Introduction 

Skin cancer is a prevalent and serious condition affecting millions of people globally.¹ Understanding its symptoms and preventive measures can significantly reduce your risk and facilitate early detection. This article addresses the most frequently asked questions about skin cancer, providing clear and comprehensive answers.

What is skin cancer?

Skin cancer is the abnormal growth of skin cells and typically occurs on sun-exposed skin.¹ There are three main types of skin cancer:^2,3

Basal cell carcinoma (BCC) 

• Basal cell carcinoma (BCC) is the most common type of skin cancer 
• It often appears as a small, shiny bump or a slightly raised patch 
• It can be pink, red, or white 

Squamous cell carcinoma (SCC) 

• Squamous cell carcinoma (SCC) often presents as a firm, red nodule or a rough, scaly patch that may bleed or crust 

Melanoma 

• Melanoma is the most dangerous form of skin cancer
• It often appears on the skin as irregular moles or spots 
• Colours can range from black and brown to pink, red, white, or blue

What causes skin cancer?

The main cause is UV radiation from the sun or tanning beds, which damages DNA in skin cells and leads to mutations.⁴ Other risk factors include:

• Having fair skin: Less melanin (a natural skin pigment that determines our skin, hair, and eye colour) means less protection from UV rays
• History of sunburns: Blistering sunburns increase the risk
• Excessive sun exposure: Spending extensive time in the sun without protection increases risk
• Sunny or high-altitude climates: Increased UV exposure leads to increased risk of skin cancer
• Having moles: In particular, having many moles or unusual moles heightens the risk
• Family history: A family history of skin cancer increases your risk
• Weakened immune system: Certain conditions (e.g. HIV) or medications that suppress your immune system (e.g. chemotherapy or immunosuppressants) can heighten your risk of developing skin cancer

How to recognise skin cancer

Early detection of skin cancer can significantly improve treatment success. Key signs to watch for are:

• New growths or sores that don’t heal within a few weeks
• Changes in existing moles. In particular, look for:
  • asymmetry 
  • irregular borders 
  • colour changes 
  • diameter larger than a pencil eraser
  • evolving shape and size 
• Unusual skin changes. Look for persistent:
  • itching 
  • tenderness
  • pain

Basal cell carcinoma

BCC typically appears as:⁴

• A small, shiny bump on sun-exposed skin
• A flat, flesh-coloured, or brown scar-like lesion
• A red, itchy patch or waxy, hard growth

Squamous cell carcinoma

SCC may manifest as:⁵

• A firm, red nodule
• A scaly, crusted flat lesion
• A wart-like growth or an open sore that doesn’t heal

Melanoma

Melanoma can develop anywhere on the body, even in non-sun-exposed areas.⁶ Key signs include:

• A large brown spot with darker speckles
• A mole changing in colour, size, or feel
• A small lesion with an irregular border, showing red, white, blue, or blue-black areas

What should I do if I notice a suspicious change on my skin?

Don't delay. Consult a healthcare professional immediately. Early detection and treatment are crucial for effectively managing skin cancer.

How to prevent skin cancer

Preventing skin cancer involves the following lifestyle changes and protective measures:⁶

• Avoid tanning beds: They emit harmful UV radiation
• Use sunscreen: Apply broad-spectrum SPF 30+ sunscreen generously and regularly
• Wear protective clothing: Hats, sunglasses, and long-sleeved clothing can shield you from UV rays
• Seek shade: This is particularly important between 10 am to 4 pm
• Regular skin exams: Both self-exams (carried out monthly), and professional checks (on an annual basis) can catch skin cancer early

Sun protection strategies

Steps you can take to protect yourself from the sun include the following:⁷

• Use sunscreen correctly:
  • Apply SPF 30+ sunscreen 15 minutes before sun exposure 
  • Reapply every two hours, or more often if swimming or sweating
• Wear protective clothing:
  • Choose long-sleeved shirts, pants, wide-brimmed hats, and UV-blocking sunglasses
• Seek shade:
  • Especially around midday when the sun is strongest
• Avoid tanning beds:
  • They significantly increase skin cancer risk
• Be extra cautious near reflective surfaces:
  • Water, snow, and sand can intensify UV rays, meaning you are more likely to burn 

Treatment options

Treatment options for skin cancer depend on the cancer type, size, location, and stage:

• Surgical procedures: Remove the cancerous tissue
• Radiation therapy: High-energy rays to kill cancer cells while doing as little harm as possible to healthy cells 
• Chemotherapy: Topical or systemic drugs to destroy cancer cells
• Photodynamic therapy (PDT): Light-sensitive medication and light to destroy cancer cells
• Biological therapy: Harnessing the body’s immune system to fight cancer
• Targeted therapy: Drugs targeting specific abnormalities in cancer cells

Surgical treatments

There are several types of surgical techniques for the treatment of skin cancer:

• Excisional surgery: Cutting out the cancer and some surrounding healthy tissue.⁸ Most small skin cancers are removed through excision surgery
• Mohs surgery: Layer-by-layer removal of skin, examining each layer until no abnormal cells remain.⁹ This surgery is particularly useful for skin cancers that:
  • Have a high risk of coming back 
  • Are in delicate areas where you want to keep as much healthy tissue as possible
  • Have difficult-to-define edges
  • Grow quickly or are large 
• Curettage and electrodesiccation: Scraping away cancer cells and using electricity to kill any that remain

Non-surgical treatments

• Radiation therapy: This is particularly useful for cancers that are difficult to treat surgically or would affect a patient’s appearance, for example, cancers that are deep in the skin or affect parts of the face such as the nose or eyes
• Topical chemotherapy: Creams with anti-cancer drugs that can be applied to the skin
• Photodynamic therapy (PDT): Applying a photosensitising agent and exposing it to light

Advanced treatments

For advanced skin cancers, treatment options include:

• Systemic chemotherapy: Drugs in the bloodstream kill cancer cells throughout the body 
• Targeted therapy: Medications target genetic changes in cancer cells
• Immunotherapy: Harneses the body’s own immune system to fight cancer¹⁰

Signs a mole could be cancerous

Follow the ABCDEs of melanoma:

• Asymmetry: One half doesn’t match the other
• Border: Irregular, ragged, or blurred edges
• Colour: Non-uniform colours, including brown, black, pink, red, white, or blue
• Diameter: Larger than six millimetres (the size of a pencil eraser)
• Evolving: Changing in size, shape, or colour

Prevention and early detection

Lifestyle in prevention

Maintaining a healthy lifestyle helps to prevent skin cancer:

• Diet: Eat antioxidant-rich foods like fruits and vegetables
• Exercise: Regular physical activity boosts overall health and immune function
• Avoid smoking: Smoking is linked to various cancers, including skin cancer

Self-examination techniques

It is advisable to perform skin self-exams every month as they are a simple way to detect skin cancer early when it is most treatable.

• Examine your body in a full-length mirror:
  • Check all areas, including front, back, and sides
• Check hard-to-see areas:
  • Use a hand mirror for the scalp, back, and buttocks
• Look between toes and on the soles of your feet: 
• Melanomas can develop in hidden places 
• Monitor your skin:
  • Make a record of moles, freckles, and marks
  • Note any changes and discuss them with your doctor

Professional skin exams

Schedule regular skin exams with a dermatologist. Their frequency depends on your risk profile:

• Low risk: Once a year is usually enough
• High risk: More frequent exams if you have a family history of skin cancer, numerous moles, or a history of sunburns

Advances in skin cancer treatment

New therapies have been developed to improve survival rates and quality of life:

• Immunotherapy: drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) boost the immune system¹³ 
• Targeted therapy: BRAF inhibitors (a type of targeted cancer drug that works by blocking the BRAF protein) and MEK inhibitors (they work by blocking the MEK protein) slow melanoma cell growth¹¹ 
• Gene therapy: emerging treatments aim to correct genetic defects in cancer cells^1,2,5 

What's the survival rate for skin cancer?

The survival rate varies depending on the type and stage at diagnosis. Early detection is key. For instance, the 5-year survival rate for localised, early-stage melanoma is very high, at around 99%.

Can skin cancer be cured?

The good news is that many skin cancers can be successfully treated, especially when caught early. The type and stage of the cancer will determine the specific treatment options available.

Myths and misconceptions 

Myth: “Skin cancer only affects fair-skinned people.”

Fact: People of all skin tones can develop skin cancer. Although the risk is lower, skin cancer can still develop in people with darker skin tones. Because it may not be as easily noticeable, it's even more important for these individuals to be aware of the signs and symptoms and to perform regular skin checks

Myth: “You only need sunscreen on sunny days.”

Fact: UV rays penetrate clouds and cause damage even on cloudy days.

Myth: “A base tan protects against sunburn.”

Fact: Any tan indicates skin damage, offering minimal protection.

Psychological impact and support

Coping with skin cancer can be emotionally tough. Here are some ways in which you can seek support:

• Counselling: Seeking professional help for the emotional impact of cancer diagnosis and treatment can be beneficial to a patient’s mental and physical well-being
• Support groups: Connecting with others who have experienced skin cancer can provide comfort and the unique support that comes with the shared experience
• Family and friends: Lean on your support network. No one knows you better than your family and friends; they will always be the first to show their support and love

Summary

• Skin cancer is a major health concern, but knowledge and prevention are key 
• Regular self-exams, professional skin checks, sun protection, and awareness of early signs are crucial 
• Several different treatment options are available for skin cancer, including surgical treatment, radiation therapy, chemotherapy, photodynamic therapy, biological therapy, and targeted therapy. 
• Advances in treatment offer hope, and a healthy lifestyle further aids prevention 
• Stay informed, vigilant, and proactive in protecting your skin health