Health + Advice

Skin cancer – what is it all about?

What is skin cancer?
Skin cancer is any rapid, uncontrolled, and abnormal growth on the surface and just under the surface of the skin.

What types of skin cancer are there?
• Actinic Keratosis (AK) – precancerous
• Basal cell carcinoma (BCC or rodent ulcer)
• Squamous cell carcinoma (SCC)
• Melanoma

Do all skin cancers spread to other parts of the body?
No. Whilst melanoma and squamous cell carcinoma can end up as secondaries (metastases) in the lungs, bone, brain, and liver, most basal cell carcinomas just stay on the surface of the skin and almost never go elsewhere. Basal cell does, however, invade surrounding tissues so it still needs to be treated.

What should I look for?
Actinic Keratosis (AK)
• Crusty and hard lumps on the surface of the skin, more common on sun exposed areas, especially the face, scalp, hands, and legs.
• Fairly flat to the skin surface.
• Sometimes the top peels off but it always grows back again.
• Growing crusty areas can indicate progression to SCC, this can happen slowly and is not always obvious.

Basal cell carcinoma (BCC)
• Nodular – most common type on the face. Shiny and ulcerated, may crust over then come back again. Blood vessels cross the surface and it often bleeds spontaneously. May have a bumpy, rough surface, or may be hard in nature.
• Superficial – spreads across the surface of the skin. Slowly growing over months or years, often bleed and ulcerate. Usually fairly flat to the surface of the skin. Pink or red and scaly.
• Grows over many years.
• Most BCCs are found between the hairline and upper lip, on sun exposed areas, ears, eyebrows and eyelids, nose and lips.

Squamous cell carcinoma (SCC)
• This is a hard one to spot as it often looks similar to AK.
• A thickened, raised, red and scaly spot which can bleed or ulcerate.
• The second most serious type of skin cancer after melanoma, it also spreads to other parts of the body if not treated.
• Grows over months.

Melanoma (ABCDE)
Melanoma is the most serious type of skin cancer that can quickly spead to other parts of the body if not treated. If it spreads, it is almost impossible to cure. Melanoma can be difficult to distinguish from other moles. If you have any moles you are worried about, it is always best to get them checked by a doctor. Features suggestive of melanoma are:
• Asymmetry – two halves do not match
• Border – irregular, scalloped or notched
• Colour – more than 3 different colours in the same mole
• Diameter – more than 6mm
• Evolving – growing, changing colour, itching, bleeding, becoming more raised, changing shape, or any other changes.

What are the risk factors?
• Sun exposure – the number 1 risk factor for all skin cancers
• Sunburn
• Fair skinned people
• Family history – SCC and melanoma
• Smoking – SCC on the lips
• Burns – SCC
• Chemicals and some immunoscuppression drugs
• Longstanding leg ulcers – SCC
• Actinic Keratosis – progresses to SCC at a rate of about 1% per year

How can I prevent skin cancer?
• Use a spray tan, not a sun bed, or avoid tanning all together
• Use high factor sunscreen and apply it regularly
• Moisturise daily with a moisturizer containing sunscreen
• Wear a hat and sunglasses whenever outside in the sun
• Avoid being outside at ‘peak times’ of day, especially between 12 and 2
• Never get sunburnt
• Cover up after 30-60 minutes of sun exposure

Can I use sunscreen safely on my baby?
• There has been some controversy surrounding this issue in recent years, as it was thought that applying sunscreen to children under 6 months could be carcinogenic.
• The American Academy of Pediatrics have recently changed their recommendations as we have realized that it’s just better for children not to get sunburned.
• It is best to avoid sun exposure completely, but if this is not possible then cover up your child with long sleeves, trousers and a wide brimmed hat, limit sun exposure, and apply high factor sunscreen to exposed areas such as face, neck, hands and feet.
• Click here for more information.

Did you know?
• The sun doesn’t just damage your skin, you can get sunburn to your eyes and eyelids, and growths across the front of your eyes because of too. much sun. Wearing UV protective sunglasses is essential to prevent this.
• 90% of all basal cell carcinomas occur between the hairline and the upper lip.

Links
Cancer Society skin advice
Dermnet – See pictures of skin problems