Be Smart About the Sun All Year Round
2 December 2019 – South Africa has one of the highest rates of skin cancer globally (1).
The SunSmart Campaign, an initiative of CANSA, is an annual awareness drive that runs throughout December and January to raise awareness about skin cancer, the most common cancer globally. Because South Africa has one of the highest UV (ultraviolet) levels in the world, we also have one of the highest skin cancer rates globally (1).
People with fair skin, especially those with red hair, moles or skin spots as well as people with a personal or family history of skin cancer, who play a lot of outdoor sport, those who work outside or spend a lot of time driving, are considered at a high risk of developing skin cancer (2). One of the myths that exist is that people with darker skins are not at risk of getting skin cancer (1). Melanoma, the most serious form of skin cancer which needs you to pay particular attention to new or changing moles, can affect all racial and ethnic groups, although it is more common in those people with fair skins who tend to sunburn rather than tan when exposed to the sun, even for a very short time (2). People with darker skins are less susceptible because their skin contains more natural melanin that helps to protect against sun damage (2).
Skin cancer is generally divided into two categories: Melanoma and non-melanoma (3). Melanoma is by far the most dangerous form of skin cancer and can be deadly. They are often dark or pink moles or patches of skin which are irregular in shape and can bleed (3). South Africa has one of the highest incidences of melanoma worldwide, with approximately 1 500 people diagnosed annually with this form of skin cancer (1). We should all thoroughly check our skin on a monthly basis and assess any changes in moles, or check if any new moles might have appeared. 60% of melanomas arise as new moles (3). The worldwide incidence of melanoma is on the increase (2).
While many people are becoming more aware of the dangers of melanoma and the warning signs, many don’t realise that there are other forms of skin cancer too, types of skin cancer that are less dangerous, but much more common and which need to be diagnosed early and treated (1,2). In fact, at least 20 000 South Africans are diagnosed annually with non-melanoma skin cancers(1). Non-melanoma skin cancers mainly consist of Basal Cell Carcinoma and Squamous Cell Carcinoma (1).
BCC, or basal cell skin cancer, is the most common form of cancer (2). This cancer starts in the top layer of the skin called the epidermis, and generally occurs on skin that is regularly exposed to sunlight or other ultraviolet radiation, such as your head or scalp (2).
Basal cell skin cancer is most common in people over the age of 40 but it can occur in younger people too (2). If left untreated, these types of skin cancers can lead to disfigurement, or the loss of an eye, nose or ear, which makes early detection so important (1).
There are several types of BCCs, of which superficial Basal Cell Carcinoma (sBCC) is the second most common. sBCCs appear as red, scaly, flat patches of skin with well-defined borders, which may be slightly rolled (4,5). These lesions typically appear on the head and neck area, but also commonly on the trunk or extremities of the body. People often complain of an area of ‘eczema’ that may be itchy or sensitive to touch but typically does not bleed (4).
Squamous Cell Carcinoma (SCC) is the second most common type of skin cancer and is curable in 95% of cases if detected early (2). This form of skin cancer begins in the squamous cells, which are found in the upper layer of the skin2 and is most frequently found on the head, neck and back of the hands as well as on the lower legs in women (1). SCC primarily develops in fair-skinned, middle-aged and elderly people who have had long-term sun exposure (2). People who use tanning beds have a much higher risk of getting SCC and they also tend to get SCC at a younger age (1).
Another risk of cumulative exposure to the sun over many years is the development of Actinic Keratoses (AK), also known as Solar Keratoses, which are areas of sun damaged skin found mostly on sun-exposed areas of the body, such as the forearms, backs of hands, face, ears, bald scalp and the lower legs (6). While these skin lesions are generally harmless, if left untreated they can progress and develop into Squamous Cell Carcinoma (6,7).
AK can be sore and itchy, and be rough and scaly (6,7). People with multiple AKs are also more at risk of other types of skin cancer, which is why it is important to have your skin examined if you suspect you have AKs (6,7).
There are various ways of treating non-melanoma skin cancers and Actinic Keratoses which can include surgery, laser treatment and freezing the skin with liquid nitrogen. Certain types of skin cancer, such as superficial Basal Cell Carcinoma as well as AK can often respond well to topical treatments which are available on prescription and can be applied at home over several weeks (5,8) including a patient-applied treatment for Actinic Keratosis and superficial Basal Cell Carcinoma (9,10).
Some tips to help protect your skin from the harmful effects of UV rays include avoiding direct sunlight between 10am to 3pm and wearing thickly-woven hats with wide brims and loose-fitting clothes, made of tightly-woven, fabric that is cool while blocking the harmful UV rays. Applying sunscreen with an SPF of between 30 and 50 and reapplying it often as well as avoiding the use of sunlamps and tanning beds is strongly recommended (2).
The bottom line is that if found early, most skin cancers can be cured (8). See your dermatologist or general practitioner if you have any suspicious lesions or moles and do this sooner rather than later. At least 80% of sun-induced skin damage occurs before the age of 18 and only manifests later in life. It is therefore of vital importance to take special care of children in the sun, not only now in the summer holidays, but every day of the year. Whether at the beach or pool, playing in the garden or at school (2).
Please see your general practitioner or dermatologist should you be concerned about your skin, particularly if you notice a new or changed mole.
DISCLAIMER: This editorial has been commissioned and brought to you by iNova Pharmaceuticals. Content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional.
1. Cancer Association of South Africa (CANSA). SunSmart Choice (2019) at https://www.cansa.org.za/be-sunsmart/(Website accessed on 10 November 2019)
2. Cancer Association of South Africa (CANSA). Fact Sheet on Solar Radiation and Skin Cancer. November 2017
3. CancerCare. Skin Cancer: What you need to know (2017) at http://cancercare.co.za/skin-cancer-need-know/(Website accessed on 10 November 2019)
4. Lee P. Chapter 17: Actinic Keratosis, Basal, and Squamous Cell Carcinoma. Clinical Dermatology, 8th ed 2013, chapter 17, McGraw-Hill: New York by Souter C & Hordinsky MK.
5. Trakatelli M, et al. Eur J Dermatol 2014;24(3):312-329.
6. Actinic keratoses – also known as solar keratoses. Product Information Leaflet. British Association of Dermatologists, 2016. [cited 2019 June 26]; Available from: http://www.bad.org.uk/for-the-public/patient-information-leaflets.
7. De Berker D, et al. Br J Dermatol 2017;176:20-43.
8. Actinic Keratosis. American Academy of Dermatology. [cited 2019 June 26]; Available from: https://www.aad.org/public/diseases/scaly-skin/actinic-keratosis#overview
9. Rx Impact Script Data, September 2019.
10. Product approved package insert, August 2007.