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

Friday - - News -

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.

Com­mon causes

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

hard-to-see places

Dr Jaf­fer Khan of Aes­thet­ics In­ter­na­tional

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