Management of sun-damaged skin and skin cancers

Each summer, we’re reminded of the importance of applying sunscreen every day – and for good reason.

According to the Medical Journal of Australia, two out of three Australians will be diagnosed with skin cancer by the age of 70. Not to mention that sitting in sunlight without sunscreen is one of the easiest ways to speed up the ageing process.

Dr Jacqueline Matulich and Dr Ritu Gupta, the principals of Platinum Dermatology, agree that sun exposure is the biggest culprit.

“Sun damage can increase the risk of premalignant change (actinic keratoses) on the skin as well as increasing the risk of skin cancer including melanoma. It can also contribute to premature ageing of the skin by causing fine lines, wrinkles (rhytides), loss of elasticity (sagging skin) and skin tone. Other effects of sun damage on the skin include increased pigmentation and freckling, and redness due to broken capillaries,” says Dr Matulich.

Dr Gupta says Australia has the highest rate of skin cancer in the world. “Unfortunately, we are the world leaders in all types of skin cancer – from the most deadly, melanoma, to squamous cell cancer and basal cell cancer, the latter being the most common of all cancers.”

“Basal cell cancer makes up 70% of all non-melanoma skin cancers reported in Australia. It is more common in men than women, and has a high likelihood of complete cure with treatment,” says Dr Matulich.

“Squamous cell carcinoma makes up approximately 30% of all non-melanoma skin cancers. It has a risk of metastasis (< 5%) which means it can travel through the blood to other parts of the body such as lymph nodes. Melanoma is the most serious form of skin cancer with an incidence of 48.8 per 100,000 in 2014. Its incidence continues to rise,” says Dr Matulich.

The sooner a skin cancer is identified and treated, the better your chance of avoiding surgery or, in the case of a serious melanoma or other skin cancer, potential disfigurement or even death.

Telltale signs of sun damage include:

Solar lentigines

Also known as age spots, these are non-cancerous, UV-induced pigmented lesions with a clearly defined edge. This damage is primarily superficial and present in the upper layers of the skin (epidermis). Lentigines may evolve slowly over years or appear suddenly and may occur anywhere on the body and vary in colour from light brown to black. These spots are caused by UV sun-exposure and the degree depends on how much UV light the melanin pigments are exposed to. These must be monitored as they may develop into skin cancer.

Pigmentation

Pigmentation is a common skin disorder, which refers to changes in the melanin (pigment) of your skin. It is caused by dysfunctional melanin production, on the surface of the skin. It can be triggered by a number of factors, including exposure to sunlight. This condition can affect all skin types.

There are different types of pigmentation and they do not all respond to the same treatments. It goes without saying that any brown or black discolouration that looks out of the ordinary should be checked by a specialist dermatologist. But correct diagnosis of the type of pigmentation you’re experiencing is also essential if you’re to benefit from treatment protocols.

Melasma

This is pigmentation that is deeper in the skin’s dermis. It appears on the face as larger brown patches, which are often symmetrical, with a non-distinct border.

This type of pigmentation mostly affects Asian and fair skinned people and is more common in women. Though causes are unknown, it is often linked to hormonal imbalances and can be made worse with UV exposure, some medications, and pregnancy. Unfortunately melasma is difficult to eliminate. However, with the correct treatments and topical home care, it can be reduced and controlled.

Protection and prevention

If you’re one of the many people who enjoy a golden glow during the warmer seasons, this sun-smart advice can easily be ignored.

However, research may change your mind. Published in the Annals of Internal Medicine, a study confirms that regular applications of sunscreen can make a big difference in the appearance of your skin.

Researchers gathered a group of individuals under the age of 55 who applied sunscreen with an SPF of 15 or higher to their head, neck, arms and hands every morning after bathing, after spending more than a few hours in direct sunlight or after perspiring heavily.

A different group was asked to apply sunscreen ‘at their discretion’, while a control group was given placebo pills or B-carotene supplements daily. Researchers took impressions of the back of the participant’s hands at the initiation of the study and again 45 years later. These impressions were able to quantify microscopic changes it the skin, including signs of ageing.

According to the Wall Street Journal, the participants who used sunscreen on a daily basis showed 24 percent less skin ageing compared with individuals who were allowed to apply lotion at their own discretion.

With the advanced beauty and skincare products with SPF available to us now – that actually affect positive changes in our skin to help combat anti-ageing, prevent breakouts and refine the complexion – there is no excuse not to protect your precious skin (and make you look better in the process!).

Prevention and protection with sunscreen really is the vital key to preventing sunspots, pigmentation and protecting the skin from harsh UVA and UVB rays.

However, Dr Matulich and Dr Gupta emphasise that use of sunscreen is not an excuse to stay out in the direct sun for prolonged periods.

In terms of the early warning signs, Dr Matulich says you should be looking for changes in your skin. “Development of a new and growing red, brown or black lump on the surface of the skin which may be tender or bleed, or a scaly red area or sore on the skin which is tender, itchy or bleeds and does not heal may indicate a skin cancer,” she says.

“A change in a pre-existing mole can indicate the development of a skin cancer. The signs include an increase in size, a change in colour including darkening or lightening of part or all of the mole, developing an irregular shape or a lump within the mole, or developing itching or a bleeding tendency in the mole. Any of these changes should be reviewed by your GP who may then refer you to a dermatologist, who is a skin specialist,” says Dr Matulich.

Dr Gupta stresses that GPs at skin cancer clinics are not specialist dermatologists. “It is important to remember that dermatologists are the only specialists in skin, hair and nails, and have trained for 16-18 years to gain this status,” she says.

“For an Anglo-Saxon person of aged 40 and above, at least start with one full skin examination by a specialist dermatologist and then be guided by their recommendation thereafter,” says Dr Gupta.

“High-risk patients (people with fair skin, a family history of melanoma, significant sun exposure, more than 100 moles, etc) should regularly self-examine their skin (at least every three months) and visit their dermatologist every six to 12 months for a skin check. Lower risk patients should have a 6 monthly self-examination and a skin check every one to two years with their doctor,” says Dr Matulich.

The skin specialists at Platinum Dermatology can help you take a close look at types of skin cancers and offer advice on how to proceed if you have concerns.

In order to prevent skin cancer, Dr Matulich recommends avoiding the sunlight between 10am to 3pm, particularly in the summertime. She also advises the application of >30+ SPF sunscreen on sun exposed areas when outdoors.

“Be sun safe – enjoy the sun, it makes us all feel good and is one of the great things about the Aussie summer. However, use sunscreen and reapply it, wear a rashie, seek out the shade and put on a shirt. Have regular skin checks as per your specialist dermatologists recommendations,” concludes Dr Gupta.