Be aware of skin cancer symptoms, get those new growths checked

An elderly Chinese lady came to see me after noticing several pigmented lesions on her face, and she was worried some of them might be down to skin cancer.

On examination, we highlighted one suspicious growth over her nose, which had been there for one to two years.

It was gradually getting bigger and recently started to bleed whenever she washed her face.

A biopsy confirmed the skin cancer and the necessary treatment was done.

This is one of the common scenarios we encounter in our clinic.

May is Skin Cancer Awareness Month, and more patients are now aware of the symptoms and seeking medical attention for new growths on their skin.

At times, as some skin cancers are slow-growing, patients do not realise it is there. The lesions get picked up incidentally when they visit the doctor for other issues.

Skin cancer is listed as one of the top 10 cancers diagnosed in Singapore.

From the Singapore Cancer Registry's annual report in 2018, between 2014 and 2018, non-melanoma skin cancers were the sixth most commonly reported cancer in males, with 1,957 cases, and seventh most commonly reported in females, with 1,568 cases.

The top three skin cancers occur in the following order: basal cell carcinomas, squamous cell carcinomas and melanomas, which are potentially more deadly.

Skin cancer may have varied presentations. It may appear as a new growth which can be slow- to fast-growing.

Things to look out for are new growths or growths that have changed and appear different from others.

Sometimes they may be painful, itchy, bleed or have a wound that does not heal, or sometimes there may be no symptoms.

It may present as a solitary red rash that does not respond to treatment, or a mole that has changed in appearance and character.

Ultraviolet (UV) radiation results in skin DNA damage, leading to skin cancers.

Hence, is it not surprising that most skin cancers commonly present on sun-exposed sites like the nose, around the eyes, forehead and the exposed part of the arms.

As UV radiation remains the most critical and modifiable risk factor for skin cancers, protecting yourself from it is good for skin cancer prevention.

Be sun smart by generously applying broad spectrum sunscreen - for protection against both UVB and UVA, with SPF 30 or higher - to all exposed skin, at least 15 to 30 minutes before going out.

When outdoors, sunscreen should be reapplied every two hours.

Being sun sensible by avoiding peak UV exposure in the day, staying shaded and wearing long-sleeved shirts, pants, large brimmed hats or sunglasses where possible, are equally, if not more, important.

Fortunately, when picked up early, skin cancers have a high chance of cure.

Performing regular self-checks certainly help. Examine your skin from head to toe monthly in a well-lit room with a full-length mirror.

Some of my patients recruit the help of a loved one to examine hard-to-see places, or you can use a hand-held mirror.

Many use their cellphones to get snapshots of growths of interest so they can compare it to a baseline.

Examine in a systematic way, from the face, neck, front and back of body, arms and legs, buttocks and genital area. Do not forget areas like behind the ears, underarms, back of thigh, between the toes and the bottom of the foot.

Mole mapping may also come in useful, especially if there are many moles.

At a dermatologist's clinic, this is done by camera scanning the body and documenting baseline images of moles, which will then be compared at regular intervals during follow-up visits.

This will enable early detection of suspicious growths and potentially reduce the need for multiple biopsies.

The writer is a dermatologist and Mohs micrographic surgeon at Dermatology and Surgery Clinic and was formerly the Skin Tumour Group lead at the National University Cancer Institute, Singapore.