... and with it, the very real possibility of terminal skin cancer. Raphael Vassallo explores the available methods of protecting oneself from the dreaded melanoma
For millennia the sun has rightly been attributed with life-bestowing properties. Worshipped in antiquity by the Aztecs – and today by millions of beach-bums worldwide – the heat and light of the closest ‘yellow dwarf’ star quite literally made all life on earth possible: providing essential nourishment for plants, which in turn altered the chemical composition of the atmosphere, and so on and so forth. And yet, the same sun is also a mass-murderer in its own right, claiming millions of lives each year. As its ultraviolet radiation penetrates the atmosphere and warms up the planet, it also causes untold damage to human skin – including cancers such as melanoma, which has a fatality rate of over 90%.
But despite awareness programmes urging people to avoid direct sunlight at peak hours (10am-4pm), sun worshippers still flock by the thousands to pay homage to their idol: all too often disregarding the possible health risks.
Leading oncologist Stephen Brincat argues that awareness levels have improved over the years, although a lot more still needs to be done.
“The public has certainly been warned intensively about the dangers of excessive sun exposure, and the message is getting through; however, as always when young one feels indestructible. Perhaps one should emphasise more the cosmetic effect for this age group...”
Brincat explains that sunlight is a natural form of radiation, and therefore produces the same damage to skin that we would expect from other radiation, for instance, the kind produced by nuclear reactors.
“We have inbuilt mechanisms to repair the damage, although the few individuals who have genetic defects that interfere with these repair mechanisms – e.g. albinos – suffer greatly from multiple skin cancers at an early age, and often die of this.”
Even among individuals with ordinary complexions, long-term sun exposure may also lead to thinning of skin, wrinkling, poor healing processes, and often multiple skin cancers, most commonly seen in exposed areas such as the face, hands and scalp (especially among bald men).
“There are three major forms of skin cancer, all related to sun damage,” Brincat goes on. “The first and most common is the Basal cell carcinoma. Luckily this almost never spreads. The second is called squamous cell carcinoma, and can spread if neglected. The third is melanoma: a highly aggressive cancer that spreads widely at an early stage.”
Melanoma is by far the biggest killer of the three types, and unfortunately appears to be on the rise in Malta.
“The incidence of melanoma has certainly shot up, and the other skin cancers have not decreased either,” Brincat says. “However, the radiotherapy department sees fewer cases nowadays, largely because of changes in treatment policy. Dermatologists and plastic surgeons are more likely to excise these tumours than refer them to radiotherapy, except in advanced cases.”
As with all other pathologies, Brincat stresses that prevention is infinitely better than cure. Any ulcer of the skin or bleeding should make a person consult a doctor.
“Any pigmented mole that bleeds, enlarges, itches or changes colour should also be taken seriously,” the cancer specialist warns. “The commonest sites for melanoma are on the leg for women and on the back for men; but they can occur anywhere. If in doubt it’s best to seek advice...”
If Brincat, as an oncologist, presents the last bastion of defence against melanoma, dermatologists such as Prof. Joseph Pace and Prof. Lawrence Scerri are invariably at the forefront of the battle.
Pace explains that the more common cases of skin cancer are usually amenable to a wide variety of therapies.
“Non melanoma skin cancer is the commonest variety and is eminently treatable with excellent cure rates,” he explains. “They can be treated with radiotherapy, though surgery, cryotherapy, and the popular Photo dynamic therapy are all good alternatives.”
However, not all skin cancers are as easily treated.
“The dreaded melanoma, on the other hand, must be detected and removed when it lies very superficially in the outermost skin layer. Failing that, it can easily spread to other organs, and most modalities of cancer therapy are powerless in this situation.”
For all this, melanoma can still be cured if detected early enough. For this reason, dermatologists such as Prof. Pace argue in favour of an early warning system, especially among the young.
“Awareness of melanoma should start at school level, carried out through health and hygiene instruction at schools,” he suggests. Pace also recommends organized national campaigns by Dermatology Societies, pointing towards the fact that a “Melanoma Monday” is held across Europe each year.
“Melanoma awareness is also brought regularly to the attention of the EU by the European Academy of Dermatology, of which I am secretary general,” he adds.
Family members of persons diagnosed with melanoma are at higher risk, as are those with multiple or large moles and a history of sunburn and should similarly consult their dermatologist regularly.
But according to Prof. Pace, any recent change in a dark mole requires a quick visit to the dermatologist. In rare cases, melanoma can even arise on non-exposed skin.
“Today, our diagnostic capabilities to detect early melanoma (called melanoma in situ) have greatly improved with the advent of dermoscopy: essentially a portable microscope,” he adds. “Efforts to increase our possibilities to make earlier diagnoses (that leads to a cure) have also resulted in the employment of computer assisted technology to narrow the gap of missed early melanoma, that every practicing dermatologist knows only too well. This promising technology is increasing in sophistication and application, and has a promising future. In some areas, it is already available today.”
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And yet, the same sun is also a mass-murderer in its own right, claiming millions of lives each year. As its ultraviolet radiation penetrates the atmosphere and warms up the planet, it also causes untold damage to human skin – including cancers such as melanoma, which has a fatality rate of over 90%.
