We all know that skincare is important, with an increasing number of Australians dropping big money to get the best products. The thing is, much of what we purchase is to undo the damage we’ve already caused to our skin. With 69 per cent* of us already worrying about getting skin cancer, imagine if we spent more time and care preventing the damage from occurring in the first place? You know, wearing sunscreen, a hat, sunglasses, long sleeves and staying out of direct sun exposure between 10am and 3pm?
According to Dermatologist Dr Cara McDonald, the right actions could potentially reduce our national rates of skin cancer significantly. But we know all that, right? What you might not know is that our skin remembers… and if it could speak, it would tell you this:
“Remember all those times you hung in the sun without SPF? I’m still feeling the pain…”
You may have a memory like a goldfish, but your skin remembers everything. And over time, that harmful UVA and UVB exposure inflicted decades earlier can result in skin cancers.
“UVB penetrates to the more superficial layer of the skin, known as the epidermis, and UVB causes direct damage to the DNA proteins of the skin cells (sunburn),” explains Dr Cara. “With ongoing UV exposure over time, abnormalities in the DNA accumulate and can be magnified by cell division, eventually resulting in a very abnormal, or ‘cancerous’ cell. This can happen years down the track from any sun exposure.”
“It’s not you. It’s me. I’ve changed.”
Just like our relationships and hairstyles change over time, so does our skin (and not always for the better). “Skin cancers, by definition, are growing lesions and therefore may change in colour, shape or size, bleed or be sore. If you feel you have a spot that has changed or is continuing to evolve it should be checked immediately.”
Dr Cara says typically, benign sunspots and skin cancers happen ‘down the track’ due to the combined factors of cumulative UV exposure and the impact of cellular ageing. Some of these UV damage skin changes appearing years later include:
- Dilated capillaries and redness, often mistakenly thought to be due to rosacea or alcohol consumption.
- Red, scaly or rough patches on the skin. “This could indicate solar keratoses. The patches on the skin appear due to pre-cancerous cells in the skin surface,” she shares.
- Lentigines, which are large, flat brown spots triggered by excess UV light.
- Moles. “Moles are often sun-induced but can also be genetic in nature, appearing in children before any known sun exposure,” says Dr Cara. “There’s also solar elastosis, which looks like deep cross-hatched wrinkles or orange peel skin results from long term UVA exposure.”
If any of these have appeared on your skin or changed, book a skin check, pronto.
“Can we start again?”
Sometimes you need to get back to basics. And in this case, that means re-learning your alphabet, or more specifically, the ABCDEs.
“The ABCDE rules are all about identifying features that are more commonly seen in a cancerous lesion,” explains Dr Cara. “People can use these as a guide to monitor their own skin lesions, but in isolation, no one rule is absolute. As an expert, these are still used to flag abnormal lesions, but we tend to use a more sophisticated type of monitoring called dermoscopy and in some cases AI, to assess the lesions and then take a biopsy to get the pathologists check it under the microscope if we are concerned.”
Protect your skin and know the warning signs. Try this checklist (in between seeing a professional for regular skin checks):
A is for asymmetry. “Melanomas tend to be variable or heterogenous in appearance. For example, one side is light and the other dark.”
B is for border. “Melanomas may not have a smooth border, and often look odd in shape.”
C is for colour. “This is an important one. It is very unusual for melanoma to be one single colour all over. You may need a special microscope to appreciate it, but we look for eight different colours in skin lesions (light brown, dark brown, black, blue, grey, red, pink and white). Melanomas often have multiple colours whereas to benign moles that tend to have only one or two.”
D is for diameter. “Melanomas tend to be slightly bigger, > 6mm, but this rule isn’t as useful as many benign moles are > 6mm and many early melanomas are smaller.”
E is for evolution. “This is of great importance. By definition, a cancerous lesion is growing and changing but sometimes it is very gradual, and people don’t notice it. Serial photography is used to track evolution or change in moles.”
Dr Cara’s advice on what to look for? “Firstly change – in my mind this is the most important. If you have noticed a spot changing, then get it checked. Secondly, the ugly duckling, if you notice a spot that doesn’t look like any others you’ve seen, then get it checked! Lastly, gut instinct. If you’re anxious about a spot but can’t pinpoint why, then get it checked! And don’t stop until you’re reassured.”
“We need professional help…”
Of course, you are independent, capable and well intentioned, but sometimes you need to call in the pros. Your skin deserves love, attention and prioritisation.
“Every Australian adult should have regular, thorough skin checks, preferably in their 20s or 30s,” Dr Cara advises. “A skin check will help you determine what your underlying risk is for skin cancer and ensure that you have no spots of concern that you didn’t know about. The best thing about a skin check with a dermatologist is that you will be educated on checking your own skin, skin cancer detections and prevention of premature ageing arming you with all the knowledge you need going forward.”
“Let’s schedule a regular date night…”
Sometimes it’s hard to know if things are changing, especially if you’re not checking your skin regularly. “My advice is to try to look over your over skin at the beginning of each season (summer, autumn, etc.), so that you remember to do it every three months,” says Dr Cara. “If you think you have a spot that is new, different or just stands out, then take a clear photograph if it and store it in a designated folder on your phone so you can find it again. Check it again three months later and if you can detect any change in that time, then it is best to get it seen by a doctor.”
*Source: Roy Morgan Single Source Australia, Jun23