Skin Cancer: Myths and Truths

The skin is the body’s largest organ, but most people tend to neglect it. Did you know that more than 2 people die of skin cancer every hour? Thankfully, the annual Skin Cancer Awareness Month in May provides a great opportunity to educate us all and to inspire the sufferers of skin cancers as well. Continue reading to find out more about the causes of this disease, its management and how we can better protect ourselves from it.

What is skin cancer?

Skin cancer is the result of uncontrollable growth of abnormal cells in the epidermis, the skin’s outermost layer. It is caused by unrepaired DNA damage that causes mutations. These mutations cause skin cells to multiply rapidly, resulting in the formation of malignant tumours. 

The 3 most common forms of skin cancer are: 

1. Basal cell carcinoma (BCC) – this begins in the basal cells, a type of skin cell that regenerates newer skin cells to replace dead cells. It is the most common form of skin cancer and starts with uncontrolled growth of basal cells. 
2. Squamous cell carcinoma (SCC) – this develops in the squamous cells making up the middle and outer skin layers. It’s typically not life threatening but can be aggressive. 
3. Melanoma – this develops in the melanocyte cells which produce melanin – the pigment giving your skin its colour. It is the most serious type of skin cancer, and is rarer but more likely to spread. Most skin cancer deaths are caused by melanoma. 

What causes skin cancer?

Most non melanoma skin cancers are caused by both long-term or short, intense exposures to the sun. UV rays damage the DNA in skin cells, causing abnormal functioning.

Older people are more likely to develop skin cancer compared to younger people. Fair skinned people are more susceptible because they have less melanin – a protective pigment. Genetics, family history of skin cancer, psoriasis and eczema treatment, birthmarks, Human Papillomavirus
(HPV), and a weakened immune system may all contribute to the occurrence of skin cancer. 

What are the symptoms of skin cancer?

Doctors will typically employ the ABCDE method to look out for warning signs that your moles and freckles are abnormal: 

• Asymmetry: When a line is drawn through the dark spot, you can clearly see that one half differs from the other. 
• Border: The borders of the mole may be uneven or blurred, compared to a normal more which will usually have an even or common border. 
• Colour: Benign moles usually show up as a shade of brown, but cancerous moles may show up in varied colours such as black, brown or tan. As it grows, you may even see other colours such as red or white. 
• Diameter/ Dark/ Different: A cancerous mole will typically look darker, or bigger in size than normal moles. If it is 6mm or larger, it is definitely time to consult a doctor. 
• Evolving: You may notice a sudden or gradual change in size, shape, or colour of the affected dark spot, and even bleeding. 

3 myths debunked

Applying sunscreen has become a regularity for most people. However, there are some common myths that many will still fall prey to. 

Myth 1: “If I stay in the shade, I will not need to worry about applying sunscreen or being at risk of getting skin cancer.”

Truth: As long as you are outdoors, staying in the shade will not provide complete protection. In fact, UV rays can still reach your skin by bouncing off surfaces. UV rays can bounce off reflective surfaces such as water, snow, or ice. Hence, sunblock should still be applied in winter seasons.

Myth 2. “If I’m dark-skinned, I am not at risk of getting skin cancer.”

Truth: Skin cancer can occur to anyone of all skin colours. It occurs less frequently in darker skinned people as their skin has more melanin, a pigmentation that protects the skin from the sun. However, enough exposure to UV rays will also be able to break past the barrier and damage the skin’s DNA, causing cancer. That’s why skin cancer is typically detected in late stages for darker-skinned people. Hence, even though skin cancer has a higher occurrence in light-skinned individuals, the mortality rate for darker-skinned people is higher. 

Myth 3. “Since sun exposure will cause skin cancer, I can stay longer in the sun if I apply a sunscreen lotion of higher SPF.”

Truth 1: Sun exposure is indeed a major factor. If you have had more than 5 sunburns, the risk of getting melanoma is doubled. However, there are other causes such as UV light from tanning devices, family history, age, and certain medical conditions such as lupus. 

Truth 2: SPF stands for Sun Protection Factor. A higher SPF does NOT mean that it needs to be applied less frequently. You would have to apply SPF 50 as often as you would for SPF 30.

Theoretically, sunscreen with a higher SPF would offer “more protection”. However, there are diminishing returns as the number climbs. There is a significant difference between SPF 10 and SPF 30 but not as marginal difference between SPF 30 and SPF 60.

How to treat skin cancer?

Treatment varies from person to person, and will depend on the severity and extent of the skin cancer. Most skin cancers can be treated and cured before they spread. 

Here are some treatment options listed starting from the most severe: 

• Surgery may be done to remove the cancerous mole. Side effects include pain, scarring and risk of infection. 
• Radiation therapy uses high-energy rays to kill off cancerous cells. Side effects include redness and swelling of skin, hair loss, and tiredness. 
• Immunotherapy involves using medicine to trigger the body’s immune system to fight cancer. It may be administered via oral capsules or injections. Side effects can be severe, causing the patient to feel sick, and have chills, fever, or rashes. 
• Targeted therapy involves selectively attacking cancer cells without harming normal cells. Such medicines affect cancer cells’ ability to grow, change, or self-repair. You may have dryness, rashes, or itching. 
• Topical or local treatments include light therapy, freezing, lasers, or the application of topical medication directly onto the skin .
• Chemotherapy uses drugs to kill off cancer cells. They are usually injected into the body or taken orally, attacking cancer cells that have spread beyond the skin. 

Do consult your dermatologist to get an accurate diagnosis or treatment plan. 

How to prevent skin cancer?

Here are some important tips that can help you reduce the likelihood of skin cancer:

1. Avoid tanning or tanning salons, and avoid sunburn at all costs. 
2. Visit your dermatologist yearly for a professional checkup. 
3. Use a water-resistant broad-spectrum sunscreen of at least SPF 30 or higher every day. This will protect you from both UVA and UVB rays. Regular sunscreen usage will reduce the likelihood of melanoma by almost 50%! 
4. Apply 1 ounce (2 tablespoons worth) of sunscreen on your body at least half an hour before stepping outside. Reapply it every 2 hours or so. 
5. Avoid chemical sunscreens and look for sunscreens with at least 20% zinc oxide. These are effective and less likely to cause negative skin reactions. 
6. Keep out of the sun when it’s at its strongest between 10am and 4pm. 
7. Wear long sleeved clothing, a wide brimmed hat, and UV-blocking sunglasses. 
8. For newborns over the age of 6 months, always keep them out of the sun and apply sunscreen. 

Skin cancer is very preventable, so let’s take this opportunity to incorporate healthy sun exposure habits into our daily lifestyles.

Do check out our page on cancer if you wish to find out more about other types of cancers!

Article is written in conjunction with Skin Cancer Awareness Month 2021.