Australia leads the world in programs for prevention of skin cancer. While it will be some years before we see all the full benefits of these programs, it has already been established that more and more people are aware of the hazardous effects of the sun and are taking effort and time to slip on protective clothing, slop on some sunscreen and slap on a hat. However, with our extremely high rates of skin cancer we still have a long way to go.
Medical Treatment
Skin cancer rates have increased over the last 50 to 60 years. This means that Australians were actually developing more skin cancers in the decade before sunbathing became a national pastime, which occurred largely in the 1950s. It is not known why skin cancers had already started to increase. Certainly the depletion of the ozone layer may accentuate the problem of skin cancer. It has been estimated that for every 1 per cent decrease in the ozone layer there will be a 2 per cent increase in the amount of harmful ultraviolet light transmitted. UVB is the type of ultraviolet light associated with the development of sunburn and skin cancer.
Basal cell carcinoma
Basal cell carcinoma (BCC) is so called because it develops in the layer of skin called the basal layer where new cells are constantly being formed. Seventy-five per cent of all skin cancers in Australia are of this type. Fortunately it rarely spreads widely to other parts of the body although it does have a propensity to invade into the surrounding skin. In some situations, such as on the face and ear, extensive and disfiguring surgery may be required to remove all the tumour. Dermatologists recognise several different types of BCC by their characteristic appearance and also by where they occur.
Types of basal cell carcinoma
The main types of basal cell carcinomas are the following:
- Nodulo-ulcerative is the most common type of BCC and is frequently found on the face. It appears as a skin-colored lump, often with superficial red blood vessels coursing over the top. It also has a characteristic pearly appearance. It may bleed and develop a central ulcer surrounded by a raised border. Skin cancers should always be suspected when spots bleed.
- Pigmented BCCs are similar to the nodulo-ulcerative type but contain melanin pigment and thus appear black and dark brown. Again they are most commonly found on the face.
- Morphoeic (fibrosing) BCCs are irregularly shaped, ill-defined plaques which may feel quite firm. This type of BCC spreads in a different way which results in its different appearance. Its edges may be poorly defined, making surgical removal more difficult, and thus these are more likely to recur than the others.
- Superficial BCCs are flat, or very slightly raised, red scaly lesions around the size of a 10 cent piece or bigger which occur most commonly on the chest and back. They may look quite similar to Bowen’s disease or even like other skin lesions which are not skin cancers, such as psoriasis or eczema. They are very superficial and can be removed by a skin curette, which literally scrapes them off the skin, or by freezing or by excision.
