Your Local Pharmacist is

Jay Koovarjee

 92 Pitt St
Sydney NSW 2000
ph: (02) 9221 0091
fax: (02) 9221 0090

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:: In Brief

 

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:: The cost of the Bronzed Aussie image

The bronzed aussieThe cost of the Bronzed Aussie image ...

When your skin is exposed to the Australian sun you are at risk of developing skin cancer.

Here are a few statistics:

  • Australia has the highest rate of skin cancer in the world
  • One out of two Australians develop some type of skin cancer in their lifetime
  • Each year about 9,500 Australians are diagnosed with melanoma. 1,200 die each year
  • Melanoma is common in people who are fair-skinned and who are exposed to higher levels of UV radiation than their skin can protect them against
  • People with naturally darker skins (for example, Australian Aborigines and Torres Strait Islanders) are much better protected against UV radiation
  • Melanoma is most common in older adults. Younger adults also get it and, sometimes, so do teenagers. It is rarely seen in children although it may start to develop in children who get too much UV radiation
  • Adults with many moles (more than 10 on the arms and more than 200 on the body) are at higher risk. They should be checked regularly by their doctor

Skin LayersYour skin is your largest body organ. It covers the entire outside of your body. The skin has many important jobs. It protects us from injury, cools us when we get too hot and it stops us from drying out (dehydrating).

There are two main layers to the skin. The top layer is called the epidermis. In this layer are cells that make melanin. Melanin gives skin its colour. The second layer is called the dermis. This layer contains the roots of hairs, glands which make sweat and oil, blood and lymph vessels and nerves.Exposure to UV radiation from the sun and other sources, such as tanning machines in solariums accounts for about 90% of the symptoms of premature skin aging and is the main cause of melanoma and other skin cancers. Most of these effects occur by the age of 20.

How does skin cancer develop?

The skin is made of tiny 'building blocks' called cells. These cells can sometimes become cancerous, for example from too much ultraviolet (UV) radiation.

The top layer of skin (epidermis) has three types of cells: squamous cells, basal cells and melanocytes. Skin cancers are named after the type of cell they start from. The three main types of skin cancer are basal cell cancer, squamous cell cancer and, the most serious skin cancer, melanoma.

What is a Melanoma?

MSun Damageelanoma develops in our skins melanocytes. Melanocytes can be found all over our skin because they supply our skins pigment, melanin. The most concentrated sites of melanocytes are moles.

Melanoma is the least common type of skin cancer, accounting for less than 5%, but it is the most dangerous of all. It is the cause of most skin cancer deaths if not detected early.

Melanoma can develop in or near an existing mole or appear on normal looking skin. These cancer cells can then invade the skin around them or even spread to other parts of the body through the lymphatic system or the bloodstream. If this metastasis occurs, further tumours may develop in other bodily organs. These secondary cancers can be very difficult to treat and may be fatal.

Melanoma is the fourth most common cancer, usually appearing as a pigmented skin lesion. Australia has the world’s highest incidence rate for melanoma.

Melanoma grows in the melanocytes. Melanoma can occur in the skin anywhere on the body, even on the bottom of feet.  Melanoma grows quickly and if it is not treated it may spread to the second layer of skin. Cancer cells can then break off and spread to other parts of the body.  Melanocytes in the eye, nervous system and mucous membranes can also become cancerous. These types of melanoma are rare.

Melanoma occurs more often in people who are exposed to the sun every now and then, that is, on weekends or on holidays, rather than a little bit everyday. However, people who receive a lot of sun exposure, in a more continuous pattern, are also at increased risk.

Melanoma is more likely to be caused by intense exposure to sunlight in early life.

Each time your unprotected skin is exposed to UV radiation, it changes the structure of the cells and what they do. Overexposure to UV radiation permanently damages the skin and the damage worsens with more UV radiation.

What is UVA and UVB Radiation?

When sunlight penetrates the top layers of the skin, ultraviolet radiation (referred to as UVA or UVB) bombards the genetic material, the DNA, inside the skin cells and damages it.

UVB radiation is the primary cause of sunburn and mainly affects the skin’s outer layers. UVB is most intense at midday when sunlight is brightest. It is interesting to note that slightly more than 70% of the yearly UVB dose is received during summer and only 28% is received during the remainder of the year.

UVA radiation penetrates more deeply and efficiently, however, UVA's intensity also tends to be less variable both during the day and throughout the year than UVB's. For example, only about half of the yearly UVA dose is received during the summer months and the balance is spread over the rest of the year. UVA is also not filtered through window glass (as is UVB).

Both UVA and UVB rays damage the skin, including genetic injury, wrinkles, lower immunity against infection, aging skin disorders and cancer, although the reasons for this are not yet fully understood. The following are some ways in which cancer may develop and some defensive actions that the skin uses to protect itself against DNA damage.

  • Oxidation and Antioxidants. UV radiation affects the production of oxidants, also called free radicals. These free radicals are unstable molecules produced by normal chemical processes in the body that, in excess, can damage the body's cells and even alter their genetic material, contributing to the aging process and sometimes to cancer. The large surface area of the skin makes this organ a prime target for oxidants.
  • Defective DNA Repair and Protective Enzymes. Some melanomas and other skin cancers are caused by a breakdown in the mechanisms that help repair DNA damage. This can occur due to various causes including an inherited condition called xeroderma pigmentosum (XP). A number of enzymes in the skin help protect against this damage. One repair enzyme called T4 endonuclease 5 (T4N5) is, in fact, being investigated in lotions to protect against skin cancers.
  • Breakdown of Immune Protection. Specific immune factors protect the skin, including white blood cells called T lymphocytes and specialized skin cells called Langerhans cells. These immune factors attack developing cancer cells at the earliest stages. Unfortunately, certain substances in the skin, in particular a chemical called urocanic acid, suppresses these immune factors when exposed to sunlight, setting the stage for skin cancers.
  • Defective Cell Death (Apoptosis). Apoptosis is the last defense of the immune system. It is a natural process of cell-suicide, which occurs when cells are severely damaged. Apoptosis in the skin kills off cells harmed by UVA preventing them from becoming cancerous. (The peeling after sunburn is the result of these dead skin cells.) In some cases, however, genetic mutations or other factors derail apoptosis. If this occurs, the cells can become immortal and continue to proliferate, resulting in skin cancers.

What else may contribute to developing Melanomas?

  • Genetic Factors - A number of genetic factors are being investigated for their role in melanomas, including inherited genes and genetic defects that are acquired from environmental causes (particularly sunlight).
  • Mutations in Genes that Regulate Cell Growth - Non-inherited mutations in a number of genes that inhibit tumor growth or other cell-protecting properties may account for cancerous changes in moles and for aggressive melanomas.

How do I know if I have a melanoma?

MelanomaMelanoma generally causes no symptoms at all, but there may be some itchiness or tingling in the early stages. Most melanomas start as minor changes in colour, size or shape; however in the later stages they may become hard or lumpy, painful to touch and even bleed.  If you have any doubts please consult your Pharmacist for GP.

Can a melanoma be cured?

Yes, melanoma can be cured. Almost three quarters of people who have had a melanoma removed will have no further problems, but removal of the tumour in its early stages is crucial. Further surgery or chemotherapy can be used to treat a patient if the cancer has spread to other organs.

What are the treatment options?

Skin Cancer surgeryCurrently, the only way to treat melanoma effectively is surgery. If a melanoma is confirmed after a mole or other lesion has been removed, most people will have a wider excision around the area where it was growing. This will remove some healthy-looking skin to ensure that any melanoma cells which were near the mole but not visible are removed.

The 'stages' of melanoma:

In situ: abnormal cells are found in the outer layer of the skin only.
Stage 1: cancer is found in the upper layers of the skin but has not spread to nearby lymph nodes. The tumour is less than 1.5 mm thick.
Stage 2: cancer has spread to the lower part of the skin's second layer (dermis). It has not spread below the skin or into the nearby lymph nodes. The tumour is 1.5 mm to 4 mm thick.
Stage 3: the tumour may be larger or smaller than 4 mm. It may have spread to lower layers of the skin and may have other tumour growths within 2.5 cm of the original tumour. Tumour cells may have spread to nearby lymph nodes. They may also be spreading to nearby areas of the body.
Stage 4: the tumour cells have spread to other organs or lymph nodes far away from the original tumour.
Recurrent: the cancer has come back after it has been treated. It may come back in the original site or in another part of the body.

Your doctor will provide more information on the stage of your melanoma when talking with you about your treatment.

What does melanoma look like?

MelanomaMelanoma can slowly develop in an already existing mole or it can suddenly appear as a new mole. It then changes in colour, shape or size. Typically, melanomas have an irregular outline and are multicoloured as opposed to a normal mole or freckle, which generally have smooth edges and equal colour.

A method of remembering the signs and symptoms of melanoma is the popular mnemonic ABCDE.

  • Asymmetrical in shape - Melanomas are typically not uniform in shape where normal (benign) moles or freckles are usually round or symmetrical.
  • Border is irregular - Melanomas often have a jagged or uneven border; normal moles have smooth, even borders.
  • Colour is uneven - Melanomas are usually multicoloured ranging from brown, tan to black and in some cases, red, blue and white. Benign moles are usually uniform in colour.
  • Diameter is greater than 6mm - Melanomas generally have a diameter greater than 6mm; normal moles or freckles are usually smaller than this.
  • Elevation of a mole - Melanoma may sometimes grow vertically making it raised from the skin, generally benign mole are flat.

Melanoma can appear anywhere on the body, not only in the places which get lots of sun. The most common site of melanoma in men is the back, and in women, the backs of the legs.

Who’s at risk of developing melanoma?

People with fair skin or who burn easily are at greatest risk because their skin contains less melanin and family history plays a role also. It is important to remember though that anyone can develop skin cancer. Statistics show that one in two Australians will develop some sort of skin cancer. There are several factors that contribute to an increased risk of developing melanoma:

  • Skin CancerA family history of melanoma
  • Previous melanoma
  • Fair skin and light coloured eyes
  • Lots of freckles
  • Previous severe sunburns
  • Many dysplastic nevi (unusually shaped moles which are noncancerous)
  • Many ordinary moles, more than 50 (most people have around 30)
  • A weakened immune system
  • Excess exposure to UV radiation
  • Use of solariums – artificial UV radiation

Ayone, even those with none of the above risk factors, can develop melanoma, however those with one or more risk factors are more likely to do so.

If you have any of the above risk factors, you should check your skin periodically yourself, and have a yearly exam by your doctor.

If you are concerned about developing melanoma, talk to your doctor about the disease. Your doctor will outline what symptoms you should look out for and an appropriate check-up schedule for you.


If you have any concerns, please speak to the Pharmacist or consult your doctor. 

More information can be found at:

www.cancercouncil.com.au
www.melanomafoundation.com.au
www.melanoma.net.au
www.smu.org.au  

 

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