Various awareness campaigns on a variety of cancers run throughout the year, with some taking precedence over others. There's Pinktober for breast cancer and Movember for prostate cancer and men's health, yet, considering the region and climate we live in, skin cancer does not get talked about as much as it should, especially since melanoma is in the top five of the most fatal cancers.
According to the American Cancer Society, which charts cancer rates across 185 countries, in 2020 more than a million people were diagnosed with non-melanoma cancer, contributing to nearly 64,000 deaths. And almost 325,000 instances of melanoma cancer were found, with 57,000 cases proving fatal.
'No such thing as zero risk'
I was diagnosed with a stage two malignant melanoma several years ago, which, thankfully, I was able to have removed under local anaesthetic with no lasting health issues.
Dr Ikramullah Al Nasir, medical director and chief executive of Dermacare Skin Centre in Dubai, was my physician. He has been working in the region for 26 years and says unfortunately there aren't any statistics locally, but anecdotally he's seen an increase of patients presenting with skin cancers.
"I have definitely seen a rise, but now the scientific statistical data cannot be supported by this statement because, at the same time, the Caucasian population [most at risk of skin cancer] in the region has also increased tenfold.
"Unfortunately, no regional association or authorities have established any database where we can show these findings." He says many of his patients are also tourists on holiday, and they wouldn't be included in local statistics, either.
There are three main types of skin cancer, Al Nasir explains. There’s basal cell carcinoma, which affects the lower epidermis and is most commonly found on the head and neck; squamous cell carcinoma, affecting the epidermis and found on the mouth, lips and genital areas; then melanoma, which is associated with areas of pigment on the skin or moles.
Within the most-at-risk Caucasian demographic there are three skin types, broken down by levels of tolerance to the sun.
“Then comes Middle Eastern [people] or Mediterraneans, who are second-highest at risk, followed by Asian patients, who have a lesser risk level.
“Africans are almost zero at risk, but there are certain cases of melanoma being detected, which are congenital melanomas that appeared at birth and turn into cancer, so there's no such thing as zero risk of skin cancer in the world.”
What causes the occurrence of skin cancer?
Skin cancers don't appear overnight, Al Nasir explains. There are different factors, such as genetics and family history, and that does not only refer to your parents or siblings, but also grandparents, aunts, uncles and first cousins. It could be congenital – present from birth – or have come from prolonged exposure to the sun and other sources.
I, for example, grew up for a few years in Saudi Arabia in the late 1970s and early 1980s. Back then, sun protection was not really something that was thought about. We were always at the beach or by the pool, playing outside, and we didn’t think anything of it. During my university years, I was an avid sunbed user and loved sunbathing on holidays. When I think back, my exposure was horrendous.
As someone who's very pale, with many moles and freckles, I believe it was inevitable I would develop some sort of skin issue, considering my exposure. I would have my moles checked annually by a dermatologist. One year, one just did not feel right, so I had it biopsied and sure enough it came back as cancerous.
Al Nasir says it’s hugely important for physicians to check people thoroughly and that you can’t do it in five minutes. There’s what’s called the ABCDE checklist for melanomas, which stands for Asymmetry, Border, Colour, Diameter and Evolution. He says a patient's feeling or intuition should also be taken note of.
“I have caught so many melanomas, which were really not very typical looking, in terms of changes, but the patient told the doctor they hadn’t liked the mole for the last few months. Doctors must respect the feeling of their patients.”
Skin screening and mole mapping are extremely important tools in the prevention and detection of skin cancers, as catching it in the early stages is the vital for treatment to be successful and for the survival of patients. Treatments include creams, localised freezing, excision surgery and radiation or chemotherapy in late-stage cases.
So, when it comes to protecting the largest organ of the body, what should we be doing? Al Nasir says in the summer months it's important to avoid being out during the sun's strongest times, usually 11am to 4pm. Use a sunscreen above SPF30 – SPF50 is ideal – and remember to reapply it often, especially if you're swimming or playing sports, and it should be applied 30 minutes before heading outside.
Al Nasir also advises wearing clothes that protect you, such as long-sleeved shirts with a collar and a hat that covers the ears and forehead. Another tip to remember is that shade only offers about 50 per cent protection, and you are still exposed from reflective surfaces such as water, sand and windows.
Educators, especially physical education and swimming teachers, need to make sure children have the time to apply sunscreen and wear appropriate clothing when being exposed to the sun, says Al Nasir. He also says physicians in every field have a responsibility to check for skin cancers, whether that's your dentist, gynaecologist, paediatrician or ENT, to name a few, as it can appear anywhere on the body.
While awareness around these matters is getting much better, a lot more needs to be done. So, remember, if you’re in a high-risk group, an annual check-up is a must and should become part of your basic healthcare routine.