Tag: skin cancer

How ironic that Chuck Cadman, 57, independent Member of Parliament from British Columbia, should die from melanoma during the summer month of July. His death reminds us again that we have to protect our skin from the damaging effect of the sunrays.

Artificial tanning machines are also dangerous. Recently, the World Health Organization (WHO) said the increased popularity of artificial tanning machines is one of the main reasons for a rapid increase in incidence of skin cancer, particularly among young women in Europe and North America.

WHO suggested Governments should pass laws on the responsible use of sun beds, banning their use for all people under 18.

For Canadian males, the rate for melanoma has tripled since the late 1960s. For Canadian females, the rates have varied over the years but still show a gradual increase.

Melanoma is the most serious form of skin cancer. If diagnosed and removed early then the cure rate can be excellent. Once the cancer advances and spreads to other parts of the body, it is hard to treat and can be deadly. The death rate from melanoma continues to rise about two percent annually.

Skin is the largest organ of our body and has many important functions to protect us from environment. Skin is constantly exposed to sun, wind, industrial elements and other causes of external and internal injury.

Melanoma arises from cells called melanocytes. These cells contain melanin (melas = black) – a principal pigment responsible for the color of human skin, hair, and eyes. Melanin also acts as a filter to decrease the harmful effects of ultraviolet rays to the dermis.

When the skin is exposed to ultraviolet radiation, there is immediate increase in the number of melanocytes and production of melanin pigment. This results in tanning. The amount of melanin produced is genetically determined. That is why some people burn easily without tanning.

The risk of skin cancer is increased in individuals who spend too much time out doors, children who have had episodic sunburn, and if there is a family or personal history of skin cancer (especially melanoma). Males are affected more than females.

Can we prevent skin cancer?

There are two important things to remember about prevention of skin cancer: cover up and stay out of the sun.

We need to remember that skin tanned by ultraviolet radiation is damaged skin which predisposes to cancer. We need to avoid sunburn and generally reduce exposure to ultraviolet radiation by staying out of the midday sun, wearing protective clothing, seeking shade, and applying sunscreen.

We should have moles or sun burnt skin surgically removed if they show signs of change or non-healing. Bleeding, chronic irritation, change in color or size should warn us to have these moles removed.

Despite having a good understanding of the relation between overexposure to the sun and skin cancer, 81per cent of North Americans still think they look good after being in the sun. Just like the smokers. They know smoking kills but they still smoke.

Does melanoma occur in children? Yes, approximately two per cent of melanomas occur in patients under the age of 20 years, and about 0.4 per cent of melanomas occur in pre-pubertal children.

Prevention of skin cancer is very important. This should start in childhood. More than 90 percent of skin cancers occur on sun-exposed areas of the body. So, protect yourselves from the damaging effects of sun and tanning beds.

This column will take a summer break and return in September. Have a safe summer!

Thought for the week:

“Genius is the ability to put into effect what is in your mind”.

– F. Scott Fitzgerald

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Dear Dr B: Recently I had surgery for skin cancer called basal cell carcinoma. Besides surgery, are there any other options for the management of this cancer?

Basal cell carcinoma (BCC) is a form of skin cancer and is the most common cancer found in humans.

BCC and squamous cell carcinoma (SCC) are also known as non-melanoma skin cancers. Melanoma is the third type of skin cancer. Approximately 30 percent of the malignant skin cancers diagnosed among Albertans each year are non-melanoma skin cancers – BCC and SCC.

Non-melanoma skin cancers account for greater than one million new cases of cancer annually in the United States and are responsible for 1200 to 1500 deaths per year. Costs of US$500,000,000 have been estimated in the management of these malignancies.

BCC usually grows slowly. It is locally invasive and does not spread to distant parts of the body – liver, lung, brain, bones etc. But melanoma can spread to other organs of the body.

The clinical outcome of BCC is difficult to predict. It may remain the same size for many years or it may grow rapidly. It can cause local destruction of tissues especially on the face.

BCC can occur at any age but the incidence increases over the age of 40. The incidence among the young people is increasing due to increased exposure to the sun.

Who are prone to skin cancer?

People who have fair skin, have tendency to freckle, have high degree of sun exposure, make excessive use of sun beds, had previous radiotherapy or phototherapy, male sex, and those who have genetic predisposition.

How is BCC treated?

“The first line treatment of BCC is often surgical excision. Many alternatives are available, including curettage, cryosurgery, laser treatment, surgical excision with predetermined margins of clinically normal tissue, excision under frozen section control, Moh’s micrographic surgery, radiotherapy, topical treatment, intralesional treatment, photodynamic therapy, immunomodulators, and chemotherapy”, says an article in the British Medical Journal.
The article says that although many treatments are used for BCC, little research is available that accurately compares these different treatment methods against each other and for different types of tumour.

If BCC is not adequately treated then two thirds of recurrent tumors appear in the first three years of treatment and 18 percent appear between five and 10 years after treatment.

According to the BMJ article the following treatments are most often used in the management of BCC:

• -excisional surgery – seems to be the most effective with low recurrence rate,
• -curettage and cautery,
• -radiotherapy,
• -cryotherapy, and more recently
• -photodynamic therapy and
• -imiquimod cream – preliminary studies suggest a short term success rate of 87-88 percent for imiquimod cream in the treatment of superficial basal cell carcinoma, although this cream has not been compared with surgery.

Surgery remains the main stay of BCC management. More research is required to compare imiquimod cream with surgery. Other methods of treatment have not shown to be superior to surgery.

Prevention of skin cancer is very important. This should start in childhood. Reduce exposure to sun, use sunscreen, use wide-brimmed hat, and have suspicious looking moles removed surgically. More than 90 percent of skin cancers occur on sun-exposed areas of the body.

If you like to worship sun, then expect to burn and eventually get cancer.

Thought for the week:

“Exercise will make you fit, but fitness and health are not synonymous. Exercise alone is not enough to make you healthy. To achieve good health, exercise is an essential part of a compressive lifestyle program ……….”

Dr. Dean Ornish’s Program for Reversing Heart Disease.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Do children get skin cancer?

Yes. Approximately two per cent of melanomas (the worst of the skin cancers) occur in patients under the age of 20 years, and about 0.4 per cent of melanomas occur in prepubertal children, says an article in the New England Journal of Medicine (NEJM).

For adults, the Canadian statistics show that for males, the incidence rate of melanoma has tripled since the late 1960s, from 3.2 per 100,000 population in 1969 to an estimated rate of 10.5 per 100,000 in 1998. For females the rate has varied a bit but still is on the rise.

It is known that high exposure to sunlight during childhood sets the scene for higher rates of melanomas as an adult. And history of sunburn as a child is a risk factor. Skin damage and probably skin cancer increases with one’s level of total cumulative exposure to the sun and number of sunburns, says an article in the Canadian Medical Association Journal (CMAJ).

People get more exposure to sunlight in July and August (just the way we are experiencing now) than at any other time of the year. Children are no exception. They spend more time outdoors than adults.

People with fair skin, such as those with Scandinavian ancestry, are more prone to sun damge than people with darker skin, says the CMAJ article. The death rate from melanoma also continues to rise about two percent annually.

What can we do to combat the rising incidence and death rate from melanoma?

According to Ca – a Cancer Journal for Clinicians, we need a three pronged approach to effectively deal with this problem:

1. Public awareness and understanding of melanoma must be improved.

We have to remember that melanoma is probably the most clear-cut case of a cancer where early detection and treatment are key to improving prognosis. New York University has developed ABCDs of early clinical signs of melanoma recognition. Public should be aware of these signs:

-Asymmetry
-Border irregular
-Color uneven
-Diameter greater than 6 mm.

2. Better methods are needed for identifying those at highest risk.

This can be achieved with more research. Hopefully, the future will bring more specific genetic and/or biologic risk models to make this exercise worthwhile.

3. More specific therapies for melanomas need to be developed.

Most early melanomas can be treated with wide surgical excision. But prognosis drops dramatically when the tumor has spread. There is no curative treatment available for advanced melanoma.

While we are waiting for scientific break through in many areas of melanoma, we can try and prevent melanoma by protecting against sun exposure and sun burn. Natural protection (shade) is considered the best protection. And sunscreen (SPF 15 or higher) should be adjunct to natural protection.

Wear sun protective clothing (tightly woven and dark in color). Wear wide brim hats. And use eyeglasses that block both UVA and UVB light.

Skin is a very precious and important organ of our body. It has many important functions. It is important for our survival. Let us protect it well – starting from childhood. There is no doubt that melanoma risk rises rapidly with increasing exposure to ultraviolet light in childhood. That’s where prevention should start and then continued into adult life.

Have a great summer!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!