Skin cancer prevention, risks and treatment

Skin cancer is on the rise in the UK and in the last decade, the number of cases is thought to have increased by half. Dr Justine Hextall, a leading dermatologist based in Arundel, West Sussex, runs through the risk factors for skin cancer, how we can prevent it and some treatment options.

What risk factors are there for skin cancer?

The risk factors for skin cancer can be broken down into those for melanoma and those for non-melanoma skin cancers.

Melanoma:

• Excessive sun exposure with sudden episodes of sunburn being particularly bad. Especially in the UK where most people spend the majority of their year covered up, and then having ‘blasts’ of sun on their summer holidays, it is this type of sudden exposure that can cause severe sunburns, which puts people at risk of developing melanomas.
• Episodes of sunburn in childhood.
• Having a family history of melanoma can increase your risk of developing melanoma. However, it is often people with a family history of melanoma that present atypical features, which can deter a diagnosis, so being vigilant of your history is important.
• Having fair skin or red hair.
• People who have lots of atypical moles are more at risk.
• If you have already had melanoma, then you are high-risk for developing further cancerous lesions.

Non-melanoma skin cancers:

• People who have had episodes of sunburn in the past.
• People who spend a lot of time outside.
• Having a family history of non-melanoma skin cancer.
• Fair skin and fair-haired people.
• Immuno-suppressed people, such as those with a renal transplant, are at a much greater risk.

If I am at risk of developing skin cancer, how often should I have my skin checked?

If you have a history of skin cancer yourself, then NICE guidelines stipulate having your skin checked periodically, either every 3-4 months or every 6-12 months.

If you have a family history of skin cancer, then having a skin check once a year is recommended.

However, it is best practice for everyone to have a yearly skin check, where you are checked head to toe. In a study reported in 2017, it showed that 17% of skin cancers diagnosed were found incidentally. Hence, having a frequent skin check can help with early detection and treatment.

What are the most effective ways of preventing skin cancer?

The key strategy to prevent skin cancer is to reduce your risk factors where possible. For example, a lot of people are not aware that the sun in the UK is strong enough year-round to cause skin cancers, and particularly between April and October people should take care to cover up and wear a high-factor SPF. Sunbeds are also not advised, as these can be very high in UVA rays which contribute to skin cancer, and age the skin rapidly.

When you are in the sun, it is best to use an SPF 50 sun cream that is for both UVA and UVB. Some sun creams only cover you for UVB, but UVA rays are also linked to causing skin cancer and skin damage. It is also not sufficient to apply sun cream just once, and it should be reapplied every 2 hours, and every time after swimming or getting wet. It is also advised to wear a rash vest if you plan on snorkelling or swimming for a long duration.

However, there is no substitute for shade and covering up, so if you are going to be exposed to sunlight, were good SPF and avoid the sun in the middle of the day when it is at its strongest.

Another tip for reducing unnecessary exposure when going on holiday is to build-up your skin’s tolerance. For example, if you are on holiday for a couple of weeks, in the first few days just have short bursts of sunshine, whilst wearing a high-factor sun cream. The worst thing you can do is to spend hours in the sun without any sun cream, whilst that may be tempting if you are hoping to suntan.

Another important preventative measure is to be vigilant about your skin and being aware of any changes. If you are concerned about a mole, you can track any possible changes using your smart phone’s camera, allowing you to be objective. Of course, if something is troubling you, it is always best to seek medical advice. If you have a sore that is itchy, painful or does not heal then you should visit your GP. The sooner pre-cancerous features are treated, the less likely skin cancer is.

How is skin cancer surgery performed?

There are numerous treatment methods for skin cancer, but for pre-cancerous lesions, they can be removed using cryotherapy or photodynamic therapy. Topical creams can also be used.

For cancerous lesions, formal excisions will be carried out where the skin cancer is removed, ensuring a suitable margin is removed as well, to reduce the chances of it returning. Mohs surgery is a technique that only removes as much tissue as is needed. This is done by removing skin in stages, with testing in between for cancerous cells. This method is often used for treating lesions in cosmetically sensitive areas, such as the nose or face in general.

Successful skin cancer treatment should also take into account the scar left behind. A good surgery will leave a small scar that isn’t very noticeable, and vigilant aftercare can also reduce the appearance of scars. Massaging scars, using silica gel or products such as Bio-Oil can help with this.

If you are concerned about your skin and would like to see a skin cancer specialist, make an appointment.