What causes skin cancer?

The vast majority of skin cancers are caused by exposure to ultraviolet light in the form of sun exposure but also from artificial sources such as solariums and arc welding.  Other causes of skin cancer include exposure to cancer causing chemicals such as arsenic, or ionising radiation.  These causes are much less common than ordinary sunburn from the sun.  There are many types of skin cancers. Many Australians are burnt on a regular basis, and sunburns are often associated with outdoor activities we spend our leisure time doing, such as outdoor sports, gardening and swimming.  Many outdoor workers are also burnt frequently although workplace health and safety preventionhas helped to some degree.

Skin cancers do occur more commonly in some families, but rather than being genetic as such, it can be that these families all experienced more sunburns due to habitual exposure to the sun through sport or other outdoor activities.  There are rare genetic mutations that can lead to a very high risk of skin cancer, including Gorlin’s syndrome, which can lead to a high risk of BCC formation.  Melanoma appears to be genetic in a small proportion of patients, but there is no genetic testing available as yet to quantify your risk of melanoma.  If you have a family history of skin cancer including melanoma, you may be at increased risk of skin cancer, and it may be worthwhile having annual skin checks, especially if you have risk factors for skin cancer yourself.

Basal Cell Carcinoma (BCC) is the most common form of skin cancer. It is derived from the basal or deepest layers of the epidermis (outer layer of skin).

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MBCHB, BSc (1st Class, Hons), MRCGP, Dip Derm (Aus), M Med (skin cancer, Dist), FAID, FSCCA

Flap surgery is a plastic surgical technique which is used for treatment of skin cancers where a simple elipse would not suffice.

Sun damage at a young age is potentially the most dangerous, because the skin is thin and delicate and may burn more easily.  It is also the time when sunburn is most likely to result in freckling and mole formation, which are both markers for people at risk of future skin cancers.  In fact, a mole count over forearms is an indication of future melanoma risk, with high mole counts being associated with increased lifetime risk of melanoma.  Children need to be protected from sun damage and in particular sun burn with hats, sunglasses, protective clothing (shirts, rash vests), high potency sunscreens (50+ SPF recommended) and avoidance sun exposure in the hottest part of the day.  Every sunburn contributes to an increased risk of skin cancer in future and there may be a very long (decades) delay before the skin cancer appears.  Skin cancers occurring after a single sunburn has been documented, with a delay of 40 years between the sunburn and the eventual cancer formation. Regular sunscreen application for skin types susceptible to sun burn can prevent accidental sunburns, and lead to a reduced risk of future skin cancers.

Most children are at very low risk of skin cancers, so regular skin checks are not routinely recommended unless there are particular concerns.  While skin cancers including melanoma are rare, they do occur, so if there is a mole or spot that is changing or growing at an accelerated rate, or looks odd or different to every other mole on the child’s body, then they should be checked to ensure it is not a cancer.

The Melanoma Scan doctor and nurse will give you detailed instructions on how to care for your wound to reduce scarring. 

Any procedure to remove a skin cancer will cause a scar and some people will scar more than others depending on their tendency towards keloid scarring and their skin type.  Scars tend to settle to a pale mark, either a oval area after curettage and cautery or as a line from excisional skin surgery.  If there is a lot of background sun damage, this pale area can become more prominent and noticeable.  Background sun damage can include solar keratosis, freckles, pigmentation, age spots and telangiectasias (dilated small vessels on the skin surface).  All of these lesions can be treated, either as individual lesions or as part of a field treatment such as efudix, PDT, lazer, IPL or skin peels. 

Mole removal occurs it two ways, either a shave excision, which is very quick, or formal ellipse excision, which takes a little longer.  Shave excision is a technique that involves putting a small amount of local anaesthetic under the mole and then using either a straight or curved blade, which is passed through the skin directly under the mole, resulting in the mole being removed with a narrow margin of normal tissue under and around it.  Occasionally, if the mole is being removed for benign reasons (for example, it is raised and gets in the way of shaving and repeatedly traumatised) the doctor may remove the raised part of the mole and leave a small amount of mole tissue behind, in an effort to minimise any visible scar or depression left by the mole removal.  This procedure normally takes between two minutes and 5 minutes to do, using low sting local anaesthetic, which has the dual advantages of hurting less and giving almost immediate numbing to superficial lesions like a mole.  This type of mole removal can often be incorporated into a skin check or 15 minute procedure time.

Formal ellipse excision takes a little longer, because a larger area of skin needs to be numbed, and a formal excision setup needs to be done by the doctor or nurse. The mole needs to be removed as an ellipse of skin (boat shaped piece of skin removed) and the wound sutured, usually in two layers, closing both deep and superficial parts of the skin, minimising the risk of scar stretching and tram track marks being left behind from the sutures.  A typical mole removal using this technique takes about fifteen minutes to perform when assisted by a nurse, or 25 minutes without the assistance of a nurse. 

Is it a standard procedure time?

A shave excision can be done in a standard 15 minute appointment, however, an ellipse excision is usually booked into a 30 minute procedure appointment, so it depends on the technique that you have discussed with your doctor.

Melanoma Scan - Skin Cancer Clinic

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The healing time is different for the two different types of mole removal and the location, and also the reason for the excision.  The healing time of a cosmetic mole removal on a face can be 7-10 days, during which there will be a scab form and then fall off as the skin heals up under the scab.  A deep shave excision for testing for possible melanoma is a much deeper and wider shave excision and depending on the location on the body, can take between 2 and 4 weeks to heal.  There can be a risk of infection on the lower leg with this technique (or any excision on the lower leg) due to poor immune function and blood supply on the lower leg, which can further delay healing.

Ellipse excision on the face takes 7 days to heal enough for sutures to be removed, and other parts of the body usually take between 7 and 14 days to heal to the point where sutures can be removed. However, this is only the early stage of healing, with deep sutures continuing to support the wound for the next 6 weeks until further strength has developed in the wound.  During this time, sporting activities, lifting, carrying, bending and squatting need to be avoided depending on the location of the wound, and the wound needs to be supported with taping with micropore tape or similar. Wound can be as little as at 10% of their eventual strength at day 7 without supportive deep sutures, and can reach 80% of their eventual strength at 3 months, hence the need to continue taping for an extended period and limit physical exertion, especially on the area affected by the surgery.

Melanoma Scan - Skin Cancer Clinic

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After a diagnosis of skin cancer the doctor will discuss treatment options, which may be as simple as a 5 minute procedure to perform curettage and cautery to the lesion, or a surgical procedure to formally excise the lesion with appropriate margins.  Most excisions are done as an elipse and suture ie the lesion is cut out as a boat shape of skin, and the edges brought together using a combination of deep dissolving and superficial sutures which are removed a week later.  Occasionally for more difficult or cosmetically sensitive areas, a flap or a graft may need to be used to maintain a normal appearance or function post skin cancer excision.  Sometimes radiotherapy or further testing may be needed for high risk lesions.

Radiotherapy is often used where there is an inoperable lesion or where surgery is not practical such as peri- neural invasion of cancer. High risk cases of melanoma may warrant testing with CT scans, PET scans, or sentinel lymph node biopsy. 

Your doctor will inform you about the nature of the cancer you have and if further testing and or treatment is necessary.

Some experts in skin cancer regard Keratoacanthoma (KA) as a subtype of SCC, but with the difference that they may eventually resolve without treatment if left alone.

Melanoma is a less common form of skin cancer but can be one of the deadliest. Melanoma can form on any part of the body but most often forms on sun exposed areas such as the arms, legs and face.

Photodynamic Therapy (PDT) is a treatment based around the compound of two chemicals. Both chemicals specifically bind to premalignant or cancerous cells, and when activated by a bright light, form a reaction that kills the affected cells.

Who should be checked?

An annual skin check (or more frequent checks) is recommended for adults if:

• you have a history of skin cancer or dysplastic naevus syndrome (abnormal mole)
• you have an extensive history of sun exposure.
• you have a family history of skin cancer or dysplastic naevus syndrome (abnormal moles)
• you have premalignant change on your skin (solar keratosis)
• you have a large number of moles on your skin
• your doctor has recommended a regular check.

What to watch out for

Skin cancers can be sometimes obvious but more often subtle changes in your skin.  Any change in your skin can alert you to the risk of skin cancer but in particular it is important to watch out for:

• any change in a mole or pigmented spot on your skin
• any new pigmented spot on your skin, particularly if it changes after you first notice it.
• any persisting itch or irritation in a mole or other spot on your skin
• any persisting red scaley mark, particularly if it grows over time.
• any spot that bleeds easily, for instance, with towelling after bathing
• any new lump that arises, particularly if it grows after you first notice it.

If you have noticed any of these changes on your skin, you should present immediately to your general practitioner or skin cancer doctor for a check.

What can happen if I don't get a check?

The most important factor in skin cancer care is the prompt recognition of a skin cancer and it's early and complete removal.  Melanoma in particular can be deadly if there is a delay in diagnosis.  The chance of a person dying from melanoma is most closely related to the thickness of the melanoma at the time of initial diagnosis and any evidence of early spread.  In most cases, with prompt recognition and treatment, the chance of dying from melanoma is rare (level 1 melanoma has a 5-year survival rate of >99%), however, in some cases the melanoma has already spread from the initial site where it arose, and in this situation treatment options can be limited. The chance of an individual patient dying from a melanoma has dropped in the last 10 years due to early recognition and treatment of this cancer, so don't delay if you believe you may have one.

Some Skin Cancer Frequently Asked Questions

What is skin cancer?

Skin cancer is a group of skin cells that have been damaged in a way that results in uncontrolled growth.  Depending on the type of skin cancer, this can result in spread to distant sites in the body or locally destructive growth.  Either forms of spread can result in damage to the body and eventual death if not treated.

What causes skin cancer?

The vast majority of skin cancers are caused by exposure to ultraviolet light in the form of sun exposure but also from artificial sources such as solariums and arc welding.  Other causes of skin cancer include exposure to cancer causing chemicals such as arsenic, or ionising radiation.  These causes are much less common than ordinary sunburn from the sun. Many Australians are burnt on a regular basis, and sunburns are often associated with outdoor activities we spend our leisure time doing, such as outdoor sports, gardening and swimming.  Many outdoor workers are also burnt frequently although workplace health and safety prevention has helped to some degree.

What is sun burn and how can I prevent it?

Sunburn is the reaction of your skin to exposure to ultraviolet radiation from the sun. Depending on your skin type and the season, sunburn can occur after as little as ten minutes of sun exposure if adequate protection is not provided. Fair skin types and people with light coloured hair and eyes are the most prone to sun burn and hence to the subsequent development of skin cancer.  Most Australians are aware of the danger of sun exposure, but sun burn is still very common because people underestimate the amount of ultraviolet radiation they are exposing themselves to.  This includes days when it is overcast, cooler or windy, when the burning effects of the sun may not be noticed before a sunburn has already happened.  All sunburns cause damage to the cells of your skin, and these changes include damage to the DNA of your cells.  Over many years, enough damage to the DNA of your cells can accumulate to cause a skin cancer to develop.  Many older people experience skin cancers many years after the activities that caused them have stopped, and may continue to have skin cancers appear from time to time despite minimal sun exposure.

Prevention of sun burn is through covering your skin with clothing, hats and sunglasses or through the use of sunscreens at all times when ultraviolet light is intense enough to damage your skin.  This is typically between 10am and 3pm although this varies with season and climate.  Here in Queensland in the summer months the UV index may be extreme from early morning though to early evening

Skin cancers are managed with either destructive methods or excision.  Radiation therapy is use in limited circumstances for aggressive skin cancer or for treatment of skin cancers where surgery or curettage is inappropriate or not possible. 

Skin cancers can be treated using surgical and non surgical treatments.

Surgical treatments used for treatment of skin cancers are physical treatments to remove the tumour.  Depending on the thickness of the lesion the treatment may be more or less invasive.  Thicker tumours are generally treated with excision and techniques include elipse (boat shaped excision), flaps and grafts. On occasion the wound may be left open for a period of time to await results of histopathology (as in the so called 'Slow Moh's'), but in most cases the wound is closed immediately following the removal of the tumour.  Surgical treatments also include diathermy and serial curettage.  This is usually used for superficial tumours on areas of the body where recurrence is less likely.  Both small and large tumours can be treated with this technique.

Non surgical treatments are treatments using medications to attack and remove the tumour. They include Aldara (Imiquimod), Efudix, and Metvix PDT (Photodynamic therapy).  These treatments are generally used for lesions which are thin and on areas of the body where recurrence is less likely, although small superficial lesions on higher risk areas may be suitable for these treatments.

Living in Australia you have a higher risk of skin damage as a result of increased exposure to the sun. Australians have a 2 in 3 chance of developing skin cancer in their lifetime. A simple yearly skin check can detect issues early and can save your life. Melanoma affects about 1 in 30 people in Australia and kills more than a 1000 people a year.

Squamous Cell Carcinoma (SCC) is the second most common skin cancer, and often occur in elderly people who have had extensive sun exposure over their lifetimes.

Sunspots, which are also called solar or actinic keratoses, are pink or tan coloured scaly spots that feel slightly rough to the touch. They occur commonly in people over 40 with light skin and hair/eyes and on skin that’s often exposed to the sun.  Most common areas are the face, tips of the ears, back of hands and forearms. 

Sunspots can be a warning sign that you’ve spent too much time in the sun without appropriate sun protection, and indicate that you have a higher risk of developing skin cancer in the future.

Squamous cell carcinoma can develop from solar keratosis.  If your sun spot feels thicker and slightly raised off the surface of the skin, it may be an indication that it has progressed from solar keratosis to intraepidermal squamous carcinoma (IEC) which is a superficial form of squamous cell carcinoma (SCC). 

Solar keratosis is often treated with destructive treatments to individual lesions, such as cryotherapy (freezing treatment) or with a field treatment to the area.  Individual destructive treatments are usually used if there is a limited number of discrete spots to treat, and has the advantage of being cheap and quick.  Field treatments are usually used when there is a large area affected by large numbers of solar keratosis lesions or when the entire area is affected to some degree with solar keratosis and individual treatment is not practical.  Field treatments include Efudix, Photodynamic Therapy (PDT), Aldara, Solaraze or Picato.

Melanoma Scan - Skin Cancer Clinic

For further information, please feel free to Contact Us or follow the link to request an appointment by clicking Book Now.