Whether you see them as beauty marks or blemishes, keeping track of your skin’s freckles and moles could help save you from skin cancer. Khulekani Madlela investigates
Whether you see them as beauty spots or blemishes, keeping track of your moles and freckles could save you from skin cancer.
Beauty may be more than skin deep, but paying attention to what’s on the surface could mean the difference between life and death. More than 132,000 instances of melanoma skin cancer are diagnosed globally every year, according to theWorld Health Organization (WHO), and over the past 30 years more people have had skin cancer than any other cancers combined, according to the US Skin Cancer Foundation. The WHO attributes the rise to the depletion of the ozone layer, among other factors. As it becomes thinner, more harmful UV rays are able to reach the Earth’s surface. In the UAE, we are seeing more cases of skin cancer, partly because it’s very hot all year round and due to the large number of fair-skinned expatriates living here, although all people can fall victim to the disease.
Very few people have flawless skin. Most of us have birthmarks, moles and freckles, and some of these blemishes could be a sign of something serious like skin cancer. That’s why keeping track of your skin and any moles or freckles is so important, as Kevin*, a 45-year-old American army officer, discovered last year. Having had a mole on his face since childhood, he’d almost stopped seeing it when he looked in the mirror. But then he noticed it was starting to get bigger and darker, changing colour from brown to black. He went straight to his GP who referred him to Dr Akbar Ali, head of dermatology at the Canadian Specialist Hospital, Dubai. “I examined the suspicious mole with a dermatoscope [a device that allows a clinician to observe and analyse skin lesions with a magnifier and a light source] and confirmed he had melanoma,” says Dr Ali.
A melanoma is the most serious type of skin cancer, lethal in 15 to 20 per cent of cases. It develops in the cells (melanocytes) that produce melanin – the pigment that gives our skin its colour and which provides natural protection against the sun.
Dr Ali did a skin biopsy, which revealed that Kevin had lentigo maligna, a type of melanoma ‘in situ’ on the outer layer of the skin that grows slowly. When detected in the early stages, while it is still small and thin, it can be surgically removed. As long as all of it is removed, the chances of a full recovery are high. The likelihood of it returning depend on how deep it was and whether or not any of the cancerous cells were left behind.
“The diagnosis was consistent with the patient’s history as someone who has spent a lot of time outside, because a lentigo maligna lesion takes several years to develop, normally appearing in areas that are exposed to the sun, like the face,” says Dr Ali.
The doctor removed Kevin’s melanoma – making sure to remove about 1cm of normal-looking skin around it. The cells were removed layer by layer and checked under a microscope to ensure that all cancerous cells were eliminated. Kevin was left with a small scar that Dr Ali says will fade with time, but most importantly six months later Kevin is free of skin cancer. If he hadn’t noticed the changes in his mole, it could be a different story – one that should be a warning for all us to be vigilant about our skin.
The WHO reports that the main factors that predispose individuals to skin cancer are connected to recreational exposure to the sun and a history of sunburn. Both factors are things we can control. While skin cancer can occur on parts of the body that are not exposed to sun, studies show that sun exposure is responsible for the vast majority of cases. Skin cancer mainly affects areas least protected from the sun like the eyelids, lips, nose, ears, neck, cheeks, forehead and head.
UV radiation, especially UVB, causes sunburn, which is linked to a higher risk of malignant melanoma and basal-cell carcinoma, a type of skin cancer that begins in the cells whose function is to produce new skin cells as old ones die off.
Dr Syed Amjad Ali Shah, a dermatologist at the American Hospital Dubai, warns that a suntan is a sign that the skin is already harmed by UV radiation and is trying to defend itself against further damage. “This kind of damage can, in turn, increase the risk of developing
skin cancer,” he says. Skin cancer can also be caused by excessive exposure to radiation such as X-rays and tanning beds or through chronic exposure to chemicals such as arsenic. And some people are just naturally more disposed towards it. Those with fair skin, green or blue eyes, a family history of skin cancer and unusual moles are at a higher risk of developing the condition.
How to spot a cancerous mole
Skin cancer starts as a precancerous lesion, raised from the normal skin or as part of a mole, and turns into cancer over time. It may not be easy to recognise the symptoms of a melanoma, since most moles – which are sometimes present at birth or develop during childhood or adulthood – are normally harmless.
Although we cannot do anything about our skin type or pre-existing moles, regular self-examination can help us identify a suspicious mole before it develops into anything more serious. Skin specialists have come up with an ABCD rule that can guide you during your regular selfexamination:
Asymmetry – An irregular, uneven or asymmetrical mole could be cancerous.
Border – If the edges are irregular get yourself checked by a doctor.
Colour – Changes in the colour of an existing mole may be a sign of a melanoma.
Diameter – If the mole is wider than 6mm consult your doctor.
A mole that has a scaly surface, oozes fluid, itches or becomes painful could also be cancerous. People who have a relative who has had a melanoma and those who have more than 50 atypical nevi – large moles with irregular borders – are at a risk of developing skin cancer, says Dr Jaffer Khan of Aesthetic International, Dubai. Ask family members to help examine places that are not easy to see like the scalp and nape of your neck. Taking pictures of the moles and keeping a photo diary is also helpful in monitoring and determining if there are any changes in size or colour. It’s crucial to examine your skin regularly. If you notice any new marks or changes to pre-existing moles, consult your doctor.
Reduce your risk of skin cancer
Limit your time in the sun. With so much evidence suggesting that skin cancer is linked to sun exposure, this should be a no-brainer. Try to stay indoors when the sun is hottest, between 11am and 3pm, and always be sure to use sun protection, including sunscreen of SPF 30 or higher, and protective accessories such as a hat.
Apply creams containing vitamin E, which is known to reduce the occurrence of skin cancer caused by UV rays, says Dr Batra of Dr Batra’s Clinic in Dubai. A fat-soluble antioxidant, vitamin E is essential for the maintenance of healthy skin. It also absorbs energy from ultraviolet light, which means it plays an important role in photoprotection, preventing UV-induced free-radical damage to skin. Topical application can provide specific vitamin E forms that are not available through diet, so using a face moisturiser and lip balm that contains vitamin E or vitamin-E-rich products before venturing outdoors can help protect your skin.
Don’t be cavalier about your health. In general, men are less likely to monitor their skin closely and to get checked out if they think there could be something wrong. Don’t put off seeing a doctor if you suspect there may be an issue and pay close attention to particular problem areas. The trunk (chest and back) is a high-risk site for cancerous moles in men, while the legs are a common site for cancerous moles in women, according to the American Cancer Society.
Wear shades. To prevent cancer of the eyelid, the most common site for non-melanoma skin cancers, protect your eyes with sunglasses. Although this is what your eyelids are designed to do, their skin is very thin and is made up of fragile tissues that may be injured by UV light. “It is important to choose sunglasses that are a perfect fit to ensure full coverage and protection from harmful UV rays to prevent damage,” says Martine Larroque, managing director for the Middle East and Africa at sunglasses manufacturer Maui Jim. Martine recommends looking for UV-protection details on product labels before buying them. “Choose sunglasses that block 99 per cent of both UVA and UVB rays. Also, opt for wraparound or closefitting sunglasses with wide lenses to protect your eyes and the delicate skin around your eyes.”
If you have moles, go for a check up at least once every year. Your dermatologist will examine your moles using new technologies like MoleMate, an FDA-approved non-invasive, painless melanoma-screening device. This method eliminates the need for a biopsy, making the check-up process far less intimidating. The hand-held scanner uses light and a skin-imaging technology to view up to a depth of 2mm below the surface of suspicious moles and lesions. It measures the concentration and distribution of the skin’s melanin, collagen and haemoglobin to detect cancerous melanoma, and the images it generates are used by doctors to ascertain if a mole is benign or malignant. The technology is available across the UAE, including Aesthetics International, and is worth doing to give you peace of mind – plus, it could save your life. “If detected in its pre-cancerous stage, a mole can be treated before it develops into skin cancer,” says Dr Khan.
Ask a family member to help you examine
Dr Jaffer Khan of Aesthetics International