Sarah's Health Notes: All about skin cancer, with Dr. Anjali Mahato
Yes, yes, I know I wrote about the benefits of the sun a couple of weeks back but I did qualify it by saying you always need to take care to protect your skin because of the risk of skin cancer. A little bit of sun is great – too much can be very bad.
According to the British Skin Foundation, ‘Skin cancer is the most common form of cancer in the UK and rates continue to rise. At least 100,000 new cases are now diagnosed each year, and the disease kills over 2,500 people every year in this country – that’s seven people each day.’
As consultant dermatologist Dr. Anjali Mahto, above, points out in her book The Skincare Bible, we need to be aware of how to protect our skin and also to be super-vigilant about spotting the early signs of skin cancer.
Rates of skin cancer have been rising significantly since the 1970s, according to Dr. Mahto, because of the accessibility of foreign travel (obvs not during lockdown but ramping up again now) and budget holidays in the sun, as well as use of sunbeds. ‘The desire to be tanned has become popular and tanning bed usage more prevalent,’ she says. ‘Combine this with the thinning ozone layer in parts of the world and you can see how the problem has developed.’
Skin cancer doesn't come in just one version: there are three main types – melanoma, basal cell carcinoma and squamous cell carcinoma. This is an edited extract from The Skincare Bible by Dr. Anjali Mahto.
MELANOMA
This is the fifth most common cancer in the UK. It develops from the pigment-producing cells in the skin, known as melanocytes. Melanoma can develop as a new mole on the skin (the majority) or within a pre-existing mole.
What are the risk factors?
Ultraviolet light from the sun or from artificial tanning beds is the single biggest culprit. Other risk factors include fair skin, multiple sunburns, family history of melanoma in close relatives, conditions that cause a weakened immune system and the presence of lots of moles.
How dangerous is melanoma?
The reason we worry about melanoma is its ability to spread to other organs, or ‘metastasise’. It has the potential to spread to the liver, lungs, bone and brain, where it can be fatal. The good news is that most melanomas are picked up at an early stage, well before this happens.
How can I reduce my risk of melanoma?
With no national screening programme your best chance of picking up a melanoma early is to know the signs and when to seek medical attention. If you have private healthcare, you can choose to have annual mole checks performed by a dermatologist as part of their preventative health screening.
What should I look out for when checking my own or others’ skin?
The acronym ABCDE is used most commonly as a tool for evaluating moles. If a mole shows any of these features, it warrants review by a dermatologist.
• Asymmetry: One half of the mole is different from the other
• Border: The mole’s edge is irregular, scalloped or poorly defined
• Colour: There is uneven colour or variable colours within the mole
• Diameter: The mole is bigger than 6mm in size
• Evolving: The mole is changing in its size, shape or colour.
Other signs to look out for include any new moles or a mole that looks significantly different from the others (known as the ‘ugly duckling’ sign). The most common site for developing a melanoma in a man is the back, and in a woman, the legs.
The tricky thing is that not all changing moles are indicative of skin cancer, and most moles are actually harmless. It can be normal for moles to change in number and appearance; some can also disappear over time. Hormonal changes during puberty and pregnancy can cause moles to increase in number and become darker.
How should I check my skin for moles?
Most dermatologists recommend you should examine your skin on a monthly basis. The ideal time is probably after a bath or shower in a well-lit room with the aid of a full-length mirror. Develop a system (e.g. from head to toe), first examining the front and then the back, to ensure that you do not miss a section of your body. It can be helpful to get someone you trust to look at your back and other hard-to-examine areas. Take care not to miss sites like the buttocks, genital area, palms and soles. Some people find taking photographs once a year is a good way to have a record of their skin. The first few months will purely be an exercise in getting used to where your moles and blemishes are, and what is normal for your skin.
What should I do if I’m worried about a mole?
If you have any concerns regarding a mole that is changing, seek medical attention. You should visit your GP who will either reassure you or refer you to a dermatologist, either on the NHS or privately if you have medical insurance. Alternatively, you can consult a private dermatologist directly.
[Dr Mahto suggests following the route above rather than going to a private mole clinic.] I’d advise caution when considering mole clinics. I often see patients that have previously been to such private clinics and learned that, frighteningly, many do not have an in-house dermatologist and simply use a computerised machine to decide if a mole is worrying or not. If the machine flags the mole as a problem, they are then advised to see a dermatologist elsewhere.
NON-MELANOMA SKIN CANCER
There are two main types of non-melanoma skin cancer: basal cell carcinoma and squamous cell. Again ultraviolet light is the most common cause of their development. These types of cancer usually look like scaly patches or pink bumps on the skin that fail to heal. They can become scabby and bleed, and are occasionally tender to touch. They can develop on any part of the body but are usually seen on sun-exposed sites such as the face, neck, forearms and hands. In men, they can develop on the scalp, especially if there is little hair to provide protection.
These carcinomas are the result of chronic sun damage over the years and usually affect people in their fifties onwards. However, you may see them in younger people, particularly if there has been a lot of sun-exposure. These types of cancer have a much lower likelihood of spread compared to melanoma, and treatment is usually curative, often with surgery.
If you notice a non-healing patch of skin that fails to settle after a few weeks, it is worthwhile seeing your GP for evaluation to exclude these types of cancer. If there is any concern, you will be referred to a dermatologist.
PREVENTION PREVENTION PREVENTION
Sun protection is the single most effective method for reducing your risk of skin cancer. This is particularly important if you have risk factors such as fair skin, a family history of skin cancer or multiple moles.
Cover up: This remains your first-line option in protecting against the sun. This should be something you think about on a hot, sunny day in the UK, on a tropical holiday or even when participating in outdoor sport. Clothing, hats and sunglasses all have a role to play.
Shelter: Ideally, stay out of the sun during peak daylight hours, when the sun is most likely to cause burning. So try to stay in the shade between 11 am and 3 pm.
Sunscreen - Look for a broad-spectrum sunscreen (SPF30 or more) that offers protection against both UVA and UVB rays.
Sunscreens use chemical or mineral ‘shields’ against UV. Chemical sunscreens need to be applied at least 20 minutes before going outdoors. Mineral sunscreens, which contain zinc oxide and/or titanium dioxide, work as soon as they are applied. Sunscreens need to be reapplied every 90 minutes to get the stated SPF (sun protection factor) and most of us are guilty of not applying enough and not reapplying as frequently as we should. You also need to remember to reapply after swimming and sweating.
Sunscreen needs to be used on all areas not covered by clothing. About one-shot-glass-full (or 35ml) should be about right for an average-sized adult. A rule of thumb is a teaspoon per body area: one teaspoon for your face, head and neck, one for each arm, one for each leg, one for your chest and abdomen and one for your back and the back of the neck. Don’t forget your ears, eyelids and the tops of your feet, which are often missed.
Many people do not use sunscreen on cloudy days – but in fact, you still need your sunscreen on grey days. And yes, do keep on wearing an SPF in the winter on exposed areas, both to get in the habit of protecting your skin and because it really helps with the ageing process.
Special care needs to be taken with small children in the sun. Blistering sunburn in childhood can double a person’s risk of developing melanoma in later life. Young skin is particularly vulnerable to the effects of ultraviolet radiation. Babies below the age of six months have little melanin in their skin and their skin is too sensitive for the use of sunscreens. It is therefore important that young babies are not left in direct sunlight. After six months of age, sunscreen is safe to apply.
