General Articles

Holidays are naturally linked to a time of relaxation and sun. There is however the dark side of sunlight. Unfortunately ultraviolet rays age the skin and cause wrinkles. It is also established that an excessive amount of sunlight and in particular ultraviolet rays increase risk of skin cancers.

There are different types of skin cancers and precancerous lesions. Solar or actinic keratoses are sun damaged superficial skin cells. They look like rough scaly areas usually on chronically sun exposed parts of the body such as the face and scalp (especially if the scalp does not have much hair) and sometimes on the hands and legs. Often actinic keratoses are easier to feel with fingers than to see. These lesions are not cancers but if left untreated they may sometimes progress to skin cancers. Solar keratoses can be treated with cryotherapy (an extremely cold spray). Alternatively, actinic keratoses may be treated with creams which stimulate the immune system locally and the resulting inflammation removes the sun damaged cells.

Basal cell carcinomas (also known in lay terms as rodent ulcers) are the most common type of skin cancers. Similarly to solar keratoses they are usually found on sun exposed areas, especially the face, trunk and arms of middle age and older people. Although formally classified as a cancer, basal cell carcinomas do not behave like a usual cancer: they do not spread around the body or shorten life. However, a rodent ulcer would continue to enlarge and grow slowly and relentlessly destroying healthy tissue locally - hence the lay term name. Patients often notice these lesions because they bleed and do not heal. The usual treatment is a complete surgical excision but if a basal cell carcinoma is detected when it is very thin it can be treated with a special blue light called photodynamic therapy or alternatively with creams which stimulate the immune system.

The most serious but rare skin cancer is malignant melanoma, or a cancerous mole. It is made of melanocytes, the skill cells which produce pigment and give the skin its colour and tan. The pigment absorbs ultraviolet rays thus protecting against the harmful effects of sunlight. For this reason suntan is in fact a natural protection of the body. Of cause a fake tan does not provide any protection and even a natural suntan lends only a partial protection. Unfortunately, if melanocytes become malignant they cause melanomas. Similarly to other skin cancers, melanomas are caused by an excessive ultraviolet radiation. However, melanomas tend to occur in much younger people: although more than half of melanomas are found in people older than 60, it is not that uncommon for a melanoma to arise in 20s, 30s and 40s. Nevertheless, less than one percent of melanomas develop in those under 20 years.

Melanomas look like an unusual mole or freckle. They can develop in brown birth-marks (also known as congenital moles), normal looking (so called benign) moles or atypical moles (also known as dysplastic or funny-looking moles). However, often they arise in normal appearing skin. The most important feature of melanomas is irregularity: look out for an irregular shape, outline, and/or colour and for a change in size. Doctors often use the ABCD system to recognize suspicious moles, which stands for:

A-asymmetry of shape
B-border irregularity
C-colour variation
D-diameter over 6mm (0.2 inch)
E-evolving (changing, enlarging)

Dermatologists also use special equipment called a dermatoscope. Dermatoscope uses a polarized light to examine the moles in depth in a non-invasive way, without taking a biopsy. If melanoma is suspected, the lesion should be excised urgently. This is important because if melanoma is detected and removed at an early stage the treatment is curative. If melanoma is removed at a later stage, when it is thicker, it may have a risk of recurrence or spread and the patient may be offered to be followed up in clinic for a few years. Fortunately in the majority of people, melanomas do not cause harm because they are detected and treated at an early stage. For this reason it is important to be aware about changes on your skin and dermatologists recommend self-examination on a monthly basis.

In conclusion, dermatologists recommend to moderate exposure to sunlight in order to reduce the risk of skin cancers. This can be achieved by avoiding direct sunlight between 10 am and 4 pm, wearing long-sleeved clothes made of closely woven material and broad-brimmed hats, and also re-applying sunscreen with SPF30* and higher every 2-3 hours.

Useful links:
For useful about skin cancers see www.alexandroff.org.uk

*SPF stands for Sun Protection Factor. A higher number provides a better protection. According to the current EU legislation SPF goes up to 50, but SPF30 is generally considered to give a reasonable protection.