Skin cancer: ‘The Big See’

Skin Cancer Awareness Month

 

Over the last few months, people all around the globe have gained a new-found appreciation for the freedom to go outside whenever they like, and here in the UK we have been grateful for any good weather and outdoor spaces that we may be lucky enough to have. However, it is worth remembering that COVID-19 is not the only danger to our health that we could be exposed to when enjoying time outside of the house, particularly as we enter the hottest months of the year.

As May is Skin Cancer Awareness Month, we are spreading the word about ‘The Big See’ campaign, which highlights the signs of skin cancer that we are physically able to see and shows us why it is important to take precautions to prevent the development of this disease.

What is ‘The Big See’ campaign?

This campaign aims to empower you to get to know your skin, check yourself in the mirror and keep these three simple words in mind: new, changing or unusual [1]. :

  1. Are there any new moles or blemishes (note in particular anything that appears after the age of 21 years)?
  2. Are any spots changing in colour, shape, size or texture?
  3. Are there any spots with an unusual irregular outline or that continuously itch, hurt, crust or bleed for more than 3 weeks?

Signs of skin cancer

How common is skin cancer?

Skin cancer is the most common cancer in the UK [2] and the US [3]; in fact, more people are diagnosed with skin cancer each year in the US than all other cancers combined [4], with incidence rates of the cancer increasing in recent decades [3,5]. Incidence rates of melanoma, the most aggressive type of skin cancer, have more than doubled in the UK since the early 1990s and now melanoma is the fifth most common cancer, with an average of 44 new cases reported each day [5]. These figures are particularly concerning because the majority of skin cancer cases (86%) are preventable [5].

Is there a perception that skin cancer is not as serious as other cancers?

There are several types of skin cancer, which are named according to the skin cells they originate in, but we broadly group them as ‘melanoma’ and ‘non-melanoma’. Non-melanoma skin cancers (which account for approximately 4 out of 5 skin cancer cases) are very slow growing and almost never spread to other parts of the body, and most people with this type of skin cancer can be completely cured with treatment [6]. As they are usually treatable, non‑melanoma skin cancers are often not considered to be true cancers by cancer registries, so their incidence data are lacking [7].

Melanoma skin cancers are grouped separately because this type of skin cancer is much less common than non‑melanoma skin cancer [7]; however, it is aggressive, and is much more likely to grow and spread if not diagnosed and treated in the early stages [4]. In the UK, 1 in 36 males and 1 in 47 females will be diagnosed with melanoma skin cancer in their lifetime, with 1 in 10 melanoma skin cancer diagnoses occurring at a late stage of the disease [5]. Melanoma skin cancers have one of the highest risks of metastasis of all malignancies, and once this type of cancer has spread, treatment options (including lymph node surgery, immunotherapy and targeted therapy) provide minimal benefits [8].

Skin cancer survival rates depend on many factors, including the stage of the disease and the nature of the malignancy. For example, only about 50% of patients with Stage IV disease will still be alive 1 year after diagnosis [5] and only about 5%–19% will still be alive after 5 years; however, these figures depend on factors such as the extent of disease spread and the sites that the disease has spread to [9]. Fortunately, when diagnosed at the earliest stage, melanoma skin cancers have a similar prognosis to non-melanoma skin cancers, with a 1-year survival rate of 100% [5]. Nonetheless, these figures are somewhat frightening and certainly shatter the notion that skin cancer is ‘not serious’.

Is skin cancer considered straightforward to treat?

Surgery is the most common treatment for skin cancer and, if caught early, small cancers can usually be excised in a minor procedure under local anaesthetic [6]. However, the wound may not be small – UK melanoma guidelines recommend that a margin of between 0.5 cm and 2 cm in size is cut out on all sides of the cancerous cells, depending on disease stage [10]. Furthermore, skin cancer commonly appears on skin that is exposed most frequently, such as the face and the legs, making any resulting scar from surgery difficult to hide [4]. Ongoing surveillance may be required, as skin cancer has been known to recur after initial excision in both patients with non-melanoma skin cancers [11] and patients with melanoma skin cancers [12]. Fortunately, if melanoma and non-melanoma skin cancers are caught at an early stage, follow-up surveillance may not be necessary [5,10].

How can skin cancer be prevented?

Although it is reassuring that the treatments and survival outcomes for skin cancer are usually less frightening than those for other types of cancer, conducting regular skin examinations and taking appropriate measures to stop the development of skin cancer should still be actively encouraged.

Top tips on how you can protect yourself from skin cancer [13]:

  • Stay in the shade on sunny days, especially between the hours of 10:00 and 16:00.
  • Cover up with clothing, and wear a broad-brimmed hat and sunglasses that protect against UV rays.
  • Avoid getting sunburned or indulging in excessive tanning, and never use UV tanning beds.
  • Apply sunscreen whenever you are outside in the sunshine.
    • Use a sunscreen that protects your skin against both UVA rays and UVB rays and has a sun protection factor (SPF) of 15 or higher.
    • If you are going to be outside for a long time, use sunscreen that has an SPF of 30 or higher.
    • Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside.
    • Reapply sunscreen every 2 hours, or after swimming or excessive sweating.
  • Examine your skin head-to-toe every month to look for anything new, changing or unusual. Consider different ways you can do this; for example, make use of smartphone technology to keep photographs of moles or spots for comparison and set regular reminders to check your skin.

It is important to spread the word about ‘The Big See’ campaign to help stop the growing numbers of cases of skin cancer in countries such as the UK and the US [3, 5]. Although skin cancer can have dismal outcomes [5], the campaign highlights that it is almost completely preventable and curative treatment is possible when the disease is caught early [5]. To read more about skin cancer and what to look for when checking your skin, or to find out how to help support this campaign, see ‘The Big See’ website.

References

  1. The Skin Cancer Foundation. Available at: https://thebigsee.org/. Accessed May 2020.
  2. British Skin Foundation. Available at: https://www.britishskinfoundation.org.uk. Accessed May 2020.
  3. American Academy of Dermatology. Available at: https://www.aad.org. Accessed May 2020.
  4. American Cancer Society. Available at: https://www.cancer.org. Accessed May 2020.
  5. Cancer Research UK. Available at: https://www.cancerresearchuk.org/. Accessed May 2020.
  6. Macmillan Cancer Support. Available at: https://www.macmillan.org.uk. Accessed May 2020.
  7. World Cancer Research Fund International. Available at: https://www.wcrf.org. Accessed May 2020.
  8. Wasif N, Bagaria SP, Ray P et al. Does metastasectomy improve survival in patients with Stage IV melanoma? A cancer registry analysis of outcomes. J Surg Oncol 2011; 104 (2): 111–
  9. Sandru A, Voinea S, Panaitescu E et al. Survival rates of patients with metastatic malignant melanoma. J Med Life 2014; 7 (4): 572–
  10. National Institute for Health and Care Excellence. Managing melanoma, 2019.
  11. Chren MM, Torres JS, Stuart SE et al. Recurrence after treatment of nonmelanoma skin cancer: A prospective cohort study. Arch Dermatol 2011; 147 (5): 540–
  12. Rueth NM, Cromwell KD and Cormier JN. Long-term follow-up for melanoma patients: Is there any evidence of a benefit? Surg Oncol Clin N Am 2015; 24 (2): 359–
  13. The Skin Cancer Foundation. Available at: https://www.skincancer.org/. Accessed May 2020.