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Skin cancer

Key points about skin cancer

Skin cancer is the uncontrolled growth of abnormal skin cells.
It is the most common cancer affecting New Zealanders; however, it is largely preventable.
If you protect your skin from the sun throughout your life, you will greatly reduce your risk of skin cancer.
Skin cancers are classified into two groups – melanoma and non-melanoma.
Melanoma is the most serious skin cancer and is the cause of more than 2 in 3 skin cancer deaths.
Do regular skin checks so that you notice any changes.
When found early, most skin cancers can be successfully treated.

Wahine wearing striped bikini on paddle board at beach

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Most skin cancer is caused by ultraviolet (UV) light damaging your skin’s cells. The main source of UV light is the sun. Artificial sources of UV light, such as sunlamps or tanning beds, can also increase your risk of skin cancer.

Protecting your skin from the sun (and not using sunbeds) combined with regular skin checks, is the best way to prevent skin cancer.

Types of skin cancer

Skin cancers are classified into two groups – melanoma and non-melanoma.

Melanoma is a type of cancer that develops in the skin’s pigment cells (melanocytes). Melanoma is less common but more serious than non-melanoma skin cancers.

Non-melanoma skin cancer refers to a group of cancers that slowly develop in the upper layers of your skin. The two most common types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma.

Name	Features
Melanoma	Usually appears as a changed or new freckle or mole. Often they have an unusual shape or colour, or a variety of colours, but sometimes may not be coloured. Some types may itch, bleed or weep. They may become raised quickly and catch on clothing. If left untreated, melanoma can spread rapidly to other parts of your body and become life-threatening. Read more about melanoma.
Basal cell carcinoma	The most common and the least serious form of skin cancer (as long as it is treated). It appears as a pale, red or pearly, smooth lump, usually on your face or neck. It's more common among older people, but can develop in people in their early 40s or even younger. Read more about basal cell carcinoma.
Squamous cell carcinoma	Common in people over the age of 40 who have spent a lot of time outdoors. It often appears as a raised, crusty, non-healing sore, often found on your hands, forearms, ears, face or neck. It is easily treated if found early but can be life-threatening if untreated. Read more about squamous cell carcinoma

Are solar keratoses a type of skin cancer?

Solar keratoses or sunspots are not a type of skin cancer. However, they are a sign of sun damage to your skin and a warning that you may be prone to skin cancer. Solar keratoses are flat, red or sometimes brown, scaly areas, which may sting if scratched. They are very common in fair-skinned people over 40 who have spent a lot of time outdoors.

People of all ages and skin colours can be diagnosed with skin cancer but those at a higher risk are people who have:

fair, light-coloured skin
skin that burns easily
had one or more severe sunburn, especially as a child
spent a lot of time outdoors unprotected from the sun
used sunbeds, particularly at a young age
a family history of skin cancer
a large number of moles or large, irregularly shaped and unevenly coloured moles.

Our high skin cancer rates are due to:

high levels of UV radiation during daylight-saving months
low ozone levels
our outdoor lifestyle
a high proportion of people with fair skin.

Most of us have freckles, moles or other spots on our skin. This is normal. However, you should see your doctor or skin specialist if you have a freckle, mole or spot that:

is new or changing
does not heal
looks different from others around it
has changed in size, thickness, shape, colour
has started to bleed.

Have your skin checked by a doctor immediately if you notice any of the changes described above.

Your GP can also perform a skin check in combination with a general health check-up. If you are at higher risk of skin cancer, you may need regular skin checks as advised by your doctor.

All New Zealanders should become familiar with their skin by doing regular skin self-checks (preferably once every 3 months). Being familiar with your skin means you will be more likely to notice any suspicious lumps or spots as soon as they develop, and at a stage when they can be successfully treated.

Skin checks are particularly important if you are over 50, have a family history of skin cancer or have had any bad sunburn as a child.

Learn how to do a skin cancer check

Checking your skin regularly (including skin not normally exposed to the sun) will help you get to know how your skin normally looks so you can be aware of any changes. This is especially important as you get older, particularly if you are over the age of 50.

Make sure you check your entire body, as skin cancers can sometimes occur on parts of your body that are not exposed to the sun.

Take the following steps to check your skin:

Use a hand-held mirror or ask for help from someone else to check hard-to-see areas, such as your back and neck.
Check underneath your armpits, inner legs, ears, eyelids, hands and feet.
Use a comb to move sections of hair aside and check your scalp.
If you notice any skin changes, see your doctor.

Skin check apps

There are a variety of apps for smartphones and mobile devices that allow you to take photos of your skin, and track and monitor changes to your skin lesions. These may be useful in learning more about melanoma and may provide a tool to capture images of skin lesions such as moles. Read more about skin check apps.

Unlike many other forms of cancer, skin cancer is often visible, making it easier to detect in the early stages. Early detection is the key to successful treatment.

Treatment depends on the type, size, location and number of skin cancers, and whether the cancer has spread to other parts of your body.

Treatment options for superficial skin cancers include:

surgery, such as an excision biopsy and Mohs surgery
cryotherapy
topical therapy such as fluorouracil cream and imiquimod cream
photodynamic therapy
radiotherapy
laser treatment.

Surgery

Most skin cancers are treated surgically (cutting out the cancer). This is done using a local anaesthetic to numb your skin. Surgical techniques include:

excision biopsy
Mohs surgery.

Excision biopsy

This is where a skin lesion is completely cut out. It is impossible to fully excise a skin lesion without leaving some scarring. The most common type of excision is an elliptical excision. This is designed so that the scar runs parallel with your skin creases, making it less visible.

There will also be a margin of normal surrounding tissue cut out. How wide the margin is depends on the type of cancer and how deep or aggressive it is. The tissue cut out is then sent to the laboratory for analysis by a pathologist.

After the pathologist has confirmed the lesion is a skin cancer, a wider incision (further surgery to remove more of the surrounding skin from the wound) is sometimes needed.

If a large amount of skin needs to be removed, or it is in a tricky area, a skin graft may be needed to cover the area.

Mohs surgery

This is a specialised, more intensive form of surgery for skin cancer, also called Mohs micrographic surgery (MMS). It uses a microscope to help check that the deep roots of the cancer have been removed.

It can be used to remove large, deep or recurring cancers. It is also often used for cancers in areas that are difficult to treat by other surgical methods, such as cancers near your eye.

Cryotherapy

This is the use of extreme cold (such as liquid nitrogen) to treat pre-cancerous skin conditions (eg, solar keratoses) and some small skin cancers. Liquid nitrogen is applied to the tumour to freeze and kill the abnormal cells. Some pain and redness may occur afterwards, and a blister may develop on the treated area. There may be a white mark or scar from the treatment.

Topical therapy

Topical therapy means applying a cream to the skin cancer.

Fluorouracil cream

Fluorouracil cream can be applied directly to your skin once or twice a day for several weeks. The area will become red, then there will be blistering, peeling or cracking. The skin settles and heals once the treatment has finished.

Imiquimod cream

Imiquimod can be used to treat pre-cancerous lesions and superficial basal cell carcenomas (BCCs). It is known as an immunomodifier because it stimulates your immune system to recognise and destroy cancer cells. It is easy to use as it is a cream applied to your skin, usually several times a week, for a period of some weeks.

It tends to cause inflammation and redness, itching and burning on the treated area. Some people may also experience flu-like symptoms such as headaches and fatigue during treatment. Side effects are generally mild, but if they are severe, stop using the cream and see your doctor.

Photodynamic therapy

This is a two-step process using a light source (such as a laser) and a photsensitising cream. In the first step, the skin area with the cancer is scraped lightly and a cream is applied to make the cancer cells sensitive to light.

In the second step, a few hours later, the area is exposed to a light source, so the cancer cells can be destroyed. If you feel any pain, you will be given a local anaesthetic.

Radiotherapy

Radiotherapy is an option for hard-to-treat skin cancer, such as cancer on your eyelids or nose, or if you are medically unfit for any type of surgery. Radiation treatment uses high-energy x-rays to destroy cancer cells.

Treatments usually occur for a short time daily or weekly. The area may become red and sore, and there may be changes in skin colour and/or texture in the long term.

Lasers

Lasers may also be used in some cases to treat skin cancers and growths. Also known a laser ablation, it uses a high-intensity beam of light to destroy cancer cells. It may be used if you have actinic keratosis, squamous cell carcinoma in situ or basal cell carcinomas on your skin’s surface only.

Laser surgery is also used for people who have lesions on sensitive locations, such as your eyelids or face, as well as for people who have a weakened immune system and so surgery is not a good option.

Apps reviewed by Healthify

You may find it useful to look at some Skin care (dermatology) apps.

Skin cancer is largely preventable. Over 90% of all skin cancer cases are caused by excess sun exposure. If you protect your skin and avoid sunburn throughout your life, you will greatly reduce your risk of skin cancer.

Be SunSmart in the months between September and April, especially between the hours of 10am–4pm when UV radiation levels are very high. Don't just use protection on hot and sunny days; UV can still be damaging on cool, cloudy days.

In winter it is also important to be SunSmart at high altitudes and around snow or water.

Steps to being SunSmart:

Slip – into shade where possible.
Slip – on some sun protective clothing, for example, a shirt with a collar and long sleeves, and trousers or long-legged shorts.
Slop – on broad-spectrum sunscreen that has a sun protection factor (SPF) of at least 30. Apply 20 minutes before you go outside, and re-apply every two hours, especially if you are swimming or sweating.
Slap – on a hat that protects your face, head, neck and ears.
Wrap – on some close-fitting sunglasses.

What if I have had a lot of sun exposure in my life?

Before the dangers of sun exposure were fully understood, many New Zealanders spent a lot of time outdoors without sun protection or used tanning beds. If you are worried you may have increased your risk of skin cancer in this way, the key is to prevent further skin damage and to have regular skin checks with your doctor. If you notice any darker, growing or changing moles, get them checked straight away.

Ways to protect your skin

Avoid outdoor activities when the sun is strongest – between 10 am and 4 pm during September to April in New Zealand
Wear sunscreen and lip balm daily that offer SPF 30 or higher sun protection.
Use sunscreen that offers broad-spectrum (UVA/UVB) protection and is water resistant.
Apply the sunscreen and lip balm to dry skin 15 minutes before going outdoors.
Apply the sunscreen to every part of your body that will not be covered by clothing. Reapply it every two hours if you are swimming or sweating.
Whenever possible, wear a wide-brimmed hat, long sleeves and long pants.
Wear sunglasses to protect the skin around your eyes.
Avoid getting a tan and never use a tanning bed or sun lamp.

See sun safety

Video: Wes Bonny's Story

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(Cancer Council Australia, 2011)

Video: Skin Cancer | Mark's story | Cancer Research UK

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(Cancer Council Western Australia, 2017)

Video: Michael's Skin Cancer Story

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(Cancer Council Western Australia, 2015)

Video: Skin Cancer Unseen: Peter’s story

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(Sanofi Australia & New Zealand, 2020)

Video: A young person talks about skin cancer

At just 19, this woman had 3 surgeries to remove a malignant melanoma. She talks about her experience, getting regular skin checks and reducing skin cancer risks by covering up in the sun. This video may take a few moments to load.