SKIN CANCER – Who is most at risk?

* People who were exposed to lots of sun as children.
* Active outdoor types or outdoor labourers exposed to regular sunburn.
* People who live close to the Equator.
* People who are outdoors when UV radiation is at its most intense.
* People who have a fair complexion, fair hair, red hair, blue eyes or freckles.
* People who don’t tan easily but tend to burn instead (but olive-or dark-skinned
  are not immune).
* People who have a family history of skin cancer.
* People who have numerous moles; the more moles, and the larger or more moles,
  and the larger or more odd they look, the greater the risk of melanoma.
* People who are addicted to unprotected suntanning, either at the beach, by the
  pool or in the solarium.

Most cancers can be prevented by protecting the skin from sunlight. People who have
already had a skin cancer or keratoses (sun spots) are at increased risk. Short periods
of intense exposure to sunlight or sun beds increase the risk of melanoma.

More common skin cancers also show up as new lumps or bumps of any color: red areas;
crusty, scaling spots or scabs; dry, rough areas of skin; spots or lumps that bleed easily
when rubbed with a towel; erosions or ulcers (sores that don’t heal properly) or a growing
scar-like area.

Types of skin cancer:
Of the three main types of skin cancers, basal cell carcinoma (BCC) is the most common
and least dangerous. On the face, head or neck they most often start off as small round
or flattened lumps, which may be red, pale or pearly and may have tiny vein-like blood
vesses on the surface. On the trunk and limbs they are more often slow-growing, red dry
patches. A sore or ulcer can appear in the middle of the lump even at an early stage.
Those who have had one BCC are at more risk of developing another.
Squamous cell carcinoma (SCC) is less common than BCC, and invasive SCC can be more
dangerous. It is most likely on areas exposed to sun (face, hands, legs). It is most serious
if it appears on the lip or on the ear. An SCC appears as a scaly nodule that may bleed and
ulcerate. Sometimes it can spread to the lymph nodes. SCCs and BCCs can vary in size from
a few millimetres to several centimetres. Invasive (deeper) SCCs often begin in sun spots,
which are dry, rough non-cancerous spots.

Malignant melanoma (MM) is the least common but most dangerous skin cancer and is more
common in people over 50. It usually starts as a new or changes colour, thickness or shape
over some months. Melanoma can be various colours; black, dark brown, red, blue-black or
a combination, and they may be irregular in shape or outline. They can develop in existing
moles. Melanomas can spread to internal organs and cause death if not detected easrly and

Some scarring is likely after most forms of skin cancer treatment.

If a large skin cancer is removed, skin grafting may be needed. Some tumours are treated
with radiotherapy.

BCCs and SCCs
Treatment of a BCC (basal cell carcinoma) depends on the type of tumour, where it is, how
big it is and how advanced its development. Invasive SCCs (squamous cell carcinomas) are
nearly always treated surgically.

Options for solar keratoses and other in situ SCCs and BCCs include excision (cutting and
stitching), cryotherapy (freezing), shaving, curettage and cautery, radiotherapy, application
of 5-fluorouracil cream or treatment of the tumour with a photosensitising chemical in a cream
which is then exposed to light). Immune modulators (imiquimod) cream and interferon injections
may be used to remove superficial skin cancers with minimal scarring). Laser treatment can also
be used.

Malignant Melanomas
Malignant melanomas can be deadly, spreading to other organs. Treated early by surgical removal,
there is a 95% chance of a cure. Risk of recurrence increases with the depth of melanoma cells.

Malignant melanoma needs to be surgically removed, rather than burnt or frozen off. The tumour
is cut out, along with an additional margin or normal skin, and the wound is then stitched. Often
this is done in two stages.

The portion removed is sent off to pathologyt for testing to measure how deeply into the skin the
cancer cells have penetrated. The deeper the cancer cells, the more likely they have spread to
the lymph nodes or internal organs.

If this is suspected, other tests may be ordered including lymph node biopsy, blood tests, a chest
X-ray and scans. Risk of recurrence increases with the depth of cells.

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