Spot The Difference!

  by Dr Toby Ford, Ford Health

Published Newsletter Article:  Agforce, January 2006

Skin cancer causes almost 1,500 deaths a year, with 374, 000 Australians treated for non-Melanoma skin cancer in 2002 - an increase of 103%.  Melanoma an occur at a young age and is the most diagnosed cancer in 15 to 44 year olds.

Summer is here and we live in a country with the highest skin cancer rate in the world.

 Even in small doses, UV radiation contributes to both skin ageing and skin cancer risk.  Research undertaken in Australia in 2005 showed that 73% of farmers though that there was some chance or a high chance that they would get skin cancer.

While most thought that they were at risk of developing skin cancer, their prevention practices were not the best, particularly in using sunscreen and long sleeved shirts.  Most wore wide-brimmed hats and 24% a peaked hat at the time of the interview.  75% of farmers usually or always wore long trousers.  However, only 27% of farmers usually wore long-sleeved shirts.  48% of farmers said that they never wore sunscreen on all exposed skin when they were working outdoors between 11am and 3pm on sunny days in summer. Only 27% usually or always wore a long-sleeved shirt.

There are 3 main types of skin cancer- basal cell carcinoma, squamous cell carcinoma and melanoma which is the least common but most serious of the three.  Australia has the highest rate of melanoma in the world.  In spite of this, many Australians are unclear on exactly what melanoma is and why it is such a concern.

Melanoma is cancer of the skin's pigment cells and the most deadly from of skin cancer.  If untreated, it can spread to other parts of the body.  A melanoma appears as a new spot, or an existing spot, freckle or mole that changes colour, size or shape.  Usually, a melanoma has an irregular or smudgy outline and is more than one colour.  It grows over a period of weeks to months and can be anywhere on the body, not only in areas frequently exposed to the sun.

The most important risk factor for melanoma is the number of moles you have.  Having suffered previous sever sunburn, having a pale complexion that tends to burn rather than tan, having a family history of melanoma and even simply growing up in Australia are all added risk factors.  It is uncommon in Asian, African and Aboriginal races.  The most common site for melanoma are the lower legs for women and the upper back for men.

What you should look out for:

• A crusty, non-healing sore
• A small red lump, pale or pearly in colour
• A new spot, freckle or mole changing in colour, thickness or shape over weeks or months.  Pay attention to spots that are dark brown to black, red or blue-black.

If your doctor spots a suspicious mole,  they may refer you to a dermatologist or surgeon.  The surgeon will take a biopsy (recommended margin is 5mm) and after it is confirmed as melanoma, a bigger excision will be made and further treatment and follow-up will proceed.

In terms of prevention, sun protection is critical.  Try to keep out of the sun between 10.00am and 3.00pm and use shade from umbrellas, canopies, tress.  Wear hats, long sleeves and long pants, wetsuits or swimming shirts, wrap around sunglasses and SPF 30+ sunscreen.  Also, make it a habit to check your body often for skin changes and ask a family member to check your back.  In Australia, we advise an annual skin check with your GP.  Skin screening may provide a method for detecting skin cancers at an earlier stage.