The risks of skin cancer
by Lilianne Fuller
When Julia noticed a small growth on her left calf, she didn’t give it much thought. The growth first appeared 16 years ago and wasn’t troublesome. When it started to bleed, she showed it to her family doctor, who then referred her to a dermatologist. Her dermatologist removed a portion of the growth and sent the sample for pathological examination. Julia was shocked to learn that she had skin cancer.
There are many types of skin cancer – the three most common types being basal cell carcinoma, squamous cell carcinoma and melanoma. A precancerous condition known as actinic keratosis also requires treatment. It appears on sun-exposed areas of the body (such as face, ear, balding scalp, back of hand, forearm and leg) as red, rough scaling spots. If left untreated, it may develop into cancer.
Julia was diagnosed with basal cell carcinoma, the most common form of skin cancer in Canada. Ultraviolet radiation is the primary cause of this skin cancer. Frequent severe sunburns and intense sun exposure in childhood increase the risk of basal cell skin cancer in adulthood.
Julia is a blonde-haired, blue-eyed 75-year-old. In her youth, she was an avid outdoors person who enjoyed hiking and outdoor sports. She, like her peers, considered sun exposure to be part of a healthy lifestyle. Studies have shown that fair-skinned people with blonde or red hair and skin that usually burns are most at risk for developing basal cell carcinoma.
According to Dr. Kevin Peter, a prominent dermatologist, intense sun exposure in childhood increases the risk of skin cancer in adulthood. “If a patient has had frequent blistering sunburns in childhood and a family history of skin cancer, their odds of developing skin cancer as they age are pretty good,” he says.
To treat Julia’s cancer, her dermatologist discussed the size and location of her tumor, her health status, and treatment options with her. Together, they decided to remove the tumour surgically. He advised Julia that, because she had been diagnosed with skin cancer, she was now at increased risk of developing further skin cancers. Her dermatologist advised her to perform a full body self-examination quarterly and to advise her family doctor if she noticed any changes.
Shortly after the removal of her basal cell carcinoma, Julia noticed a red, rough scaly spot on the back of her hand. This time the diagnosis was actinic keratosis. Fair-skinned people who freckle and burn easily are at greatest risk for developing actinic keratoses. People over 40 who have had considerable sun exposure and outdoor workers face greater risk because of their extensive sun exposure.
“Actinic keratosis must be treated as it can transform into basal cell carcinoma or squamous cell carcinoma,” says Dr. Peter.
Squamous cell carcinoma, the second most common skin cancer in Canada, appears as thickened, red, scaly bumps, wart-like growths or open or crusted skin. It grows quickly and appears on chronically sun-exposed areas such as the head and neck, arm. Frequent sun exposure is the leading cause of squamous cell carcinoma. “Unlike basal cell carcinoma, squamous cell carcinoma has the potential to metastasize (spread) to other parts of the body so it’s important to seek medical advice,” he explains. When discovered at an early stage, melanoma has one of the highest cure rates of all cancers but if left untreated, it will invade the skin. When it reaches the bloodstream or the lymphatic system, it can spread to other parts of the body and may cause death.
Indoor tanning before the age of 35 has been associated with a significant increase in the risk of melanoma. In fact, the World Health Organizations’ International Agency for Research on Cancer indicates that UV tanning beds are group 1 carcinogenic to humans.
Avoiding UV exposure altogether is the best way to prevent both skin cancer and the premature signs of aging. Dr. Peter advises avoiding sun exposure when the sun’s UV rays are strongest. Seek shade whenever possible, and wear clothing that covers as much skin as possible. Broad spectrum sunscreens with a minimum SPF 30 should be applied liberally and worn daily, even in winter. Look for the Canadian Dermatology Association logo for effective products that meet these criteria.
Julia is among thousands of Canadians who have been successfully treated for skin cancer every year. She is now sun-aware and knows the importance of being sun-protected. She hopes that her story can help others.
Much of the information in this article was taken from the Canadian Dermatology Association website (www.dermatology.ca). Thanks to Dr. Kevin Peter, MD, FRCPC, DABD, FAAD, a dermatologist in Surrey, BC with 33 years of experience, for providing information for this article.