Lifestyle Choices

Skin cancers

Skin cancer is already a common disease but we are seeing it more and more. There may be several reasons for this but an important one is that more fair-skinned people are being exposed to sunlight, either on holiday or having emigrated to a hot country. The problem is so great in subtropical Australia that almost every adult has at least one skin cancer in their life. Much more will be said about the damaging effect of sunlight on skin but it is such an important subject that there is no harm in mentioning it twice.

To have the best chance of a cure of any skin cancer, early diagnosis is needed. Skin doctors have a head start on many of their colleagues in the detection of cancer because the skin is visible to patient and doctor alike. It should therefore be possible to pick up most tumors at an early stage of their development. That is why people are recommended to see their doctor sooner rather than later if they are worried.

Basal cell carcinomas (rodent ulcers)

This is by far the commonest skin cancer, and as suggested by the name it is derived from the basal cell layer of the epidermis. Middle-aged and elderly people are most likely to have the tumor but occasionally it may be found in people as young as twenty years. Too much ultraviolet from sunlight over a number of years is a factor. However, these ulcers also develop in people from cold climates who have never sunbathed in their lives.

The face, ears and neck are particularly disposed to developing rodent ulcers. The first sign is often an innocuous-looking whitish, translucent, slightly pearly lump. It may be pink and have an obvious dilated blood vessel running over the surface.It usually enlarges slightly before almost completely disappearing. This may happen again with the lump more obvious in its growth phase. An ulcer may form in the center, with some oozing or bleeding, but this may also heal temporarily. In other words it never heals but things happen so slowly that it is often ignored for up to a year or two. By the time a doctor is consulted the rodent ulcer is often 0.5 to 1 .0 centimeters (1/4 to 1/2 inch) in diameter. Fortunately these tumors never spread to distant parts of the body. They enlarge locally and eat away at the healthy surrounding tissues. They can damage the ear, eye, nose or any other structure and obviously should be treated before this happens. Most can easily be removed by a small operation under local anesthetic. Big tumors may require more difficult surgery, necessitating a stay in hospital and a general anesthetic. An alternative may be radiotherapy.

Squamous cell carcinoma

The cells responsible for these tumors are in the squamous cell layer of the epidermis. Like basal cell carcinomas, they develop on sun-damaged skin in most instances. However, they may be seen in individuals who have always avoided excessive sun and also on skin that is covered by clothes. Rarely, they also develop at the site of some previous skin damage – for example, previous scars from radiotherapy. Squamous tumors grow more quickly than rodent ulcers. The first sign is usually a pink or red lump. It tends to be irregular, hard and scaly on top and within a couple of months may be more than one centimeter in diameter. The center may break down to form an ulcer. Squamous cell carcinomas can spread to lymph glands or to other parts of the body, although fortunately they usually remain a local problem. This ability to spread means that rapid treatment is advisable.

If it is still small the tumor can readily be removed under local anesthetic. The site is important and it is easier to remove one from the neck, where there is often some loose skin, than from the nose or lip. Larger operations may require the use of a skin graft. An alternative treatment is radiotherapy but this is more often reserved for elderly patients.

Malignant melanoma

This form of skin cancer has a terrible reputation for several reasons. The number of people getting melanoma has nearly doubled in the last ten years. It can affect young people. It can spread to other parts of the body and show up years later. Lastly it may, in the early stages, be difficult to differentiate from normal moles and indeed the tumor may start in a previously harmless mole. This terrible reputation is, however, largely unjustified. Although less rare than it was, it is still not as common as basal cell or squamous cell carcinomas. Most malignant melanomas are diagnosed and removed in their early stages, in which case there is approximately a ninety-five per cent chance that they will cause no more trouble.

Malignant melanoma begins either as a new area of pigmentation or as a change in an existing mole. Any area of the body can be affected. Many existing moles change without there being a threat of melanoma, but certain appearances give grounds for suspicion and may warrant its removal for examination under a microscope. Worrying changes include much variation of the color, for example light brown, black and red brown; a jagged edge; recent increase in size. None of these changes guarantee that a mole has become malignant but they should prompt a visit to the doctor.

There has been much discussion in the media concerning melanoma. It has been part of a national campaign to make people more aware of the dangers of too much sunlight and to consult the doctor sooner rather than later if a mole seems to have changed. The obvious goal is to try and pick up most melanomas at a very early stage. It has a negative side because many people will start to worry about moles which are in fact harmless.

The effects of sunlight on the skin are discussed later but it is important to stress here that there is no doubt about the role of ultraviolet in causing malignant melanoma. Not everyone’s tumor is due to sun but the more sun you get and the more often you burn the more likely you are to develop a melanoma. Just as heavy cigarette smoking seems hazardous today, so in years to come, sun worshipping may seem a stupid pastime.

When a melanoma has developed it should be treated by surgery. It is usual to remove some normal- looking skin around the tumor at the same time to be on the safe side.

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