How to spot skin cancer
It [melanoma] kills roughly one New Zealander a day, so it is not to be taken lightly.
The taxi driver who ferried me from Palmerston North airport last Friday was colourful in many ways. Brightly inked tattoos and colourful language greeted me along with friendly banter and a welcome to the Manawatu¯ .
As we left the airport, she stated she had met me before. I banter back, ‘It may have been in a student bar’’, to which she retorted that I could be a notch in her belt.
It got a little more surreal when she told me my name was Tom and then nailed my last name. As my brain Googled itself to find the association, my expert driver proclaimed she had a scar on her back thanks to me.
She then put me out of my misery. When I owned my own general practice in Taranaki, she was visiting with a friend when she came and asked what skin cancers looked like. I looked at her back and told her she needed a lesion cut out as it was suspicious. She heeded the advice and had it removed. It was indeed cancerous but she lived to tell the tale some 25 years later.
With summer upon us there will be many more suspicious moles formed. Sadly some that could have been removed before spreading to become potentially fatal will be missed.
There are three main types of skin cancer, basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and the nastiest of all – malignant melanoma. The first two cause local invasion. While SCC rarely spreads, melanoma grows deep and invades blood vessels, spreading to other organs such as the brain, lungs, liver and bone.
New Zealand and Australia have the highest rates of melanoma in the world. One in 15 Caucasians here can expect to develop a melanoma. It kills roughly one New Zealander a day, so it is not to be taken lightly. A good resource for skin conditions and cancer is dermnetnz.org/topics/ melanoma/.
Melanoma can occur anywhere on the body and not just sun-affected areas. It’s what killed Bob Marley and his started on his toe. So, what do you look out for? Well anything you are concerned about should be checked by your doctor or a dermatologist. Melanoma can develop from an existing mole that begins to grow funny, or can start as a new lesion and grow rapidly. There is an ABCDE for spotting melanoma outlined here. Add an F if it looks funny. ● A – asymmetry
● B – border irregularity
● C – colour variation
● D – diameter more than 6mm
● E – evolving or changing.
There is a saying ‘‘if in doubt cut it out’’, and having cut out many skin cancers myself, there have been a few I have had low suspicion of that have turned out to be nasty when examined under the microscope. There are new technologies such as apps like firstcheck.me which let you take photos of yourself or others (with their permission) and get an expert opinion from a skin cancer doctor. You can even get a small dermatoscope called a Skinscope which sticks onto your phone. I have used it myself to get reassurance that lesions are not cancerous.
It is best to reduce your risk by avoiding sunburn and long sun exposure that damages the DNA in our skin causing cancer. I am still surprised at how much sunburn I see clinically, and this is a definite risk factor.
Skin cancers, if detected early, can be cured. While there are increasing treatments for metastatic melanoma it is still best to get it early to avoid its spread through your blood and lymphatic system. Enjoy the summer, but be vigilant and cover up to avoid long-term damage and an increased skin cancer risk.
Dr Tom Mulholland is a GP with 30 years’ experience. He’s on a mission, tackling health issues around New Zealand.