Everywhere you look these days, skin cancer is in the news. This comes as no great surprise to most dermatologists, as the number of melanomas we see each week continues to increase. Data shows that over the last thirty years, rates of malignant melanoma in Great Britain have risen faster than any of the current ten most common cancers.
Risk Factors for Skin Cancer
1. Skin Type
Before you look at moles consider what skin type you are, as this makes a big difference to your risk of skin cancer. The Fitzpatrick Skin Type classification is a scale for human skin colour and it’s response to ultraviolet radiation.Type 1: white skin, blond or red hair, freckles – always burns, never tans
Type 2: white skin – usually burns, tans minimally
Type 3: white skin, fair with any hair or eye colour – sometimes mild burn but tans uniformly
Type 4: moderate brown skin, Mediterranean skin tone – rarely burns, tans well
Type 5: dark brown, Middle-Eastern or Asian skin – very rarely burns, tans easily
Type 6: deeply pigmented or Black skin – never burns, tans very easily
The risk of developing skin cancer is much higher in type 1 skin compared to type 6 skin. However, skin cancer can occur in any skin type.
2. Sunburn
A person’s risk of melanoma doubles if he or she has had more than 5 sunburns
3. Outdoor hobbies and occupation
Individuals that have worked outdoors (e.g. in the building or construction trade) or enjoy outdoor hobbies such as running or gardening are at higher risk of developing skin cancers by virtue of sun exposure. The same applies for people that have lived abroad in sunny climes.
4. Tanning bed use
Sun-bed users are 74% more likely to develop melanoma that those who have never tanned indoors.
5. Family history of melanoma
Approximately 10% of people with melanoma will have a family member with the disease
6. Lots of moles
Although the risk of a single mole becoming malignant over your lifetime is very low, the more moles you have the greater the risk.
7. Immunosuppression
Often forgotten about, but a compromised immune systems as a result of chemotherapy, organ transplant, lymphoma or HIV/AIDS can increase the risk of melanoma.
Early Detection is Key
There is no doubt that finding skin cancer early saves lives. Melanoma detected and removed early is almost always curable. If caught late, there is a much higher chance of the cancer spreading to other parts of the body. The 5-year survival rate is 95% for early, stage 1, disease compared to about 16% for late, stage 4, disease.
The skin is the largest and most visible organ of the body so often any changes or new moles will be overtly visible unlike cancer of an internal organ. This means that if more people know what to look for, we should be able to detect more melanomas at an early stage.
What changes are we looking for?
The acronym ABCDE can be extremely helpful in evaluating moles. If a mole shows any of these features, it warrants review by a GP or dermatologist to exclude melanoma.
Asymmetry: one half of the mole is different to the other
Border: irregular, scalloped or poorly defined edge
Colour: uneven colour or variable colours within a 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, a mole that looks significantly different to the others (known as the ugly duckling sign), or any skin lesion that bleeds or fails to heal.
Changing moles do not always represent skin cancer and most moles are usually 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.
Seeing a Dermatologist
Dermatologists will usually carry out a full skin check if a patient is referred for changing moles. They will use the aid of a dermatoscope to assess the mole itself.
If there is any doubt regarding a pigmented lesion, it will usually be excised with at least 2mm margins of normal skin and sent for histology. Partial biopsies (e.g. punch or shave biopsies) are not recommended as they are often unsatisfactory, can cause sampling error, and problems with diagnosis (e.g. inability to assess melanoma depth or Breslow thickness).
Mole Self-Examinations – When? How often?
Most dermatologists recommend skin self-exam on a monthly basis. The ideal time is probably after a bath or shower and should be carried out in a well-lit room with the aid of a full-length mirror.
Look closely at your entire body including the scalp, buttocks and genitalia, palms and soles including the spaces between the fingers and toes. Use the ABCDE rules above and see your doctor about any concerns.
Sun Safety
Prevention is better than cure, so follow these tips to keep your skin safe:
- Sunscreen – this should be broad spectrum containing protection against UVA and UVB and a factor of at least 15-30 should be recommended. This needs to be applied at least 30 minutes before going outdoors and reapplied every 2 hours for maximum benefit
- Seek shade particularly between 11am to 4pm
- Wear a wide-brimmed hat and sunglasses
- Wear protective loose cotton clothing over the arms and legs
- Try not to use tanning beds
