May is Skin Cancer Awareness Month

Learn more about how to prevent skin cancer.

What is skin cancer?

Divided into 2 categories Melanoma and Non Melanoma Skin Cancer (NMSC), caused by ultraviolet (UV) radiation from the sun, or artificially from sun bed use.

Melanoma:

Melanoma is a type of skin cancer that arises in the pigment producing skin cells.

It is potentially a very serious, sometimes fatal form of skin cancer.

Between 2018 – 2020 there were 639 Melanoma diagnosis in SJH (Three Year Cancer Audit Report 2018 – 2020, Trinity St James’s Cancer Institute)

Over the last 17 years there has been an increase of 257% in SJH and is predicted to rise by at least 10% per year.

Non Melanoma Skin Cancer (NMSC)

NMSC is any skin cancer that is not a Malignant Melanoma.

Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) are the most common types.  With over 13,000 cases it is the highest rate of all cancer diagnosis every year in Ireland. In fact, these numbers are only reflecting cases of first diagnosis – a second or any subsequent NMSC’s are not included in the figures – therefore the numbers are actually much higher.

Between 2018 – 2020 there were on average 1,533 new NMSC diagnosis in SJH (Three Year Cancer Audit Report 2018 – 2020, Trinity St James’s Cancer Institute)

Alarmingly the prediction is that between 2020 and 2045, the number of cases of NMSC will increase by 110% (NCCP, National Skin Cancer Prevention Plan 2019-2022 Implementation Review 2020)

Who are the team?

The Dermatology team in SJH is supported by the multidisciplinary team. 

Medical Dermatology Consultants – Dr Bairbre Wynne, Dr Susan O’Gorman, Prof Alan Irvine and Dr Maeve McAleer

Surgical Dermatology Consultants with sub-specialty in Mohs Micrographic Surgery (MMS) – Dr Patrick Ormond, Dr Rupert Barry and Dr Benvon Moran

Medical Oncologist - Dr Fergal Kelleher

Radiation Oncologist - Dr Sinead Brennan

Plastics – Mr Beausang, Ms Healy, Ms Dempsey, Ms Torre, Mr Theopold and Mr Shelley

Maxfax and ENT colleagues

Histopathologists – Dr Niamh Leonard, Dr Mairin McMenamin and Dr Lisa Mellerick

Nursing and administration staff including a Melanoma CNS and cANP in Surgical Dermatology

Laboratory scientists

Signs and symptoms

Melanoma;

A new mole or one that is changing – can be the ‘ugly duckling’ of your moles, may be concerning for a melanoma

Think: ABCDE

A = asymmetry (one side does not look like the other)

B = border (irregular)

C = colour (multi-coloured)

D = diameter (over 6mm)

E = evolving (noted by you or someone else a change in an existing mole)

NMSC

Basal Cell Carcinoma; can present in many different ways.  The most common are pink dry patches, a spot that keeps coming and going and never heals, a scar like area where there was never any injury, a new raised area that is slowly getting bigger over months/years.

Key point: BCC’s do not cause any symptoms such as pain. They are locally destructive and surgery is generally curative.

Squamous Cell Carcinoma; can also present in many different ways.  The most common are red/pink raised lesions that can bleed easily.  Some may have a crusted ‘plug’ (keratin centre).  The grow rapidly over weeks/months and can be painful.

SCC’s in certain areas have a higher risk of metastasis e.g. lip, ear, scalp. Whilst surgery can be curative, follow-up (adjuvant) radiotherapy is sometimes required.

How to access our service?

Via GP referral.  Each week there are rapid access pigmented lesion clinics for urgent referrals.

Diagnosing

We use both visual (macroscopic) and dermoscopy (dermoscopic) to assess lesion(s) usually a full skin examination is performed during consultation.

Treatment options

There are a number of treatment options depending on diagnosis.

These include surgery – MMS, excisions, shave, curettage & cautery, punch biopsies & punch excisions. Topical treatments such as Efudix (chemotherapy cream) and cryotherapy.

Mohs Micrographic Surgery

Having 3 of the 5 Mohs Micrographic Surgeons in Ireland, SJH set up and runs the National MMS service. 

MMS is a tissue sparing, surgical technique for the treatment of NMSC and is of particular importance in cosmetically sensitive areas e.g. face 

Sun protection advise

Slip = clothing. Cover as much sun exposed skin as possible

Slop = on water resistant sun cream – Factor 50 with high UVA/UVB – use every couple of hours

Slap = on a wide brimmed hat to protect your eyes, ears and neck

Seek = shade

Slide = on sunglasses with UV protection

The golden rules are no sun bathing and no sun burning