Skin cancers need vigilance even during COVID

Skin cancers are the most commonly diagnosed type of cancer in Canada.

By Ronnie Borsuk
Skin cancers are the most common type of cancer in Canada, accounting for one third of new diagnoses. The good news is that most skin cancers are curable. While the skin is our largest organ, it is also the most amenable to direct observation, so finding skin cancers does not usually require any special equipment. With a bit of information, you can help prevent, diagnose and get treatment for yourself and loved ones in a timely fashion.

What causes skin cancer?
There are several reasons why skin cancers form. The most common is ultraviolet radiation that causes damage to the DNA of cells. UV radiation comes mostly from the sun but can also come from other sources such as tanning beds. Less common causes include other ionizing radiation such as the radiation that radiation technicians and flight attendants are exposed to, smoking, some viruses (like human papiloma virus) and immunosuppression.

Who can get skin cancers?
The simple answer is anyone. That said, there are certain populations who are more likely to get skin malignancies. People with lighter skin are at higher risk because they have less melanin to absorb harmful UV radiation. So are people who have more exposure to UV radiation, a family history of skin malignancies or a history of sunburns, especially ones that have blistered. Certain jobs put people at higher risk, like being a pilot or working with certain chemicals like arsenic.

What are the main types of skin cancer?
Basal Cell Cancers: These are the most common and the least worrisome. They can look like a small dome-shaped bump on the skin. They can have little visible blood vessels just under the skin and are often described as “pearly.” They can ulcerate, where the skin opens and leaves a little bleeding area.

Squamous Cell Cancers: These are fairly common. They tend to have the appearance of a raised rough patch, often with flakiness of the skin and may have an ulcer in the center.

Melanomas: These are the least common and the most worrisome. Using a mnemonic called the “ABCDE” can help identify them. These cancers are usually pigmented lesions that are Asymmetrical, have irregular Borders, have Colour changes within the lesion itself (some parts are dark, others are light, perhaps with some white or red areas), have a Diameter more than 6mm and Evolve over time.

Those guidelines are helpful, yet some skin cancers do not follow these rules. For instance, amelanotic melanomas have no pigment and are the same colour as the skin around them. These types do not match the classic picture of melanoma. Some basal cell cancers can look like a scar that appears even though there has been no wound. Cancers around nail beds often look unusual. As such, it’s important to monitor your skin and see a health care professional if you notice any skin changes. Getting regular skin checks is also helpful so your doctor can look at areas that are hard to see by yourself.

Skin cancer can be diagnosed visually by your doctor simply looking at your skin. Some dermatologists use a dermatoscope, a magnifying polarizing lens, to get a closer look. Final diagnosis if often made by biopsy – the doctor takes a small piece of the lesion and sends it to be analyzed.

Treatment for skin cancers
There are several options for treatment. Certain creams, like Aldara (Imiquimod) and Efudex (Fluorouracil), can be quite effective for some patients. Scraping and burning the base of a lesion or freezing the lesion (cryotherapy) are also options, and they are quick treatments that can be done in the doctor’s office.  If the lesion is a bit larger, the treatment of choice is often surgical removal. This is generally done in the doctor’s office with local freezing. The whole procedure usually takes between 30 minutes and an hour. For melanomas, the treatment can be a bit more involved and may include referral to an oncologist.

Prognosis of skin cancers
The majority of skin cancers are simple to treat and cure. The key is to catch them early and get treated. Advanced skin cancers can be more difficult to treat and may not be curable.

Prevention and next steps
Limit your exposure to the sun and avoid tanning beds. Use a good sunscreen and re-apply often as directed. Choose clothing and hats with UV protection. Check your skin regularly. Ask a family member to check areas that are hard to see yourself. See your doctor regularly for skin checks. If you have a lot of spots, consider taking a photo every three to six months and compare the images to look for changes over time. If you are concerned about something you see, speak to your family physician or dermatologist.

Dr. Ronnie Borsuk is a plastic surgeon with a busy practice in the Ottawa area. His interests include skin cancer treatment and body contouring.

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