3 February 2021
MY WELLNESS
Albertyn
Dangers of skin cancer not only skin deep S
outh Africans spend a great many hours outdoors. All the while the sun above, providing warmth and energy necessary for our survival, is also posing one of the greatest risks to our health if we do not all protect ourselves from its dangerous cancer-causing rays. According to Dr Dineo Tshabalala, a medical oncologist practising at Netcare Olivedale Hospital, if left undetected skin cancer can be devastating in ways people often do not realise. “Skin cancer is often thought of as being quite literally only on the surface of our bodies. Yet the threat is not only skin deep – without early treatment skin cancer can spread, metastasising to other organs.” According to the Cancer Association of South Africa (CANSA), skin cancer is the most common cancer worldwide, and as South Africa has one of the highest monitored ultraviolet (UV) levels in the world, it also has one of the highest incidences of skin cancer globally. UVB rays can cause sunburn within 15 minutes, resulting in permanent damage, while UVA rays can contribute to ageing the skin and DNA damage. Damage from both UVA and UVB rays can lead to skin cancer. “While the highest incidence continues to occur among white people, in sub-Saharan Africa it is becoming increasingly prevalent among black people with HIV as well as those with albinism, although anyone with compromised immunity is at risk. The risk factors for developing skin cancer include cumulative sun exposure, sun damage
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and sunburn,” Dr Tshabalala adds.
genetically predisposed to the disease.
“The hard truth is that skin cancer spares no one,” says dermatologist, Dr Hetesh Pitamber who practises at Netcare Sunninghill Hospital. “There tends to be a general misconception that non-whites are safe from developing skin cancer because their skins are darker and therefore less sensitive to the sun. However, this is simply not the case. While the disease is certainly more common in the white population, it affects us all.”
Dr Tshabalala notes that basal cell carcinoma rarely metastasizes while squamous cell carcinoma can metastasize if not caught early, with a tendency to spread to the brain via the lymph nodes. Cutaneous melanoma has the highest risk of metastasising and if left unchecked and untreated will spread to the lymph nodes nearest the affected lesion, mole or birthmark.
Dr Pitamber cautions that the non-white population needs to keep a close eye on any pigmented lesions on the palms of their hands and soles of their feet as well as their nails. Everyone should be aware of the risk areas, with those parts of the body exposed to sun more often being most vulnerable. “People don’t often consider areas such as the back of the neck, the feet and the ears, including inside and behind the ear,” he says. The three most common types of skin cancer are squamous cell carcinoma, which develops in the squamous cells that make up the middle and outer layers of the skin; basal cell carcinoma, which most often occurs when DNA damage from exposure to UV radiation from the sun or the use of indoor tanning beds triggers changes in basal cells in the outermost layer of skin, resulting in uncontrolled growth; and cutaneous melanoma, which is thought to be triggered by intense, occasional exposure to UV radiation, either from the sun or tanning beds, especially in people who are
“From there it can affect multiple organs as the cancer starts to spread through the body. It is for this reason that we must try and diagnose skin cancer as early on as possible, while it is still only at the surface. The only way to cure skin cancer is to cut it out – chemotherapy does not work for melanoma. There are some targeted therapies and other modalities that can be applied, but once the cancer has started to spread an oncologist needs to be consulted and further treatment will be advised on a case by case basis,” says Dr Tshabalala. According to Dr Pitamber, it is during one’s youth when the course for skin health is set. As much as 80% of the damage that will start to show up later in life is caused by sun-induced skin damage that occurred by or before the age of 18 – 21 years. It is for this reason that parents are advised to take extreme precautions in protecting the skin of their children from an early age. “Sunblock needs to be applied liberally on all
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areas of the body that are exposed to the sun including the hands, feet, neck and ears as these areas are often neglected. Hats with a wide brim protecting the back of the neck as well as the face are a must, and appropriate UV protective clothing should be worn together with sunscreen when swimming, as UV light penetrates water as well. Sunglasses are important for protecting the eyes too,” he cautions. Checking your body for any unusual pigmented spots or pointing out any changes you may notice on your loved ones, particularly when it comes to moles or birthmarks, can be the first life-saving step. Use this ABCDE checklist for moles: A – Asymmetry (one half different to the other half ) B – Border irregularities (scalloped or poorly defined edges) C – Colour (moles with more than one colour, or changes occurring in the colour) D – Diameter (larger than 6mm) E – Elevation (becoming raised and more prominent) Any lesion that is crusted, not healing, ulcerating or continuously bleeding should alert you to possible basal or squamous cell carcinoma. “It is tragic when something that could so easily have been stopped in its tracks is left to develop into cancer elsewhere in the body,” says Dr Tshabalala. - MNA on behalf of Netcare
