Skin cancers are the most common type of cancer in New Zealand – in fact they account for about 80 per cent of all new cancer diagnoses each year.
Yet when we think of skin cancer, most of us automatically assume we are talking about melanoma and know very little about other common forms.
Top of the list of "other skin cancers" are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) which, although not as dangerous as melanoma, are far more prevalent, affecting thousands of us every year. Grouped together, they are the so-called non-melanoma skin cancers, or NMSCs.
Although most NMSCs occur in older people (over the age of 65), they can definitely target younger people as well, with cases reported even in rare occasions. NMSCs are usually caused by excessive UV damage, hence they tend to occur more often in fair-skinned individuals and areas of the skin where there is more exposure to the sun. For SCCs in particular, there are other risk factors as well: smoking, having HPV virus and being on "suppressants" such as chemotherapy or long-term steroids, can increase the likelihood of developing this type of NMSC.
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BCCs are four times as common as SCCs. They are slow-growing and occur on the areas that have the most sun exposure, such as face, ears and neck. Although the risk of spread to other parts of the body is very low, they cause the local "invasion", which means that they spread outwards and downwards, attacking the body tissues around the site and often causing a lot of disfigurement. If you have been diagnosed with a BCC, you are at the higher risk of getting others in the future.
In their early stages, BCCs look like small, smooth, raised bumps on the skin surface, often with translucent or "pearly" hue to them. As they grow, they can become ulcerated and developed by the outer-edge and a "raw" center that can just look like an unhealed spot or scab on the skin. Although they tend to be skin-colored, they can be "pigmented", which will give them a brown color.
SCCs on the skin can look very similar to BCCs and it is not possible to tell them apart just by looking. They can have a characteristic crusty, raised appearance, but they can ulcerate, making them appear like a sore that isn't healing. Although their usual course is invade local tissues, much like BCCs, they have potential to spread or metastasize to lymph nodes and other sites, especially if they are large, not picked up early, or located on the lip, ear or areas of The Body That Haven't Had A Lot Of Sun Exposure. If they do metastasise or spread, mortality rates are high, with around 25 to 40 per cent of patients surviving at five years. SCCs can also be found inside the mouth, but these tend to behave differently, and management is more aggressive.
The key to successful treatment of both SCCs and BCCs is early detection. The sooner NMSC is diagnosed and managed, the lower risk of both local invasion and more distant spread. I know we get this message for melanoma all the time, but it is equally important for NMSCs – if you notice and change in skin lesion or something new on your skin that doesn't look like your other moles – please don't hesitate. Book and doctors appointment, initially with your GP, and they will be able to check it out for you and make a referral to a dermatologist for further assessment if needed. The longer you leave these lesions, the outcome can be, and although it is highly unlikely they will affect your lifespan, they can cause a lot of distress and disfigurement if left untreated for any length of time. I recommend many of my older patients, especially those who have had a lot of sun exposure in their lives (either due to repeated episodes of sunburn, or career or lifestyle that has been largely outdoors), come in every year for a routine skin check, where we can take a close look at any changes that might have occurred over the previous 12 months.
Once detected, optimized management depends on how much the NMSC is located on the body. If detected at the early stage, your doctor will discuss whether or not you require removal of the whole lesion by excision (ie, cutting all the cancerous cells, which will obviously leave some scarring), or whether other treatments could be effective .
Back in July last year, and New Zealand skin cancer specialist said improved access to advances in treatment mean fewer are dying from it. Meanwhile, a new global skin cancer study confirmed New Zealand's place at the top of the new case of the disease.
Other options include freezing the NMSC off with liquid nitrogen, using 5-fluorouracil or imiquimod, photodynamic-light therapy, or radiation to the affected area.
For more information and pictures of BCCs and SCCs, see Dermnet on dermnetnz.org