As another summer draws to a close, I thought it would be timely to talk about skin cancer. The importance of regular, annual skin checks cannot be understated in this country. We have the highest rates of skin cancer in the world, and by a long way, too. It’s also worth remembering that the sun does something else that most people would rather it didn’t: it ages you. Quickly. Anyone with children does not need any external help with their wrinkle collection.
Skin cancer prevention advice: here it is again, for any babies who were born yesterday. ‘Hello, babies! Be kind, and wear a hat,’ as Kurt Vonnegut would say…
Protect your skin
Let’s cover the basics first. You probably already know them, but it would be remiss of me to not mention sun protection recommendations on this post.
- Wear SPF50 Sunscreen. You only need to put it on the parts of your exposed skin where you don’t want to have skin cancers cut out.
- Wear a broad-brimmed hat and long-sleeved, collared shirt in the sun.
- Wear sunglasses, and make sure they have a proper UV rating.
- Stay in the shade. Avoid sun exposure between 10am-2pm.
How often should you get your skin checked?
In general, adults should be having a skin check every 12 months. If you have risk factors for skin cancer apart from living in Australia (age, family history, past history of skin cancer, occupational risk, certain medical conditions/ immunosuppressive medications) then your doctor will negotiate the schedule for skin checks with you.
Who should conduct the skin check?
You can get your skin checked by a a dermatologist, a plastic surgeon or general surgeon, a GP who is trained and skilled in the diagnosis and management of skin cancer, or a dedicated skin cancer clinic (these are usually staffed by such GPs). It must be a medical practitioner who is properly trained to detect and treat skin cancer.
What happens during a skin check?
You will be exposed down to your underwear. If you’re shy, ask for a doctor or the same gender and wear your swimmers under your clothes, if you prefer. Don’t wear nail polish – it’s good to be able to see your nails, too. The doctor will examine your skin from top to toe and will use a little piece of equipment called a dermoscope if required. This is a handheld magnifying lens with a special light that helps us look at skin lesions in more detail.
If your doctor finds a ‘suspicious lesion’, the next step is to arrange a biopsy, which is done by different methods depending on the type of lesion (i.e. what the doctor is suspicious of, based on its appearance) and part of the body. Sometimes the appropriate action is ‘watchful waiting’ and/or photographing the lesion for later comparison, but your doctor will discuss this with you. Basically, if it looks dodgy you have to find out exactly what it is, and this involves sending a piece of it to the lab. Sorry.
Is there a list of GPs who are qualified to perform skin cancer checks on the north shore?
No, unfortunately not. It would be great if there was. Medicare Locals (used to be called Divisions of General Practice) can often help you to locate a GP who has certain special interests, if you are having trouble finding someone. The ML for the North Shore is called the North Shore and Beaches Medicare Local, and they have a publicly-accessible website.
You should always feel free to ask a doctor of any stripe to explain their qualifications to you, if you are concerned or even interested. Most doctors hold themselves to a very high standard, and are more than happy to puff up and tell you exactly what pieces of paper they have to prove themselves. So you should make sure you feel confident with your caregiver.
The three main types of Skin Cancer
1. Melanoma
Unfortunately there’s more to skin cancer than melanoma, but it’s the one that most people think of first. It is a cancer of the melanocytes, the pigment-producing cells present in the skin. It’s potentially fatal. It can arise from an existing mole (naevus) that undergoes change, or it can pop up out of nowhere. They are usually dark in colour, and may itch, bleed or change. Or they may not. The only way to cure it is to find it in time, i.e. in the first stage, when you will have an almost 100 per cent survival rate. After this stage, the potential for bad outcomes increases with the depth of the melanoma in the skin. The treatment is to remove the melanoma and a certain amount of the surrounding tissue, to reduce the risk of spread or recurrence.
2. Squamous cell carcinoma (SCC)
Squamous cells are basically regular skin cells, and this is their cancer (almost all cells have one – isn’t it great?!). Like melanoma, SCC is also a serious diagnosis as it can spread through the bloodstream like melanoma, and can be fatal if not detected. The SCC is often like a new red lump, or a sore that won’t heal for weeks. Depending on the situation, some SCCs need to be completely removed, but sometimes special creams can be used to help your immune system to attack and remove the cancer by itself. Another option for ‘sun spots’ (solar keratoses) in the ‘pre’ stage of becoming an SCC, is to freeze them with liquid nitrogen (cryotherapy) which is quick and easy and not very painful. (Yes, I’ve frozen myself to see what it feels like. We all have. It’s not that bad.)
3. Basal cell carcinoma (BCC)
These guys aren’t exactly ‘killers’, but they burrow downwards and can do scary, disfiguring damage if you don’t find them and have them removed. Usually occurring on the face, they often look like pink or flesh-coloured lumps, sometimes with a ‘pearly’ surface. Superficial types can sometimes be treated with creams, but usually BCCs require removal.
What happens if you have a ‘suspicious’ lesion?
Ah, ‘removal’. Yes, I’m talking about cutting things out, sorry again. However if you’re browsing this website you’ve probably given birth to one or more babies, so nuts to that. Surgical removal of skin cancers is usually performed in your doctor’s surgery under local anaesthetic, and only rarely in a hospital operating theatre if the situation is complex. Occasionally a second excision is needed if the first – despite the best efforts of your doctor – did not quite take all the cancer tissue. This can only be seen under the microscope at the lab. We call the edges of the removed lesion ‘margins’ and when they aren’t clear of cancer then the party isn’t over yet. This is uncommon, but it happens to a certain number of patients for all doctors who treat skin cancers. It’s a balance between wanting to leave you with as small a wound as possible, and taking enough tissue to reasonably expect to have the lesion completely gone. We have specific guidelines for this, but like everything in life there are exceptions to the rule.
It’s important to know that most skin checks involve just that, a check. Only a small proportion of people go on to need a biopsy, and an even smaller number have a diagnosis of skin cancer made. However this chance increases with age, and the extent of UV damage to the skin. The other important message I want to share is that it’s never too late to help reduce your risk of skin cancer by protection from the sun. As with smoking, your good old body starts repairing itself when the problem is removed. So let your last sunburn be exactly that – your last.
Thanks to my clever colleague at the Practice, Dr Phil Keys, for his help with this post.