Skin deep: Spotlight on skin cancer

When was the last time you checked your skin? It sounds like a weird question, but consider this – if there was a change, would you notice it? Unless you’re checking your skin on a regular basis, chances are you wouldn’t. It’s exactly the same for moles. You may have had them since childhood, but unless you regularly keep an eye on them, would you be able to spot any small changes?

Despite our less-than-stellar weather, skin cancer is the most common cancer in Ireland.

THE STATS ON CANCER

“There’s about 10,000 unique cases being diagnosed in the country [every year] and that number is increasing,” says Roseleen Flaherty, a cancer nurse with the Irish Cancer Society.

There are three main types of skin cancer: basal cell carcinoma and squamous cell carcinoma (known together as non-melanoma skin cancers) and melanoma. The vast majority of skin cancers tend to be made up of non-melanoma skin cancers, however melanomas can and do occur. Melanoma is the more serious type of skin cancer.

“The non-melanoma skin cancers are the very common ones and they take up the majority of the numbers, however, about 850 melanomas are diagnosed each year and they [make up] 75 per cent of the death rate. They’re very serious. This number is increasing,” says Roseleen.

Most skin cancers are caused by unprotected exposure to the sun. This may be from long term exposure or short periods of intense sun exposure. The ultraviolet or UV light in sunlight damages the DNA in our skin cells. This damage can happen for years before cancer develops.

CHECKING YOURSELF

As melanoma can begin in moles, it is important to check moles regularly if you have them and to be aware of the moles you have and any changes that may be taking place.

“Moles can fluctuate in relation to hormones. Some of them are present from birth, some of them get darker during pregnancies, some of them actually emerge more during puberty and others can darken over time with the sun as well and others may fade after the age of 50,” says Roseleen.

“Most moles are not cancerous, but the important thing is that we learn to monitor them. We get to know our moles and begin to be aware if there’s a change that’s of concern. It’s going back to know your moles and know if there’s a change and if there’s a change, have them seen by your GP.”

So what changes should you be looking for? Roseleen advises using the A, B, C, D and E system.

“A is asymmetry – is it equal and does it look round on both sides? B is the border – is it regular or round? Is there scaling or crusting on it? C is the colour – is it changing? Has it got a couple of colours or is it colourless? D is the diameter – is it widening? E is evolving – is it beginning to change? Is it growing?” says Roseleen.

“E is the most worrying of the symptoms. If it’s evolving or if you’re unsure, check your skin on a regular basis after your shower. Does it look the same? If there’s a change photograph it [so you can compare]. Check it again. If you think it’s different then see the GP.”

When it comes to skin cancer it’s important not to put the focus solely on moles. Roseleen says that as well as looking at moles, we should be looking at all of our skin too and doing what we can to protect it. The Irish Cancer Society has devised its own ‘sun smart’ code to help people protect their skin during bright days.

“[The sun smart code is] seek shade, especially when the UV rays are strongest, between 11am and 3pm. Cover up – wear your t-shirt or hats and your sunglasses to protect your eyes because eyes can be damage by UV rays. Wear your sunscreen,” says Roseleen.

“Wearing sunscreen is really, really important because it’s protecting us from UVA and UVB rays. The UVA’s are the ones that cause ageing and the UVB’s are the ones that you’re concern about causing damage further below your [surface] skin. You’re trying to protect yourself from that. Even if it’s a cloudy day, look at what the UV index is and if it’s higher than three, you’d certainly want to put on your sunscreen.” (You can view the UV index by logging on to www.weatheronline.co.uk/Ireland/Dublin/UVindex.htm)

Another part of minding our skin is to change our attitude when it comes to the sun. In Ireland, on a fine day, you’re likely to see everyone soaking up the sun – mainly because we don’t see it too often. However instead of thinking in terms of sun, Roseleen says we need to think in terms of UV.

“We need to look at UV rays instead of the sun. Do we really need to lie in the sun or, as so many of us are doing now, can we be out walking, cycling, getting out and enjoying nice weather as opposed to lying out.”

At the moment there is no national screening programme for skin cancer in Ireland so it is essential to check your skin and look out for changes. So what types of changes should we be looking for?

SKIN CHANGES

“Like breast awareness, we want to become skin aware. Therefore we’re looking for small lumps, flat red spots, firm red lumps, a lump or a spot that’s tender to touch, an ulcer that will not heal, a lump with a scaly top, rough scaly patches and new or changing moles,” says Roseleen.

“Also a growth under the nail – a black mark – that’s the melanomas that people aren’t aware of. Non-melanoma also appears as one of the following; a new growth or sore that doesn’t heal in a few weeks, a spot or sore that continues to itch, hurt or crust, scab or bleed and a skin ulcer that’s not explainable by other causes.”

GETTING HELP

If you find a change in your skin then it’s important to remain calm.

“It’s not always jumping to the conclusion that it’s a malignancy or that it’s a cancer. You do need to be seen by the GP,” says Roseleen.

“There are other conditions that cause changes in our skin but you do need to see your GP for an exam and if there’s a concern regarding a mole change, that it’s a suspicion of a melanoma, there’s national GP melanoma guidelines where patients with unusual moles will be referred to a pigmentation/lesion clinic where they’re seen rapidly.

“That’s been set up by the National Cancer Control Programme and that’s to really try and bring through that rapid access for your moles that are suspicious.”

If you have recently been diagnosed with skin cancer, have concerns or would like to learn more about skin cancer you can log on to the Irish Cancer Society website www.cancer.ie or speak to a specialist cancer nurse by calling the Cancer Nurseline Freephone on 1800 200 700.