Dealing with the deadliest skin cancer

While summer is a much loved and anticipated time of year for enjoying the sun, catching some vitamin D, spending time at the beach, being entertained at outdoor events or taking fun trips, some invisible dangers are there to be mindful of.

UV radiation from the sun can cause skin cancer. According to the Royal Australian College of GPs, around two in three Australians will develop skin cancers in their lifetime. The country’s high incidence of skin cancer is attributable to a combination of its predominantly fair-skinned population and high levels of ambient UV radiation due to proximity to the equator, the Cancer Council reports.

Of the three main skin cancer types, melanoma is the deadliest. Exposure to UV radiation causes 95 per cent of melanomas, the Cancer Council also reports.

Melanoma Institute Australia (MIA) says this country has the highest rate of melanoma in the world, with one Australian diagnosed with the disease every 30 minutes.

What is melanoma?
MIA advises that melanoma develops in the skin’s pigment cells, known as melanocytes, and If left undetected, can spread via the blood and lymphatic system to distant organs such as the lungs, liver and brain. This process of spreading is called metastasis.

Melanocytes are cells that produce melanin to give skin colour and protect the skin from ultraviolet radiation, such as from sunlight. As these cells cluster, they form a mole. Melanoma can develop when abnormal melanocytes grow uncontrollably. The MIA says a third of all melanomas develop from existing moles, but they can also develop anywhere on the skin.

Melanoma mostly starts in the skin, but also less commonly in the eye (ocular melanoma) or the body’s mucosal lining (mucosal melanoma) in certain parts inside the body.

Melanomas can appear black, brown pink or skin coloured.

The most serious of the three skin cancer types, melanoma is rarer than basal cell carcinoma, the most common, which seldom spreads from the skin to other parts of the body and usually develops on areas of heavy sun exposure. The third type is squamous cell carcinoma, the second most common form of skin cancer, often seen on sun exposed areas but which can also happen on any other parts of the body, such as the lips, mouth and genitals.

Ninety-five per cent of melanomas are caused by overexposure to UV radiation. However, there are also increased risks for those who have fair skin, though any skin type is at risk of melanoma.

People at risk are those who have lots of moles or atypical moles, have previously had skin cancer, or have a history of tanning and sunburn, or a family history of melanoma.

MIA’s website has a ‘melanoma risk prevention’ tool that can be accessed to assess melanoma risk.

According to MIA, most melanoma diagnoses start with a suspicious looking spot on the skin, and if caught early, 90 per cent of melanomas can be cured by surgery alone. Therefore, it’s important for patients to see a doctor or visit a skin cancer clinic as soon as possible if they notice any strange changes to their moles, or any new ones appearing.

Skin self-checks
Moles are harmless clusters of pigment cells (melanocytes) in the skin. However, one that is developing a melanoma may look different to the surrounding one. The signs of melanoma to look for in moles that have changed, using the MIA’s simple ABCDE guide, are:

  • Border irregularity.
  • Colour variation.
  • Area is larger than 6mm or is growing larger.
  • This is likely the strongest of all warning signs and it means a change in size, colour, elevation or other trait (such as itching, bleeding or crusting).

The entire body should be checked, including the scalp, and even skin not normally exposed to the sun. Photos can be taken of the moles to help monitor them over time, though this should not replace a visit to the doctor if signs of melanoma can be seen.

Treatment of melanoma depends on the stage of the disease.

The stages consist of O, I, II, III or IV, and melanoma can also have a substage (A-D). Surgery is the main treatment for all stages.

Surgery alone, as mentioned, can cure 90 per cent of melanomas if caught early. For later stage melanoma, surgery is used as a diagnostic tool to assess how far the cancer has spread. In stages III or IV, drug and radiation therapies may be considered.

As most melanomas are caused by excessive exposure to the sun’s UV radiation, the best way to prevent melanoma is to protect skin from the sun. It’s easy to think that the UV rays won’t have an effect because they cannot be seen, but even clouds don’t necessarily shield the skin from the rays. The UV index is a tool that can help guide how much protection is needed and when. Sun protection is always needed when the UV index is at three or above. Those with fair skin may still need protection even if the UV index is under three.

The SunSmart app features UV index levels personalised to the user’s local area and even has a sunscreen calculator to help assess if someone is using enough sunscreen.

The five sun safety rules MIA advocates are:

  • Seek shade.
  • Wear sun protective clothing to cover the back, shoulders, arms and legs.
  • Wear a wide brimmed hat.
  • Apply a broad spectrum sunscreen with SPF of at least 50+ every two hours and after swimming or exercise.
  • Wear wraparound sunglasses.

Role of pharmacies
Emma Glassenbury, Head of SunSmart Victoria, says pharmacists and pharmacy assistants can play a significant role in educating patients about sun protection, skin cancer risks and the importance of regular skin checks.

“They can provide personalised recommendations for sun protection products based on individual skin types and lifestyles,” she said. “Pharmacists can guide patients on the correct application of sunscreens and the importance of other protective measures. They can also recommend tools like SunSmart’s free Global UV app to help people understand their daily UV exposure risks and when to use sun protection.

“It’s important to remember that while sunscreen provides protection, people need to use all five forms of sun protection, such as covering clothing, a wide-brimmed hat, sunglasses, using sunscreen and seeking shade for optimum protection.

“We know the earlier skin cancer is found, the better our chances of treating it. If customers ask about sun protection, pharmacists can ask them if they check their skin and know what to look for. If customers share any concerning moles, spots, or changes to their skin, encourage them to book in with their GP as soon as possible. They can learn more about checking their skin on the SunSmart website.”

SunSmart Victoria recommends that pharmacists encourage customers to buy SPF50+ broad-spectrum and water-resistant sunscreen. Both chemical and mineral-based sunscreens can provide effective sun protection when used correctly.

Considering patient skin type and any allergies or sensitivities is advised when recommending sunscreens, says Dr Amy Chahal, a cosmetic doctor and founder of The Centre for Medical Aesthetics. She adds that pharmacists can explain the differences between physical (mineral) and chemical sunscreens.

“Chemical sunscreens contain chemical filters that absorb UV radiation and convert it into heat, which is then released from the skin,” she said. “[This is] generally lighter and easier to apply for everyday use, and less likely to leave a white cast on the skin.

“Mineral sunscreens contain active ingredients like zinc oxide or titanium dioxide, which create a physical barrier on the skin’s surface, reflecting and scattering UV radiation. These are suited to those with sensitive skin but are denser in texture and may leave a white cast on skin.”

For those who work outdoors, Dr Chahal suggests that sport- or outdoor-specific sunscreens, designed to withstand extended periods outdoors, are more durable and resistant to sweat and water.

She says it’s important to remind patients to use lip balms with sunscreens to also protect their lips from UV damage.

When it comes to medications, Dr Chahal says pharmacists should be aware of medications that may increase photosensitivity, and advise patients to take extra precautions when using these.

“Patients who express concern about their skin or request a skin check should be encouraged to consult a doctor for a thorough evaluation,” she said.

A GP, a skin cancer clinic or dermatologist can provide such a skin check.



By Tracey Cheung.

This article was first published in Retail Pharmacy Assistants Nov/ Dec e-magazine