Introduction

Skin cancer is one of the most common types of cancer around the world. It is the 5th most common cancer in the UK and is more prevalent in people assigned male at birth than in people assigned female at birth. UV rays are the main culprit and a popular risk factor for skin cancer.

But there are some other less familiar ones that we often disregard. One such factor is alcohol. The relationship between alcohol consumption and skin cancer has been the focus of attention for several years. According to the International Agency for Research on Cancer (IARC), the incidence and mortality rate of melanoma (a type of skin cancer) in Europe is 46.4%.¹ Researchers are working tirelessly to identify skin cancer risk factors, so appropriate measures can be advised to minimise the risk of developing it.

Understanding skin cancer

Types of skin cancer

Skin cancer is usually divided into two main categories: melanoma and non-melanoma.

Melanoma

• Melanoma is the 17th most common cancer globally. Melanocytes are the cells responsible for producing a brown pigment that gives colour to your skin and shields it from damaging UV rays
• It is the most dangerous type of skin cancer and has a high mortality rate. It metastasises, meaning it spreads to other organs quickly, thus early diagnosis and treatment are crucial
• Most melanomas appear as brown or black-coloured spots or moles but can also be red, pink, purple, and skin coloured. About 30% of these melanomas begin in moles already present on your body, while the rest develop in normal-looking skin
• Melanoma has a 99% cure rate if diagnosed early as it tends to spread quickly. This makes it very important to look out for any weird-looking moles and other changes to your skin²

Non-melanoma

There are two types of non-melanoma skin cancers:

1. Basal cell carcinoma (BCC)
2. Squamous cell carcinoma (SCC)

Basal cell carcinoma (BCC)

• Basal cells are the base of your top skin layer (epidermis) and are responsible for producing new layers of your epidermis
• Insignificant and abnormal production of basal cells results in basal cell carcinoma (BCC)
• It is the most common type of cancer
• Usually develops due to excessive UV exposure
• Occurs in areas of skin heavily exposed to the sun:
  • Face
  • Head
  • Neck
  • Arms
• Lesions are usually blush pink and pearly in appearance 
• Grow slowly and rarely spread to other organs 
• Early Diagnosis and treatment have a high 5-year cure rate of 95%³

Basal cells are found at the base of your top skin layer (epidermis). These cells are responsible for producing new layers of your epidermis. Insignificant and abnormal production of basal cells results in basal cell carcinoma (BCC).

It is a common type of cancer and usually develops due to UV exposure. It occurs in areas heavily exposed to the sun, such as the face, head, neck, and arms. The lesions are usually blush pink and pearly in appearance. They grow slowly and rarely spread to other organs. Early diagnosis and treatment have high 5-year cure rates of 95%.³

Squamous cell carcinoma (SCC)

• SCC are from an already present lesion called actinic keratosis
• Actinic keratosis or solar keratosis appears as dry and scaly skin due to sun damage
• Long-term exposure to UV rays can result in these lesions which can later become cancerous
• This type of cancer rarely spreads (metastasises)
• UV radiation is the most common risk factor for this type
• Other carcinogens can also lead to SCC:
  • Tar in cigarettes
  • Scars from burns
  • Ulcerative lesions
• SCC can occur in several locations, not just skin
  • It can also occur in mucous membranes of the throat and lungs⁴
• Human papillomavirus (HPV) is an important risk factor for SCC in the genital area. It can also occur in the mucous membranes of the throat and lungs

Causes and risk factors for skin cancer

Genetics

• Genetics is an important risk factor for skin cancer
• Individuals who have a family history of skin cancer are more likely to develop skin cancer in their lifetime⁵

Ethnicity

• Persons of European, Caucasian, and Australian descent have a high potential of developing skin cancer
• Fair skin does not protect well against the harmful UV rays from the sun
• Long-term repeated exposure to UV radiation distorts the DNA in your skin cells resulting in abnormal cancerous cells

History of skin cancer

Individuals who have a history of skin cancer and are cured of it, are also prone to developing skin cancer again.

Immunodeficiency

• A weak immune system is also a risk factor for skin cancer
• The immune system can get compromised when a person is suffering from:
  • Chronic inflammatory conditions like IBS (irritable bowel syndrome)
  • HIV
  • AIDs
• Transplants also weaken the immune system and increase the risk of developing cancer⁶
  • Organ transplants
  • Bone marrow transplant

Certain chemicals

Certain industrial chemicals are carcinogenic:⁷

• Arsenic
• Tar
• Petroleum products
• Creosote
• Polychlorinated biphenyls used in making plastics
• Benzoyl peroxide, commonly found in acne products, is also a cancer causing agent⁸

Alcohol consumption

• Alcohol is notorious for impairing health
• It's inflammatory and damaging to the cells
• One of the byproducts of alcohol decomposition, acetaldehyde is a known carcinogen. It damages the DNA and interferes with its repair. This results in abnormal cells which can become cancerous⁹

Diagnosis and prevention 

Diagnosis of skin cancer is done via biopsy. The biomarkers for skin cancer aid in its prognosis, diagnosis, and monitoring. These biomarkers are^10,11

• Melanoma-associated antigens (MAAs)
• S100B
• MicroRNAs (miRNAs)
• Circulating tumour cells (CTCs)
• Human Melanoma Black-45 (HMB-45)
• Melan-A
• Tyrosinase
• Microphthalmia transcription factor

In people assigned female at birth below 50 years of age, the chances of developing skin cancer are higher. Whereas, people assigned male at birth, have a higher chance if they are above 50.¹² Thus, taking care of your skin in your early years can help prevent skin cancer. You can take the following measures to prevent skin cancer:

• Avoid staying in direct sunlight for longer periods
• Stay away from sun tanning and tanning products
• Wear clothing that protects you from the sun such as:
  • long-sleeved shirts
  • hats
  • gloves
  • sunglasses etc
• Wear a broad-spectrum, water-resistant sunscreen. It’s best to wear SPF 50 sunscreen as it filters 98% UVB radiation.
  • Apply 5 ml or 1 teaspoon of sunscreen 20 minutes before going out
  • Reapply after every two hours and after swimming and excessive sweating¹³
• Avoid drinking alcohol in the sun as it increases the probability of skin cancer
  • According to research, every 10g increase in alcohol consumption per day increases the risk of non-melanoma skin cancers¹⁴

Treatment of skin cancers

Skin cancers are highly treatable if diagnosed early on. The patient's survival rate is high if the cancer is localised and has not yet spread to distant lymph nodes or organs.

Following are the treatment options for skin cancer¹⁵

• Surgery
• Chemotherapy
• Radiotherapy
• Immunotherapy, and 
• Photodynamic therapy (PDT)

Summary

Skin cancer is a common health concern worldwide. The daunting climate change and progressive destruction of the ozone layer add to the risk of skin cancer. While genetics, ethnicity, immunodeficiency, and certain chemicals, contribute to the risk of skin cancer, alcohol consumption is also being investigated as a possible contributing factor.

Thus, adhering to a healthy lifestyle that includes sun-safe practices and moderate alcohol consumption can play a pivotal role in mitigating the risk of skin cancer and promoting general well-being.