Getting to Know Skin Cancer
Some Helpful Skin Cancer Terminology:
Ultraviolet (UV) light refers to light emitted from the sun
a region in an organ or tissue which has suffered damage through injury or disease, such as a wound, ulcer, abscess, or tumour
Basal Cell Carcinoma (BCC)
The most common type of skin cancer
Squamous cell Carcinoma (SCC)
Second most common type of skin cancer
Malignant Melanoma (MM)
A skin cancer, dangerous and lethal if not attended to as early as possible
To remove a lesion from the skin
A drug injected directly to the site of a planned incision during an operation to relieve pain and create numbness
Drugs and/or gases used during an operation to relieve pain and alter consciousness
Blood pooling beneath the skin
Solar or actinic keratoses are rough, red or brown, scaly patches on the skin
A malignant form of melanoma that can appear on any part of the body including areas that are not exposed to the sun
Clusters of heavily pigmented skin cells, either flat or raised above the skin surface
Squamous Cell Carcinoma:
A type of skin cancer that frequently appears on the head, neck, hands and forearms
Skin cancer is the uncontrolled growth of abnormal skin cells. It is the most common of all cancers. South Africa has the third highest incidence of skin cancer in the world, after Australia & New Zealand. A large number of South Africans will develop a skin cancer of some kind during their lives.
Skin cancer usually occurs in people who have been exposed to too much ultraviolet (UV) light from the sun.
People in the higher risk category of developing skin cancer usually have
- Fair skin and freckle easily
- Light-coloured hair and eyes
- A large number of moles, or moles of unusual size or shape
- A family history of skin cancer or a personal history of blistering sunburn
- Spent a lot of time working or playing outdoors
- Intense, year-round sun exposure. This includes people who live closer to the equator, at a higher altitude, or in any place that gets intense sunshine
Some less common causes of skin cancer include:
- Some medications, such as immunosuppressant drugs
- UV therapy for conditions such as psoriasis and adolescent acne
- Use of sunlamps sunbeds and solariums
- Over-exposure to chemicals such as coal tar, soot, asphalt, paraffin waxes, petroleum derivatives and arsenic
- Some rare hereditary conditions
Skin cancer needs to be treated promptly as it can be just as life threatening as any other cancer if left untreated. The danger of skin danger of skin cancer is that it can spread (metastasise) to other parts of the body if treatment is not undertaken
Types of Skin Cancer
There are three main types of skin cancer:
- Basal cell carcinoma
- Squamous cell carcinoma
The first two are often called “non-melanoma skin cancer”.
Basal Cell Carcinoma
Basal Cell Carcinoma (BCC) is by far the most common type of skin cancer. Fortunately, it’s also the least dangerous. Three-quarters of South Africans who have skin cancer have BCC. It tends to grow very slowly, and rarely spreads beyond its original site. However, if left untreated, it can grow deep beneath the skin and into the underlying tissue and bone, causing serious damage, particularly if it is located near the eye.
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is faster growing than Basal Cell Carcinoma (BCC). Of those South Africans with skin cancer, about 2 in 10 have a SCC. It frequently appears on the head, neck, hands and forearms, which typically receive more sunlight. SCC is more dangerous than BCC because it can spread to other parts of the body if not treated promptly.
*SCC can become life threatening if left untreated.
SCC looks like a red scaly spot or lump and is usually thickened. It can bleed easily and may ulcerate. It is usually tender to the touch, though can also be painless.
Although melanoma is usually highly malignant, it occurs in only about 5 people out of 100 with skin cancer. Melanoma can usually be treated successfully if diagnosed early. If it’s not treated quickly, however, malignant melanoma may quickly spread throughout the body and is often deadly. Malignant melanoma can occur on any part of the body, including areas that have not been exposed to the sun. In women, it is more common in the arms and legs, and in men on the face, back and chest. About half of all cases of melanoma develop from moles.
The other half develop on previously normal skin
Other skin growths you should know about
Two other common types of skin growths are moles and keratoses.
are clusters of heavily pigmented skin cells, either flat or raised above the skin surface. While most pose no danger, some-particularly large moles present at birth, or those with mottled colours and poorly defined borders, may develop into malignant melanoma. Moles are frequently removed for cosmetic reasons, or because they’re constantly irritated by clothing or jewellery (which can sometimes cause pre-cancerous changes).
Solar or actinic keratoses
are rough, red or brown, scaly patches on the skin. They are usually found on areas exposed to the sun, and sometimes develop into squamous cell carcinoma.
10 warning signs of Skin Cancer (BCC & SCC)
- Small, white or pink nodules or bumps that are smooth and shiny, waxy, or pitted on the surface
- A red spot that is rough, dry, or scaly
- A firm, red lump that may form a crust
- A crusted group of nodules
- An open sore that does not heal and may bleed, ooze or crust, may persist for weeks, appear to heal and then come back, often painless
- A shiny bump or nodule that is pearly white or clear, pink or red
- A bump can also be more tan, black or brown, especially in darker-skins and can be mistaken for a normal mole
- A small pink growth with a slightly raised, rolled edge and a crusted indentation in the centre that may develop tiny surface blood vessels over time
- A raised white patch with tiny red vessels
- A scar like area that is flat white, yellow or waxy in color
5 Warning signs of Malignant melanoma : look for ABCDE
- Malignant melanoma is usually signalled by a change in the size, shape, or colour of an existing mole, or as a new growth on normal skin. Watch for the “ABCD” warning signs of melanoma
Asymmetry – a growth with unmatched halves
Border irregularity – ragged or blurred edges
Colour – a mottled appearance, with shades of tan, brown, and black, sometimes mixed with red, white, or blue
Diameter – a growth more than 6 millimetres across (about the size of a pencil eraser), or any unusual increase in size
Evolving – a mole or birthmark changes in size, shape color
It is important that you get to know your skin and examine it regularly, from the top of your head to the soles of your feet, including your back. Ask your partner & friends/ family members for assistance here If you note any unusual changes on any part of your body, talk to your Specialist Plastic Surgeon/ Dermatologist for an examination.
Where will the surgery take place?
Depending upon the cancer and the extent of the procedure, surgery for the removal of skin cancer can be performed either as a day case or alternatively with a short hospital stay
What do I need before surgery?
Before undergoing surgery, it is important that you:
- Be as fit as possible to help the recovery process
- Check with your surgeon about your medications as some may need to be stopped eg. Warferin
- Stop smoking
- You will also be asked to provide a complete medical history for your Dr Chetty-B including any health problems you have had, any medication you are taking or have taken, and any allergies you may have.
- Reach your optimal weight
You may be advised to stop taking certain medicines such as non-steroidal anti-inflammatory drugs (NSAIDs) eg. Ibuprofen, aspirin, and medicines that contain aspirin. You may also be asked to stop taking naturopathic substances such as garlic, ginkgo, ginseng and St John’s Wort as they may affect clotting and anaesthesia. For full list see List of Medications to stop before operation
Always tell your surgeon EVERYTHING you are taking
You may be given medicines to take before the surgery, such as antibiotics.
Your surgeon will also advise you if any other tests are required, such as
- Blood tests
- X-ray examinations
- Electrocardiograph (ECG) to assess your heart
Prepare a “recovery area” in your home. This may include pillows, ice packs, a thermometer and a telephone within easy reach. Make sure you arrange for a relative or friend to drive you to and from the hospital or clinic. Someone should also stay with you for at least 24 hours after you return home.
Dr Chetty-B surgeon will give directions on how to take care of your specific wound.
Basically keep the wound area clean and dry. Refer to you Post-op Instruction sheet for further details.
What do I need after surgery?
Depending on the extent of the procedure, you may be able to go home the same day. With more complex cases, you may have to stay overnight in hospital or for a day or a few days.
In the case of minor procedures, you may experience some pain and mild discomfort. If a large skin cancer has been removed or a skin graft performed, discomfort and pain may be significant. Pain relief may be required for several days, your Dr Chetty-B will prescribe painkillers or sedatives as required.
Is it normal to experience bruising and swelling post-op?
This will usually settle down in the week after surgery. Elevating and appropriate use of ice-gel to the affected area will help reduce swelling.
If you experience any of the following symptoms, notify your surgeon’s office immediately:
- Temperature higher than 38ºC or chills
- Shortness of breath
- Nausea, vomiting, or continuous diarrhoea, you may have mild symptoms post – Anaesthesia, though these should not persist
- Heavy bleeding from the incisions
- Leakage of blood or fluid beyond the first day after surgery
- Worsening and/or spreading redness around the incision sites
- Increasing pain or tenderness in either breast
- Any other concerns or problems regarding your surgery, particularly if it appears to be worsening
Your will receive a specific Post-operative care instructions sheet
With this you will get instructions that may include:
- How to care for your surgical site(s) following surgery
- Medications to apply or take orally to aid healing and reduce the risk of infection
- Specific concerns to look for at the surgical site(s) or in your general health
- When to follow-up with your Plastic surgeon
Be sure to ask your surgeon specific questions about what you can expect during your individual recovery period, such as:
- Where will my surgery take place?
- What medication will I be given or prescribed after surgery?
- When do I return for follow-up care?
- Will I have dressings/bandages after surgery? If so, when and who will they be removed by?
- Are stitches removed? When have they/will they be removed?
- When can I resume normal activity and exercise?
Scars are an inevitable part of any invasive surgery. Your Specialist Plastic Surgeon will endeavour to minimise scarring and to keep your scars as inconspicuous as possible.
Over exposure to sunlight in childhood and adolescence is a major factor in the development of skin cancer. In recent years, more young adults and even teenagers have been diagnosed with skin cancer related to over-exposure to the sun.
How could I reduce the risk of developing skin cancer?
- Avoid tanning booths
- Avoid the sun between 10am and 3pm when UV intensity is at its greatest
- Wear a broad-brimmed hat and UV-protective sunglasses
- Wear a long-sleeved shirt and long pants of tightly woven cotton
- Use sunscreen with a Sun Protection Factor (SPF) of at least 30+
- Apply sunscreen well before swimming or exercising to allow it to absorb into the skin
- Replace the sunscreen every 2-3 hours if perspiring or swimming
- Wear protective swimwear at the beach, this is especially important for children