Worrying increase in skin cancer

The Cancer Association of South Africa (CANSA) reports that climate change is broadly affecting human health, with grave concern that continued warming of the earth’s atmosphere will result is serious harm.

Since the mid-20th century, skin cancer incidences have risen at an alarming rate worldwide. According to CANSA, strong circumstantial evidence supports the hypothesis that factors related to climate change, including stratospheric ozone depletion, global warming, and ambient air pollution, have likely contributed to the increasing incidence of cutaneous malignancy globally and will continue to impose a negative influence on skin cancer incidence for many decades to come.

Second only to Australia, South Africa has the highest rate of skin cancer in the world, with approximately 20 000 new cases being reported every year. Skin cancer is the most common cancer in our country, and more than 700 South Africans die from this disease every year. Melanoma is the most common cancer in people aged 25–29 years.

The Skin Cancer Foundation says that skin cancer is the out-of-control growth of abnormal cells in the epidermis, the outermost skin layer, caused by unrepaired DNA damage that triggers mutations. These mutations lead the skin cells to multiply rapidly and form malignant tumours.

It is extremely important that you protect your and your children’s skin against the harmful rays of the sun. An estimated 80% of skin damage occurs before the age of 18 and manifests later in life.

According to Dr. Jacques du Toit, a dermatologist at Louis Leipoldt Mediclinic in Bellville, Cape Town, the three major types of skin cancer are:

Basal cell carcinoma (BCC) — often mistaken for a sore that does not heal, it usually looks like a raised, smooth, pearly bump or ulcer on the sun-exposed skin of the face, neck or shoulders.

Squamous cell carcinoma (SSC) — appears most often on exposed areas of the body, usually in the form of raised, pink, opaque nodules, plaques or patches that frequently form ulcers or sores in the centre.

Malignant melanoma — small, brown or black or larger multi-coloured plaques with an irregular outline, which may crust or bleed.

Dr. Du Toit says the ABCDEF guideline is useful for identifying malignant melanoma:

A – Asymmetry (one side of the lesion does not mirror the other)
B – Border irregularity (margins may be notched or irregular)
C – Colour (melanomas are often more than one colour)
D – Diameter (cancerous lesions are usually larger than 6 mm across — roughly the size of a pencil eraser)
E – Evolution (most important criteria as any mole can change)
F – “Funny” looking mole that looks different from others.

The following are risk factors in the development of skin cancer:

Fair skin, especially types that freckle and sunburn easily
Fair hair and blue or green eyes
A personal or family history of skin cancer
Numerous moles
One or more severe sunburns at an early age

Although there are other causes of skin cancer, such as the use of tanning booths, exposure to unusually high levels of X-rays and contact with certain chemicals such as arsenic and hydrocarbons, the most frequent cause is exposure to the ultraviolet (UV) rays in sunlight.

Preventative measures

Avoiding sunburn is a great preventative measure, but keep in mind that UV exposure occurs every day, even when it is overcast. Take great care when you are outdoors by limiting time spent in the sun, especially between 10:00 and 15:00, when the sun’s rays are at their most dangerous. Stay in the shade as much as possible and be aware that UV light reflects off grass, cement, glass, water and sand.

“Apply generous amounts of sunscreen with a sun protection factor (SPF) of at least 30, which offers protection against both UVA and UVB. Make sure to check the back of the bottle,” says Dr. Du Toit. Sunscreen should be applied 30 minutes prior to sun exposure, and re-applied after swimming and every 2 hours during sun exposure.

Wear sunglasses to protect your eyes while you are outdoors, and use a lip balm that contains sunscreen.

Cover yourself and your children up with hats and shirts. The hat should completely shade the face, neck and ears. The tighter the weave, the better the UV-protection the clothing affords.

Avoid tanning booths. According to dermatologists, the use of an artificial tanning booth will double the melanoma risk of any individual, regardless of other factors.

Go for mole mapping annually. During mole mapping, each mole is photographed with a specialised camera. The picture is then mapped out on the patient’s body and stored in the computer’s database, so that each new image can be analysed and compared against the original image.

Treatment

Dr. Du Toit advises having any worrisome mole or lesion examined by a dermatologist. “If there are lesions that are difficult to identify or thought to be skin cancer, a biopsy will be taken. If the biopsy shows that you have a malignant melanoma, you may have to undergo further tests, such as a blood test and a chest X-ray,” he says.

Dealing with BCC and SCC usually involves surgical removal of the lesion, which is usually adequate treatment. Malignant melanomas are treated more aggressively, and may require several treatment methods, including surgery, radiation therapy and chemotherapy.

Be active in preventing and detecting skin cancer on yourself, family members and others. Examine your skin thoroughly every month, and note if there are any changes. Early detection significantly increases the chances of successful treatment.

The information contained in this article is of a general nature and intended for information purposes only. The information and other content provided in this article are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment. If you think you may have a medical emergency, call your doctor or emergency services immediately.