Skin cancers

Dr Grace Allen-Young, (left), permanent secretary in the Ministry of Health, grabs the attention of Dr Jean Marie Rwangabwoba, right, PAHO/WHO Advisor and Dr Alafia Samuels, PAHO Washington Representative. They were present for before the start of the Ministry of Health's National Policy Dialogue on Non-Communicable Disease Prevention and Control at the Hilton Hotel in Kingston on Wednesday. - ian allen

Dear readers,

D.D., 30, is a woman who is very concerned about her skin. She is of light complexion and a few years ago noticed a dark patch on her face which seemed to be spreading. She visited a dermatologist (skin specialist) who told her that the spot was a type of skin cancer. It was excised. Recently another dark area of skin was removed from near her eyelid and she was told that this also was skin cancer. D.D is very worried about this tendency towards skin cancer and asks LIFELINE how best to prevent recurrences of skin cancer. She applies sunscreen regularly to her face and to areas exposed to the sunlight but she is concerned that this might not be enough to keep the cancer away.

Skin cancer is actually a very commonly occurring cancer but all skin cancers are not the same. Skin cancer is characterised by the uncontrolled growth of various cells which originate in the outer layer of skin, the epidermis.

The most common types of skin cancer are:

Squamous cell carcinoma

Basal cell carcinoma

Melanoma

Squamous cell cancers are usually located in the middle of the epidermis (outer layer of skin). These cancers are also strongly linked to sun exposure but can sometimes also be found on the tongue and on the inside of the mouth. These cancers begin as scaly, reddish bumps which grow large and appear as warts. As this cancer grows an ulcer forms in the middle of the swelling, and the cancer grows downwards, invading deeper skin layers. Squamous cell carcinoma also does not tend to spread to distant parts of the body but because much of it is hidden under the skin, it is often more extensive than it visually appears to be and is therefore a more serious cancer to contract than the basal cell cancer.

Basal cell cancers occur very near the skin surface. They comprise 75 per cent of all skin cancers. They often appear as a firm patch of skin which tend to ulcerate and then form a scab. The area tends to go through cycles of bleeding and healing. Basal cell cancers tend to grow very slowly and to spread only to adjacent tissues and not to distant parts of the body. Basal cell cancers are highly associated with over-exposure to sunlight.

The third type of skin cancer, the melanoma, is the most feared of the skin cancers, with good reason. Although only five per cent of skin cancers are melanomas, in 75 per cent of deaths related to skin cancers, melanomas are the cause. The melanoma originates from the melanocytes which are the pigment producing cells in the body. These cells are deeply located within the epidermis, near the dermis, where the hair follicles are located.

The melanomas grow rapidly, invade nearby tissues and also spread through the *lo** to other parts of the body forming new tumours at new sites. Melanomas are found both on sun exposed and covered areas of the body. Often they initially look like a mole and can be black, brown, red or white in colour. Another even more rare type of skin cancer is kaposis sarcoma which is seen often in association with AIDS.

To prevent skin cancer - be careful about sun exposure. Avoid being outdoors in the hot sun and always apply sunscreen to all uncovered areas of skin. Choose a product which protects against both UVA and UVB rays and has a sun protection factor (SPF) of 15 or over. When in the sun, wear a broad brimmed hat to shield the face. If the person has reason to be cautious about this cancer then apply sunscreen to the entire body before putting on clothes and wear loose, light coloured clothing to cover the chest, arms and legs as much as possible.

Remember, sun damage is cumulative so even if the effects of the sun on the skin are not immediately apparent, they may show up at a later date, in the form of a skin cancer. D.D. seems to have basal cell cancer on her face.

Although this needs to be watched closely and all precautions taken to avoid the effects of the skin and recurrence of the cancer, this cancer is not so serious and is probably not life-threatening. She should have this diagnosis confirmed with her dermatologist. She should visit her dermatologist at least twice a year for a check up.

Write to:Lifeline

PO Box 1731

Kgn 8

A.J.M