Skin Cancer 

Many skin cancers could be avoided by a change of lifestyle. There are three main ways in which you can help to reduce your chance of getting one.  

• Sunscreens should not be used as an alternative to clothing and shade, rather they offer additional protection. No sunscreen will provide 100% protection.
  
• Most skin cancers, if treated early, can be cured. That is why it is important to report any new or changing skin lesion to your doctor.
  
• Basal cell carcinomas can be cured in almost every case and seldom, if ever, spread to other parts of the body. Treatment may be more complicated if they have been neglected for a very long time, or if they are in an awkward place - such as near the eye, nose or ear.
  
• In a few cases squamous cell carcinoma and melanoma may spread (metastasize) to lymph glands and other organs.
  

Learn how to recognize their early signs

Examine your skin regularly for these signs, and get an annual check from your doctor or nurse

Protect yourself from the sun

Exposure to the sun is the main cause of skin cancer. This does not just mean sunbathing. You expose yourself to the sun every time you do anything out of doors, including gardening, walking, sports, or a long drive in the car (even with the windows closed). You can take some simple precautions to help prevent a skin cancer appearing:

Cover up

• Wear a sun hat, long sleeves and trousers in sunny weather.
  
• Stay in the shade, particularly between 11 am and 3 pm
  
• When outdoors, use a sunscreen of Sun Protection Factor (SPF) 30 or above, and star rating ****, that protects against both
• Ultraviolet A and Ultraviolet B, and apply it every 2-3 hours.
  
• Remember that winter sun, such as on a skiing holiday, can contain just as much of the damaging ultra-violet light as summer sun.
  
• Don’t use sunbeds.
  

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 3 pm when it’s sunny
  
• Use a 'high protection' sunscreen of at least SPF 30 which also has high UVA protection, and make sure you apply it generously and frequently when in the sun.
  
• Keep babies and young children out of direct sunlight
  
• The Canadian Dermatology Association recommends that you tell your doctor about any changes to a mole – if your GP is concerned about your skin, make sure you see a Dermatologist, the most expert person to diagnose a skin cancer. 
  

Treatment will be much easier if your skin cancer is detected early.  For this reason, check your skin for changes once a month. A friend or family member can help you with this.  You may need to use a mirror to check your back.

You should see your doctor if you have any marks on your skin which are:

• • Growing
    
  • Bleeding
    
  • Changing in appearance in any way
    
  • Never healing completely

Actinic keratoses (also known as solar keratoses)

Skin cancers may be preceded by a pre-cancerous condition known as actinic keratoses. These are usually pink or red spots, with a rough surface, which appear on skin that is exposed to the sun. The head, face, backs of the hands and forearms are most often affected.  Actinic keratoses may be easier to feel (their roughness) than they are to see. Early treatment may prevent them changing into skin cancer.

Basal cell carcinoma (rodent ulcer)

Most basal cell carcinomas are painless. People often first become aware of them as a scab that bleeds occasionally and does not heal completely. Some basal cell carcinomas are very superficial and look like a scaly flat red mark: others show a white pearly rim surrounding a central crater. If left for years, the latter type can erode the skin, eventually causing an ulcer – hence the name “rodent ulcer”. Other basal cell carcinomas are quite lumpy, with one or more shiny nodules crossed by small but easily seen blood vessels.

Squamous cell carcinoma

A squamous cell carcinoma usually appears as a scaly or crusty area of skin, with a red, inflamed base. It may look like an irritated wart, or break down to form a bleeding ulcer. Most small squamous cell carcinomas are not painful. They occur most often on the head, neck, ears, lips, back of the hands and forearms. This is the most frequent type of skin cancer in organ transplant patients.

Melanoma

Melanomas are much more rare, but are the most serious type of skin cancer.  They are usually an irregular brown or black spot, which may start in a pre-existing mole or appear on previously normal skin. Any change in a mole, or any new mole occurring for the first time after the age of thirty, should be shown to your doctor. Remember, if you see any change in your skin - whether an ulcer or a spot - you must tell your doctor or nurse. Any skin problem that does not heal should be shown to a skin specialist (dermatologist).

Most cancers can be avoided if you follow these basic rules:

• Check your skin for changes regularly
  
• Report any skin changes to your doctor or nurse promptly
  
• Always protect yourself from the sun
• Treatments for Skin Cancer 
  
• Surgery
  
• Most skin cancers are excised (cut out) under a local anesthetic. After an injection to numb the skin the tumour is cut away along with some clear skin around it.  Sometimes, a small skin graft is needed.
  

 
Curettage and cautery

This is another type of surgery, done under local anesthetic, in which the skin cancer is scraped away (curettage) and then the skin surface is sealed (cautery).
 

Cryotherapy

Freezing the skin cancer with a very cold substance (liquid nitrogen). Creams – these can be applied to the skin. The two used most commonly are 5-fluorouracil (5-FU) and imiquimod.
 

Photodynamic therapy

This involves applying a cream to the skin cancer under a dressing for 4-6 hours.  A special light is then shone on to the area and this destroys the skin cancer.
 

The removal of lymph nodes

This is usually undertaken only if the cancer has spread there, causing them to enlarge.
 

Radiotherap

X-rays are shone onto the area containing the skin cancer. It may also be used to relieve symptoms when a skin cancer has spread to other parts of the body. Some patients with organ transplants may be advised to reduce or stop their immunosuppressant medication by their transplant surgeon in conjunction with their dermatologist.  Sometimes, medication known as retinoids may be prescribed to inhibit the further production of skin cancers.