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Skin cancer

Skin cancer is an abnormal and uncontrolled growth of cells in the skin, causing a tumour.

About skin cancer 

There are two main types of skin cancer: non-melanoma skin cancer (NMSC) and melanoma. Around 430,000 Australians are treated each year for NMSC, and there are over 10,000 new cases of melanoma diagnosed each year. Australia and New Zealand have the highest rates of skin cancer in the world. Melanoma is the most serious form of skin cancer but it is curable if found early.

The skin

Your skin is made up of three layers:

  • the epidermis
  • the dermis
  • the supporting subcutaneous layer of loose tissue and fat.

Cancer can start from cells in any of these layers.

The Skin

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Types of skin cancer 

Non-melanoma skin cancer (NMSC)

NMSC mostly occurs in areas of your body that are exposed to the sun, such as your head or neck. There are different types of NMSC, which are named after the cells they form from. The most common types are found in the top layer of your skin (the epidermis).

  • Basal cell carcinoma (BCC). About 68 percent of Australians diagnosed with NMSC have BCC. It usually grows slowly and doesn't normally spread to other tissues. If left untreated, a BCC will turn into an ulcer. It can grow deeper into your skin and damage other areas such as your bone.
  • Squamous cell carcinoma (SCC). About 32 percent of Australians diagnosed with NMSC have SCC. An SCC can spread into your surrounding skin. It can also spread to other areas of your body, but this is rare.

Melanoma

Melanoma is an overgrowth of the cells known as melanocytes. These cells make a pigment called melanin when your skin is exposed to the sun. Melanoma can spread to other parts of your body (through your blood or lymph system) where it may grow and form secondary tumours. This spreading is called metastasis.

Melanoma affects slightly more women than men. The most common place for women to develop melanoma is on their legs; for men, it's on their chest or back.

Skin cells become cancerous

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Symptoms of skin cancer 

Skin cancer is often painless and each type can look different.

  • BCC often appears as a small red or pink, waxy or shiny lump.
  • SCC often appears as a small pink lump with a hard or scaly or crusty skin.
  • Melanoma usually starts as a dark spot or mole. If a melanoma spreads to other parts of your body, you can develop other symptoms such as swollen lymph nodes (glands throughout your body that are part of your immune system).

Symptoms that may indicate skin cancer include any mole, spot, lump or patch that:

  • doesn't heal after four weeks
  • gets bigger – especially over 7 mm (a quarter of an inch) in diameter
  • changes shape – look for an irregular edge
  • changes colour – darkens, becomes patchy or multi-shaded
  • becomes inflamed
  • is itchy or painful
  • bleeds or is crusty.

These symptoms aren't always caused by skin cancer, but if you have them, see your GP.

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Causes of skin cancer 

The causes of skin cancer aren't fully understood at present. But there are certain factors that make skin cancer more likely. The main risk factor for any type of skin cancer is over-exposure to sunlight.

You may also be more likely to get skin cancer if you:

  • have fair skin that burns easily
  • have a lot of moles (more than 100)
  • have red or fair hair and blue or green eyes
  • have lots of freckles
  • have certain skin conditions; for example scarring from burns or skin ulcers
  • have had repeated sunburn, especially during childhood
  • have close relatives who have had skin cancer
  • use a sunbed
  • work outdoors
  • smoke
  • have a weakened immune system; for example, if you have HIV/AIDS, or are taking medicines that suppress your immune system
  • have been exposed to certain chemicals (a rare cause).

Age is also a factor – NMSCs are more common in people over 60 but are rare in children under 14.

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Diagnosis of skin cancer 

Your GP will ask about your symptoms and examine you. He or she may also ask about your medical history. Your GP may refer you to a dermatologist (a doctor who specialises in skin conditions) to have further tests including those listed below.

  • A biopsy – a sample of your skin is taken and sent to a laboratory for testing.
  • Scans – these may include X-rays, CT scans, MRI scans or ultrasound scans.
  • A sentinel lymph node biopsy – an investigation which can help your doctor to find out if the cancer has spread to your lymph nodes.

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Treatment of skin cancer 

Your treatment will depend on your age, the type of skin cancer you have, where it is and whether it has spread.

There are a number of treatments for skin cancer, which are described below. Your doctor will advise you on which is best for you.

Surgery

There are different methods of surgically removing skin cancer depending on the type of skin cancer you have.

Your surgeon will aim to remove the cancer and some of the healthy skin surrounding it. The amount of healthy skin that is removed will vary depending on the type of cancer and how deep it is in your skin. For NMSC, the amount of healthy skin removed varies between 4 and 6 mm. Melanoma is removed with a small margin of healthy skin. This skin is analysed in a laboratory and if it's found that not all of the cancer has been removed, a further margin of healthy skin is removed around the scar.

Your surgeon may also remove some of your lymph nodes if they’re found to be cancerous or if they want to check that they’re healthy.

Non-surgical treatments

There are several different types of non-surgical treatment for skin cancer, including the following.

  • Photodynamic therapy – this is a fairly new treatment for BCCs. It uses a cream that makes your skin sensitive to light. Your skin is then exposed to a laser, which kills the cancer cells.
  • Freezing and destroying BCCs with liquid nitrogen.
  • Imiquimod cream – a prescribed cream that uses your immune system to attack BCCs.
  • Biological therapies – manufactured antibodies, such as interferon, help your immune system to fight the cancer. A more recent advance in this area is the development of melanoma vaccines. However, they are only being used in research trials at present.
  • Radiotherapy – X-rays are used to kill cancer cells. You may have radiotherapy if the cancer covers a wide area or after surgery to stop the cancer coming back.
  • Chemotherapy – medicines are used to destroy cancer cells. These are usually given as injections or tablets.

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Prevention of skin cancer 

To reduce your risk of skin cancer, always take care in the sun and don't let your skin burn. If you're spending longer than a few minutes out in the sun between 10am and 3pm or if the UV index is 3 or higher you should protect yourself as follows.

  • Use a broad-spectrum sunscreen with an SPF (sun protection factor) of 30 that will protect you against both UVA and UVB radiation. Use a water-resistant sunscreen if you like to swim or participate in water sports and if you are active or likely to sweat a lot. Apply sunscreen thickly onto the skin about 15¬–20 minutes before you go out and re-apply every two hours, or more often if you go swimming or sweat a lot.
  • Stay in the shade as much as possible.
  • Cover up with suitable clothing and a wide-brimmed hat, and wear close-fitting or wrap-around sunglasses that meet the Australian Standard for UV protection.

Don’t use sunbeds if you want to reduce your risk of skin cancer. If you notice any changes in your skin, visit your GP as soon as possible.

Sun protection and vitamin D

Balance sun protection against skin cancer with maintaining healthy vitamin D levels. Vitamin D is essential for healthy bones and muscles. The body requires UV radiation to manufacture vitamin D as there are not many natural food sources of this vitamin.

It is important not to forgo wearing sunscreen during peak UV times due to concerns about vitamin D deficiency. Most people in Australia will achieve adequate vitamin D levels through their usual day-to-day activities. Only a few minutes of sun exposure to the face, arms and hands (or equivalent skin area) is required on most days in summer outside of peak UV times to generate sufficient vitamin D in the body for a fair-skinned person.

The amount of exposure needed for healthy vitamin D levels will vary, partly depending on your skin type (darker skin requires longer exposure), the time of year and which state you are in. For more details about this, visit the Cancer Council Australia website noted in the further information section of this factsheet.

To check the UV levels in your area and the times of the day that sun protection is required, consult your state’s Cancer Council website for their UV Alert. Also look out for the SunSmart UV Alert in the weather pages of most daily newspapers. You can also download the free Cancer Council SunSmart app for smartphones.

For more information see the health page on Sun protection.

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Further information 

Australasian College of Dermatologists

www.dermcoll.asn.au

Cancer Council Australia

www.cancer.org.au

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Sources  

Australian College of Dermatologists. A–Z of skin: skin cancer. [online] [Last reviewed October 2004, accessed 22 February 2012]. Available from: http://www.dermcoll.edu.au/

Australian College of Dermatologists. A–Z of skin: sun protection. [online] [Last reviewed March 2001, accessed 22 February 2012]. Available from: http://www.dermcoll.edu.au/

Australian Department of Health and Ageing. Skin cancer: key statistics. [online] Canberra: Australian Department of Health and Ageing. [Last updated June 2011, accessed 27 February 2012]. Available from: http://www.health.gov.au/internet/skincancer/publishing.nsf/Content/fact-2

Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia working Group. Vitamin D and adult bone health: Position statement. MJA 2005; 182: 281-85.

Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia, Australasian College of Dermatologists and Cancer Council Australia. Risk and benefits of sun exposure: Position statement, 2007. Available from: http://www.cancer.org.au/Healthprofessionals/PositionStatements/sunsmart/risksandbenefitsofsunexposure.htm

Better Health Channel. Skin cancer – prevention and early detection. [online] Melbourne, VIC: State Government of Victoria. c1999-2012 [Last reviewed September 2011, accessed 22 February 2012]. Available from: http://www.betterhealth.vic.gov.au/

Better Health Channel. Skin cancer – risk factors. [online] Melbourne, VIC: State Government of Victoria. c1999-2012 [Last reviewed September 2011, accessed 22 February 2012]. Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Skin_cancer_risk_factors_and_early_signs?open

Better Health Channel. Vitamin D. [online] Melbourne, VIC: State Government of Victoria. c1999-2012 [Last reviewed June 2011, accessed 22 February 2012]. Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Vitamin_D?open

Cancer Council Australia. Be SunSmart factsheet [online]. Surry Hills, NSW: Cancer Council Australia. [Last reviewed August 2011, accessed 22 February 2012]. Available from: http://www.cancer.org.au/Healthprofessionals/patientfactsheets/Lifestyle/Be_sunsmart.htm

Cancer Council Australia. Melanoma [online]. Surry Hills, NSW: Cancer Council Australia. [Last reviewed September 2011, accessed 22 February 2012]. Available from: http://www.cancer.org.au/aboutcancer/cancertypes/melanoma.htm

Cancer Council Australia. Non-melanoma skin cancer [online]. Surry Hills, NSW: Cancer Council Australia. [Last reviewed September 2011, accessed 22 February 2012]. Available from: http://www.cancer.org.au/aboutcancer/cancertypes/nonmelanomaskincancer.htm

Clinical Knowledge Summaries. Skin cancer – suspected. [online] London: National Institutes for Health and Clinical Excellence. 2005 [last updated Jun 2009, accessed Jul 2010] Available from: http://www.cks.nhs.uk/skin_cancer_suspected

Fisher RA Larkin J. Malignant melanoma (metastatic). [online] BMJ Clinical Evidence. Mar 2010 [accessed May 2010] Available from: http://clinicalevidence.bmj.com/x/systematic-review/1718/overview.html

Green AC McBride P. Squamous cell carcinoma of the skin (non-metastatic). BMJ Clinical Evidence. May 2010 [accessed May 2010] Available from: http://clinicalevidence.bmj.com/x/systematic-review/1709/overview.html

myDr. Skin cancer: the warning signs. [online] St Leonards, NSW: UBM Medica Australia. 2001 [Last reviewed August 2006, accessed 22 February 2012]. Available from: http://www.mydr.com.au/skin-hair/skin-cancer-the-warning-signs

myDr. Skin cancer risk factors in Australia. [online] St Leonards, NSW: UBM Medica Australia. 2001 [Last reviewed April 2010, accessed 22 February 2012]. Available from: http://www.mydr.com.au/skin-hair/skin-cancer-risk-factors-in-australia

myDr. Skin cancer: treatment. [online] St Leonards, NSW: UBM Medica Australia. 2001 [Last reviewed January 2007, accessed 22 February 2012]. Available from: http://www.mydr.com.au/skin-hair/skin-cancer-treatment

National Institute for Health and Clinical Excellence (NICE). Improving outcomes for people with skin tumours including melanoma. [online] May 2010. Available from: http://www.nice.org.uk

Royal College of Physicians (RCP) and British Association of Dermatologists (BAD). The prevention, diagnosis, referral and management of melanoma of the skin: concise guidelines. Concise guidance to good practice series, No 7. [online] London: RCP. Aug 2007 [Accessed Feb 2012] Available from: http://bookshop.rcplondon.ac.uk/contents/f36b1656-cc74-4867-8498-cc94b378312a.pdf (PDF 31.4kB)

Last published: 31 March 2012

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