What is Skin Cancer?
Skin cancer is one the commonest cancers worldwide. Early detection, meticulous management, and vigilant monitoring of skin cancer by surgeon and specialists well-versed in this disease can have profound impact on patient outcomes. These are some clinical features, management strategies, prevention tips, and monitoring approaches essential for skin cancer.
How Common is Skin Cancer in Singapore?
Skin cancer is a significant health concern in Singapore, ranking as the sixth most common cancer among men and the seventh among women.
It’s important to note that skin cancer can affect individuals of all skin tones, including those with darker skin. Early detection through regular self-examinations and skin cancer screenings is crucial for effective treatment. Protective measures, such as limiting sun exposure and using broad-spectrum sunscreen, are recommended to reduce the risk of developing skin cancer.
Risk Factors for Skin Cancer in Singapore:
- Prolonged Sun Exposure: High levels of ultraviolet (UV) radiation increases the risk of developing skin cancer especially in Singapore with our sunny climate all year round.
- Fair Skin: Less melanin provides lower natural protection.
- Frequent Sunburns: Particularly in childhood or adolescence.
- Family History: A genetic predisposition to skin cancer.
- Weakened Immunity: From pre-existing autoimmune conditions or certain medications which can suppress your body’s immune functions.
- Age: Higher incidence in older adults.
- Occupational Exposure: Outdoor work with prolonged UV exposure.
- Exposure to Harmful Substances: Examples would include carcinogenic materials such as arsenic or radiation.
Clinical Features of the Common Types of Skin Cancers
Skin cancers primarily encompass three major types: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Each type presents with distinct clinical features.
Basal Cell Carcinoma (BCC)
BCC is the most common type of skin cancer in Singapore, typically presenting as a small, pearly or waxy bump. They may also appear as flat, flesh-colored, or brown scar-like lesions. While BCCs rarely metastasize, they can cause significant local destruction if not treated promptly.
Squamous Cell Carcinoma (SCC)
SCCs often manifest as firm, red nodules or as flat lesions with a scaly, crusted surface. These tumors may develop from actinic keratoses, which are precancerous lesions caused by sun damage. Unlike BCC, SCC has a higher propensity to metastasize, particularly when arising on the lips, ears, or in immunocompromised individuals.
Melanoma
Melanoma is the most aggressive form of skin cancer, originating from the melanocytes. It is often characterized by the ABCDEs:
- Asymmetry: One half of the mole does not match the other half.
- Border: Edges are irregular, ragged, or blurred.
- Color: Coloration is not uniform and may include shades of black, brown, and beige.
- Diameter: The spot is larger than 6mm, although melanomas can be smaller.
- Evolving: Changes in size, shape, color, or elevation, or new symptoms such as bleeding or itching.
Early detection of melanoma is crucial, as it can metastasize rapidly to other organs.
Treatment Options for Skin Cancer in Singapore
The surgeon’s management of skin cancer in Singapore involves a multi-faceted approach tailored to the type, location, and stage of the tumor, as well as patient-specific factors.
Surgical Excision
Surgical excision remains the cornerstone of treatment for most skin cancers in Singapore. This involves removing the tumor along with a margin of healthy tissue to ensure complete excision. For melanoma, the excision margins are wider due to the higher risk of metastasis.
Mohs Micrographic Surgery
Mohs surgery is a tissue-sparing technique practiced by skin cancer surgeons which is particularly effective for small BCC and SCC. It involves the stepwise removal and microscopic examination of the tumor until no cancer cells remain. This method although more time-consuming, ensures complete tumor removal with minimal loss of surrounding healthy tissue, and is ideal for cosmetically sensitive areas like the face.
Cryotherapy
Cryotherapy uses liquid nitrogen to freeze and destroy superficial skin cancers and precancerous lesions such as actinic keratoses. It is a quick, effective treatment used by skin cancer surgeons with minimal discomfort and downtime.
Radiation Therapy
Radiation therapy is an option for patients who cannot undergo skin cancer surgery or for tumors in locations difficult to treat surgically. It can be used as a primary treatment or as adjuvant therapy to reduce recurrence risk.
Chemotherapy and Immunotherapy
For advanced or metastatic skin cancers, systemic treatments like chemotherapy and immunotherapy are employed. Immunotherapy, including checkpoint inhibitors such as pembrolizumab and nivolumab, has revolutionized the treatment of advanced melanoma by harnessing the body’s immune system to target cancer cells.
Targeted Therapy
Targeted therapies specifically attack cancer cells with certain genetic mutations, such as BRAF and MEK inhibitors for BRAF-mutant melanomas. These skin cancer therapies offer a personalized approach and have significantly improved outcomes for patients with advanced melanoma.
Skin Cancer Prevention Tips in Singapore
Preventing skin cancer involves a combination of protective measures and lifestyle modifications.
Sun Protection
Ultraviolet (UV) radiation from the sun is a primary risk factor for skin cancer in Singapore due to the consistently strong sunlight throughout the year. Effective sun protection strategies include:
- Using broad-spectrum sunscreen with an SPF of 30 or higher, applied generously and reapplied every two hours, or more frequently if swimming or sweating.
- Wearing protective clothing, including wide-brimmed hats, long-sleeved shirts, and UV-blocking sunglasses.
- Seeking shade, especially during peak sun hours from 10 a.m. to 4 p.m.
- Avoiding tanning beds, which emit harmful UV radiation.
Regular Skin Exams
Self-examinations and regular skin checks screening by a dermatologist are critical for early detection of skin cancer. Monthly self-exams help individuals become familiar with their skin and recognize any new or changing lesions.
Steps and Guidelines for a Skin Cancer Self-Examination:
- Proper Set Up: Use a full-length mirror, a handheld mirror, and good lighting.
- Check All Areas: Examine your entire body, including hard-to-see areas like your scalp, back, buttocks, and soles of your feet.
- Use the ABCDE Rule for Moles:
- Asymmetry: One half of the mole doesn’t match the other.
- Border: Irregular, scalloped, or poorly defined edges.
- Color: Varying colors (brown, black, red, white, or blue).
- Diameter: Larger than 6mm (size of a pencil eraser).
- Evolving: Changes in size, shape, or color over time.
- Look for Unusual Spots: Non-healing sores, new growths, or scaly patches.
- Document Changes: Take photos to track changes over time.
- Seek Medical Advice: If you notice anything unusual, consult a skin cancer specialist promptly.
Regular self-checks done at least once a month can help to detect skin cancer early, improving treatment outcomes.
Healthy Lifestyle Choices
Maintaining a healthy immune system through a balanced diet, regular exercise, and avoiding smoking can also help reduce the risk of skin cancer.
Skin Cancer Survivors - Surveillance Strategies
Regular Skin Cancer Screening & Monitoring
Ongoing monitoring is essential for individuals diagnosed with skin cancer to detect recurrences or new primary cancers early. Regular follow-up appointments and skin cancer screening with your doctor is vital. The frequency of visits depends on the type and stage of the skin cancer, as well as the patient’s risk factors. Typically, follow-ups are more frequent in the first few years post-treatment and may become less frequent over time if no recurrences are noted.
Patient Education
Educating patients about the signs of recurrence and new skin cancers empowers them to participate actively in their care. Patients should be aware of the importance of reporting any new lesions or suspicious changes promptly.
Tips to help you prepare for a skin cancer screening:
- Wear Comfortable Clothing: Choose loose, easy-to-remove clothing for a thorough examination.
- Avoid Makeup and Skincare Products: Remove makeup, nail polish, and lotions to allow a clear view of your skin.
- Avoid Tanning: Do not go sun-tanning before the visit; they can mask skin changes.
- List Concerns: Note any new, changing, or unusual moles, spots, or symptoms to discuss with your doctor.
- Bring Photos: If you’ve documented changes in your skin, bring these for comparison.
- Know Your History: Be ready to share personal and family history of skin cancer or other skin conditions.
- Ask Questions: Prepare any questions about prevention, treatment, or risk factors to make the most of your visit.
A thorough physical examination may include a full-body check to visualize all areas of your skin, so be prepared for this possibility.
What to Expect After a Skin Cancer Screening Appointment:
- Receiving Results:
- If no suspicious areas are found, the doctor may reassure you and recommend routine self-checks monthly and annual screenings.
- If a biopsy was performed, results typically take 1-2 weeks. The clinic will notify you via a call, SMS, email, or during your follow-up visit.
- Follow-Up Appointments:
- If results are abnormal, you may be scheduled for a follow-up appointment to discuss next steps.
- Additional tests, like further biopsies or imaging, may be required to confirm the diagnosis.
- Recommended Actions:
- Monitor Your Skin: Continue regular self-examinations and note any changes.
- Preventive Measures: Follow sun protection guidelines, such as using sunscreen and avoiding prolonged UV exposure.
- Treatment Planning: If skin cancer is detected, your doctor will outline treatment options, such as surgery, topical therapy, or other interventions.
Early detection often leads to better outcomes, so staying proactive is key.
Book Your Skin Cancer Screening Appointment in Singapore
By understanding the clinical features, adhering to preventive measures, and committing to regular skin cancer screening and follow-ups with your skin cancer surgeon, we can significantly reduce the burden of this prevalent malignancy. Through continued research and patient education, we aim to enhance the outcomes and quality of life for those affected by skin cancer in Singapore.
If you suspect that you have any unusual skin changes, such as new growths or changes in existing moles, it is crucial to seek medical advice promptly. Early evaluation by a dermatologist or specialist skin cancer surgeon can lead to timely diagnosis and treatment, potentially preventing the progression of skin cancer. Remember, taking proactive steps in monitoring your skin health can make a significant difference. Contact Dr. Natascha at Cancer Surgery International today.