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Skin Cancer Statistics
Skin cancer is the most common form of cancer diagnosed in Australia. Australia has one of the highest rates of skin cancer in the world with 2 in 3 Australians estimated to get some form of skin cancer by the age of 70 (AIHW, 2016; MIA, 2018). While these numbers appear significantly high, the fatality rate associated with skin cancer is low.
To understand how skin cancer develops it is imperative to have a basic understanding of the body's largest organ, the skin, its structure and funsctions to enable us to conceptualise the changes happening deep within it. Figure 1 shows the different skin layers and their constituents to help with visualising certain elements pertinent to how skin cancer develops. For detailed information about the anatomy and functions of the skin please click the link below.
Image retrieved from www.nci-media.cancer.gov
Figure 1
How does Skin Cancer develop?
How does Skin Cancer develop?
Skin cancer usually develops in the epidermal layer of the skin when skin cells grow and multiply in an abnormal and uncontrolled manner. If left undiagnosed for a prolonged period these cells could metastasize or spread and invade other healthy parts of the body resulting in further damage (Figure 2). Metastases occurs more commonly in the melanoma type of skin cancer and sometimes occurs in another type of skin cancer known as squamous cell carcinoma if a late diagnosis was made. Basal cell carcinoma (BCC), which is the most diagnosed form of skin cancer in Australia, rarely metastasizes far beyond it's surrounding location but can in some cases. These are three main types of skin cancer diagnosed yearly in Australia which will be discussed in this post.
Image retrieved from www.cancervic.org.au/cancer-information/what-is-cancer
Figure 2
Main Types of Skin Cancer
Main Types of Skin Cancer
There are 3 main types of skin cancer. These are:
Basal Cell Carcinoma (BCC)
Squamous Cell Carcinoma (SCC)
Melanoma
BCC and SCC are classified as keratinocyte or non-melanoma skin cancers, as they start in skin cells called keratinocytes. In contrast, melanoma begins in melanocytes which are the cells that produce melanin that gives skin its unique colour. This is the main difference between melanoma, and non-melanoma or keratinocyte skin cancers.
Figure 3
Adapted from: www.cancervic.org.au/cancer-information/what-is-cancer and www.carecover.in/what-is-skin-cancer-and-its-symptoms/
1- Basal Cell Carcinoma (BCC)
Non-melanoma skin cancers (NMSC) are the most common form of skin cancer diagnosed in Australia with BCC having the highest incidence rate of non-melanoma skin cancers accounting for two-thirds of cases diagnosed in Australia (AIHW, 2016).
BCCs arise in skin cells called basal cells called keratinocytes which are produced in the bottom layer (stratum basal) of the epidermis (Figure 1 & 3). BCC cancer cells tend to grow slowly and rarely spread to other healthy tissue when diagnosed early. BCC occurs commonly on sun exposed areas that have been exposed to repeated sunburns.
Being diagnosed with a BCC once increases an individual's chances of having another BCC diagnosed again. BCC is typically easier to treat but if the diagnosis is delayed, and it metastasizes, treatment can result in disfigurement and scarring.
Basal Cell Carcinomas (Medical Animation Video 3D)
This video illustrates how Basal Cell Carcinomas grows and spreads. It also discusses SCC and Melanoma.
This video illustrates how Basal Cell Carcinomas grows and spreads. It also discusses SCC and Melanoma.
2- Squamous Cell Carcinoma (SCC)
2- Squamous Cell Carcinoma (SCC)
SCC is less prevalent than BCC but is more dangerous as it can grow quickly and potentially spread to other sites in the body if a diagnosis is delayed. SCC arises from squamous cells located in the upper layers of the epidermis (Figure 3). They commonly develop on areas frequently exposed to the sun like the face, neck, ears, scalp, and upper limbs. SCCs on a previously treated area, or those that arise on the lips or ears and are bigger than 2 cm in size can spread or reoccur after treatment.
3- Melanoma
3- Melanoma
Melanoma is the most aggressive and potentially fatal form of skin cancer. It makes up 1-2% of the total skin cancer cases diagnosed yearly in Australia (AIHW, 2016). It is the deadliest form of skin cancer due to its ability to spread rapidly and invade healthy tissue. This makes early diagnosis and treatment of melanoma a critical factors in saving lives.
Melanoma is the most common form of skin cancer among individuals aged between 20 to 39 (MIA, 2018). Men are more susceptible to developing melanomas than women due to a higher rate of men working and participating in outdoor work or recreational activities and neglecting to use sun protection (AIHW, 2016). This form of skin cancer is different from BCC and SCC which arise from keratinocytes in the epidermis. Melanomas arise from melanocytes, which are specialised pigment producing skin cells located in the bottom layer (stratum basal) of the epidermis (Figure 3 & 1). They produce melanin which is the pigment that gives skin its unique colour and protects it against sun damage.
Melanoma develops when melanocytes grow uncontrollably in an abnormal fashion in the basal layer of the epidermis (Figure 3) hence where the name melanoma originates. If not diagnosed early, these malignant cells could spread to the dermis and in some cases travel through lymph and blood vessels to other parts of the body and invade them resulting in further damage. Melanoma is linked to frequent sunburns resulting from intense, cumulative overexposure to UVR over many years leading to irreversible damage to melanocytes. For more information about melanoma clink this button 🔳
Skin cancer - How skin cancer develops Video.
This video focuses on melanoma, how it develops and spreads.
This video focuses on melanoma, how it develops and spreads.
Role of Melanin in Skin Protection
Melanin plays a vital role in protecting the DNA of skin cells from damage by forming a protective shield around the cell’s nucleus where the DNA is housed. This is a self-defense mechanism that protects the skin against sun damage which is seen as a tan or darkening of the skin when moderate skin damage occurs, but when the damage is severe due to overexposure to UVR it is seen as a sunburn. Sunburns are indicative of severe and permanent damage to melanocytes which mainly increases the risk of melanoma. Exposure to UVR without the adequate use of sun protection increases the risk of keratinocyte skin cancers (BCC, SCC) as well.
What Factors Increase Your Risk of Skin Cancer?
Age
Age
Being over the age of 65, except for melanoma skin cancer which is more common in individuals between the age of 20 to 39 (MIA, 2018).
Genetics
Genetics
Having a family or personal history of skin cancer.
Skin Colour
Skin Colour
Having lighter skin, coloured eyes, freckles, blond or red hear.
Individuals with darker skin could also get skin cancer but are less susceptible than individuals with lighter skin.
Overexposure to UVR
Overexposure to UVR
UVR is main factor implicated in the development of skin cancer and is the primary factor in the development of Melanoma.
Having a history of sunburns.
Having a history of prolonged unprotected sun exposure at an early age.
Moles
(Melanoma Specific Risk factor)Moles
Having many moles (more than 11) on the body.
Melanomas can arise from pre-existing moles. In men, they are more likely to occur on the chest and back (AIHW, 2021).
Sun Protection
Sun Protection
There is a high correlation between unprotected sun exposure and skin cancer. Evidence from studies indicates that exposure to UVR without proper use of sun protection triggers the formation of malignant skin cells resulting in skin cancer. This highlights the importance of sun protection as a crucial step in reducing the risk of developing skin cancer. There are many ways protection from the sun can be achieved.
Signs and Symptoms of Skin Cancer
Signs and Symptoms of Skin Cancer
General skin cancer signs and symptoms:
Itching or tingling sensation
Scaling or rough patches with a red or brown background colour
Ulceration
Pain
Sore that is changing in shape
A non-healing sore.
BCC specific:
BCC accounts for 66% of skin cancers in Australia.
Grows slowly over a course of months or years. Rarely spreads to other parts of the body. The least dangerous form of skin cancer.
Can look like a round, shiny or pale lump with a pink or red colour. It can also be a flat spot that appears like a scaly patch of eczema.
The spot may look like a sore that is ulcerated, bleeds and does not heal. It might appear to heal temporarily then becomes inflamed again.
Usually found on the upper body, head or neck, but can occur on other sun exposed areas of the body.
Retrived from www.cancerresearchuk.org/about-cancer/skin-cancer/symptoms/photos
SCC specific:
SCC accounts for about 33% of skin cancers.
Grows over months and may spread if not treated.
Can appear as a scaly red area that looks like a non-healing sore (ulcer) that may grow rapidly, bleed easily, and is often painful when touched.
Often develops on parts of the body frequently exposed to the sun like the lips, ears, scalp, backs of the hands and lower legs.
Retrived from www.cancerresearchuk.org/about-cancer/skin-cancer/symptoms/photos
Melanoma specific:
Melanoma ccounts for 1–2% of skin cancers in Australia.
Can grow rapidly over a short period of weeks to months.
Can grow from an existing or new freckle or mole.
Can appear as a freckle or mole that changes in size, colour, or shape.
Can grow on areas of the body that are not exposed to the sun.
Occurs most frequently on the:
upper back in men
lower legs in women
How to check your skin for Skin Cancer?
One of the best ways to check your skin for unusual spots is by getting your partner, a family member, or a friend to help. This makes it easier to check areas like the scalp, behind the ears, and back which are hard to reach. Research shows that the back is the most common location in men for melanoma skin cancers to develop which is one of the trickiest places to examine by yourself.
Below are step-by-step guides to help you with your skin checks.
FACT: Did you know that......
Skin Check Step-By-Step Guides:
Partner Skin-Check
Adapted from www.aad.org
Skin checks should be done every month if you:
have a history of cancer
have a history of sunburns
work or stay long hours outdoors without sun protection (i.e. sunscreen, hats, protective clothing).
For more information about sun protection and sunscreen click the link below.
Self-check
Adapted from www.melanomafoundation.org
How to keep track of skin changes?
Take photos of any spots that stands out from the rest of your skin.
Measure the spot if possible or get a friend to do it for you if it is out of reach. Document the date, place, size, and colour of the spot. This will help you keep track of any changes. Repeat your skin-check again after one month to see if lesion is changing.
If there are changes or signs and symptoms of skin cancer. Arrange to get a skin check by a GP or dermatologist, do not delay. Skin cancer is highly treatable when detected early.
See a doctor immediately if you notice these signs (Cancer Council, n.d.):
A spot that is different from other spots around it, is itchy or bleeds.
A new spot (mole or freckle) that has changed over weeks or months in size, shape or colour.
An inflamed sore that has not healed within three weeks.
ABCDE of Melanoma Tool (Melanoma Specific Skin-Check tool)
Melanoma is the most aggressive and deadliest form of skin cancer due to it's ability to spread to other parts of the body if not detected early. Melanoma can appear as a new spot or mole. It can also grow from an existing spot or mole. Therefore, it is important to know how to detect it.
The ABCDE of Melanoma Tool is a screening tool designed specifically for melanoma detection which can help you recognise features that are specific to melanoma skin cancers only. It is used by clinicians for the identification of melanoma.
Clinicians use the ABCDE Melanoma Tool to compare the characteristics of melanoma vs a normal mole and to distinguish between melanoma and non-melanoma skin cancers (BCC, SCC).
The ABCDE is an acronym that stands for:
Asymmetry
Border irregularity
Colour
Diameter
Evolution
Use the ABCDE of Melanoma tool to check for unusual spots on your skin,
Where to go for more information or help?
Your local GP or dermatologist
Skin Cancer clinic
Cancer Council Helpline +13 11 20
www.cancer.org.au
www.cancervic.org.au
www.sunsmart.com.au
Checking for skin cancer - How to check your skin
References:
Australian Institute of Health and Welfare. (2016). Skin cancer in Australia. Canberra: AIHW. https://www.aihw.gov.au/reports/cancer/skin-cancer-in-australia/summaryAustralian Institute of Health and Welfare (AIHW). (2021). Cancer data in Australia. Retrieved from https://www.aihw.gov.au/reports/cancer/cancer-data-in-australiaCheck for signs of skin cancer. (n.d.). Cancer.org.au. https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/check-for-signs-of-skin-cancer
Daniel Jensen, J., & Elewski, B. E. (2015). The ABCDEF Rule: Combining the “ABCDE Rule” and the “Ugly Duckling Sign” in an Effort to Improve Patient Self-Screening Examinations. The Journal of Clinical and Aesthetic Dermatology, 8(2), 15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345927/ Davis, K. E. (2020). Skin Cancer. Journal of the Dermatology Nurses’ Association, 12(2), 78–84. https://doi.org/10.1097/jdn.0000000000000523 Gandhi, S. A., & Kampp, J. (2015). Skin Cancer Epidemiology, Detection, and Management. Medical Clinics of North America, 99(6), 1323–1335. https://doi.org/10.1016/j.mcna.2015.06.002Iannacone, M. R., Hughes, M. C. B., & Green, A. C. (2014). Effects of sunscreen on skin cancer and photoaging. Photodermatology, Photoimmunology & Photomedicine, 30(2-3), 55–61. https://doi.org/10.1111/phpp.12109Jones, O. T., Ranmuthu, C. K. I., Hall, P. N., Funston, G., & Walter, F. M. (2019). Recognising Skin Cancer in Primary Care. Advances in Therapy, 37(1), 603–616. https://doi.org/10.1007/s12325-019-01130-1 Kyrgidis, A. (2017). Melanoma Epidemiology. Cutaneous Melanoma, 1–9. https://doi.org/10.1016/b978-0-12-804000-3.00001-6*** Li, H., Colantonio, S., Dawson, A., Lin, X., & Beecker, J. (2019). Sunscreen Application, Safety, and Sun Protection: The Evidence. Journal of Cutaneous Medicine and Surgery, 23(4), 357–369. https://doi.org/10.1177/1203475419856611Linos, E., Katz, K. A., & Colditz, G. A. (2016). Skin Cancer—The Importance of Prevention. JAMA Internal Medicine, 176(10), 1435. https://doi.org/10.1001/jamainternmed.2016.5008 Linares, M. A., Zakaria, A., & Nizran, P. (2015). Skin Cancer. Primary Care: Clinics in Office Practice, 42(4), 645–659. https://doi.org/10.1016/j.pop.2015.07.006Matthews, N. H., Li, W.-Q., Qureshi, A. A., Weinstock, M. A., & Cho, E. (2017). Epidemiology of Melanoma. Cutaneous Melanoma: Etiology and Therapy, 3–22. https://doi.org/10.15586/codon.cutaneousmelanoma.2017.ch1Melanoma Institute Australia (MIA). (2018). Melanoma facts and statistics. https://www.melanoma.org.au/understanding-melanoma/melanoma-facts-and-statistics/ Que, S. K. T., Zwald, F. O., & Schmults, C. D. (2018). Cutaneous squamous cell carcinoma. Journal of the American Academy of Dermatology, 78(2), 237–247. https://doi.org/10.1016/j.jaad.2017.08.059 Saginala, K., Barsouk, A., Aluru, J. S., Rawla, P., & Barsouk, A. (2021). Epidemiology of Melanoma. Medical Sciences, 9(4), 63. https://doi.org/10.3390/medsci9040063 Sander, M., Sander, M., Burbidge, T., & Beecker, J. (2020). The efficacy and safety of sunscreen use for the prevention of skin cancer. Canadian Medical Association Journal, 192(50), E1802–E1808. https://doi.org/10.1503/cmaj.201085Shanbhag, S., Nayak, A., Narayan, R., & Nayak, U. Y. (2019). Anti-aging and Sunscreens: Paradigm Shift in Cosmetics. Advanced Pharmaceutical Bulletin, 9(3), 348–359. https://doi.org/10.15171/apb.2019.042 Sommers, M. S., Fargo, J. D., Regueira, Y., Brown, K. M., Beacham, B. L., Perfetti, A. R., Everett, J. S., & Margolis, D. J. (2019). Are the Fitzpatrick Skin Phototypes Valid for Cancer Risk Assessment in a Racially and Ethnically Diverse Sample of Women? Ethnicity & Disease, 29(3), 505–512. https://doi.org/10.18865/ed.29.3.505 Skin cancer in Australia (full publication; 21jul2016 edition) (AIHW)Van Onselen, J. (2019). Skin cancer: educating the public on signs and symptoms. British Journal of Nursing, 28(11), 672–672. https://doi.org/10.12968/bjon.2019.28.11.672
Daniel Jensen, J., & Elewski, B. E. (2015). The ABCDEF Rule: Combining the “ABCDE Rule” and the “Ugly Duckling Sign” in an Effort to Improve Patient Self-Screening Examinations. The Journal of Clinical and Aesthetic Dermatology, 8(2), 15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345927/ Davis, K. E. (2020). Skin Cancer. Journal of the Dermatology Nurses’ Association, 12(2), 78–84. https://doi.org/10.1097/jdn.0000000000000523 Gandhi, S. A., & Kampp, J. (2015). Skin Cancer Epidemiology, Detection, and Management. Medical Clinics of North America, 99(6), 1323–1335. https://doi.org/10.1016/j.mcna.2015.06.002Iannacone, M. R., Hughes, M. C. B., & Green, A. C. (2014). Effects of sunscreen on skin cancer and photoaging. Photodermatology, Photoimmunology & Photomedicine, 30(2-3), 55–61. https://doi.org/10.1111/phpp.12109Jones, O. T., Ranmuthu, C. K. I., Hall, P. N., Funston, G., & Walter, F. M. (2019). Recognising Skin Cancer in Primary Care. Advances in Therapy, 37(1), 603–616. https://doi.org/10.1007/s12325-019-01130-1 Kyrgidis, A. (2017). Melanoma Epidemiology. Cutaneous Melanoma, 1–9. https://doi.org/10.1016/b978-0-12-804000-3.00001-6*** Li, H., Colantonio, S., Dawson, A., Lin, X., & Beecker, J. (2019). Sunscreen Application, Safety, and Sun Protection: The Evidence. Journal of Cutaneous Medicine and Surgery, 23(4), 357–369. https://doi.org/10.1177/1203475419856611Linos, E., Katz, K. A., & Colditz, G. A. (2016). Skin Cancer—The Importance of Prevention. JAMA Internal Medicine, 176(10), 1435. https://doi.org/10.1001/jamainternmed.2016.5008 Linares, M. A., Zakaria, A., & Nizran, P. (2015). Skin Cancer. Primary Care: Clinics in Office Practice, 42(4), 645–659. https://doi.org/10.1016/j.pop.2015.07.006Matthews, N. H., Li, W.-Q., Qureshi, A. A., Weinstock, M. A., & Cho, E. (2017). Epidemiology of Melanoma. Cutaneous Melanoma: Etiology and Therapy, 3–22. https://doi.org/10.15586/codon.cutaneousmelanoma.2017.ch1Melanoma Institute Australia (MIA). (2018). Melanoma facts and statistics. https://www.melanoma.org.au/understanding-melanoma/melanoma-facts-and-statistics/ Que, S. K. T., Zwald, F. O., & Schmults, C. D. (2018). Cutaneous squamous cell carcinoma. Journal of the American Academy of Dermatology, 78(2), 237–247. https://doi.org/10.1016/j.jaad.2017.08.059 Saginala, K., Barsouk, A., Aluru, J. S., Rawla, P., & Barsouk, A. (2021). Epidemiology of Melanoma. Medical Sciences, 9(4), 63. https://doi.org/10.3390/medsci9040063 Sander, M., Sander, M., Burbidge, T., & Beecker, J. (2020). The efficacy and safety of sunscreen use for the prevention of skin cancer. Canadian Medical Association Journal, 192(50), E1802–E1808. https://doi.org/10.1503/cmaj.201085Shanbhag, S., Nayak, A., Narayan, R., & Nayak, U. Y. (2019). Anti-aging and Sunscreens: Paradigm Shift in Cosmetics. Advanced Pharmaceutical Bulletin, 9(3), 348–359. https://doi.org/10.15171/apb.2019.042 Sommers, M. S., Fargo, J. D., Regueira, Y., Brown, K. M., Beacham, B. L., Perfetti, A. R., Everett, J. S., & Margolis, D. J. (2019). Are the Fitzpatrick Skin Phototypes Valid for Cancer Risk Assessment in a Racially and Ethnically Diverse Sample of Women? Ethnicity & Disease, 29(3), 505–512. https://doi.org/10.18865/ed.29.3.505 Skin cancer in Australia (full publication; 21jul2016 edition) (AIHW)Van Onselen, J. (2019). Skin cancer: educating the public on signs and symptoms. British Journal of Nursing, 28(11), 672–672. https://doi.org/10.12968/bjon.2019.28.11.672
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