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Skin Cancer

Skin cancer is the most common cancer in Australia, and two out of three Australians will develop some form of skin cancer in their lifetime. It is also one of the most common cancers leading to death in Australia, as well as being the most costly cancer in Australia.

There are many risk factors for developing skin cancer. These include: skin type, particularly fair; sun exposure; occupation; family history; immune status; age greater than 40 years.

There are three common types of skin cancer:
  • Basal Cell Carcinoma
  • Squamous Cell Carcinoma
  • Malignant Melanoma.

Basal Cell Carcinoma (BCC)

Basal cell carcinoma is the most common human cancer, and is the most frequent type of skin cancer in Australia related to excessive sun exposure. It can be very destructive locally if left untreated.

Risk factors: Fair skin; light coloured or red hair; inability to tan; history of childhood freckling; can have genetic component.
Presentation: May present as nodules; papules; non-healing sores; scar-like plaques; may be pigmented.
Common locations: face, lips, ears, nose, eyelids, back, shoulder and neck.
Diagnosis: Punch or shave biopsy
Treatment: Usually surgical excision. Superficial BCC can be treated by curettage and diathermy or the use of topical creams. More advanced BCC might be treated with radiation.

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma is a common cancer due to accumulated sun exposure, and its incidence increases with age. It has high morbidity and mortality, particularly when there is lymph node spread and lung metastasis. Due to its higher incidence it actually kills more Australians per year than malignant melanoma.

Risk factors: Fair skin; light coloured or red hair; chronic sun exposure; smoking; chronic ulcers or scars.
Presentation: Presents with raised, firm, red flesh plaques, or papules. May scale, ulcerate or have horn-like growths and may be tender.
Common locations: face, lips, ears, nose, neck, eyelid, dorsum of hands, forearms and scalp.
Diagnosis: Punch or shave biopsy.
Treatment: Surgical excision remains the treatment of choice, and complete excision delivers the highest and most reliable control rates.

Malignant Melanoma

Melanoma is one of the most common causes of cancer death in Australia. It is the most common cancer in the 15 to 44 year age group, and the second most common cause of cancer death in that age group.

Risk factors: Multiple moles, sun exposure, genetic influences. Two thirds of all melanomas can be attributed to sun exposure. The pattern of exposure is important, with intermittent exposure, such as holiday, weekend and recreational exposure being more closely associated with melanoma than regular patterns of exposure, such as for outdoor workers.
Presentation: Macules with irregular borders, papules, nodule, pigmented or may be amelanotic (not pigmented).

Features that can indicate melanoma include:
  • Asymmetry
  • Border variation / irregularity
  • Colour variation
  • Diameter >6mm
  • Evolving or growing

Common locations: Sun exposed area; for men it is more common on the back and for women it is more common on the legs.
Diagnosis: Excision biopsy.
Treatment: Surgery with appropriate margins is the gold standard. Melanoma, if detected and excised early can save lives.

Specialist referral is recommended for thick melanomas for possible lymph node biopsy/excision.
Chemotherapy may be considered for metastatic melanoma.

The Cancer Council of Western Australia provides very comprehensive and independent information on skin cancer, and can be accessed at: https://www.cancerwa.asn.au/resources/specific-cancers/skin-cancer/