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The Benefits of Skin Cancer Screening

Skin cancer screening can be a lifesaver, especially in a nation grappling with the widespread prevalence of this disease. In Australia, where the incidence of skin cancer is alarmingly high, early detection becomes our strongest defence. Those who grew up in Australia are more likely to encounter skin cancer than not.

Consider this compelling statistic: approximately 2,000 Australians die from Melanoma each year. However, when melanoma is identified in its early stages, before it leaves the skin’s surface, 5 year survival rates are 99%. This data underscores the profound significance of early detection through good quality skin cancer screening.

By promptly identifying skin cancer, we not only improve life outcomes but also reduce the necessity for more invasive and aggressive treatments. Furthermore, the early detection of Basal Cell Carcinomas and Squamous Cell Carcinomas offers the potential for non-surgical treatments.

Along with primary sun protection, skin cancer screening offers us an opportunity to minimise the generational effects of skin cancer in Australia.

Why Do I Need a Biopsy?

A biopsy is performed to determine if a suspicious mole or spot on the body is cancerous, or to assist in diagnosing a lesion or skin condition.

Possible Complications of Biopsies

Bleeding: Bleeding can occur after the procedure and is more common in people who are taking blood thinning medication. If you have any bleeding put firm pressure on the wound with a bandage or clean cloth for 15-20 minutes.

Infection: A bacterial infection of the wound can occur. This is increased with some health conditions such as diabetes or some sites such as the legs or near the groin. Signs of infection are increasing pain or increasing redness. Contact the clinic is this occurs.

Scarring: It is common for a scar to form at the biopsy site. Some areas of the body such as the chest are more likely to result in excessive (hypertrophic or keloid) scars in some people. This is more common in darker skin types.

Nerve Injury: The area of the biopsy can occasionally become numb. This usually resolves with time. Very rarely and in certain body locations nerve injury can occur.

Persistence or Recurrence of the Skin Lesion: Some biopsies deliberately remove only part of a lesion, so the lesion will persist or grow unless treated. It is possible that some lesions which initially appeared to be completely removed with the biopsy recur later.

Skin Cancer Excision

A skin cancer excision rarely requires hospital admission and general anaesthetic. The vast majority can be done in a primary care setting under local anaesthetic. Sometimes we utilise regional nerve blocks to numb an area of the skin prior to surgery such as the ear, nose and lip. Following successful anaesthetic infiltration we use an approach of margin control, where the lesion and an appropriate margin of normal skin is removed to ensure minimal risk of recurrence. Occasionally we might suggest you see a specialised dermatologist for a procedure called MOHs. This allows for a smaller defect and may be important for cosmetically sensitive areas.

Why Do I Need Cryotherapy

Cryotherapy is an appropriate treatment for some benign skin lesions, most pre-cancerous skin lesions, and some types of superficial skin cancers.

Cryotherapy is commonly used on pre-cancerous solar keratoses on all parts of the body, including the scalp, face, neck, hands, limbs and torso.

Cryotherapy is sometimes used on superficial skin cancers on the limbs and torso. It is not commonly used for skin cancers on the face due to the risk of leaving a cosmetically unacceptable depigmented scar.

What Happens Next?

As cryotherapy is a minimally invasive procedure, limited aftercare is required.

The area will be painful and a blister will form which will need to be kept clean. Normal daily washing will be sufficient care. Only use a dressing if the affected area is subject to trauma or clothing rubbing on it, or if the area weeps.

Your skin cancer doctor may recommend a simple analgesic such as paracetamol.

After a few days, the area will dry to form a scab. Avoid picking at this scab. The scab will normally peel off after about 10 days for treated areas on the face and scalp and after 2-3 weeks on the hands. Healing on the lower leg is often slower than other parts of the body, where the scab may take up to 2-3 months to heal.

A wound infection may occur rarely. If there is increasing pain, swelling, surrounding redness, or the formation of a yellow discharge (pus), consult your treating doctor.

A pale depigmented area (scar) may be left at the treatment site.
No leave from work or study is usually required during the healing phase.

Here’s How Photodynamic Therapy Works

Photosensitising Agent: The first step in PDT involves the administration of a topical cream that acts as a photosensitising agent. This agent is a light-sensitive compound that can accumulate in target cells, such as cancer cells, more than in healthy cells.

Uptake by Abnormal Cells: Over a period of time, the photosensitising agent is absorbed by the abnormal or cancerous cells in the body. This is why we apply the cream, cover the areas with dressings and wait 2-3 hours prior to administration of the light source.

Light Activation: Once a sufficient amount of the photosensitising agent has accumulated in the target cells, a specific wavelength of light is applied to the treatment area. We can use the daylight sun UV rays for pre cancerous lesions but we need to use an LED light in clinic for skin cancer treatment. This treatment usually lasts 8-10 minutes and can be moderately painful. To improve clearance rates we recommend repeating this treatment 2 weeks later.

Production of Reactive Oxygen Species: When the photosensitising agent is exposed to the specific light wavelength, it becomes activated and reacts with oxygen molecules in the surrounding tissue. The reactive oxygen species generated during this process cause damage to the target cells. They can disrupt cell membranes, proteins, and other cellular components, ultimately leading to the destruction of the abnormal cells.

Selective Targeting: One of the advantages of PDT is its ability to selectively target abnormal or cancerous cells. This is because the photosensitising agent tends to accumulate more in these cells, and the light is directed precisely at the treatment area.

Minimal Damage to Healthy Tissue: Normal, healthy cells are less affected because they either do not take up the photosensitising agent as effectively or they can better withstand the effects of the reactive oxygen species.

Topical Treatments

Keratinocyte cancers, including basal cell carcinoma (BCC) and superficial squamous cell carcinoma (IEC / Bowens Disease), are common types of skin cancer. Topical treatments are often considered for certain superficial or early lesions. It’s important to note that the choice of treatment depends on factors such as the type, size, location, and extent of the cancer. The topical treatment options for early keratinocyte cancers are:

• imiquimod 5% cream
• diclofenac 3% gel
• 5-fluorouracil 5% cream
• ingenol mebutate gel.
• PDT

Imiquimod:
Mechanism of action: Immune response modulation by stimulating the production of cytokines.
Application: Topical cream.
Indications: Superficial BCC (sBCC), Solar Keratosis
Treatment duration: Typically applied Monday-Friday for 6 weeks.
Side Effects: Severe redness (24%), severe scabbing and crusting (20%), itching (14%) and burning (5%)
Clearance rates: 85-90% sBCC

Ingenol Mebutate:
Mechanism of action: Induces cell death and inflammation in treated areas.
Application: Topical gel.
Indications: Actinic keratoses.
Treatment duration: 3 days
Note this is currently not available in Australia due to reports of increased rates of invasive SCC following its use. We await further data.

Photodynamic Therapy (PDT): (see section on PDT for more detail)
Mechanism of action: Photosensitizing agent is applied to the skin and activated by light to destroy targeted cells.
Application: Topical photosensitizing agent followed by light exposure.
Indications: Actinic keratoses, Superifical squamous cell cancer (IEC) and superficial BCC.
Treatment duration: Typically involves 1 session for AK and 2 sessions 1-2 weeks apart for IEC and sBCC.
Side Effects: Erythema (can last weeks – months), pain
Clearance rates: 75-80%

Benefits of Total Body Photography

There are many reasons why TBP may be a good idea for you. Some of the most important reasons are that it:

• Supports imaging of all of your moles
• Provides reassurance- professionals work to detect
  any concerns as early as possible to reduce the risk of
  unnecessary procedures
• Is quick! Takes less than 15 minutes

The Importance of Sunscreen:

Sunscreen is a protective barrier that shields your skin from the sun’s ultraviolet (UV) radiation, which is a leading cause of skin damage, premature aging, and skin cancer. Regular use of sunscreen can significantly reduce your risk of developing harmful skin conditions.

The Effectiveness of Sunscreen:

The effectiveness of sunscreen is measured by its Sun Protection Factor (SPF) rating and its ability to block both UVA and UVB rays. UVA rays can cause long-term skin damage, while UVB rays are responsible for sunburn. A higher SPF indicates increased protection against UVB rays. It’s important to note that no sunscreen can provide 100% protection, so it’s recommended to combine sunscreen use with other protective measures like wearing sun-protective clothing and seeking shade.

2. Physical Sunscreens:

How they work: Physical sunscreens contain active mineral ingredients, typically zinc oxide or titanium dioxide. These minerals create a physical barrier on the skin’s surface that reflects and scatters UV radiation away from the skin.

Pros:
Provide immediate protection upon application.
Less likely to cause skin irritation or allergies, making them ideal for sensitive skin.
Offer broad-spectrum protection against UVA and UVB rays.
Long-lasting and more stable in sunlight.

Cons:
May leave a white or chalky residue on the skin, although newer formulations are designed to be more cosmetically appealing.
Can be thicker and heavier on the skin compared to chemical sunscreens.
Limited availability in various formulations compared to chemical sunscreens.

4. Water-Resistant Sunscreens:

How they work: Water-resistant sunscreens are formulated to maintain their effectiveness even when exposed to water or sweat for a certain duration. They often contain additional ingredients to help the product adhere to the skin.

Pros:
Ideal for outdoor activities, swimming, or heavy workouts.
Maintain their protection even when you’re in the water or sweating.
Available in various SPF levels and formulations for different preferences.

Cons:
Still require reapplication after swimming, excessive sweating, or towel drying.
The term “water-resistant” is not synonymous with “waterproof,” so regular reapplication is essential for continued protection.
Remember that the choice of sunscreen type often depends on your skin type, sensitivity, and specific needs. Consulting with a skin cancer doctor can help you select the most suitable sunscreen for your individual requirements and ensure you’re adequately protected from the sun’s harmful rays.

Sebaceous Cysts

Description and Appearance

Sebaceous cysts are small, closed sacs filled with a white, cheesy substance called sebum. They are present in the skin to lubricate and feed the hair follicles. In some people who are genetically predisposed to these the pathway to the hair follicle can become blocked and the sac expands. They often appear as:

Round or oval bumps under the skin.
Flesh-colored or yellowish in appearance.
Ranging in size from a pea to a marble.

Common Locations

Sebaceous cysts can develop in areas with many oil glands, such as:
Back
Scalp
Face
Genitalia

Symptoms and Signs

Sebaceous cysts are typically painless and slow-growing, but they may become inflamed or infected, leading to:
Redness
Swelling
Pain or tenderness
Discharge of thick, foul-smelling material

Treatment Options

Treatment for sebaceous cysts may include:
Incision and drainage
Complete surgical removal (excision)
Antibiotics for infected cysts even if the plan is to excise them as infected tissue heals poorly post operatively.
Avoiding squeezing or popping the cyst, as this can lead to infection.

When to Seek Medical Attention

While sebaceous cysts and lipomas are generally harmless, you should seek medical attention if you notice:

Rapid growth or changes in appearance.

Pain, tenderness, or signs of infection (redness, warmth, swelling).

Discharge from the growth.

Concerns about the location, size, or discomfort.

Diagnosis and Treatment

Both sebaceous cysts and lipomas can be diagnosed through a clinical examination. Treatment options will depend on the location, size and growth.