HPR2075: Skin cancer

This is a very personal podcast, discussing minor surgery. If that sort of stuff makes you cringe at all, this may not be the recording for you. I should also point out that I am not a medical professional, you should not take this recording as medical advice, if you have any concerns about your skin, seek professional medical advice.

I am a very white person living in Queensland, Australia. Our state has amongst the highest rate of skin cancers in the world, I believe we're in a tussle with New Zealand for first place at the moment.

There are two main types of skin cancer, melanoma and non-melanoma. The non-melanoma type is slow growing, and rarely spreads to other parts of the body, while melanoma is fast growing and spreads to the rest of the body.

Both my parents have had multiple lesions excised, so something like this was always on my mind. We live in a sunny, sub-tropical environment, the sort of clothing you'd want to wear for comfort is light, breezy, and not covering much skin, exactly the wrong sort of clothes you'd need to wear to protect yourself from ultraviolet (UV) rays that help cause skin cancer.

According to the Australian BoM FAQ https://www.bom.gov.au/uv/faq.shtml the per capita risk of skin cancer in Australia is ten times higher than America and sixty times higher than the UK.

The UV scale rarely gets above eight in the UK, in Brisbane the UV scale is above eight for roughly eight months of the year.

There are a lot of variables when it comes to UV. Cloud cover is probably the most important. Something that I can't stress enough is that heat and UV are not correlated, you can definitely be exposed to lots of UV when it's cold (see New Zealand, they're much more south, much more cold, and have more exposure due to the ozone hole). Another example is snow, UV will bounce off the snow and back at you.

The link between skin cancer and UV is quite strong, 95-99% of skin cancers are caused by excess sun exposure. (https://www.cancer.org.au)

So, with all that history, I started getting yearly skin checks a couple of years ago. I'd had a couple of skin checks when I was very young, and now that I'm more advanced in years I wanted something less ad-hoc. Someone working for one such organisation gave a talk at one of the user groups I attended, and i made an appointment with Molemap. It's a full on procedure where your entire body is photographed, and each mole, freckle, bump and lump that is of possible concern is photographed from a few centimetres off the skin, and with the magnification lens sitting right on top of the mole.

I have some near 200 spots on myself that are of interest, so my follow up appointments take about two and half hours to go over all these spots, plus looking for new ones. The hope is that, by doing this close to yearly, small changes in all these spots won't go unnoticed, and we can get on top of any cancers early.

Interestingly, the spot that was actually a problem was a new one, so under a year old, and was hiding underneath my beard, so in future I'm definitely going to have my skin checked clean shaven.

The other thing I want to communicate is that early detection is key, all the skin cancers have a 90% plus survival rate (at five years) if caught early enough. This does potentially mean that a yearly check is not enough, but it's already proven it's worth to me.

Molemap only does photography of spots, and visual diagnosis. It does not do any treatment or biopsies or excisions, therefore there it has no self interest in recommending treatment on borderline cases. Molemap sprang out of a University of Queensland project, which is my alma mater. After receiving the diagnosis (via an online form, secured with a second factor sent to my phone) and panicking a fair bit, I contacted my regular doctors practice (we call them general practitioners in Australia, I'm sure they're called different things elsewhere) for an appointment with a GP who had experience with skin cancers. In QLD, most medical centres will have at least one doctor with experience in this area. As it turns out, my regular GP has such experience and I got an appointment for the following week.

I wasn't really sure what to expect from my GP appointment, but I was mostly expecting to get the diagnosis confirmed, and either get sent to a specialist to deal with it, or organise another appointment at the GP.

What actually happened was it took all of five minutes for my doctor to confirm the diagnosis, then work how he had time in his schedule, and there was a nurse free, to excise the lesion straight away. I was given a local anaesthetic, so I felt no pain whatsoever, but you still feel the doctor pulling on your skin up, down left and right, so that the complete lesion can be removed, as well as a small amount of surrounding skin in case the cancer has spread.

Here I should mention that melanomas spread very fast, and when they're excised up to a centimetre of skin may need to be removed, where as for a non-melanomic, a millimetre or so is good enough.

I got four sutures put in, they stayed for a week (we have a long easter break in Australia) so it ended up being closer to a week and a half. I had no problems, my scar healed up quickly and nicely. Now, a couple of months later, there's a little redness along the scar line, but that's about it.

So. The take aways. UV is not correlated to heat, you can get a lot of UV exposure in cold environments. If you're travelling through a high UV area, take precautions (clothes that cover a lot of your skin, hat, sunglasses, sunscreen). If you live in a high UV area, get your skin checked regularly. Also, keep an eye on your own skin. Use a diary to record any new bumps, lumps, spots etc.

Links

• https://www.bom.gov.au/uv/faq.shtml
• https://www.cancer.org.au

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