It is International Skin Cancer Awareness month and as many of us are likely to be based in the tropics this mid-year break, it’s a good time to draw attention to this insidious cancer.
I completed my medical training in Australia, so you can imagine how it was of upmost importance for a GP to be fully attentive to changes in moles and skin cancer. Two thirds of Australians will be diagnosed with skin cancer by the age of 70. Skin cancer ranks 6th most common cancer in Singapore and is increasing in frequency.
The Rise of Tanning
In the 1920s, Coco Chanel introduced the concept of “healthy tanning”. Various tanning oils were used during the golden age of the tan in the 60s-80’s, leading to the Bridget Bardot South of France golden tan look. Since then, unfortunately we have seen a 5 x increase of melanoma – a sun related skin cancer derived from moles. Many Australians got on board with the risks of skin cancer early – but it is worth noting that repeated exposure to UV rays is considered the most important risk factor in developing skin cancer. In Singapore we live near the equator which puts the sun directly overhead for most of the year. The UV Index is an international stanard of measurement of the level of UV radiation. It ranges from 0 to 11+ (low to extreme). In Singapore we average around 6 to 9 on the UV Index. It has been known to reach ‘extreme’ levels at 15.
Risks and types of skin cancer
Skin cancer risks are determined by your skin type (the fairer you are, the higher the risk), family history, the number of moles you have (unfortunately the higher the risk) and the degree of sun exposure throughout your life.
Over 80% of skin cancer are considered preventable by reducing UV radiation exposure. Melanomas can spread quickly and is responsible for up to 90% of skin cancer dealths. The positive news is that if detected and treated early, it has a 95% survival rate at 5 years.
Other common skin cancers are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs).
Some types of SCCs can arise from Human Papillomavirus infection and genital warts. Some chronic skin conditions can develop into a non-melanoma skin cancer (lichen sclerosus, lupus, tuberculosis).
What can you do to protect yourself?
- Quit smoking – smoking is a risk factor for SCCs
- Minimise ultraviolet radiation from sunlight and tanning beds
- Ensure you have adequate sun protection before your outdoor activities
- Choose a sunscreen that is broad spectrum – anti UVA and anti UVB
- The SPF index depends on your skin type. The fairer you are, the higher the SPF index but it is not necessary to choose an SPF over 50. Well applied SPF 50 blocks 98% of UVB versus 99% with SPF 100.
- Apply sunscreen 20 minutes before going out
- Always apply sunscreen before any insect repellent
- Watch for changes in your moles or skin texture that do not seem to heal well – potential skin cancer can present as a progressive lump, nodule, ulcer and may bleed
- Pay particularly attention to moles or skin lesions that are difficult to see – back of legs, back, between toes, behind ears, scalp
- Have regular skin checks with a trained professional. Depending on your risk factors, skin checks can be as often as every three months!
- Check your vitamin D levels. A low vitamin D level has been shown to increase your risk of skin cancer.
- Consider getting the full HPV vaccine series.
When caught and treated early, skin cancers are highly curable. And in the early stages of skin cancer development, you’re the one with the best chance to see changes…but remember you cannot see all your skin (when was the last time you saw the tops of your ears or upper back?)! Please check your skin and if you have any concerns and do visit your GP who can quickly assess all your skin.
Dr Valerie Druon is a French speaking Australian family physician who has been caring for the international community of Singapore for over 9 years. In addition to her General Practice medical degrees she also holds a Graduate Diploma of Family Practice Dermatology.