According to Dr Dineo Tshabalala, a medical oncologist practising at Netcare Olivedale Hospital, without early treatment skin cancer can spread, metastasising to other organs.
According to the Cancer Association of South Africa (CANSA), skin cancer is the most common cancer worldwide, and as South Africa has one of the highest monitored ultraviolet (UV) levels in the world, it also has one of the highest incidences of skin cancer globally.
UVB rays can cause sunburn within fifteen minutes, resulting in permanent damage, while UVA rays can contribute to ageing the skin and DNA damage. Damage from both UVA and UVB rays can lead to skin cancer.
“The hard truth is that skin cancer spares no one,” says dermatologist, Dr Hetesh Pitamber who practises at Netcare Sunninghill Hospital. “There tends to be a general misconception that non-whites are safe from developing skin cancer because their skins are darker and therefore less sensitive to the sun. However, this is simply not the case. While the disease is certainly more common in the white population, it affects us all.” Dr Pitamber cautions that the non-white population needs to keep a close eye on any pigmented lesions on the palms of their hands and soles of their feet as well as their nails.
“People tend to think mostly of the face, arms and hands along with the lower legs if out in shorts. What they often don’t consider are the back of the neck, the feet and the ears including inside and behind the ear,” he says.
The three most common types of skin cancer are squamous cell carcinoma, basal cell carcinoma, which most often occurs when DNA damage from exposure to ultraviolet radiation, and cutaneous melanoma, which is thought to be triggered by intense, occasional exposure to ultraviolet radiation, especially in people who are genetically predisposed to the disease.
Dr Tshabalala notes that basal cell carcinoma rarely metastasises while squamous cell carcinoma can metastasise if not caught early, with a tendency to spread to the brain via the lymph nodes. Cutaneous melanoma has the highest risk of metastasising and if left unchecked and untreated will spread to the lymph nodes nearest the affected lesion, mole or birthmark.
“From there it can affect multiple organs as the cancer starts to spread through the body. The only way to cure skin cancer is to cut it out – chemotherapy does not work for melanoma. There are some targeted therapies and other modalities that can be applied but once the cancer has started to spread an oncologist needs to be consulted and further treatment will be advised on a case-by-case basis,” says Dr Tshabalala.
According to Dr Pitamber, as much as 80% of the damage that will start to show up later in life is caused by sun-induced skin damage that occurred by or before the age of 18 - 21 years.
“Sunblock needs to be applied liberally on all areas of the body that are exposed to the sun including the hands, feet, neck and ears as these areas are often neglected. Hats with a wide brim protecting the back of the neck as well as the face are a must, and appropriate UV protective clothing should be worn together with sunscreen when swimming, as UV light penetrates water as well. Sunglasses are important for protecting the eyes too,” he cautioned.
