Everything you need to know about detecting skin cancer

With early detection, skin cancer – even malignant melanoma – can be stopped in its tracks. Here's what you need to know.

11 May 2015
by Rebekah Kendal

Get in front of the mirror!

Regular self-examinations – particularly for those over the age of 40 – are the surest way to detect skin cancer before it begins to spread. “A self-examination may help in determining where moles, freckles and other skin marks are on the skin," explains Professor Michael Herbst of the Cancer Association of South Africa (CANSA). "One can then, on a regular basis, inspect one's skin with the purpose of noticing any changes. It is best to do this standing in front of a full-length mirror while using a hand-held mirror to inspect hard-to-see areas."

You probably won't remember where all of your moles and freckles are, so draw a rough figure on a piece of paper and make notes about your spots so that you can track changes from one year to the next.

Recognising the signs of skin cancer

Basal cell carcinoma is the most common form of skin cancer in South Africa, followed by squamous cell carcinoma. Malignant melanoma is far less common, but it can spread (and rapidly) to other organs and is the most dangerous form of skin cancer.

Here's what you need to look out for:

  1. Basal cell carcinoma (BCC): Most often appears on skin that is exposed to sun such as your face, scalp, neck, hands and arms. It may look like a reddish patch of dry skin, a pearl-shaped lump, a sore that bleeds easily and returns after healing, or a group of slow-growing shiny pink growths.
  2. Squamous cell carcinoma (SCC): In addition to appearing in areas that are exposed to the sun, squamous cell carcinoma is also often found inside the mouth, on the lip or on the genitals. Typically it will appear as a firm red nodule, a rough scaly patch that bleeds when bumped, an ulcerated sore or a flat white patch inside the mouth.
  3. Malignant melanoma: Melanomas often look like moles and can even develop from moles. Look out for moles that are: asymmetrical, have a scalloped or poorly defined border, have colour that varies from one area to another, change in shape or size or have diameters greater than 6mm.

Getting a diagnosis

First, the dermatologist will conduct a physical examination. He or she may use a technique called dermatoscopy (using a special magnifying lens and light source) to see the skin more clearly. If the doctor finds a suspicious growth, they will do a skin biopsy so that a sample of the skin can be sent to a laboratory for analysis.

"During this procedure, the doctor will numb the area before removing a tissue sample," explains Herbst. "There are several different biopsy methods, but removal of the entire growth through an excisional biopsy is often sufficient to remove a squamous cell carcinoma. Other types of biopsies include a shave biopsy, in which the doctor shaves off the top layers of the lesion, and a punch biopsy, where the doctor uses a special tool to cut a tiny round piece of the tumour, including deeper layers of the skin."

Depending on the suspected type of cancer, the doctor may also perform other tests. The doctor will probably check nearby lymph nodes in case the cancer has spread and may even biopsy the lymph nodes.

"In very rare cases where it is suspected that the cancer has spread, other imaging tests such as X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI) scans may be used to determine if cancer cells have spread to internal organs and bones," says Herbst.

Treatment options

  • Mohs' surgery: During this type of surgery, the affected tissue is removed one layer at a time. Microscopic examination of the tissue takes place during – not after – the surgery, so that the surgeon can make sure that he or she has removed all of the cancer cells, while sparing as much of the normal tissue as possible.
  • Curettage and electrodessication: Usually used on small SCC and BCC tumours, this process involves scraping the tumour with a curette and then cauterising the remaining cancer cells with an electric needle.
  • Cryosurgery: The skin and cancer cells are frozen using liquid nitrogen. The cells in the frozen area, which are destroyed, slough off. 
  • Radiation therapy: In areas where surgery is difficult – such as the eyelids, ears or nose – or if the cancer covers a large area, radiation therapy might be used. Older patients are more likely to receive radiation therapy than younger patients.
  • Chemotherapy: Chemotherapy drugs in the form of a cream (generic name:
    5-fluorouracil) are applied directly to the skin. The cream destroys the cancerous cells. Chemotherapy may also be used if the cancer spreads beyond the skin. 

For more information, visit the CANSA website or call the CANSA helpline on 0800 22 66 22.

IMAGE CREDIT: 123rf.com

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