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Our weather in South Africa is often described as idyllic1. In fact, most areas in the country average more than 2 500 hours of sunshine per year, among the highest in the world2. We certainly are a sun loving nation. Whether it’s enjoying the beach during the summer, playing golf every week or basking in the winter sun3, unfortunately one of the risks of all of this sun exposure, even for those of us who don’t deliberately spend a lot of time in the sun, is skin cancer3.
While many South Africans are fortunately becoming more aware of the dangers of melanoma, the most aggressive and potentially deadly form of skin cancer4, many don’t realise that there are other types of skin cancer that may be less dangerous but are far more common5.
In fact, South Africa has the second highest incidence of skin cancer in the world after Australia, with more than 20 000 South African being diagnosed annually with what are termed “non-melanoma” skin cancers.
Alarmingly, what many people may think is a chronic area of eczema that may be itchy or sensitive to touch but typically does not bleed, could actually be skin cancer6.
Some types of skin cancers
Some of these types of skin cancers include Basal Cell Carcinoma (BCC) or Basal Cell skin cancer, the most common form of cancer7 of which superficial Basal Cell Carcinoma (sBCC) is the second most common type of BCC. sBCCs appear as red, scaly, flat patches of skin with well-defined borders6,8.
Squamous Cell Carcinoma (SCC) is the second most common type of skin cancer, primarily developing in fair-skinned, middle-aged and elderly people who have had long-term sun exposure and is curable in 95% of cases if detected early7. People with darker skins are less susceptible to skin cancer because their skin contains more natural melanin that helps to protect against sun damage7.
Actinic Keratoses (AK), also known as Solar Keratoses, are another type of skin lesion that can be sore, rough, itchy and scaly and can appear in areas of sun damaged skin and while generally harmless, there is a small risk that they can progress and develop into SCC if not treated9,10. Someone who has Actinic Keratoses is more at risk of all types of skin cancer compared to a person of the same age without actinic keratoses9.
Fortunately, if diagnosed and treated early, many patients with these more common types of skin cancer or skin lesions can avoid surgery by early diagnosis and treatment with light therapy, topical treatments or medication3.
One such topical treatment, which can be applied yourself at home, includes an immune response modifier that works by activating your immune system to target and destroy sBCC cells and Actinic Keratoses and not the healthy surrounding cells8,9. Results using this non-invasive treatment show clearance rates of up to 85 % and very good cosmetic outcomes11.
Images of patient using topical treatment:
Other options within a dermatologist practice could include cryotherapy (freezing of the skin cancer or lesion using liquid nitrogen), skin peels (strong, medical peels that remove the top layer of the skin to destroy AKs), curettage and cautery (removal of the sBCC or lesions with an instrument called a curette, followed by burning the lesion), photodynamic therapy (a solution applied to the skin, which destroys AKs and sBCC when activated by laser or blue light) and laser12.
More aggressive types of skin cancer have to be removed surgically3, which is when the skin cancer is cut away with some clear skin around it to make sure that all the cancer cells are removed12.
Fortunately, there have been many medical advances in these types of surgeries, including Mohs surgery, a type of micrographic surgery which is done in stages. Layers of cancerous tissue are removed and these sections of removed tissue are examined immediately on site while the patient waits. The surgical team then repeats this whole process until the margins (edges) of the last removed tissue sample are clear and cancer-free13.
The bottom line is that there are treatments available, but not to ignore sore, red, rough, itchy and scaly skin lesions and to get them checked and treated early to avoid long term complications3,6.
What to do
Please see your general practitioner or dermatologist should you be concerned about your skin, including if you notice a new or changed mole. Your doctor may look at your skin to determine whether your skin changes are likely to be skin cancer. Further testing may be needed to confirm that diagnosis14.
Remember to avoid direct sunlight between 10am to 3pm and where possible to wear thickly-woven hats with wide brims and loose-fitting clothes, made of tightly-woven, fabric that is cool while blocking the harmful UV rays. Applying sunscreen with an SPF of between 30 and 50 and reapplying it often as well as avoiding the use of sunlamps and tanning beds is strongly recommended7.
This editorial has been commissioned and brought to you by iNova Pharmaceuticals. Content in this editorial is for general information only and is not intended to provide medical or other professional advice. For more information on your medical condition and treatment options, speak to your healthcare professional.
Further information is available on request from iNova Pharmaceuticals. Name and business address: iNova Pharmaceuticals (Pty) Ltd. Co. Reg. No. 1952/001640/07. 15E Riley Road, Bedfordview. Tel. No. 011 087 0000. www.inovapharma.co.za. IN3823/20
- The Conversation. Does sunny South Africa really have an ideal climate for tourism? (2018) athttps://theconversation.com/does-sunny-south-africa-really-have-an-ideal-climate-for-tourism-103852 (website accessed on 25 May 2020)
- The Solar Future –Solar Energy In South Africa (2020) at https://www.thesolarfuture.co.za/solar-energy-in-south-africa/(website accessed on 24 May 2020)
- Skin Matters – Make the most of Mohs (2020) (https://www.skinmatters.co.za/sk/index4e28.html?option=com_content&view=article&id=228&Itemid=242) website accessed on 25 May 2020
- CancerCare. Skin Cancer: What you need to know (2017) at http://cancercare.co.za/skin-cancer-need-know/(Website accessed on 10 November 2019)
- Cancer Association of South Africa (CANSA). SunSmart Choice (2019) at https://www.cansa.org.za/be-sunsmart/(Website accessed on 10 November 2019)
- Lee P. Chapter 17: Actinic Keratosis, Basal, and Squamous Cell Carcinoma. Clinical Dermatology, 8th ed 2013, chapter 17, McGraw-Hill: New York by Souter C & Hordinsky MK.
- Cancer Association of South Africa (CANSA). Fact Sheet on Solar Radiation and Skin Cancer. November 2017
- Trakatelli M, et al. Eur J Dermatol 2014;24(3):312-329
- Actinic keratoses – also known as solar keratoses. Product Information Leaflet. British Association of Dermatologists (2016) athttp://www.bad.org.uk/for-the-public/patient-information-leaflets (website accessed 26 June 2019)
- De Berker D, et al. Br J Dermatol 2017;176:20-43.
- Geisse, J. et al. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: Results from two phase III, randomized, vehicle-controlled studies. J Am Acad Dermatol volume 50, Number 5 May 2004
- Actinic Keratosis. American Academy of Dermatology (2019) at https://www.aad.org/public/diseases/scaly-skin/actinic-keratosis#overview (website accessed 26 June 2019)
- Skin Cancer Foundation. MOHS: The Gold Standard (2020) at https://www.skincancer.org/treatment-resources/mohs-surgery/mohs-the-gold-standard/ (website accessed 24 May 2020)
- Mayo Clinic. Skin Cancer (2019) at https://www.mayoclinic.org/diseases-conditions/skin-cancer/diagnosis-treatment/drc-20377608 (website accessed on 25 May 2020)