Health Issues

Skin Cancers

“Yes, you must do skin self-assessments”

Abnormal Skin Lesions: After the age of 50, our risk for skin cancers increases significantly. Therefore, it is important to perform thorough skin assessments and check for any change or new development of moles. This should be done annually at your complete physical check-ups with your healthcare provider, as well by doing self-assessments on a monthly basis. There are a couple factors that may determine if you are at higher risk of abnormal skin lesions: how much sun you have been exposed to throughout your life; your skin type. Those with fair skin are more likely to burn and are more susceptible to abnormal skin lesions.

Basal Cell Carcinoma: Basal Cell Carcinoma (BCC) is the most common form of skin cancer found in Canada. Fortunately, it is the most treatable but will continue to grow if left untreated. Basal cell skin cancers usually appear on sun exposed areas as a result of radiation from the sun. Frequent severe sunburns and intense sun exposure in childhood increase the risk of BCC in adulthood. Many people are susceptible to this form of skin cancer, however those with fair skin and blond or red hair who usually burn when out in the sun are most at risk. The risk also increases as people get older, especially those over the age of 50.

Early warning signs to look for are:

•a firm, flesh colored or slightly reddish bump, often with a pearly border. It may have small blood vessels on the surface, which gives it a red color.

•a sore or pimple-like growth that bleeds, crusts over and then reappears.

•a small, red scaling patch seen most often on the torso or limbs.

Treatment for BCC: Treatment options depend on the tumour (size, location etc.) and the patient’s own health status. Your dermatologist will discuss treatment options with you. Some treatment options are simple surgical excision (removal), curettage (scraping out tissue), electrodesiccation and cautery (electric current to destroy cancerous tissue), or laser surgery.

*Remember any sore that does not heal within four weeks should be examined by your dermatologist.

Squamous Cell Carcinoma: Squamous Cell Carcinoma (SCC) is the second most common form of skin cancer found in Canada, after basal cell. This form of skin cancer may grow quickly over a period of a few weeks and must be treated because it may continue to grow in size, damaging the surrounding skin, and may spread to other areas of the body. It appears on chronically sun-exposed areas such as the head and neck, arm, back of the hand and leg. Areas to be particularly careful to check for this cancer include the rim of the ear and the lip since the cancer can be more aggressive at these locations. Frequent sun exposure is the leading cause of this skin cancer.

Early Warning Signs and Treatment of SCC: Watch for thickened, red, scaly bumps or wart-like growths. They may also look like an open sore or crusted skin.

Treatment of squamous cell carcinoma can be discussed with your dermatologist. It consists mainly of surgical excision (removal), but other treatments can be explored.

Malignant Melanoma: Malignant melanoma is a less common but a highly dangerous form of skin cancer. When found at an early stage, melanoma has one of the highest cure rates of all cancers, at more than 90 percent. If left untreated, melanoma starts to invade deeper into the skin. When it reaches the blood stream or the lymphatic system, it can spread to other parts of the body, possibly resulting in death. Melanoma can develop within weeks or months or it can be slow growing over several years.

Melanoma can start as a new, brown or black, flat, freckle-like spot on the skin. It can also begin as a change in the shape or colour of an existing mole or coloured spot. Melanomas tend to be dark in colour, although some are a mixture of colours including red, blue and white. These tumours grow, so look for a change in the size of a spot. The key is to look for changes. Excessive sun exposure plays a leading role in the development of this type of skin cancer, especially those who have had severe, blistering sunburns.

Anyone can get melanoma, however fair skinned people who have sun-sensitive skin that often burns are more likely to get this disease. People with freckles and red or blond hair fall into this group as well as those with blue or green eyes. Those with many moles (more than 50), or moles with an unusual colour or shape, or with large moles, have an elevated risk. A close family history of melanoma is another risk factor. Anyone with one or more of these risk factors should have a spot check by a dermatologist; it could prove to be a life saving visit.

Actinic Keratoses: Although actinic keratoses are not true skin cancers, it is important to have these lesions treated as they have the potential to change into squamous cell skin cancers. Too much sun exposure over many years leads to a disruption in the normal development of skin cells, affecting the upper layer of the skin, called the epidermis. The sun’s rays damage the skin’s DNA, leading to this abnormal growth of the cells. Fair-skinned people who freckle and burn easily are at greatest risk. People over the age of 40 who have had a lot of sun also have a high risk for developing actinic keratoses. Outdoor workers face a greater risk because of their widespread sun exposure.

Warning Signs of Actinic Keratoses:

•Red, rough, scaling spots on sun-exposed areas.

•It is common to have a few at a time.

• These spots may sting or itch.

Treatments for Actinic Keratoses: There are a variety of treatments. Your dermatologist will advise you of the most suitable treatment based on the number of lesions, their location, your age and your general health. Treatments include cryosurgery (freezing of the lesion with liquid nitrogen), surgical removal, and creams.

Remember to check ABCDE:

Asymmetry: If the shape on one side is different from that of the other, not even.

Borders: Are the borders are irregular or ragged.

Color: Are there color variations of black, brown, red, blue or white throughout.

Diameter: The diameter should be no more than 1 cm.

Evolution: Changes in color, size, shape, or symptom, such as itching, tenderness, or bleeding.

Reference: Canadian Dermatology Association. (2013). Skin Cancer.
Retrieved from http://www.dermatology.ca/skin-hair-nails/skin/skin-cancer/#/

Additional Resources:

Skin Cancer Foundation
http://www.skincancer.org/

Mayo Clinic Skin Cancer:
http://www.mayoclinic.com/health/skin-cancer/DS00190 Health Canada: http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/cancer-eng.php

Canadian Cancer Society:
http://www.cancer.ca/

By: Lauren Dawes
Nursing Education Program of Saskatchewan Student
February, 2013

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