SKIN CANCER

This article was contributed by Dr Lim Ai Wei, Consultant Dermatologist at Pantai Hospital Klang.
To book an appointment or learn more about Dr Lim Ai Wei and her clinic, click here.

SKIN CANCER

What is skin cancer?
Skin cancer is the uncontrolled growth of abnormal skin cells. More than 1.5 million new cases estimated annually worldwide. Most common skin cancers are Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC) and Melanoma. Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) are classified as Non- melanoma skin cancer (NMSC)

What causes skin cancer?
Most often caused by damage from ultraviolet (UV) radiation from the sun. UV rays cause mutations in the DNA of skin cells, leading to uncontrolled cell growth, causing cancer. Risk factors include chronic sun exposure, fair skin, weakened immune system or immune suppressing drugs, advanced age, personal and family history of cancer

How does skin cancer look like?
BCC: On sun exposed area, especially the face, nose, eyelids, scalp

SCC: On sun exposed area especially face, ears, lips, neck, arms

Melanoma: Commonly on face, arms, back and legs
- Look for new, changing, or unusual mole on both sun-exposed and sun-protected areas of the body.

• Warning signs for melanoma include:
  • Asymmetry – One half of the spot is unlike the other half
  • Border – Irregular edges
  • Colour – Uneven colour with different shades of brown and black, sometimes with blue, grey, red, pink or white
  • Diameter - The diameter of the spot is more than 6 mm
  • Evolving - The spot is changing color, size, or shape
  
  
  

How is skin cancer diagnosed?

• A detail clinical history
• Physical examination.
• Dermoscopy examination: Dermoscope is a diagnostic tool which visualizes subtle clinical patterns of skin lesions not normally visible to naked eye
• Skin biopsy for histopathological examination

How is skin cancer treated?

Treatment for skin cancer depends on the type, size, location, and stage of the cancer

• Surgical removal with margin clearance is the main treatment. Mohs micrographic surgery, a precise surgical technique is used to treat certain skin cancers, when tissue preservation is critical at areas where cosmetic and functional preservation is important such as face, nose, eyelids, lips, hands and feet.
• Destructive therapies involve physically destroying cancerous tissue rather than surgically excising it. This is used for superficial or low risk lesion of BCC or SCC, when surgery is not ideal. Therapies include:

Cryotherapy: Freezing cancer cells with liquid nitrogen

Curettage and Electrodessication (C & E): Scrapping the tumour with a curette followed by cauterization (electricity & heat are used to burn or destroy the tissue)

• Topical therapy such as Imiquimod and 5-Fluorouracil, applied directly to the skin cancer to kill the abnormal cells. They are used for superficial or low risk lesion of BCC or SCC, especially when surgery is not ideal.
• Radiation therapy uses high energy rays (X-rays) to destroy cancer cells, typically reserved for cases where surgery is not ideal.
• Chemotherapy involves using drugs to kill fast-growing cells including cancer cells. It is used for skin cancer that spreads.
• Immunotherapy uses the body’s own immune system to recognise and destroy cancer cells, especially in melanoma that spreads.
• Targeted therapy uses drug designed to specifically attack genetic mutations or molecular pathways that involves in cancer growth. It is mainly used in melanoma that spreads.

Its best to discuss with your dermatologist for the most appropriate and individualised treatment.

Is skin cancer fatal?
Skin cancer can be fatal, depending on the type, stage, and how early it is diagnosed and treated. Basal cell carcinoma grows slowly and rarely spreads. It is not fatal but can cause local damage if untreated. Squamous cell carcinoma is more aggressive (grow quickly and spread) if it is not diagnosed or treated early, but less aggressive compared to melanoma. However, it can be fatal if spreads, especially in people with weakened immune systems.

Melanoma spreads quickly and is life-threatening if not treated early. Hence in all types of skin cancer, early detection, and treatment lead to good prognosis.

How can I prevent from getting skin cancer?

• Seek shade between 10 a.m. and 2 p.m. when the sun’s UV rays are strongest.
• Wear protective clothing, wide-brimmed hat and sunglasses
• Wear sunscreen that’s at least SPF 30, broad spectrum and water resistant. Apply liberally every two hours. Pls refer the guide on How to Choose a Sunscreen?
• Check your skin monthly for any new or suspicious lesions.