Skin Cancer and Skin Checks

What is skin cancer?

Skin cancer occurs when skin cells are damaged, for example, by overexposure to ultraviolet (UV) radiation from the sun.

There are three main types of skin cancer:

• basal cell carcinoma
• squamous cell carcinoma
• melanoma – the most dangerous form of skin cancer

Both basal cell carcinoma and squamous cell carcinoma are known as non-melanoma skin cancer.

Approximately, two in three Australians will be diagnosed with skin cancer by the time they are 70, with more than 750,000 people treated for one or more non-melanoma skin cancers in Australia each year. Non-melanoma skin cancer is more common in men, with almost double the incidence compared to women.

Excluding non-melanoma skin cancer,* melanoma is the third most common cancer in Australians. In 2014, 13,134 Australians were diagnosed with melanoma.

Every year, in Australia:

• skin cancers account for around 80% of all newly diagnosed cancers
• the majority of skin cancers are caused by exposure to the sun
• GPs have over 1 million patient consultations per year for skin cancer
• the incidence of skin cancer is one of the highest in the world, two to three times the rates in Canada, the US and the UK.

In 2015, 2162 people died from skin cancer in Australia, 1520 from melanoma and 642 from non-melanoma skin cancers.

*Non-melanoma skin cancers are not notified to cancer registries.

Skin cancer symptoms

The sooner a skin cancer is identified and treated, the better your chance of avoiding surgery or, in the case of a serious melanoma or other skin cancer, potential disfigurement or even death.

It is also a good idea to talk to your doctor about your level of risk and for advice on early detection.

Become familiar with the look of your skin, so you pick up any changes that might suggest a skin cancer. Look for:

• any crusty, non-healing sores
• small lumps that are red, pale or pearly in colour
• new spots, freckles or any moles changing in colour, thickness or shape over a period of weeks to months (especially those dark brown to black, red or blue-black in colour).

How can I prevent or minimize risk of skin cancer?

Slip on some sun-protective clothing that covers as much skin as possible.

Slop on broad spectrum, water resistant SPF30+ (or higher) sunscreen. Put it on 20 minutes before you go outdoors and every two hours thereafter. Sunscreen should never be used to extend the time you spend in the sun.

Slap on a hat – broad brim or legionnaire style to protect your face, head, neck and ears.

Seek shade.

Slide on some sunglasses – make sure they meet Australian Standards.

We recommend Ultraceuticals SunActive Range, SPF50+ when you are going to be outdoors for a period of time. We also recommend Ultraceuticals Protective Daily Moisturiser SPF 50+ or 30+, to use EVERY morning. Jane Iredale powders and some liquid foundations also have SPF protection, perfect for touching up your SPF protection during the day. Supplementation with oral Vitamin B3 may have some benefit in reducing the incidence of Non melanoma skin cancers eg BCC and SCC

Why do I need a professional skin check?

Doctors use a number of tools and techniques to examine skin thoroughly, beyond what the naked eye can see. Melanomas that are detected and treated early are cured in 90% of cases. So, in addition to self-checking regularly you should have a professional skin check once a year. It is also important to get a professional skin check by a doctor if anything suspicious appears, in addition to having your annual skin check.

How do I check myself for melanoma?

Follow the links below for full information about how to perform a skin check.

Remember, if in doubt, get it checked!

How to check yourself

Check signs of sckin cancer

Treatment for Skin Cancer

There are various treatment methods for skin cancer, depending on the severity, size and location of the lesion. Brighton Day Surgery offers the following treatment methods for precancerous and cancerous lesions. Your doctor will discuss the best treatment for you.

Topical Treatments

Picato Gel

Picato Gel (Ingenol Mebutate) is a fast acting topical gel that is used to treat solar keratoses (sun damage) on the face, body and scalp. It is used for either 3 consecutive days for face or 2 consecutive days for the body. It comes in 2 different strengths. The response is variable but most people would expect some redness or ulceration. 2% of people would experience a severe inflammatory response with treatment. Most healing has occurred in 2 weeks after commencing treatment. The area for treatment should not exceed a total of 25cm2.

Follow up to determine lesion clearance is important

Aldara

Aldara (Imiquimod) is a topical gel used to treat solar keratoses, superficial basal cell carcinoma (BCCs) and some forms of warts. The average time for use is 4-6 weeks for solar keratoses, or BCCs or until ulceration occurs. It is used at night three times per week. A small amount of gel should be spread just beyond the limits of the visible lesion. It should be left for 6-10 hours before showering. Aldara is an immune modifier. It stimulates the immune system to recognise and destroy cancer cells. It comes in 2 forms – either gel sachets or a 2g pump pack.

Follow up to determine lesion clearance is important

Efudix

Efudix (5-fluro-uracil) is a topical cytotoxic agent used to treat solar keratoses and Bowen’s disease (a type of early skin cancer). You would expect a reaction to the cream with redness, generally followed by blistering, peeling and cracking over about 2 weeks of use. Usually 4 weeks of use is recommended. The area treated should not exceed 500cm2. Once or twice daily application will be recommended.

Follow up to determine lesion clearance is important.

Solaraze

Solaraze is gel used topically for 3 months. Generally only minor skin reactions are seen with this medication. Diclofenac 3% gel (brand name Solaraze 3% Gel) can be used to treat solar keratoses (also called actinic keratoses) – a type of pre-cancerous lesion – but is not a treatment for established skin cancer.

Follow up to determine lesion clearance is important.

Photo Dynamic Therapy

Daylight Photodynamic therapy is a treatment option for mild to moderate solar keratosis on the face and scalp. It is a one-off treatment that treats a whole face or scalp or both (2 areas).

Daylight PDT requires 2-step preparation with facial cleansing and application of a physical sunscreen. This is followed by skin preparation involving removal of scale and crust. The activating agent is then applied to skin as a thin smear of cream. This agent is methyl aminolevulinate and is activated by daylight exposure. A 2-hour period of exposure is required for the full effect of the treatment. The product will need to be wiped off thoroughly after the light exposure period.

Pre-malignant areas of sun damage (solar or actinic keratosis) will then scale and flake over the next few days. The worst day is about day 4-5 for most people. The skin may feel tight and irritated. Moisturiser and sunscreen are applied regularly during the healing phase. Results should be checked at 4 weeks and 12 weeks after treatment.

Cryotherapy

Cryotherapy includes dry ice and liquid nitrogen treatments. This technique uses extreme cold to treat pre-cancerous skin conditions and some small skin cancers.

Liquid nitrogen is applied to the lesion to freeze and kill abnormal cells. Some pain and redness may occur after the area has thawed, and a blister may develop. A small white scar may remain over the treated area.

Follow up to determine lesion clearance is important.

Biopsy

A biopsy is performed as an outpatient procedure. It involves taking a small sample of the lesion, and sending it to the pathologist for diagnosis. Further treatment would depend on the pathology results. Most commonly used for very small skin cancers, and suspicious lesions in areas where a scar from surgical excision would be obvious.

Surgical Excision

Surgical excision is performed under local anaesthetic with or without sedation. Local Anaesthetic will be injected around the lesion, and the surgeon will then remove and suture. This procedure normally takes 20-60 minutes. The excised specimen will be sent to pathology for diagnosis and to determine clearance. A follow up appointment with the nurse will be made for 7-14 days post surgery.

Skin Flaps and Grafts

Flap surgery is a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. This is similar to but different from a graft, which does not have an intact blood supply and therefore relies on growth of new blood vessels. This is normally only required for large lesions, or lesions in awkward places where direct closure (suturing) is not possible. This procedure is done under Local Anaesthetic with or without Sedation.