Early detection and treatment is important. Currently there is no screening program me for skin cancer. However, it is important to check yourself regularly and get a skin check with your GP, skin cancer doctor or dermatologist if you have any concern or for high risk patients.
Risk Factors:
Anyone can get skin cancer, but people with certain characteristics are at higher risk-
- Fair skin that burns, freckles, reddens easily or gets painful in the sun Blue/green eyes, red or blonde hair.
- Large number of moles
- Family history of skin cancer
- Personal history of skin cancer
- Older age
- History of > 5 episodes of severe sunburn in the past, use of solariums
Causes of Skin cancer:
There are many causes of skin cancer, the most important being UV exposure.
Types of Skin cancer:
There are 3 main types of skin cancer: Basal Cell Carcinoma(BCC) Squamous Cell Carcinoma(SCC) Melanoma
Basal Cell Carcinoma.
Basal Cell Carcinomas (BCC) form 70 % of all non- melanoma skin cancers. They present as flat red patches with a little scale or small lumps that are pearly, red or pale. They tend to bleed at times and may have small areas of ulceration. BCCs rarely spread to other parts of the body, however, if left untreated they can get bigger and grow deeper into the skin making treatment more difficult.
Squamous Cell Carcinoma
Squamous Cell Carcinomas (SCC) make up the remaining 30% of NMSCs. They present as red scaly or crusty non-healing sores that grow quickly over weeks or months into a lump. If left untreated they can spread to other parts of the body. Bowens or SCC in situ is a type of SCC that involves only the very superficial layer of skin called epidermis. It presents as a red scaly patch. If left untreated it could progress to invasive SCC
Melanoma.
Melanomas present as changing moles, freckles or new spots on your body. They may appear uniform and normal looking moles in the early stages which could change size, shape or colour over several months. They usually exhibit the ABCDE criteria (Asymmetry, Border irregularity, Colour varigation, Diameter >6mm and Evolving/changing). Melanomas can meta stasise if not treated early( spread to other parts of the body such as the lymph nodes, lungs, brain and bones).Some melanomas lack pigment and could appear as a pink/red flat lesion or a nodular pink/red lesion that lacks the ABCDE criteria. It is very important to pick the nodular melanomas early as they grow rapidly and could meta stasise.
Diagnosis & Treatment.
Skin cancers are diagnosed by doing skin checks with a skin cancer doctor/GP or a dermatologist. Lesions are examined using a hand held magnifying device called dermatoscope. Sometimes it is not possible to distinguish between a skin cancer and a non-cancerous lesion on examination. In that case a biopsy is done where a small piece of tissue is taken under local anaesthesia and sent to a pathologist for examination.
Treatment
Surgical excision is the gold standard for management of most skin cancers. Some skin cancers can also be treated with radiotherapy, cryotherapy( liquid nitrogen), curettage( scraping), cautery(burning) and topical creams depending on the type and stage of presentation
Facts and figures
- Australia and New Zealand have the highest incidence of skin cancer in the world.
- 2 in 3 Australians will be diagnosed with skin cancer by the age of 70.
- Skin cancer can develop in young people but is more common in people over 40
- Skin cancer does not discriminate with age – you can develop skin cancer at any age. In 2019, there were 2,602 adults aged between 25-49 years diagnosed with melanoma.
- Having more than 5 sunburns doubles your risk of melanoma
- Melanoma if detected early has a survival rate of 99 %
- Melanoma is the most common cancer in young Australians between 20-39 years of age
- Melanoma is the second most common cancer in Australian Men after Prostate cancer. It is the 3rd most common cancer in Australian women after breast and colorectal cancer.
Outlook
Most skin cancers can be completely cured if picked up early before they have a chance to spread. The earlier the skin cancers are treated the better the chances of full recovery