Skin cancer and premature ageing are very real risks from too much sun exposure.
With Summer just around the corner, now is an excellent time to check your skin for any changes, writes Dr Chris Ahn, Specialist Plastic Surgeon in Sydney and an Australasian Society of Aesthetic Plastic Surgeons (ASAPS) Member.
How do I check my skin?
Current clinical guidelines recommend examining your skin and asking your GP for a skin check if you notice anything suspicious. This entails familiarising yourself with your skin and looking for new moles, sores, lumps or lesions – or those that have changed size, shape or colour.
If you notice anything peculiar, see your GP. If they deem it necessary to have the mole removed, ask them for a referral to a Specialist Plastic Surgeon if you’re concerned about scarring.
What effects can the sun have on my skin?
We are lucky to live in Australia with a climate envied by the world over, but with it comes an increased risk of sun exposure which can lead to skin cancer and premature ageing if you aren’t sun smart.
Brown spots / Dark spots / Sunspots
Spots on the skin—also known as hyperpigmentation, age spots, solar lentigines, or liver spots, depending on their cause—can happen at any time, but most often appear in middle age.
Most often, they are a consequence of past sun exposure or artificial UV light used in tanning beds. The spots are also associated with certain skin conditions and can occur as a side effect of some medications as well. Dark spots are generally harmless, but there are times when they could be cancerous. They can be lightened or removed if they cause you concern.
Sunlight has a profound effect on the skin that can result in premature ageing.
The UV radiation can cause collagen to break down at a higher rate than normal ageing. It does this by penetrating the middle layer of skin (dermis), causing the abnormal buildup of elastin.
When these elastins accumulate, enzymes are produced, which inadvertently break down collagen and create so-called “solar scars.” Continued exposure only speeds the process, leading to further wrinkling and sagging.
People often underestimate the sun’s effects on the skin. But it’s not just premature ageing that should make you afraid. Australians have the highest rate of skin cancer in the world.
What are the types of skin cancer?
1. Melanoma and subtypes
Melanoma is cancer that arises from melanocytes, the cells that provide pigment (or a tan). With sun exposure, these cells are stimulated to produce pigment to protect the deeper layers of skin.
There is a correlation between the amount of childhood exposure to the sun and the risk of developing melanoma. Due to the developmental origin of this cell, when it develops into cancer, it has a much higher chance of spreading than most other types of skin cancer.
2. Basal Cell Carcinoma
Basal Cell Carcinoma (BCC) is a common type of cancer that arises from the cells in the deeper layers of skin. The risk of developing this cancer is related to cumulative sun exposure. It tends to grow in the upper face.
This type of skin cancer rarely spreads to distant sites (metastasises) but spreads in the local area, leading to the need for removal and then skin cancer reconstruction. Some subtypes of this cancer can spread quickly and with indistinct edges.
3. Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) of the skin is also a common type of cancer. It tends to be found on the lower face (especially lower lip) and is the most common type of skin cancer for all areas of the body other than the face.
The risk of developing SCC seems to be linked to the number of sunburns suffered. This type of skin cancer can metastasise to other organs, but the risk is small if the cancer is removed while it is small.
What is involved in skin cancer reconstruction?
Depending on your type and size of skin cancer, a margin is required to be excised with it to ensure that it is completely removed. This establishes the area, shape and depth of the necessary reconstruction. Depending on the position and orientation of the defect, differing reconstruction options may be suggested.
Specialist Plastic Surgeons have been trained to analyse these problems and provide the best functional and cosmetic outcome from your skin cancer reconstruction. Here are a few common ways to remove skin cancers:
1. Direct closure
Skin lesions that are small enough orientated well and in areas where there is enough laxity in the skin, can usually be removed and closed with a straight-line scar.
A flap is a segment of tissue (skin) with an intact blood supply. They can be twisted and manipulated through various geometric patterns to cover up a section of missing skin. Depending on the site and size of the defect, these can be simple or very complicated.
A graft is a segment of tissue (skin) that is separated from its blood supply and used to cover a defect. It relies on a good bed for new blood vessels to grow into it – much like laying turf. There are varying thicknesses of graft that can be used in skin cancer reconstruction, each with advantages and disadvantages.
4. Moh’s micrographic surgery
Moh’s surgery refers to a technique of excising the lesion and mapping it. It is analysed under the microscope using frozen section techniques. It is reported to have clearance rates of over 99 per cent.
By taking fine slices and examining them before removing more tissue, a skilled medical practitioner may be able to minimise the amount of tissue requiring later skin cancer reconstruction.
Are there any options other than surgery for treating my skin cancer?
Yes. Very thin cancers of some types can be treated with creams that stimulate the immune system. Other skin cancers can be treated with radiotherapy.
There are several other less common methods of treating skin cancers. The advantage of these treatment modalities is the absence of a surgical scar.
The inherent limitation of non-surgical management of skin cancers is that you never know if you have treated enough of the cancer. With surgical excision, the pathologist can inform you if the cancer is completely removed.
Non-surgical treatment of skin cancers requires ongoing surveillance to watch for signs of cancer recurrence.
The best advice you can adhere to is age-old, slip on a t-shirt, slop on some sunscreen and slap on a hat. This advice has been updated to include wrapping on a pair of sunglasses to protect your eyes from the sun’s harmful rays.