May has been skin cancer awareness month. Most skin cancers are caused by ultraviolet (UV) exposure from the sun. In this blog Dr Randhawa from your Harborne, Birmingham clinic gives her expert advice about how to examine your skin.
There are three types of UV light:
1. UVA infiltrates into the layer of the skin called the dermis (middle layer of the skin). It damages the collagen in the skin which can lead to wrinkles. It can also accelerate the effect of UVB and therefore skin cancer.
2. UVB causes sunburn and skin cancer by penetrating into the epidermis (top layer of the skin). This causes DNA damage in the skin cells. Lots of DNA damage over time can lead to skin cancer.
3. UVC is the third type but does not actually reach us on the Earth’s surface because it is blocked by the ozone layer in the atmosphere.
Those most at risk of skin cancer are those on the lower end of the Fitzpatrick skin type scale. People who are type one on the scale, with fair skin which burns easily but does not tan are at the highest risk. Although people at the other end of the scale with darker skin tone, which tans easily but does not burn, are at a lower risk of skin cancer, they do still get it.
Here are some statistics on skin cancers in people of colour:
- Skin cancer represents 1 to 2% of all cancers in Black people
- Skin cancer represents approximately 2 to 4% of all cancers in Asian people
- Squamous cell carcinoma is the most common skin cancer in Black people
- Black patients with melanoma have an estimated five-year melanoma survival rate of 70%, versus 94% for white patients
- Melanoma in people of colour most often occurs in areas that get little sun exposure. Up to 60 to 75% of tumours arise on the palms of the hands, soles of the feet, under the nail/nail areas
Other risk factors for skin cancer include a family history of skin cancer, older age and having a large number of moles.
The best way to try and prevent skin cancer is by staying sun safe as much as possible. This means seeking shade at midday, wearing sunglasses, wide brimmed hats, long sleeved tops and trousers. Of course you should ALWAYS be wearing sunscreen in the day. Choosing your sunscreen is also important; make sure it protects against both UVA and UVB and is at least SPF 30. Higher SPF numbers do mean more protection, but the higher you go, the smaller the difference becomes. There is a big difference in protection between SPF 15 and 30 but not much of a difference between 30 and 50. SPF 15 blocks 93% of UV rays, SPF 30 blocks 97% and SPF 50 blocks 98%.
There is no sunscreen which blocks 100% of UV rays, which is great as we still need some UV light to help make vitamin D. Vitamin D is essential for our bone growth and the need for it is often given as a reason as to why some people do not wear sunscreen. However, clinical studies have never shown that regular use of sunscreen leads to vitamin D deficiency.
There are three main types of skin cancer:
- Basal cell carcinoma (BCC)
- Squamous cell carcinoma (SCC)
- Melanoma
Basal cell carcinomas and squamous cell carcinomas are collectively called non-melanomas. Non melanomas present differently to melanomas. They tend to be smooth, waxy and pearly-white or a firm, red lumps which have a sunken crater-like appearance in the middle. Melanomas usually present as changing or abnormal looking moles on the skin.
Self-examination of the skin is an important way to detect any changes that may indicate the presence of skin cancer or other skin conditions. It should be done at least once a month, alongside breast self-examinations for women and testicular self-examinations in men. Unlike other cancers, there is not enough evidence for routine screening for skin cancers. So we rely on patients examining their skin regularly and flagging up any concerns to us as healthcare professionals.
Look out for areas of the skin that are itchy, bleeding, crusting or not healing. By examining your skin regularly, you will learn what your usual moles look like. This allows you to recognise any moles that are changing. Any mole which stands out compared to the other moles, sometimes called the ‘ugly duckling’ sign.
Here are some tips on how to perform a self-examination of your skin:
- Perform a head to toe examination of the skin. After the bath or shower is a good time.
- Check your scalp by parting your hair in different sections with a comb or using a hair dryer.
- Don’t forget the commonly missed areas: ears, nose, under the breasts, spaces between the fingers and toes, soles of the feet, toenails.
- Use a mirror to inspect areas which are hard to see such as the back of your neck and buttocks or ask a friend or relative to help you. Make sure you have good lighting.
- Take photographs of your moles every month so it is easier to decipher any changes in them, it is also useful to show these to healthcare professionals if concerned
- Use the ABCDE approach when examining moles (see below)
During the examination, look for any new or changing moles, freckles, or spots on your skin.
ABCDE Skin cancer approach
The ABCDE approach (asymmetry, border, colour, diameter and evolution) is a system that is used to decipher whether a mole is non-cancerous or a skin cancer.
If a lesion is asymmetrical, has an irregular or notched border, has multiple colours in it, is more than 6mm in diameter (the size of a pencil eraser) or is changing over time, it could be a melanoma rather than a benign mole.
If you are concerned about any moles, please make an appointment with your GP. They can discuss this with you and make a referral to Dermatology for further investigations (such as a biopsy) if needed. Do not leave it too late; early detection of cancer can lead to much better outcomes.
Click here to book a skin care consultation with our skin care expert Dr Randhawa at our clinics in Harborne and Quinton, Birmingham.