Skin

Hello and thank you for joining us on this myth busting session on all things skin cancer.

So Petra, to start off with what are the different types of skin cancer?

Well, Zoe, we broadly define them into two groups.

Melanoma skin cancer and non-melanoma skin cancer.

Most people have heard about melanoma, skin cancer.

These are the types that we talk to people about looking for changes in moles or new moles.

But actually the much more common skin cancers of the non-melanoma skin cancers such as basal cell carcinomas and squamous cell carcinomas So three types that can be grouped into those two groups.

Okay.

And what sort of symptoms should people be looking out for when it comes to skin cancer?

You mentioned the moles and I think people tend to be aware of that, but what else is there?

So in addition to changes in moles, which I think people are very aware of, I think people are much less aware of the symptoms that you might see with the other two skin cancers which make up the vast majority of skin cancers we see.

So things like new skin growths.

So flesh coloured growths, particularly particularly on the face, head and neck that develop over weeks and months, they may get little blood vessels on them.

They look kind of pearly.

Those are things that need to get checked out.

And the other things are skin lesions, ulcers, scratches that don't heal.

So we're looking at things that change over weeks and months and things that don't heal after three or four weeks.

That's not common and probably needs to get checked out.

Brilliant.

And then lifestyle factors.

So what are the things that might increase the risk of somebody getting skin cancer?

We know that obviously genetics play a role.

We can't do anything about our genetics.

But what are the lifestyle factors that we can adjust?

Well, the main one is exposure to sunlight.

All skin cancers have a relationship to sunlight.

Sunlight is UV light and UV light damages the skin.

So we know that sunlight is the major factor.

So for that, that's two things, really, the amount of time you spend in the sun, which actually can be reflected on how brown your skin goes and whether you've had periods of sunburn.

These are two factors when it comes to sun exposure that increase your risk of skin cancer.

There are other things such as genetics.

So if you've got a family history of skin cancer that can make you more likely to get it, especially if there's a family history of melanoma and for some people, if they're on certain medications, that can make you more likely to have some of these non-melanoma skin cancers.

And what types of medications would they be?

So things affect your immune system.

So the immunosuppressants are the ones we need to be most cautious about.

Okay.

So you mentioned that about genetics.

The next question we can probably do quite quickly is, is skin cancer hereditary?

In most cases it isn't.

However, if you have had someone in the family, particularly with melanoma, it is worth mentioning that especially if you have a change in a mole or a new pigmented mole type lesion that you need checked out.

I guess another reason to be really, really careful about protecting yourself from the sun.

Here’s one, quick one to deal with.

Probably.

You can only develop skin cancer by sunbathing.

True or false?

I guess the answer is false, but also a little bit true.

So sunbathing is exposure to the sun, but it's not just lying on a sun bed.

Is that is that the thing that makes you get skin cancer?

Not at all.

It's any exposure to the sun.

So I think people need to change their mindset.

So there are lots of people that work outdoors and they feel that because they're outdoors and they get a base tan, they're protected.

They're actually much more at risk than someone that might spend just one week a year on a sunbed.

So it's the amount of sun you get and not in what position you are when you get that sun exposure.

And I'm sure you are the same in GP, often the type of patient we will see who's affected by skin cancer will be often men who've worked outdoors, who've never sunbathe, so they think they're fine.

And it's places like the tops of the ears, the nose, those places are pointing up towards the sun for many, many hours.

Yeah, absolutely.

And if you've not got much hair so the top of your head.

So you haven't noticed it, the chest area, shoulders, so really common, those kind of areas.

And you're absolutely right people think because they've not been sunbathers that their immune from those problems but actually they've they've still got the same risks.

So here's another one, something I often get asked.

People with dark skin do not develop skin cancers.

That true or false?

Oh, you know, I wish that was true.

Certainly it’s much less common to get melanoma type skin cancers and all skin cancers in people with darker skin because the melanin they have in their skin is a protective factor.

It's the thing your skin produces to protect the skin from the UV rays, which is.

Why we do get a tan when we are in the sun because the skin's desperately trying to protect itself.

Absolutely.

But but it doesn't mean you're protected.

And we still get skin cancers if we have pigmented skin, and it can be harder to pick them up.

And for some reason and we don't know why, it seems that for people that do get melanoma, particularly in pigmented skin, they tend to have worse outcomes.

So we pick them up later and they're more aggressive.

So it's even more important to keep an eye on your skin and no reason not to use sun protection if you have pigmented skin.

And Bob Marley, not a lot of people know, but Bob Marley actually died of skin cancer, so he had a type of skin cancer that affected the sole of his foot.

We call that area if you get skin cancer, an ankle skin cancer, and that's what he got.

And really unusual.

And people perhaps if they see a pigmented lesion on the palm of their hand or sole of their foot, it wouldn't occur to them that this could be a skin cancer.

But I think if that happens and, you know, go and see a GP.

And also on the nail, you can get a melanoma on the skin underneath the nail, so worth getting that checked out as well.

If your skin tans and you don't burn.

So, yeah, you go out in the sun, you turn a lovely, beautiful brown without any burning.

Then you don't need to wear sun protection.

True or false?

False.

False.

Again.

So yeah, tanning is a sign of sun damage and we know that UV light causes DNA changes in skin that actually makes you predisposed to skin cancer.

So the browner you are, the more sun damage your skin has got.

So, unfortunately, a tan, if it's come from sunlight, means you're damaging your skin and you know, premature ageing and wrinkles.

Definitely one of the outcomes but increased risk of skin cancer.

So unfortunately also false.

But if you are somebody who so whether you tan beautifully or whether you burn to a crisp, you know, the fact that you're exposing your skin to the sun and seeing changes is a sign that you're damaging your skin.

But if you're somebody who does burn easily, is that damage more significant than somebody who tans?

Well, there's two groups of people, I think.

We know that people that burn or have have episodes of burning, even if you don't burn easily.

We know that causes significant DNA damage to the skin and will make you more likely to have a skin cancer.

But people that have long exposure also have increased risk of skin cancers, different skin cancers, admittedly, but still problems in the future.

If you are someone with very fair skin and you do burn easily, however, your overall risk of skin cancer is higher than if you're someone who tans easily.

So I think that may be where this information might be misunderstood.

I tan easily, therefore it's protective.

Not true.

You tan easily.

Maybe your risks are lower than someone who burns easier, but it doesn't mean it's protecting you.

Brilliant.

Great.

And then what about choosing the SPF?

The number?

So the question is, a higher SPF means you can spend more time in the sun.

SPF have been designed and explained in such a way that the higher the SPF, the longer you can stay in the sun before you burn.

However, truthfully, the higher the SPF, the better protection you're giving your skin from sun damage.

I mean, that's the simplest way.

So really, you should use the highest SPF you can get your hands on for the best protection from the sun.

And actually, if you do want to go a slightly brown colour, most people do when they've been on holiday, you will still tan through SPF 30 or SPF 50.

You are just less likely to burn and there'll be less damage to your skin.

So the higher the better.

Okay.

Next question.

This is an interesting one.

Do you need to put a sunblock or higher sunscreen on moles?

Should you be spotting yourself ?

A common misconception.

So although some people with lots of moles are higher risk of skin cancer, it's not necessarily that it's the moles that will be affected.

It's the whole skin.

And actually, most skin cancers don't originate in a moles.

So put your sun cream everywhere.

And the same thickness all over.

You don't need to look like you've put your calamine on chickenpox.

Next one then is about moles.

What signs should people be looking out for?

What is a sign of concern?

When should you go and see your doctor?

So the things we're worried about as doctors are changing moles and changing over a short period of time, over days and weeks, many people's moles might change over years.

That's not to be concerned about.

It's changes in shape, colour and size, Any crusting or bleeding.

And if the colour appears to be bleeding out of the mole or suddenly looking very dark and different.

Some people call it the ugly duckling mole.

It looks completely different to any of the mole that you've had before or currently have.

And I think a good tip as well is if you're not sure, take a photograph of it.

You know, cameras, just phone cameras.

Now zoom in, take a photograph in good light and take, you know, do that weekly monitoring and then you can look at it, see if it's changing.

But if in doubt.

It's so helpful for the doctor, if you come with this was a picture three weeks ago, this now.

And if you can put something next to it for a kind of size comparison, a ruler.

A tape measure.

And especially with all the virtual consultations, it can really mean that you can have a mole safely assessed if you've taken those pictures.

So completely, agree, it’s a brilliant idea.

What you can do, even if you have to wait a little while for your appointment, is send an econsult with the pictures, and as a GP you love that.

This is brilliant.

I've got all the information I need.

And if there is concern, we're probably going to bring you in sooner.

Thank you so much for joining us.

I hope you found that both interesting and useful.