Late effects: Skin cancers

Very few people realise that the skin is the largest organ in the body. The skin is the body’s first line of defence against outside invaders. It also keeps the body temperature normal and stores water, fat and vitamin D. Such an important organ requires care and monitoring. Treatment for blood disorders sometimes causes damage to the skin.

Who is at risk?

The following people are at risk of damaging their skin:

Patients who received radiation to any part of the body, including total body irradiation (TBI).
Patients with chronic graft versus host disease (GVHD) following stem cell transplantation from a person other than yourself (allogeneic)
Patients who have had skin cancer or melanoma, or you have a family history of skin cancer or melanoma
Patients who have dysplastic (atypical) moles
Patients who had a severe sunburn at a young age

Skin cancers

There are three major forms of skin cancer.

Basal cell carcinoma

Basal Cell Carcinoma (BCC) is the most frequent form of skin cancer. BCC usually appears as a rough, raised, area of skin.

As the BCC progresses, it may become an ulcer or sore that does not heal. BCC can occur anywhere on the skin, but is seen most frequently in areas of sun and/or radiation exposure. Protecting your skin from the sun is the most important thing you can do to avoid developing BCC. Treatment for BCC is surgical removal of the affected skin. BCC can spread to surrounding tissues but does not usually spread throughout the body and is not usually life threatening.

Squamous cell carcinoma

Squamous cell carcinoma (SCC) is another form of skin cancer that can develop from exposure to sun or radiation. Its appearance is similar to BCC, usually an ulcerated sore that does not heal.

SCC can be more aggressive than BCC and can spread more readily to surrounding tissues and even to other parts of the body. With early surgical treatment SCC is usually curable, so it is important to report any suspicious sores to your doctor right away.

Melanoma

Melanoma is a much more serious form of skin cancer. Unlike BCC, left untreated it can spread to other organs and can be lethal. Melanoma often arises from moles. The key to successful treatment of melanoma is early diagnosis.

Moles should be monitored for the changes. Monitoring of moles can be remembered using the ABCD warning signs:

A is for Asymmetry (one half of the mole looks different than the other half)

B is for Border (moles that have an irregular, scalloped or poorly defined border)

C is for Colour (variations in colour from one area of the mole to another, such as different shades of tan and brown or black, or colours such as white, red or blue within a mole)

D is for Diameter (moles larger than 6 millimetres - about the diameter of a pencil eraser - should be evaluated)

If you notice any of the ABCD changes, have your doctor check the mole. Moles that have any of these changes usually need to be removed.

What monitoring is needed?

If you have any risk factors, you should check your skin each month for changes. If you notice any new or unusual spots or discover a spot that changes shape, colour or size, see your doctor immediately

Have a thorough skin examination by a doctor at least once a year.

What can I do?

The most important thing to remember in caring for your skin is to protect it from the sun. Here are some things you can do:

Wear protective clothing including a hat and sunscreen at all times when your skin is exposed to the sun, even on cloudy or hazy days. We recommend a sunscreen or moisturiser with an SPF (sun protection factor) of 15 or higher.
Sand, snow, concrete, water and high altitudes all increase the risk of sun damage - take extra caution to protect your skin in these environments
Do not attempt to tan your skin - avoid tanning booths
Avoid outdoor activities from 10am to 2pm when the sun’s rays are most intense (11am to 3pm during daylight savings time). Plan outdoor activities in the early morning or late afternoon hours.
Reapply sunscreen frequently or use a water resistant sunscreen when swimming or perspiring heavily