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Dr Rory Dower

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Skin Cancer: what are the signs and what are my treatment options?

With the summer holidays fast approaching, there’s never been a better time to ensure that your skin is protected against the sun’s harmful rays. It’s also the perfect time to clue yourself up on the facts surrounding skin cancer.

The three most common types of skin cancer are Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma. Although incidences of Melanoma are still relatively uncommon compared to Basal Cell Carcinoma and Squamous Cell Carcinoma, it’s certainly the most feared skin cancer. It also has the highest mortality right.

Diagnosing Melanoma

The most common signs of Melanoma are changes to existing moles, whether it’s in shape, size or colour. You should also keep an eye out for any suspicious, pigmented lesions, or a wound that doesn’t heal. The initial diagnosis will be done via a biopsy, where your doctor will remove all or part of the suspicious mole or lesion. This will then be sent off to be analysed and if it does come back as positive for Melanoma, your doctor may advise that you undergo Sentinel Lymph Node Biopsy (or SLNB).

SLNB involves identifying the sentinel lymph node, which is the lymph node into which the tumour first drains. A radioactive tracer or dye (or both) is injected around the area of the Melanoma. The radioactive tracer or dye stains the affected lymph nodes, and your surgeon will then remove them via a small incision. Your doctor will then examine these to check for cancerous cells.

A positive SLNB result indicates that cancer is present in the sentinel lymph node, and may be present in surrounding lymph nodes and organs as well. A negative SLNB result means that the cancer has probably not yet spread to other lymph nodes or organs.

This procedure can help your doctor identify the stage and prognosis of the cancer, so that he or she can prescribe an appropriate treatment plan.

Treating Melanoma

Some of the latest developments in terms of treating Melanomas include immunotherapy and targeted therapy. Immunotherapy utilises drugs that stimulate the body’s own defenses in order to destroy cancer cells. Target therapy, on the other hand, makes use of drugs that target specific pathways that the cancer cell uses to grow and replicate.

SLNB has been shown to improve the survival rate for those with Melanomas between 1,2 to 3,5mm thick. However, complication rates are between 5 to 10 percent, and include infection, hematoma, seroma, wound dehiscence (coming apart), and lymphedema (swelling of the limb).

Non-Melanoma Skin Cancer

Although there are several cancers that fall under the broader category of Non-Melanoma skin cancers, Basal Cell Carcinoma and Squamous Cell Carcinoma are the two most common types. That said, Basal Cell Carcinomas (BCC) is about 4 to 5 times more common than Squamous Cell Carcinoma (SCC).

One of the most common signs of BCC is a small, pearly or waxy bump on your skin. These often resemble a pimple or a small, flesh-coloured mole. SCC usually presents as a res, scaly patch or a wart that may bleed when scratched. Although these are considered less dangerous that Melanoma, they are destructive and can result in damage to facial structures, such as the eyes and ears. They are also often more challenging to remove, since they are often lager in size and typically occur on the face. In the case of SCC, it may also spread to distant lymph nodes.

Treating Non-Melanomas

The primary goal when treating skin cancers is the complete removal of the tumour. This is usually done via surgical excision performed by a plastic surgeon, dermatologic surgeon, or your GP – depending on the size and location of your tumour. The aim is to remove the tumour in its entirety, while preserving as much of the tissue as possible. In some instances, non-invasive treatments (such as radiotherapy, curettage, and cryosurgery) can be used. Your doctor may recommend these if you’re at a high risk fo surgery. They’re also ideal in instances of large, non-invasive Melanomas or early BCCs.

Your doctor may perform the surgery under local anaesthesia, sedation, or with general anaesthetic. This decision is based, once again, on the size and location of the tumour. Your age is another factor that may play a role in this decision. Excision is usually a day case surgery, but there are instances when patients may need to stay in hospital overnight.

What you need to know after surgery

You can expect a fair amount of downtime, with bruising taking roughly two weeks to settle. Swelling may take a little longer to go down, usually subsiding after three or four weeks. Procedures performed on the forehead and around the eyes may result in more significant swelling around the eyes. Fortunately, this usually settles fairly quickly.

You can expect wounds on your face to heal fully within two to three weeks. Wounds on the body may take a little longer to heal – roughly three to four weeks. Skin grafts on the lower leg may take even longer to heal, depending on how good the blood supply is.

Your scars may be red and raised throughout the healing process. It could take about 9 – 12 months for these scars to mature fully. Fortunately, scars in elderly patients usually heal very well and are hardly noticeable with time.

Skin cancer prevention

If you’ve been diagnosed with skin cancer before, you’re at a high risk for developing a second cancer. This means that life-long follow ups and skin checks are essential.

Make sure that you apply a sunscreen with SPF15 or higher on a regular basis. Doing so for the first 18 years of life could reduce the lifetime incidence of Non Melanoma skin cancers by an extimated 78%. This is why it’s vital that you protect your children from the sun’s damaging rays at all times.

Regular daily use of a sunscreen with an SPF15 or higher could reduce your chances of developing Melanomas by 50%. It also cuts your chances of developing Squamous Cell Carcinoma by approximately 40%.

When it comes down to it, there really is no reason not to apply sunscreen on a daily basis. It could greatly reduce your chances of developing both Melanoma and Non Melanoma skin cancers. It’s a small amount of effort that could end up saving your life!