Travelling with Skin Cancer

In recent years, from my perspective as a doctor, we’ve all become much more aware of the dangers of sunburn. In Australia, the launch of the ‘Slip, slop, slap’ (Slip on a shirt, slop on sunscreen, and slap on a hat) campaign in 1981 has been credited with preventing thousands of cases of skin cancer.

In 2007, another two "S's" were added, making the new message Slip, Slop Slap, Seek, Slide (seek shade and slide on a pair of sunglasses). Getting out of the sun regularly not only reduces the risk of sunburn but also of heat exhaustion and heatstroke. The importance of protecting your eyes was included because too much sunshine increases the risk not just of cataracts, but also of glaucoma and age-related macular degeneration – the most common cause of visual impairment in those over 50.

But it seems we’re not putting this knowledge into practice. For instance, in the last 30 years, rates of melanoma skin cancer have doubled among women and almost trebled among men. In fact, they have gone up by around a third in the last decade alone. About 156,000 people in the UK are diagnosed every year with other forms of skin cancer. And in the last 30 years, the number of cases has increased by more than two-and-a-half times, with rates going up by more than 40% in the last decade alone.

The risk of skin cancer increases with age, with half of all skin cancers found in those over 75. However, the damage that leads to them starts much earlier and younger people can get skin cancer too.

What types of skin cancer are there?

Skin cancers are divided into two main types – melanoma skin cancers and non-melanoma skin cancer (mostly basal cell cancers, or BCC, and squamous cell cancers, or SCC).

Melanoma skin cancers are much more likely to metastasise (spread to other parts of your body). This means they’re far more dangerous than other types of skin cancer. Although they get more common with age, they can occur in your youth. In fact, melanoma is the second most common type of cancer diagnosed in 15-34 year-olds.

What does a melanoma look like?

For melanomas, you’re looking for new dark mole-like patches or changes in an existing mole. The ABCDE rule is very helpful:

• Asymmetry – an irregularly shaped mole.
• Border – the edges between the melanoma and the skin are blurred or ragged, and the pigment might look as if it has ‘bled’ into the surrounding skin.
• Colour – melanomas often have several different shades, as opposed to moles which are usually all the same colour.
• Diameter – a melanoma is usually more than 6mm (the diameter of a standard pencil) across and keeps getting bigger.
• Evolving – melanomas tend to change size, shape or colour over time.

What does a squamous cell cancer look like?

An SCC can occur anywhere but is most common on the head and neck (most often on or around your lips or ears). It often looks like rough, thickened, or warty skin, or a scaly red patch. It often has a pink or red base. As time goes on, it may grow into a warty lump.

If it’s not picked up early, the skin over it can break down to form a skin ulcer that doesn’t heal. The edges of the ulcer are often hard and raised. An SCC can crust over, itch, or bleed but isn’t usually painful.

What does a basal cell cancer look like?

Like SCC, BCCs are found most often on the scalp or face but can happen anywhere. A BCC tends to start as a painless dome-shaped lump that can be pink, red, or shiny and pearly. In people with darker skin, about half of BCCs are brown in colour.

BCCs tend to grow very slowly, but over time the skin over the surface can break down, forming an ulcer. This often looks like a small crater with a rolled, raised edge and an indentation in the middle.

What should I do if I think I have skin cancer?

It’s always important to see a doctor quickly if you have a suspicious lump or patch on your skin. Your doctor would much rather reassure 100 people than miss a single cancer! If they think you may have skin cancer, they will refer you under the ‘2-week wait’ rule. This means you should be seen by a specialist within 2 weeks. The specialist may take a biopsy or may be able to rule out cancer on the spot. However, early diagnosis and treatment are important to prevent the spread of any cancer, so it’s always better to be safe than sorry.

What are the risk factors for non-melanoma skin cancer?

BCC and SCC get more common with age. BCC is about twice as high among redheads compared to people with dark hair, and over a third higher among people with blonde hair. Likewise, your risk of BCC is affected by your eye colour: people with blue or blue-grey eyes are at the highest risk, followed by those with green or hazel eyes.

Having moles or freckles in childhood also increases your risk of BCC. Having family members who have had SCC puts you at higher risk, while a family history of melanoma increases your chance of BCC.

Among the factors that don’t depend on your genes, the biggest risk factor for non-melanoma skin cancer, especially in fair-skinned people, is lifetime sun exposure. People who work outdoors are almost 50% more likely to get this form of cancer than those who work indoors.

Using sunbeds is extremely risky, particularly for fair-skinned people and children. Interestingly, large numbers of moles (which increase your risk of BCC) are more affected by how much sun you get over a lifetime rather than how often you’ve been burnt. However, sunburn greatly increases your risk of melanoma.

What are the risk factors for melanoma skin cancer?

Although your genes and your age do affect your risk of getting melanoma, it’s estimated that almost 9 in 10 cases of melanoma skin cancer are preventable, and the same proportion are caused by overexposure to ultraviolet (UV) radiation.

In particular, melanoma is closely linked to how often, and how badly, you’ve been burnt. For instance, if you’ve had sunburn once every couple of years or so, you’re three times more likely to get melanoma than someone who has never been sunburnt. Getting sunburnt in childhood poses an even greater risk. As a result of global warming, the sun’s radiation is stronger and warmer weather means we spend more time in the sun.

Of course, how likely you are to burn depends to a large extent on your skin type – pale English roses with red or fair hair, freckles, and blue or green eyes are most likely to burn. Even compared to people with white skin and dark brown eyes and hair, redheads and pale-skinned blondes are more than twice as likely to develop melanoma. Having melanoma in the family doubles your risk, although sometimes you can get a malignant melanoma, but it is always best to stay protected and get your skin checked if you're concerned.

If you have a lot of moles, it’s very important to keep a careful eye out for any changes that might suggest melanoma. Having large or unusually shaped moles means you’re 4-10 times more likely to get melanoma.

How can I avoid skin cancer?

The key to avoiding skin cancer is to avoid getting sunburnt (especially for melanoma) and to reduce your overall exposure to the sun. The ‘slip, slop, slap, seek, slide’ advice from Australia really sums up what you should be doing.

Take extra care in the sun and make sure you apply sunscreen regularly, including after swimming or showering. Wearing long-sleeved clothing means your skin is protected against the sun if you’re worried. Use at least Sun Protection Factor (SPF) 15 if you have dark skin that tans easily, SPF 30 if you usually tan and SPF 50 if you’re prone to burning. Stay out of the sun between 11am and 3pm when it’s at its hottest.

By taking out skin cancer travel insurance, you’re covered if you have any concerns whilst you’re away from home and can get them checked quickly and hassle-free.