Jon Pleat MA DPhil FRCS(Plast), Plastic Surgeon and Scientific Advisor at SCaRF details the risks of skin cancer and how it can be prevented
Skin cancer is the most common form of cancer globally. There are more than 80,000 deaths a year from its different forms. Within the UK, the incidence of skin cancer is doubling every 10 to 20 years. The major killer is malignant melanoma for which there are around 12,000 new cases annually in the UK.
Tragically, the vast majority of skin cancer cases – more than 90% – are entirely preventable. These are skin cancers in which ultraviolet (UV) radiation has damaged the skin. Ultraviolet light in the form of excessive sun exposure or the use of sunbeds damages the DNA of the skin cells that constantly divide. The DNA damage in the form of a mutation allows the cells to divide at an excessive and uncontrolled rate. Further, both the harmful wavelengths, UVA and UVB, may suppress the immune system and allow cells that are dividing to escape our normal, natural surveillance mechanisms for detecting cancer. As with most diseases, it is the combination of our genes and environmental exposures that drive the process. Our genes clearly have an influence on skin cancer. People who have less protective melanin within the skin seem to be more at risk of UV damage, and there are a few rare genetic diseases where DNA repair is deficient. However, there is overwhelming evidence that how we protect our skin from earliest childhood can have a vital influence on the development of skin cancer.
Types of skin cancer
There are a variety of forms of skin cancer depending on which cell divides. Melanoma arises from the pigment cells within the skin and is very aggressive.
Usually, it arises from an existing mole within the skin or a new mole that changes rapidly. More frequently within the UK, we see non-melanoma skin cancer (NMSC) and chiefly, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). BCC’s are the most common form of all skin cancers – they grow slowly and are common on the head and neck. They arise as pearly lumps, patches of inflamed skin or non-healing ulcers. SCC’s are rarer but more aggressive: if left, they may spread around the body. They can appear as scaly patches which can eventually change to rapidly growing nodules or ulcers. For most skin cancer, change is a key feature that indicates an emerging problem, be it quick growth, altered pigment or new bleeding.
Prevention is vital
A simple operation to remove early skin cancer can be curative in most cases and a judicious amount of sunlight can be good for growing bones. However, prevention is better than a cure and the vital message is that we need to avoid excessive UV exposure. Our skin needs to be protected from burning as indicated by sunburn. In hot climates, the sun should be avoided when it is most intense around midday, a broad-brimmed hat and protective clothing should be worn, and sunscreen should be applied. Sunscreen should contain UVB protection that is sun protection factor (SPF) 30 or greater. Additionally, it should contain UVA protection as indicated by a 4 or 5-star rating. Moreover, it should be waterproof, given time to absorb into the skin and be reapplied regularly in generous quantities. This is particularly relevant to at-risk groups including those with fair skin, people with lots of moles, outdoor workers and children’s skin which is more vulnerable to damage – childhood sunburn equates to a much greater risk of skin cancer in later life. Sunhats and sunsuits can be invaluable in this respect. For the same reasons, the damage of sunbed usage in childhood is being increasingly prevented by public health campaigns and legislation around the world.
Role of research
While the adaptation of our behaviour will be key to reducing skin cancer, research is crucial. At its most global, public health research is informing clinicians how best to get the message across about prevention. In terms of diagnosis, modern approaches have looked at the genetic complement (genome) of whole populations to identify those who are most susceptible to damage and potential molecular pathways that have been altered by UV radiation. With regards to treatment, ongoing international trials are investigating the benefit of surgery, radiotherapy, chemotherapy and immunotherapy for different types of skin cancer. There have been spectacular successes in recent years in certain areas such as advanced melanoma were targeting the BRAF gene and its effects have improved the prognosis dramatically.
It is this type of work that the Skin Cancer Research Fund (SCaRF; www.skin-cancer-research-fund.org.uk) based in Bristol, UK, have pioneered for the last 35 years. Please visit our website to support our vibrant campaign of basic research, prevention and treatment.
For more information, please contact Mrs Caroline Newton on 0117 340 3130, or email: Caroline.Newton@nbt.nhs.uk
Jon Pleat MA DPhil FRCS(Plast)
Plastic Surgeon and Scientific Advisor
SCaRF (Skin Cancer Research Fund)