After having had skin cancer twice a day – once on her arm as a teenager and another on her back, four decades later – Lavinia Newlands was understandably nervous when she developed an elevated brown spot just above her lip two years ago.
There was also a smaller, rough spot under her right eye (which she could feel but was hard to see in the mirror). They had risen slowly in months.
They did not resemble the skin cancers she had previously had: these were basal cell carcinomas (BCC), which usually form red, scaly patches that can ulcer and cause scabs. But Lavinia, 62, was worried and feared more bad news – not least because she often had sunburn as a child.
& # 39; I grew up in a generation that was unaware of solar filters & # 39 ;, she says. & # 39; I spent the summers on British bucket and skate vacations, running around all day without any form of sun protection. I remember peeling off my swimwear and crying because my skin was so bad due to sunburn. & # 39;
Treatment: Lavinia Newlands, from Amberley, West Sussex, is one of the thousands that has dangerous sun damage – but a single Daylight PDT treatment might be the answer
When she asked her doctor about the suspicious spots, & # 39; he was rather dismissive and said they would not kill me & # 39 ;, says Lavinia, a private chef and mother of two, from Amberley, West Sussex. & # 39; So I continued to hydrate the rough spot above my lip and monitor the other. & # 39;
Then, last year, both patches started to grow. Lavinia went to another doctor, who personally referred her to a dermatologist.
The news was far from reassuring; both plasters were what are known as actinic keratosis, of which Lavinia was warned that it could become a kind of skin cancer, called squamous cell carcinoma (which can be seen in the first image on the right that leaves Lavinia & sun damaged skin see).
Unlike BCC, if not treated, they can spread to other parts of the body and in some cases be fatal.
Actinic keratoses are innocent-looking rough spots or raised brown growths – sometimes referred to as sun or liver spots – that occur on areas exposed to the sun, such as the face, back of hands, ears and scalp of balding men.
They are unbelievably common, with one in four of all Northern Europeans over 60 years of age having at least one, according to Dr. Bav Shergill, a dermatologist for consultation in Sussex and spokesperson for the British Association of Dermatologists.
Risk: Lavinia was warned that sun damage could become a kind of skin cancer called squamous cell carcinoma, which could be fatal if not treated
Actinic keratoses are a sign that you have underlying sun damage (what dermatologists call & # 39; field change & # 39;) – but there may be other cancer precursors in the area that are not visible to the naked eye.
Millions of Brits can be affected. But the good news is that there is now a cream available on the NHS that can undo the vast majority of this damage – and thus reduce the risk of cancer – with minimal side effects.
Many people who can benefit from this, however, are missing.
WHY IT IS SO EASY TO USE
Actinic keratoses are formed by abnormal keratinocytes, the most common cells in the skin; these produce keratin, a waxy protein that forms a protective barrier.
But after years of exposure to the sun, the DNA in these cells can be damaged and grow abnormally, creating rough spots that can be raised and discolored.
& # 39; If you were to take biopsies from the environment, they would show significant skin damage and these areas could develop into non-melanoma skin cancer – basal cell or squamous cell carcinoma & # 39 ;, adds Dr. Anthony Bewley, a dermatologist at Barts Health NHS , trust. & # 39; However, many of the changes are at a subclinical stage, so you cannot see them. & # 39;
Sunburn as a child is a high risk factor for malignant melanoma, the most serious form of skin cancer. But accumulative sun exposure – not just sunburn – can also be a risk factor for BCC and squamous cell carcinoma. There are creams that can undo most, if not all, damage. However, some must be applied daily for weeks and lead to unpleasant side effects.
The newer, light-activated cream is applied once and you are in the sun for two hours. It is so simple that some people have used it at home themselves.
It could help hundreds of thousands of patients, and the NHS also explains Dr. Justine Hextall, who is on the committee for skin cancer at the British Association of Dermatologists.
She believes that there is a reason to use it, and other treatments, on a larger scale for background zone damage. & # 39; As clinicians, we support field change treatments – signs of widespread sun damage – such as small red spots, areas with more pigmentation, age spots, and small wart-like growths. & # 39;
& # 39; I grew up in a generation that was unaware of solar filters & # 39 ;, she says. & # 39; I have summer outside running around all day without any form of sun protection. I remember peeling off my swimwear and crying because my skin was so bad due to sunburn. & # 39;
A 2014 study at the European Academy of Dermatology and Venereology suggested that 63 percent of squamous cell carcinoma cancer cases arose from flat, early actinic keratosis.
& # 39; These are the ones we tend not to treat – we generally suggest treating the treated only & # 39 ;, says Dr. Hextall. & # 39; But this study suggests that we should treat even these early ones. & # 39;
& # 39; We could save the NHS a lot of time and money if we were to come in earlier, especially in the case of frequent flyers – people who show up with a few lesions, but also widespread sun damage & # 39 ;, Dr. Hextall adds, at Tarrant Street Clinic in Arundel, West Sussex.
YOU CAN AVOID FACE CARS
She adds: & # 39; These are often people from the late sixties or seventies who will repeatedly present new skin cancers, often with complex, and unfortunately sometimes unsightly, surgical treatment, because there are so many non-melanoma skin cancers and so much sun there are damage has been done. & # 39;
Treatments that work on field damage and pre-cancerous stages can help to significantly reduce the number of skin cancers diagnosed annually.
Figures from a new skin cancer database published in the Jama Dermatology journal in November last year found that 45,000 cases of squamous cell carcinoma were diagnosed in England every year, 350 percent more than previously estimated.
The chance of actinic keratosis that turns into a squamous cell carcinoma is around 5 percent, which means that treating the cancer precursors can save thousands of people developing cancer every year.
So what is this new cream and why is it not being used on a larger scale?
It is based on a principle known as daylight photodynamic therapy (PDT for daylight). It contains aminolevulinic acid (ALA), which uses the body's immune system to kill the cancer cells and is activated by sunlight. & # 39; ALA is preferably absorbed by the sun-damaged cells that you want to target – and does not affect healthy skin & # 39 ;, says Dr. Hextall.
And it not only clarifies squamous cell carcinoma, it also cleans up BCC & # 39; s.
To activate the ALA, the patient must sit in daylight within 30 minutes after applying the cream and stay there for two hours, even if it is cloudy, but the sun is strong enough from April to October in the UK.
It can tingle for a few days and some crusting, which comes out within a week and disappears within fourteen days.
Sunburn as a child is a high risk factor for malignant melanoma, the most serious form of skin cancer, but accumulative sun exposure – not just sunburn – can also be a risk factor
IT IS NOT ONLY CHANGING MILL THAT YOU NEED TO REMAIN …
If you have birthmarks with any of these symptoms (below), or all of them, consult your doctor and ask to be referred to a dermatologist.
A – Asymmetrical shape
B – Edge is irregular
C – Color is not uniform (i.e. two or more colors)
D – Diameter more than 6 mm
E – Evolving in size, shape or color
& # 39; People should also look for red, flaky areas or nodules, such as actinic keratosis, which could potentially cause problems due to the risk of squamous cell carcinoma, & # 39 ;, consultant dermatologist Dr. Anthony Bewley adds.
& # 39; People often ignore pieces of skin that become flaky or red or sore, but this must be seen, especially if it is displayed in areas exposed to the sun, such as the nose, forehead, shoulders in men or the lower legs. woman.
& # 39; Bald men tend to be very bad at checking their scalp, but this is such an important area to check. It is not easy to keep an eye on your scalp without a partner, so I advise people to use their smartphone and take photos.
A recent study in the Journal of the European Academy of Dermatology and Venereology, involving 50 patients with actinic keratoses who received PDT daily to use at home, found that 98 percent thought it was easy to use and 62 percent free of all after three months visible lesions. & # 39; Daylight PDT clears up about 70 percent or more of the pre-cancer cells, and if it were cheaper, it would be used on a larger scale & # 39 ;, says Dr. Shergill. And therein lies the friction. A tube of cream costs around £ 150 and each treatment requires one or two tubes.
Current treatments for actinic keratosis usually start with liquid nitrogen to freeze or scrape them off – which is cheaper.
However, the PDT daylight also grabs & # 39; invisible & # 39; background damage to; those treatments don't.
Daylight PDT is normally a one-time treatment (sometimes a second treatment is required) and aftercare is usually minimal, while recurrences and clearance of scraping or freezing may mean more follow-ups.
A study in Jama Dermatology in 2014 found that after three months the clearance rate with PDT (the precursor to daylight PDT) was 14 percent better than the freezing point.
Although daylight PDT is available on the NHS, it is usually only used for people with multiple acute keratoses who have not responded to other multiple treatments.
OTHER CREAMS THAT CAN HELP
It is not the only product available for the treatment of actinic keratosis and field change.
General practitioners can offer a non-steroidal anti-inflammatory cream called Solaraze to be used twice daily for 90 days, although it is not as effective in treating background damage. & # 39; In addition, it takes 90 days, and sometimes people give up & & # 39 ;, says Dr. Hextall.
Another recipe cream, imiquimod, stimulates the immune system to attack the abnormal skin cells. This causes an inflammation that ultimately destroys actinic keratosis. It should be used five days on, two days off, usually for four weeks.
How often do you have to hear it? Many people do not realize that they must use sunscreens in the UK, assuming that our weather means that they do not get much sun damage
SUN SCREEN HAS NO EFFECT ON YOUR VITAMIN D LEVELS
Many people worry that the use of sunscreens reduces the vitamin D content that our body produces in response to sunlight.
In fact, these fears are unfounded, according to a major review of 75 studies recently published in the British Journal of Dermatology.
& # 39; This is not the first time a study has demonstrated this – you don't actually need that much sun exposure to synthesize vitamin D, & # 39 ;, says dermatologist Dr. Justine Hextall. & # 39; I am very pleased that this study has been published because fear of vitamin D deficiency is the main argument that I hear from patients about the use of sunscreens. I personally use factor 50 on my face every day. & # 39;
Many people do not realize that they must use sunscreens in the UK, assuming that weather means that they do not get much sun damage.
& # 39; Often it is the young people who are the worst & # 39 ;, says dermatologist Dr. Bav Shergill. & # 39; There is a window of independence from teenagers when they do what they want – and get burned. Sun exposure before the age of 20 is the highest risk factor for all skin cancers. & # 39;
Although effective for some, it can lead to weeping, cracked skin that lasts for weeks, making people nervous about continuing. It costs around £ 55 per tube.
Another alternative, Efudix, contains fluorouracil, a type of chemotherapy. This is used once or twice a day for four to six weeks. Cheaper than PDT for daylight (it costs around £ 65 for four to six weeks of treatment), it attacks abnormal skin cells and can be used on lesions and areas with sun-damaged skin.
This can also cause crusting and inflammation, which may take weeks, which means that not everyone continues.
A trial last year, published in Dermatologic Therapy, where Efudix was compared with PDT for daylight, found that Efudix was slightly more effective, clearing out 93% of lesions compared to 80% with PDT in daylight. However, the PDD with daylight caused fewer adverse effects and patients preferred it.
But these are all variable treatments and experts think they are not offered wide enough.
WHEN YOU SHOULD ASK FOR ADVICE
Dr. Bewley says that pre-cancerous tumors in general are not taken seriously enough by doctors or the public. & # 39; There is some familiarity with the need to watch out for potentially malignant melanomas (often in the form of brown, birthmarks), & # 39; he says. & # 39; But when it comes to actinic keratosis, doctors often say they just keep an eye on it – which is sometimes the right advice, but it's always important to watch for any changes. & # 39;
Currently, doctors advise keeping an eye on & # 39; early & # 39; actinic keratosis, when it is small, flat and alone. Some can solve this themselves. If it becomes painful or inflamed, this may be a sign that it is transforming into a squamous cell carcinoma.
But Dr. Hextall says: “GPs and hospitals are overwhelmed. So when someone comes in with actinic keratosis, she often freezes him there and then. We miss the opportunity to treat the field changes and pick up the small squamous or basal cell carcinomas that are possible. & # 39;
After Lavinia was diagnosed with actinic keratoses, the dermatologist tried to freeze them. But & # 39; the one under my eyes didn't really respond and the one sitting on my lip came back after a few months & she said.
She then went to another private dermatologist who suggested daylight PDT. It not only eliminated actinic keratosis, it also treated some larger underlying sun damage on her face, reducing her risk of skin cancer.
& # 39; I was pretty surprised at how much scaling appeared afterwards – a sign of how much sun damage I had that was just not clear, & # 39; says Lavinia. & # 39; The treatment was pain free. If I hadn't done it, I might have been even more at risk for skin cancer. I have had a happy escape and I hope that more people can benefit from this. & # 39;
WHAT IS MELANOME AND HOW CAN YOU AVOID IT?
Melanoma is the most dangerous form of skin cancer. It happens after the DNA in skin cells is damaged (usually as a result of harmful UV rays) and has not been repaired, causing mutations that can form malignant tumors.
The American Cancer Society estimates that more than 91,000 people will be diagnosed with melanoma in 2018 in the US and that more than 9,000 people are expected to die from it.
Every year around 15,900 new cases occur in the UK, of which the British die in 2016 from 2285 Britons, according to the statistics from Cancer Research UK.
- Exposure to the sun: UV and UVB rays from the sun and tanning beds are harmful to the skin
- Moles: the more moles you have, the greater the risk of getting melanoma
- Skin type: nicer skin has a greater risk of getting melanoma
- Hair color: red heads are more at risk than others
- Personal history: once you have had a melanoma, you are more likely to get it again
- Family history: if previous family members have been diagnosed, this increases your risk
This can be done by removing the entire part of the tumor or by removing the surgeon layer by layer. When a surgeon removes it layer by layer, this helps them figure out where exactly the cancer stops, so they don't have to remove more skin than necessary.
The patient may decide to use a skin graft if the operation has left a discoloration or mark.
- Immunotherapy, radiation or chemotherapy:
This is necessary if the cancer reaches phase III or IV. That means that the cancer cells have spread to the lymph nodes or other organs in the body.
- Use sunscreen and do not burn
- Avoid tanning outside and in beds
- Apply sunscreen 30 minutes before you go outside
- Keep newborns out of the sun
- Examine your skin every month
- Consult your doctor every year for a skin test
Source: Skin Cancer Foundation and American Cancer Society
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