Skin cancer is a very common type of cancer throughout the world. It is a disease that occurs when skin cells grow abnormally in the epidermis (the outermost skin layer), usually due to the overexposure of ultraviolet (UV) radiation from the sun.

As for Caucasian (white-skinned) people, they are more prone to getting skin cancer due to the exclusion of non-producing melanin (natural skin pigments), which help to block out ‘considerable’ amounts of UV radiation. Having said that, skin cancer can also affect any skin-coloured people around the world. Skin cancer patients with ‘skin of colour’ (brown and dark) are often diagnosed in its later stages, hence being more difficult to treat.

Skin cancer is the most common in the USA, Australia and New Zealand. Australia is known as the ‘skin cancer capital of the world.’ Almost two-thirds of Australians would get a type of skin cancer by the age of 70.

There is 3 dangerous type of skin cancers:

1. Basal cell Carcinoma

2. Squamous cell Carcinoma

3. Melanoma

Basal cell and squamous cell carcinomas are the two most common forms of skin cancers.
Basal cell carcinoma (BCC)

Basal Cell Carcinoma (BCC) is the most common type of skin cancer. Mostly takes place on face and neck areas’ but can occur anywhere on the skin. BCC generally does not spread to other parts of the body, but local invasion happens if untreated for a long time. If diagnosed early BCC can be treated easily with very high curative rate.

Figure 1: Caucasian patient with basal cell carcinoma (BCC) on the cheek, below right eye

Figure 2: Brown skin patient with basal cell carcinoma (BCC) on the cheek, below left eye

Squamous cell carcinoma (SCC):

Quite dangerous cancer. Mostly occurs in sun-exposed areas including face, neck, and hands. It can occur on the scalp with bald people. This type of cancer can spread to other parts of the body if untreated for a long time. Any painful non-healing bleeding rash or skin ulcer more than 6 months withstanding, has to be checked to ward off SCC.

Figure 3: Caucasian patient with squamous cell carcinoma (SCC) on the left ear

Figure 4: Brown skin patient with large squamous cell carcinoma (SCC) on the left cheek

Smokers can get SCC on their lips.

Figure 5: Squamous cell carcinoma (SCC) on lower lip

Melanoma:

Melanoma is a rare but very dangerous cancer. A normal mole can change to become melanoma. Melanoma can spread to other parts of the body quickly when compared to other skin cancers. Melanoma of the skin is the third most commonly diagnosed cancer in Australia after breast and prostate cancer.

Figure 6: Brown skin patient with melanoma on the thigh

Figure 7: Caucasian patient with melanoma on the skin

South Asian and Chinese people are prone to skin cancer in areas that are not commonly exposed to sunlight including the palms of the hands, the soles of the feet, the groin, and inside of the mouth. Melanoma can arise under nails (fingers & toes) as well.

Figure 8: Subungual melanoma under the nail

Risk factor for skin cancers:

1. Skin type - light skin, blue colour eye, red hair (very high risk)

2. UV radiation - long intervals of sun exposure

3. People with weak immune systems, including patients who have been treated with chemotherapy or radiotherapy

4. Transplant patients

5. People who work with welding (artificially produced radiation)

6. Various harmful chemicals

Prevention of skin cancer:

1. Avoid sunlight - especially between hours from 10 am to 2 pm (summertime)

2. Put on a sufficient amount of sunscreen when outdoors

3. Be more vigilant if you a have family history of skin cancer

Diagnosis:

Skin cancer physicians use a Dermatoscope (medical device) to diagnose skin cancers. They will take samples of (biopsy) to confirm the diagnosis if they find any suspicious moles or rashes during the skin cancer examination process. Depending on the biopsy results, doctors will suggest treatment and management plans for the individual affected.

Treatment for skin cancer:

The most common and definitive treatment for skin cancer is surgery to remove cancer.

Other treatments include:

Cancer cream - for superficial skin cancers

Cryotherapy (liquid nitrogen spray to freeze off skin cancer cells) - superficial skin cancer

Electrocautery (burning) and curettage (scraping) and LASER ablation

As a Skin Cancer Doctor…

Skin cancer is one of the most widespread problems all around the world and is still an ongoing cause of cancer deaths in today’s society. As for skin cancer mainly being the burning issue and top headline among western societies including the USA, Australia and New Zealand; this is ignored by countries of ‘coloured skin.’ This is inclusive of Asian, African and South American countries.

As an Australian based skin cancer physician of Bangladeshi origin, I found most of the time skin cancer problems are taken out of the question and are completely ignored by the community. Skin cancer can happen regardless of skin colour and because coloured skin ‘is more protected’ to UV radiation due to melanin, thus this can lead to the false impression that skin of colour people cannot get skin cancer.

This is why most skin cancer cases for coloured skin people are diagnosed in later stages meaning this can have serious consequences for the individual and the society as a whole. As the increasing trends in skin cancers cases in Bangladesh, individuals need to have regular skin cancer check-ups. More and more doctors and nurses should be trained to diagnose and treat skin cancer patients.