Melanoma (Skin Cancer)

Nov 06, 2022

MELANOMA (SKIN CANCER)


As a massage therapist, I have the opportunity to observe changes on clients skin, in areas that they may not be able to see themselves. Last summer I got extremely sunburnt and still have marks on my skin from that nearly a year later. Since I’ve spent the last week looking at the development of cancer cells and with summer coming up, I thought this would be the perfect time to give some information about melanoma.

FACTS ABOUT MELANOMA

  • remains the UK’s most common cancer with 130,000 cases of non-melanoma skin cancer diagnosed in the UK each year and over 2,400 deaths from melanoma every year
  • the rates of melanoma (1 in 54 people) are rapidly increasing due to ignorance regarding the early signs
  • this is one of the biggest cancers causing death in those aged 15-34
  • 86% of melanoma cases are preventable - with early diagnosis you can avoid disfigurement through surgery and improve prognosis and even prevent death
  • can appear anywhere on the body
  • all skin types can be damaged by UVR

RISK FACTORS

  • fairer skin that burns more easily
  • sunbed users and active tan seekers due to intense and cumulative damage
  • anyone with a history of sunburn, particularly in childhood and/or adolescence
  • outdoor workers that spend regular, prolonged periods of time outdoors
  • sports enthusiasts who enjoy extended, regular time outdoors without protection
  • mature skin which has accumulated UV damage over longer periods of time
  • those with more than 100 moles over the entire body
  • family history of skin cancer or melanoma

RISKS OF UVR

The sun emits three types of UV rays, which are carcinogenic:-

  • UVA - UVA rays penetrate the middle layer of the skin, contribute to skin burning and skin cancer, and are responsible for premature ageing
  • UVB - UVB rays reach the outer layer of the skin and are the primary cause of sunburn and skin cancer
  • UVC - UVC rays are blocked by the ozone layer

Sunburn, reddening, blistering, peeling and even tanning of the skin are clear signs of sun damage, causing the superficial layers of the skin to release chemicals which cause the blood vessels to expand and leak fluid. This is why sunburn is painful. When UV radiation penetrates into the deeper layers of skin, the cells become damaged, and while the tan fades the damage remains.

However, some exposure to UVB (15- 20 minutes day) is beneficial, as it is the main source of vitamin D, so it is important to get the balance right.

Vitamin D can also be found in egg yolks, fatty fish eg. trout, mackerel, salmon or tuna, cod liver oil, fortified milk, juices and cereals.

SUNBEDS AND GEL NAILS

Sunbeds have been proven to emit around 10-15 times the amount of UV rays as the sun at midday, and is thought to be a leading cause of skin cancer in younger people. Even using a sunbed once a month can double the risk of skin cancer, in addition to causing premature ageing, sagging, wrinkling and blotching.

Even the UV light used when having gel nails done can be damaging to the hands and feet as well as the nail beds themselves.

PREVENTION


Approximately 86% of skin cancer is preventable by:-

1) keeping shoulders covered as they can easily burn

2) using an SPF 30+ broad-spectrum sunscreen to exposed skin

3) wearing a wide brimmed hat to shade the face, neck and ears

4) wearing good quality sunglasses to protect the eyes

5) staying in shaded areas when possible, during peak UV hours (11am-3pm)

DETECTION OF SKIN CANCERS

Recognising changes in the skin is crucial as skin cancer rarely hurts.

There are 2 types of skin cancer:-

  • Non-melanoma skin cancer
  • Basal Cell carcinoma
  • Squamous cell carcinoma
  • Melanoma

Whilst non-melanoma skin cancers are more common,  melanoma is more deadly and can quickly spread to form new cancers around the body.

BASAL CELL CARCINOMA


  • the most common type of skin cancer, usually occurring on areas that are exposed to the sun eg. head, face, neck, ears
  • slow growing and rarely spread elsewhere
  • can be different shapes and sizes
  • if a basal cell carcinoma is ignored it can grow large and be disfiguring
  • Symptoms include (see comments):-
  • A persistent non healing sore
  • A pearly, shiny bump or nodule
  • A pink growth with a rolled, slightly elevated border
  • A patch of reddish irritated skin
  • A white, yellow or waxy scar like area

SQUAMOUS CELL CARCINOMA


  • the second most common form of skin cancer
  • usually occurs on areas exposed to the sun eg. face, neck, ears, forearms
  • can be different sizes and shapes
  • grow at variable rates
  • rarely spread unless ignored
  • can cause discomfort and become disfiguring
  • can be life threatening if left untreated
  • Symptoms may include (see comments):-
  • Persistent, thick, scaly patches that may bleed – may look like warts with a crusty surface
  • Small hard, white or skin coloured lumps
  • Persistent scaly red patch with irregular borders
  • An elevated growth with a central depression
  • Open crusty sore that bleeds

MELANOMA

  • the most deadly form of skin cancer
  • can occur anywhere on the body
  • the appearance of melanomas can vary considerably
  • usually appears as a new mole or an existing mole that changes in appearance
  • if not treated early melanoma can spread to other areas in the body
  • is difficult to treat
  • can be fatal

Use the ABCDE rule :-

  • Asymmetry
  • Border
  • Colour
  • Diameter
  • Evolving

NODULAR MELANOMATHIS

  • most aggressive form of melanoma
  • accounts for approximately 20% of cases
  • does not follow the ABCDE melanoma rule and tend to be more even in shape and colour
  • is usually invasive by the time it is diagnosed (when it becomes a bump)
  • commonly occurs on areas exposed to the sun eg. head, neck, the torso in men and legs in women - but can appear in other areas of the body
  • grow fast, downward and become invasive within months
  • usually black, but occasionally are blue, grey, white, brown, tan, red or skin tone

Use the EFG rule (see comments):-


  • Elevated?
  • Firm?
  • Growing?

CHECKLIST

Take action if:-

  • a mole changes shape, particularly gaining an irregular outline
  • a mole changes colour, becoming darker, patchy or multicoloured
  • a mole is getting larger or growing quickly
  • a mole starts to itch, bleed or become painful, crusty or inflamed
  • any lesion on the skin, lips, genitalia or nails behave differently to moles/lesions elsewhere

ACRAL LENTIGINOUS MELANOMA

  • located on the palms of the hands or soles of the feet
  • the only type of melanoma which occurs equally across all skin types
  • can quickly become invasive compared to other forms of melanoma
  • often appear as black discolouration but may present as grey or light brown
  • ABCDE rules of melanoma apply
  • A flat patch of discoloured skin that gradually enlarges is an early sign

SUBUNGUAL MELANOMA

  • Begins in the nail matrix as opposed to the skin
  • Symptoms may include:-
  • a dark band, usually vertical, on the nail that slowly expands
  • dark nail pigmentation that spreads to the surrounding skin
  • a nodule underneath the nail
  • usually occurs on just one nail
  • brittle and cracked nails with pigmentation and possibly bleeding

Not all GP’s are sufficiently trained in the detection of skin cancers and it is not uncommon for these to be misdiagnosed, so you should ask for a dermatology referral. You can also access MASCED online for information, sun safety tips, early detection advice, a self examination body mapping chart, a mole ruler and other educational resources.