Melanoma & Skin Cancer
What is skin cancer?
Skin cancer is the abnormal, uncontrolled growth of skin cells. It develops when the genetic material (DNA) inside skin cells is damaged, for example from overexposure to ultraviolet (UV) radiation in sunlight or sunbeds, triggering changes that lead these cells to multiply rapidly and become cancerous.
Skin cancer is the most common cancer in Ireland. Yet in most cases, it is preventable and early detection leads to better outcomes. The vast majority of these cancers are caused by overexposure to UV radiation, mainly from sunlight, although UV radiation from artificial sources (e.g. sunbeds) can also cause skin cancer.
There are two main categories: non-melanoma skin cancer (comprising of basal cell carcinoma and squamous cell carcinoma) and malignant melanoma. Of the different types of skin cancer, melanoma is not the most common but raises the greatest concern as it can spread to other parts of the body, where it becomes difficult to treat and can be fatal.
A majority of people in Ireland have fair skin which burns easily and tans poorly, so are particularly vulnerable to sun damage and skin cancer.
The most obvious warning sign of skin cancer is a change in the appearance of the skin, such as a new growth, a sore that will not heal, a new and changing mole, or the change in appearance of an existing mole.
Melanoma skin cancer
Melanoma: the facts
Melanoma is a potentially serious type of skin cancer. It occurs when the pigment-producing cells (melanocytes) in the skin grow unchecked. Non-cancerous growths of melanocytes are known as moles or freckles.
Unlike many other types of cancer, melanoma often occurs in young and middle aged adults. It is the fourth most common cancer in Ireland. The number of cases of melanoma and the number of deaths from melanoma have been increasing in Ireland over the last 20 years.
Fortunately, melanoma can be completely cured if it is identified and removed early. You can reduce your risk of melanoma by seeing your doctor if you find a suspicious growth on your skin, and by avoiding excessive sun exposure and sunburns.
What does a melanoma look like?
Most melanomas appear on apparently normal looking skin. Others arise from a pre-existing mole or freckle which grows or changes in appearance. Some melanomas are itchy, painful or may bleed.
Melanomas can occur anywhere on the body, including areas that are protected from the sun. The commonest site for melanoma in women is the lower leg. For men, the commonest site is the back.
A handy way to remember what melanoma looks like is the ‘ABCDE’ mnemonic. Melanomas tend to:
- be Asymmetrical
- have an irregular Border
- have multiple Colours
- have a Diameter greater than 6mm
- Evolve, enlarge or change
However, not all melanomas have these features, and some growths with these features are not melanoma. If you are concerned about a skin growth, you should always see your GP or Dermatologist.
Risk factors for melanoma
You may be at increased risk of melanoma if you have:
- pale skin that burns easily
- many moles
- multiple large or unusual moles
- previous skin cancers
- a family history of melanoma
- had severe sunburns in the past, especially with blisters and particularly during childhood
- used tanning booths
The best way to prevent melanoma is to avoid tanning booths/sunbeds and protect yourself from the sun. It is particularly important to avoid intense sun exposure and sunburns, for example when on sunny overseas holidays.
You can also protect yourself by regularly checking your own skin (ask a family member or friend to help you check your back) and by seeking early medical attention if you notice any suspicious growth.
Treatment and prognosis
If your doctor is concerned about a particular growth, they will remove it and send it for testing. If you are subsequently diagnosed with melanoma, you will usually need further surgery. If a melanoma is diagnosed early enough, it can be completely cured with simple surgery alone.
If a melanoma has spread to other parts of the body, the prognosis is worse. There are many new treatments available for advanced melanoma, however they do not always work and are usually not curative. It is therefore important that melanoma is treated promptly, before it spreads.
Anyone diagnosed with melanoma will need follow up because there is a risk of the melanoma recurring, as well as an increased likelihood of developing another melanoma.
Things to remember about melanoma
- Melanoma is a potentially serious type of skin cancer
- Melanoma often looks like an unusual freckle or mole that is changing or growing
- Early detection and treatment is key to a positive outcome
- You can reduce your risk of melanoma by avoiding sunburns and checking your skin
- If you are concerned about a growth on your skin, you should see your GP or Dermatologist
Non-melanoma skin cancer
Non-melanoma skin cancer: the facts
Non-melanoma skin cancer (NMSC) is a common problem in Ireland, affecting 1 in 6 men and 1 in 9 women over their lifetime. The incidence of NMSC in Ireland has been increasing over the last decade. There are many types of NMSC, the commonest being basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
Skin cancer occurs when cells in the skin become damaged over many years, usually from the sun. The damaged cells grow unchecked, leading to the development of a tumour, or lump in the skin. If left untreated, some types of NMSC can spread to other parts of the body.
Thankfully, NMSC can almost always be completely cured if identified and treated early. Furthermore, there is emerging evidence that protecting yourself against the sun is effective in reducing the risk of NMSC.
Risk factors for non-melanoma skin cancer
The most important risk factor for skin cancer is exposure to ultraviolet light, usually from the sun. Frequent sunburns, sunburns in childhood, chronic sun exposure over many years (in work or recreational activities) and tanning salon use all increase the risk of NMSC.
People with fair skin, freckles or red hair are particularly at risk, as are people with an impaired immune system (for example those taking certain medications or organ transplant recipients). Smoking has been associated with the development of SCC.
Basal cell carcinoma (BCC)
BCC is the commonest type of NMSC. There are three main types BCC, each of which has a different appearance:
- Nodular: Often appear on the face as a shiny, skin coloured lump. May ulcerate or bleed.
- Superficial: Tend to occur on the chest, back and limbs. Usually appear as a red, scaly patch.
- Morphoeic: Usually scar-like, hard lumps in the skin. Tend to be more aggressive.
BCCs are usually painless and grow slowly over months to years. While they almost never spread to other parts of the body, if untreated they can cause damage to the skin and surrounding structures, such as the eyes, nose or ears.
Squamous cell carcinoma (SCC)
SCC tends to arise in areas of skin exposed to the sun, namely the face, backs of the hands, forearms, shins and the balding scalp. They usually appear as red, scaly lumps that may be painful. In contrast to BCCs, they can arise quickly, over a period of weeks to months. If untreated, they may spread to other areas of the body, particularly if they arise on the ear or lips.
Treatment and prevention
NMSC is usually treated with surgical removal. Some BCCs and SCCs can be treated with other techniques such as specialised creams, liquid nitrogen therapy, curettage (scraping of the skin) or radiotherapy. In general, the earlier the skin cancer is diagnosed, the less invasive the treatment options.
NMSC can be prevented by sun protection, which includes avoiding the sun, using protective clothing and applying sunscreen regularly. This is particularly important in Ireland between March and October, and also during sunny overseas holidays. Those who have had an NMSC before should take extra care, as they are at higher risk of developing another NMSC.
Things to remember about non-melanoma skin cancer
- It is common in Ireland, occurring in 1 in 6 men and 1 in 9 women over a lifetime
- It can appear as a smooth or scaly lump, patch or scar-like area
- The strongest risk factor is exposure to ultraviolet rays, from the sun and tanning beds
- If diagnosed early, it is almost always completely curable
- If you are concerned you may have a non-melanoma skin cancer, please see your doctor.
Moles are normal non-cancerous clusters of melanocytes (pigment-producing cells in the skin). Moles are normal and having 20-40 moles is not unusual.
A mole is more correctly referred to as a ‘melanocytic naevus’ (spelled ‘nevus’ in the USA and ‘nevi’ to indicate more than one mole). You may hear your doctor use some or all of these terms or encounter them online yourself.
The vast majority of moles are not dangerous. Be alert for a new and changing mole, or the change in appearance of an existing mole.
Risks: know your skin type
Most Irish people have fair skin which burns easily and tans poorly, so are particularly vulnerable to sun damage and skin cancer.
You are more likely to develop skin cancer if you have fair complexion (pale skin, blue or green eyes, red or blond hair); spent a lot of time in the sun whether for work or recreation; those who have experienced intermittent, short bursts of intense sunlight (on holiday for instance); have a history of sunburns particularly during childhood; or use tanning devices.
Know your skin type
A person’s natural skin colour influences their risk of skin cancer, but many of us tend to think we are darker than they actually are. This is why it is so important to know your ‘skin type’ to get a better sense of the care you need to take in the sun.
The Fitzpatrick Skin Classification Scale is a scale that ranges from 1 (high risk) to 6 (low risk), and considers skin colour (pale white to black), and how the skin reacts to sunlight (whether it burns easily or tans).
Protect & Inspect ™
Think the five ‘Ss’ of sun safety — Slip on t-shirt; Slop on (broad-spectrum) sunscreen factor 30+; Slap on a sun hat; Slide on sunglasses; Seek shade: Save Your Skin advice from dermatologists.
- Slip on a t-shirt with a collar.
- Slop on broad spectrum (UVA/UVB) sunscreen with a sun protection factor (SPF) of at least 30+, with high UVA protection, and water resistant if you intend to swim.
- Slap on a hat with a wide brim.
- Slide on sunglasses with UV protection.
- Seek shade – particularly between 11am -3pm, when UV rays are strongest.
REMEMBER!! Protect your family: Keep babies and young children out of direct sunlight.
Regular self-examination of skin, looking out for the appearance of a new mole or a change in an existing mole, can also help with melanoma detection: A Guide to Checking Your Skin.
Video: your skin and the sun
Watch Dr. Patrick Ormond, Consultant Dermatological and MOHS Micrographic Surgeon at St James’s Hospital, and learn more about “Your skin and the sun“.
Mohs surgery is a precise technique considered to be the gold standard for treating many skin cancers. During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains.
The goal of Mohs surgery is to remove as much of the skin cancer as possible, while doing minimal damage to surrounding healthy tissue. Mohs surgery is usually done on an outpatient basis using a local anesthetic.
Mohs surgery is an improvement to standard surgery (local excision), which involves removing the visible cancer and a small margin of surrounding healthy tissue all at once. Mohs surgery allows surgeons to verify that all cancer cells have been removed at the time of surgery. This increases the chance of a cure and reduces the need for additional treatments or additional surgery.