Professional, Accurate Skin Cancer Screening

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Skin Cancer Detection Basics – Tips From A Patient

Often when we think of skin cancer, we are unsure of what it may look like.  Is it a disfiguring growth, a hideous mole, or a painful bump on the skin? Is it itchy, scaly, or a patchy varied colour? Is it on the face, ears, back, arms, legs, hiding in between toes, or on the scalp?  Is it invisible or under the skin?

In fact, it is all of these things.  There are several different kinds of skin cancer, and knowing what to look for, and when to seek the advice of a medical professional, is crucial to survival of this widespread disease.

Skin cancer is the most common form of cancer, and numbers of diagnoses are rising.  In Canada, almost 75,000 new cases of non-melanoma skin cancers are estimated to be diagnosed this year.

Skin cancer results from cells that multiply out of control. As a result, tumours, lumps, or masses can sometimes form on normal skin, and can be either benign (non-cancerous) or malignant (cancerous). Skin cancers are generally categorized as non-melanoma skin cancers (basal cell and squamous cell cancers) and melanoma.

There are three main types of skin cancer found in the outermost layer of skin, the epidermis:

  • Basal cell carcinoma (least serious and most common)
  • Squamous cell carcinoma (more serious than basal cell carcinoma, but less common)
  • Melanoma (most serious and least common)

The difference among the three is the type of cells that the cancer affects. In the case of non-melanoma skin cancers (i.e., basal cell carcinoma and squamous cell carcinoma), the cell affected is the keratinocyte. In human skin, this cell starts out at the basal layer (the lowest layer of the epidermis) and then moves up to the squamous (or middle) layer of our skin. The non-melanoma cancers derive their names from where in the epidermis the affected keratinocyte is located.

Over time the skin accumulates sun damage that may lead to precancerous changes. The most common precancerous conditions of the skin is actinic keratosis. Actinic keratosis is also called solar keratosis, it is found on sun-exposed areas of the skin in people middle-aged or older.  Actinic keratosis is often felt before it is seen. It feels like rough patches. With time the lesions become visible as flat red scaling patches. It may be mistaken for eczema. Unlike eczema it is typically not itchy but may be tender and not completely respond to steroid creams.  A person with actinic keratosis will often develop more. The number of actinic keratoses often increases with age. Actinic keratoses are considered pre cancerous. Up to 10% of actinic keratoses may develop into squamous cell carcinoma (SCC) if left untreated. Treatment and sun protection is required to minimize the risk of developing skin cancer.

Early detection is key. Skin Cancer is easy to treat when caught early. If you are suspicious of a lesion then seek attention. Assessing a skin lesion takes literally one minute.

It is very important to check your skin regularly in order to detect any new or changing spots. Make sure to look over and under your shoulders, your nails, your neck, your ears and your head. Once you’ve done that you can check out the people around you. If you see something, say something.

95% of skin cancers are Non melanoma cancers. This type of skin cancer is usually skin colored and are often mistaken for common inflammatory conditions like a pimple,  scratch or insect bite. But unlike these inflammatory conditions, skin cancers don’t improve with time, they tend to persist and worsen.

5% of skin cancers are Melanomas. 95% of melanomas are pigmented, meaning some shade of brown They may appear as a new lesion or as change to an existing mole or brown spot.

Steps of a Skin Cancer Self-Exam

  1. Using a mirror in a well-lit room, check the front of your body -face, neck, shoulders, arms, chest, abdomen, thighs and lower legs.
  2. Turn sideways, raise your arms and look carefully at the right and left sides of your body, including the underarm area.
  3. With a hand-held mirror, check your upper back, neck and scalp. Next, examine your lower back, buttocks, backs of thighs and calves.
  4. Examine your forearms, palms, back of the hands, fingernails and in between each finger.
  5. Finally, check your feet – the tops, soles, toenails, toes and spaces in between.

Canadian Dermatology Association, patient handout “Melanoma Skin Cancer: Know the Signs, Save a Life” 2009.

When checking your own skin or that of your loved ones, keep in mind the “ABCDE’s of skin checks.”

A – Asymmetry. The shape of one half does not match the other half.

B – Border that is irregular. The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.

C – Color that is uneven. Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.

D – Diameter. There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than 6 millimeters wide (about 1/4 inch wide).

E – Evolving. The mole has changed over the past few weeks or months.

F – Firm – is the mole harder than the surrounding skin?

G – Growing – is the mole gradually getting larger? 

Early detection of skin cancer can be a real life-saver.  Check your skin every month, keep an eye on any abnormalities or problem areas which just do not seem to heal, and always consult with your family doctor about questions or concerns.

For more information, please see the resources I have learned from and shared in this blog: Canadian Skin Patient Alliance, Canadian Cancer Society, Save Your Skin Foundation

Natalie Richardson, mother, writer, melanoma survivor and advocate.

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Skin Cancer Prevention Basics – Tips From A Patient

Since I was diagnosed with skin cancer in 2014, I have spent considerable time trying to learn more about this widespread disease.  The words “skin cancer” have more than one connotation, for example, many people think that skin cancer is a minor blemish on the skin that can simply be removed and not thought of again.  Others believe it is not a common problem, or that they are not at risk to develop it, or they think it is a disease that happens only in tropical countries.

Patients like myself learn the hard way that skin cancer is neither easy nor unimportant, and it does hit very close to home.

A person is more likely to develop a non-melanoma cancer if they have a family history of skin cancer, have already had skin cancer, or have fair or freckled skin, blue eyes and light-coloured or reddish hair. However, anyone who has had excessive or prolonged and repeated lifetime sun exposure, or severe and frequent sunburns during childhood is at increased risk of developing skin cancer. Those who use immunosuppression drugs following an organ transplant, and other patients with suppressed or weakened immune systems are also at higher risk of non-melanoma cancer.

Although it is impossible to change some of these risk factors, there are ways to reduce skin cancer risk, by decreasing sun exposure, using sunscreen or long-sleeved clothing, avoiding sunburns, having regular skin check-ups, and avoiding tanning lamps and beds.

While sunlight does have health benefits, it is important to take precautions to protect ourselves from potentially harmful UV rays. Here are some tips to protect yourself and your loved ones:

  • Always have sunscreen with you so you can apply it if an unplanned outdoor activity arises
  • Apply sunscreen at least twenty minutes before going outside
  • Use a sunscreen with an SPF of at least 30 whenever you are outdoors (even on cloudy days); in Canada, look for sunscreen that says ”Broad Spectrum” on the label, as that is regulated by Health Canada to provide protection from both UVA and UVB rays
  • Use the correct amount of sunscreen – an ounce or golf ball size quantity to cover all exposed skin – even the tops of your ears!
  • Lotions or creams are recommended over spray or mist sunscreens, as they provide more thorough coverage. Apply lotion prior to outdoor activity, and then apply sprays or mists as touch-ups to thoroughly protect the skin
  • Use lip balm that has a SPF of at least 15
  • Wear protective clothing with long sleeves, hats, and full-spectrum sunglasses that protect from UVA and UVB rays
  • Limit sun exposure between 10 am and 4 pm
  • Do not use tanning beds

During the winter and spring months, it is important to protect yourself while pursuing snow sports, such as skiing, snowboarding, or snowshoeing. The sun’s reflection off of snow can increase the amount of UV radiation you receive by up to 85%. Wearing sunscreen and sunglasses will help protect exposed areas. It is recommended that you take the same precautions during summer water sports.

An SPF30 is the minimum protection recommended, and sunscreen should be applied twenty minutes before heading outdoors to allow for activation time. Remember to reapply every two hours, and after swimming or perspiring.

When you are unsure of the UV strength on a particular day, it is useful to consult the UV index. The UV index is a simplified measurement system for the sun’s damaging rays and a guideline to protection. These are available online and in phone apps.

The UV index measures as follows:

  • 0-2 – Low Risk – minimal sun protection required (unless near water or snow). Wear sunglasses if bright
  • 3-5 – Moderate Risk – take precautions – wear sunscreen, sunhat, sunglasses, seek shade during peak hours of 11 am to 4 pm
  • 6-7 – High Risk – wear sun protective clothing, sunscreen, and seek shade
  • 8-10 – Avoid the sun – seek shade – wear sun protective clothing, sun screen & sunglasses. White sand increases UV radiation exposure
  • 11 + – Take full precautions. Unprotected skin can burn in minutes. Avoid the sun between 11 am and 4 pm, wear sunscreens & sun protective clothing

Following all of these prevention methods, and teaching the young people in our lives to do the same, will help reduce skin cancer incidence, keeping us safe.  As part of a healthy routine, it is also important to thoroughly check our skin from head to toe on a monthly basis, keeping an eye on any irregular or suspicious bumps, markings, lesions or patches on our skin.

 

For more information, please see the resources I have learned from and shared in this blog: Canadian Skin Patient Alliance, Canadian Cancer Society, Save Your Skin Foundation

Natalie Richardson, mother, writer, melanoma survivor and advocate.

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