Dr Ian Webster has many years of experience with skin cancer which is the most commonly diagnosed type of cancer worldwide and in South Africa. Malignant melanoma in particular is increasing in frequency and is most generally found in people with a fair skin who have had excessive amounts of sun exposure over their whole lifetime.

 

Non-melanoma skin cancer, including Basal Cell Carcinoma, as well as Squamous Cell Carcinoma is caused by the accumulative effect of sun exposure over a person’s whole lifetime and two thirds of that sun exposure is often before the age of 20.

 

Malignant Melanoma seems to be more related to short intensive bursts of sun exposure, for instance, bad sunburn in childhood.

 

Actinic Keratoses are pre-cancerous lesions that commonly occur on sun-exposed areas and they are usually small, rough spots that do not heal. If these Actinic Keratoses are left untreated, a certain percentage of them will become a proper cancer, usually a Squamous Cell Carcinoma.

 

Actinic Keratoses

It is generally recommended that the Actinic Keratoses be treated and the commonest method is with cryotherapy (freezing with liquid nitrogen). If the Actinic Keratoses are too numerous to freeze, one can treat a large area with Efudix® ointment or Aldara® cream. Unfortunately with this form of treatment, the whole area becomes red and inflamed and the patient will experience some downtime. However these treatments are usually extremely effective and should only be used under the supervision of your doctor.

 

Basal Cell Carcinoma or Rodent Ulcer

This is the commonest form of skin cancer but fortunately is generally not life-threatening. There are different types of Basal Cell Carcinoma which usually present with the symptom of bleeding from the site and often look like a pink, pearly bump on a sun-exposed area. The tumour is usually slow growing and if left for a long period of time it can cause local destruction. There are various treatments for a Basal Cell Carcinoma but the main treatment is surgical excision or curettage and cautery. Superificial Basal Cell Carcinomas may be treated very successfully with Aldara® cream.

 

Squamous Cell Carcinoma

Squamous Cell Carcinoma usually presents as a rapidly growing wart-like bump that may arise in a previous Solar Keratoses or may arise from normal skin. If not treated properly, this form of skin cancer may spread to the regional lymph nodes. The treatment of choice is generally surgical excision.

 

Malignant Melanoma

This is the most dangerous type of skin cancer as it can spread through the lymphatic system and through the blood stream to various organs of the body causing the death of the patient.

 

The earliest stages of a Malignant Melanoma are often asymptomatic and this is where mole mapping (Fotofinder® ) is very useful to identify an early melanoma. If the Dermatologist excises a thin melanoma, ones chances of survival are excellent but with a deep, nodular melanoma the chances of survival are not so good.

 

Most melanomas are dark in colour, with an irregular edge and greater than 7mm in size with an irregular colour. This is the classic melanoma but unfortunately there are exceptions to every rule and one does sometimes see amelanotic melanomas, in other words, a pink lesion that is in fact a Malignant Melanoma.

 

The treatment of the primary melanoma is generally surgical excision.

 

Therefore any mole that starts bleeding, itching or changes in size or shape should be assessed by a medical practitioner or Dermatologist as soon as possible. Unfortunately, melanoma can kill not only older people but also young people.

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Mole Mapping or Digital Dermoscopy

Fotofinder®, a mole-mapping device, is a useful diagnostic tool that digitally monitors moles or melanocytic naevi.  Using a digital video camera within the device, it is able to take a magnified image of the naevus and thereafter, a software programme is able to analyse the mole and this image can then be stored and the patient followed up closely. This has been a major technical advance in that it allows Dermatologists to look into a mole and to make a far more accurate diagnosis. Should there be the slightest change to the mole on follow-up, then the lesion should be surgically excised.

 

If patients present with a large number of moles, Mole Mapping technology will make sure that nothing is overlooked and once the images are stored, each time the patient pays a visit to their Dermatologist, a comparative image will be shown from the previous visit, on a split screen.

 

Thanks to ongoing observation and the storage of the Mole Mapping images, unnecessary excisions of harmless moles can be avoided and only moles that are a threat to the patient will be removed.

 

It is advisable to make an appointment to see your Dermatologist if you observe any of the following changes to a mole/s:

 

• Change in colour i.e. darkening, loss of colour or the appearance of other colours;

• Irregular edge;

• Increase or decrease in size or thickness;

• Changes to the mole i.e. swelling, pain, redness;

• Bleeding – a mole that is bleeding needs urgent attention;

• New moles that occur especially after the age of 25 years;

• Paraesthesia – itchiness, odd sensation.