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More than Skin Deep 13 October 2014 South Africa has the highest incidence of skin cancer in the world. Knowing how to protect yourself and your customers is essential in the fight against this common cancer, which if caught early can often be cured writes Sandton, Dermatologist, Dr Lushen Pillay. It’s well known that the sun is particularly harsh in the southern hemisphere, due to the depletion in the protective ozone layer around the earth. This means that educating your clients about the facts of skin cancer and going for regular screening at the dermatologist is essential practice to avoid skin cancer. It’s the downside of living in year round sunshine. Who is most susceptible to skin cancer? People of all colours and races get skin cancer – nobody is excluded. However, those with light skin who sunburn easily do have a higher risk. Risk factors include: unprotected or excessive UV exposure such as from sunlight or tanning booths; pale skin which burns easily and is often associated with natural redheads and blondes; if their job exposes them to certain chemicals such as in coal tar, arsenic and radium; a family history of skin cancer; if they have many moles on their skin and particularly unusual shaped moles; and if they have suffered severe sunburn in the past. What happens in the body to cause skin cancer? Sometimes errors or mutations occur in the DNA of skin cells, and when these mutations grow out of control they can turn into cancer cells. Are there different types of cancer? Actually there are many different types, but the three most common types are BCC (Basal Cell Cancer) SCC (Squamous Cell Cancer) and Melanoma. These skin cancers have different subtypes so it’s difficult to describe how each looks like. There are many variants as well. Can some of the types of skin cancer enter the blood stream and cause cancer elsewhere in the body? All types of cancer can spread to other areas of the body, skin cancer included. Ranging from BCC which is generally slow growing, to Melanoma, which is very aggressive. Are sunbeds safe? No. A recent report has found a direct link between the use of sunbeds and skin cancer. Many sunbeds give out greater doses of UV rays than the midday Mediterranean sun. What about fake, rub on tanning products – are they safe? The main ingredient in fake tan is DHA, or dihydroxyacetone. It’s listed as a cosmetic ingredient under EU legislation, so it’s likely to be safe with normal dose and usage.   So what can the average person do to protect against skin cancer? Broadly speaking, the best way to keep safe it to avoid long exposure to intense sunlight and practice sun safety. They can still exercise and enjoy the outdoors, but it just needs to be done safely. Always avoid direct sun exposure between 10am and 4pm. Teach children the shadow rule – if your shadow is shorter than you, the sun’s rays are at the harshest. Practise the SLIP, SLOP, SLAP and WRAP rule, which means: Slip on a shirt; Slop on sunscreen – SPF of at least 30+ and reapply it every two hours even on overcast days. Remind them to apply sunscreen on your ears and neck too. Slap on a wide-brimmed hat; and wrap on sunglasses. Also avoid other sources of UV light, such as tanning beds and sun lamps which are dangerous. Importantly, get them to check their  skin regularly and report any changes to your dermatologist. Self-examination is essential, so get them to check their skin often for any new skin growths or changes in existing moles, freckles, bumps and birthmarks. How does the layperson know if they have skin cancer? Any change on their skin – especially in the size or colour of a mole, growth or spot – must be checked by a dermatologist. Also any change in sensation, a spread of pigmentation, oozing, scaling or bleeding from a skin lesion must be assessed immediately. Always look out for pre-malignant evidence such as areas of skin that are red and rough to touch, as these can easily be treated with liquid nitrogen. Can areas of the body that have never been exposed to the sun still get skin cancer?  Yes, they certainly can. Sun exposure is just one of the risk factors for skin cancer. Other risk factors include: a family history of cancer, using irritating substances, moles or birth marks. Any of these can lead to skin cancer anywhere on the body. Are there special precautions to be taken for children? Most important is to educate  children on the risks of sun exposure, and teach them the sun safety advice of slip, slap, slop, wrap and staying out of the sun between 10am and 4pm. Babies under a year old should be kept out of direct sunlight. Which area of the body is skin cancer generally the most common? The upper back and lower legs are common for melanoma in light skinned people and other skin cancers are found mostly in the areas most often exposed to the sun, such as the face and arms. Dark skinned people should be vigilant of melanoma on the palms of their hands and soles of their feet. If they have never experienced bad sunburn, can they still get skin cancer? Yes they certainly are, because sunlight is just one of the risk factors for skin cancer. What should we look for on sunscreen to ensure we are being protected? It is always best to encourage the use of the best sunscreen possible. Most contain a combination of ingredients for effective protection against damaging ultraviolet rays — both the deeply-penetrating UVA and the shorter-wave UVB. Look for the Cansa sign or a circle around the letters UVA to indicate UVA protection too. In general, it’s easier to use the spray-on sunscreens for the body, and gel- or cream-based formulations for the face, ears and neck. Encourage them to use sunscreens with an SPF of 30 +. How is skin cancer treated? There are many options for treating skin cancers, depending on the type, area, depth, severity, age and skin type of the patient. They will need to see a dermatologist and discuss the various options, which range from freezing (freezing using liquid Nitrogen), to radiation, excision (surgical removal), curettage (scraping out)  and cautery, Laser, PDT ( Photodynamic therapy) , Mohs (micrographic surgery), etc. Dr Pillay adds that: “Skin cancer is the most common of all cancers and its incidence is increasing. So encourage your clients to be more aware of their skin and anything that changes. Simple non-invasive treatments for early skin cancer or precancerous lesions can save time, money and heartache. Annual mole scans done by a dermatologist should be mandatory, especially for light skinned people.”
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