Sun spots, moles and skin cancer


Sun spots

A sunspot or ‘actinic keratosis’ has a scaly, pinkish appearance on sun-exposed skin. Sunspots are extremely common among fair-skinned people living in Australia. When sun spots develop, this indicates that the skin has been damaged by the sun and there is an increased risk of skin cancers developing. If left untreated, sun spots may progress to squamous cell carcinomas (SCCs), which are cancerous. This is why sun spots are usually treated upon detection. Cryotherapy (freezing) is the standard treatment but there are other treatments available.

Moles

A mole is a pigmented spot that appears on the skin during childhood, which develops from melanocyte cells. Most adults have around 20 pigment spots somewhere on their body which develop over the years, usually peaking in adolescence. The number of moles a person has depends upon their family history, sun exposure and other factors such as pregnancy.


Most moles are harmless. However, sometimes moles can change into a potentially fatal form of skin cancer known as melanoma. If melanoma is detected early, it may be effectively treated. So whenever you notice a change in a mole or find anything suspicious, see your doctor as soon as possible. Harmless moles are usually small (less than 5mm in diameter) with well defined edges. They may be flat or raised and are usually evenly coloured with no more than one or two shades of brown. They may also be what is known as ‘dysplastic’ – larger with ill-defined edges and irregular colouring. The majority of melanomas arise from normal skin and not from a pre-existing mole. The removal of normal moles to prevent the development of melanoma is strongly discouraged as it does not reduce the risk of melanoma. Melanoma can arise from any melanocyte in the body including in the eye, gall bladder and mucosal surfaces.


Moles and freckles that may prove problematic include those that:

  • Increase in size
  • change colour (melanomas often develop a blue or black colour)
  • change shape
  • have an irregular border
  • become itchy
  • bleed
  • have recently appeared on normal-looking skin.

These changes are normally noticed over several weeks or months, rather than days.


It is advisable to perform a do-it-yourself skin check every three months by following six easy steps:

  1. Strip off and have a mirror handy
  2. Check your chest, stomach and the front of your arms and legs
  3. Check the back of your arms and legs including soles of feet
  4. Twist to see your sides
  5. Check your face, ears and back with the mirror
  6. Ask someone to check your back, or examine your back with a hand-held mirror while facing a wall mirror.
If you find a mole, freckle or spot that looks suspicious, see your doctor as soon as possible.

Skin cancer

Australia has the highest rate of skin cancer in the world. According to The Cancer Council, two out of three people who spend their childhood and teenage years in Australia will develop some form of skin cancer later in life [unprotected sun exposure during the first 15 years of life more than doubles your chance of developing skin cancer]. Given that the majority of us have migrated from Northern European territories, we’re essentially a pale-skinned population living in a dark-skinned people’s land.

The fact is, anyone who spends time in the sun can develop skin cancer.
Some people have a higher risk than others. Your skin type, the colour of your eyes, the number of times that you have experienced sunburn, any history of previous skin cancers, your location on the planet (latitude and longitude) can all play a contributing role.


What’s important is to be aware of the warning signs of skin cancer because early detection may be crucial to survival.


Are you at risk?

You should be particularly careful about checking your skin if you have any of the following:

  • A large number of moles
  • Suffered from sunburn in the past
  • Fair skin that burns easily, freckles and doesn’t tan
  • Blue or green eyes and/or fair or red hair
  • Been diagnosed with skin cancer in the past
  • A family history of melanoma.

Fortunately, most skin cancers can be completely cured if found early.


Skin cancer is caused by the build-up of ultraviolet radiation (UVR) in the cells of the skin, which may eventually cause a tumour to develop. The skin’s immune system is an important defence mechanism in preventing potentially cancerous cells from developing into tumours. When the immune system is weakened, more cancers will develop.


The three most common skin cancers in Australia which are named after the type of skin cell from which they arise include basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma (cancerous mole).


Basal cell carcinoma (BCC)

The most common type of non-melanoma skin cancer in Australia is the basal cell carcinoma. BCCs account for approximately 80% of all skin cancers. BCCs are most commonly located on the ears, nose and other exposed parts of the body (the face and neck). Normally they do not spread beyond the skin, but when they are neglected, can penetrate the skin quite deeply, producing a destructive ulcer. This is why they are usually removed. This may be by a minor surgical procedure performed under anaesthetic by a GP, dermatologist or surgeon. After assessment by a dermatologist, some BCCs can be removed by curettage and cautery (sharp scraping and burning), cryotherapy (freezing with liquid nitrogen) or some new medicated creams in select cases.


Squamous cell carcinoma (SCC)

Squamous cell carcinomas (SCCs) are very common in Australia but potentially much more dangerous than BCCs if left untreated, because they can spread to other parts of the body. SCCs arise from the outer layers of the skin. They have a red, scaly sore appearance that may itch, weep and never seems to heal. They appear in areas most commonly exposed to the sun – the head, neck, upper back and the arms and legs.


SCCs may develop from pre-existing “sun spots” (actinic keratoses) which are not yet cancerous. While these sun spots can be treated with liquid nitrogen cryotherapy, SCCs, except in very special circumstances, should not be treated with this technique, as the freezing does not penetrate deeply enough to kill the tumour cells, allowing the cancer to recur, often much more aggressively and extensively (deeper into the skin).


As they grow, SCCs can spread to the lymph nodes (under the armpits, in the groin and neck) or via the bloodstream to other organs. This creates a dangerous situation where the cancer is much harder to treat or cure by simple removal.


For this reason, SCCs must be removed when detected. This is usually done with surgery (by a GP, dermatologist or surgeon) under local anaesthetic. Radiotherapy, which uses X-rays to kill the cancer cells, is an alternative in selected patients following assessment by a dermatologist. If the SCC is found to have spread to the lymph nodes these may also need to be removed, or if small enough, can be removed completely with regular surgical excision resulting in cure.


Melanoma

Melanoma (cancerous mole) is the fifth most common (but curable) cancer in Australia and the most common cancer affecting men and women aged 15 to 44 years. It is also the most dangerous form of skin cancer and in one-third of cases may arise from a pre-existing mole. [The risk of developing melanoma is 1 in 25 for males and 1 in 38 for females]. Since it is known to run in families, genes are thought to play a role in developing the disease.


A melanoma arises from the pigment forming cells in the skin and can spread throughout the body if undetected and untreated. A melanoma can occur anywhere in the body, not just on those areas that are exposed to the sun. Sometimes it can arise on the sole of the foot, the palm of the hand or under the nails. It is usually dark and can grow quickly and spread to nearby lymph nodes, or via the bloodstream to distant organs like the bones, liver, lungs or brain. On occasions, melanoma may be flesh-coloured, making early detection hard. Furthermore, many dark spots can be confused with melanomas, while other melanomas may appear to the untrained eye to be quite harmless.


Most melanomas are linked to too much sun exposure and the number of moles you have. They can be effectively treated if diagnosed early enough. To allow for early detection of melanoma, anyone with a family history of the disease and anyone who has multiple moles should be examined regularly by an appropriately trained and experienced doctor (such as a dermatologist).


Sun protection and regular skin checks, particularly if you have fair skin, are the best form of protection against melanoma.


What to look for

Although the skin on our bodies is always changing, most harmless or benign moles do not change over a short period of time. Key features of malignant moles include:

  • Changes in size
  • Changes in shape
  • Changes in colour or pattern
  • Bleeding or itching.

Any of these features are cause for concern and should be checked promptly by your dermatologist.


At Eastern Suburbs Dermatology we use the world-leading, locally developed SolarScan monitoring system – an advanced skin imaging system approved by the Melanoma Foundation – to help in the analysis and detection of even minute changes in a mole.


Preventing skin cancer

Take the following measures to minimize your chance of developing skin cancer:

  • Avoid the sun in the middle of the day (10am to 4pm) as much as possible
  • Stay in the shade whenever possible
  • Wear protective clothing (preferably closely woven fabrics that aren’t transparent when held up to the light or those with UV ratings on the labels) that covers the arms, legs and neck
  • Don a broad-brimmed hat and wrap-around sunglasses that block out 95-100% of UV rays
  • Apply SPF30+ broad-spectrum sunscreen to the skin. Apply it 20 minutes or so before going outside and reapply every two hours while in the sun
  • Do not use sunbeds, solariums and tanning lamps
  • Examine your moles regularly
  • Protect your children from sun damage with a hat, T-shirt and sunglasses
  • Have regular skin checks by your GP or dermatologist, especially if new and persisting skin spots develop.


Things to remember

According to The Cancer Council:

  • It is your right to seek a second opinion about any diagnosed and proposed treatment for skin cancer. Your GP will refer you to a dermatologist if s/he thinks it is necessary. You can arrange to see a dermatologist without a GP referral but under Medicare you will be rebated for a non-referred consultation. This means that your rebate will be a smaller percentage of the total fee
  • Your skin cancer (especially melanoma) should be treated promptly after diagnosis.
  • The risks associated with most treatments will be minor but may include infection, pain and permanent scarring
  • Whoever plans your treatment should also provide follow-up care and information.

 


 

To make an appointment or for more information call 02 9389 7333 or email info@easternsuburbsderm.com.au
Office hours: Mon to Fri 8am - 5pm | Level 6, 3 Waverley Street (cnr Hollywood Ave), Bondi Junction. Click here for directions and map