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December 2018 | Published by RCPA

Issue #087

Remember to be sun smart this summer

Richard Scolyer – Remember to be sun smart this summer

As we head into summer, it’s important to remember the dangers of the sun, and to be aware of any changes in our skin. We spoke to world-leading melanoma pathologist Professor Richard Scolyer to discuss melanoma and non-melanoma skin cancer. Prof Scolyer is Co-Medical Director and Consultant Pathologist at Melanoma Institute Australia; Senior Staff Specialist, Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney; and Clinical Professor, The University of Sydney.

“Australia and New Zealand have the highest incidences of skin cancer in the world. That is because we live in a place that basks under the sun. We’re close to the equator and we have many people with pale skin which is not well-suited to this environment. We also have our “great Australian outdoor lifestyle” where we spend a lot of time outside. It is most of these things combined which makes us susceptible to getting skin cancer.

“We talk about melanoma the most because, although it represents only about 2% of skin cancers, it causes about 75% of skin cancer-related deaths. Around 14,000 Australians will be diagnosed with melanoma this year, and about 1,800 Australians will die from melanoma this year. Melanoma is the commonest cancer in Australians who are 15 to 39 years old, and the incidence in people over 60 is high and increasing.

“Non-melanoma skin cancer is also a major problem for our country. Although not as many people die from it as melanoma, it is four times more common than all other cancers combined, which is astounding. Basal cell carcinoma (BCC) is the most common of those; it’s a tumour which causes local problems and rarely spreads beyond the site where it started. Squamous cell carcinoma is the other common type of non-melanoma skin cancer and unlike BCC, has more of a propensity to spread beyond the initial site, especially in people who are immunosuppressed for any reason.”

The majority of skin cancers in Australia and New Zealand are caused by exposure to UV radiation in sunlight. Being sensible in the sun is a simple yet effective way to help reduce the risk of developing melanoma and non-melanoma skin cancers.

“There are five things that you need to do to protect yourself from the sun. First is to avoid sun exposure during hottest part of the day. Secondly, wear protective clothing when outside to protect your skin from the sun’s damage. Third, wear a broad brimmed hat. Fourth, ensure you wear sunglasses to protect your eyes, and finally, use a high SPF sunscreen which is SPF factor 30 or above. We actually also recommend that people apply sunscreen to their face every morning even when they are not spending time in the sun – it should be part of everyone’s routine.”

Early diagnosis of skin cancer is important and gives the best chance of successful treatment. Therefore, it is important to “know your own skin” to increase the chances of noticing any changes that may suggest a skin cancer, such as

  • New moles,
  • Moles that increases in size,
  • An outline of a mole that becomes notched,
  • A spot that changes colour from brown to black or is varied in colour,
  • A spot that becomes raised or develops a lump within it,
  • A mole with a surface that becomes rough, scaly or ulcerated,
  • Moles that itch or tingle,
  • Moles that bleed or weep,
  • Spots that look different from the others.

“If you see any changes or anything different then seek medical attention. The really important message that we want people to heed is that if you detect melanoma early, then 90% of people will be cured by simple surgery – that’s why it’s really important to know the skin you’re in.”

“At Melanoma Institute Australia, we have also just launched an education program for high school students. People are generally well aware of the importance of sun smart behaviour in primary schools, and there is a ‘no hat no play’ initiative in effect in most of them. Teenagers are much harder to get the message through to, and so we recently launched a program aimed at educating high school students which we have named the Sun Smart Ambassador Program. High schools select students to become leaders who we then meet with and educate about the importance of sun safety. We provide them with presentation skills to go back to their school and educate their peers. We had a pilot in NSW in late 2018 and we’re going to roll it out across the country in 2019.”

Pathology is essential for the diagnosis of all skin cancers. If cancer is suspected, then following a skin biopsy a diagnosis will be made by a pathologist.

“Skin cancer can be suspected clinically but it is pathology that makes a definite diagnosis. Pathology is needed to diagnose all skin cancers. The pathological factors of the tumour also determine what it means for the patient in terms of risk of the disease spreading or recurring. The next phases of the management of skin cancer depend on what the pathologist recognises and reports.

“At Melanoma Institute Australia, our program spans prevention and management for those people at high risk of melanoma, early stage melanoma, and advanced melanoma. A lot of the major breakthroughs that have received publicity in recent years have been in relation to ways of treating advanced melanoma, particularly with immunotherapy. Up until less than a decade ago, once you had advanced melanoma your outlook was very poor – most patients would die within a short period of time - but now things are much better than that. The survival rates of people with advanced or Stage IV melanoma have more than tripled over the past ten years. Many people are having great responses and many people are being cured. But we still have a lot of work to do to reach our mission of zero deaths from melanoma.”








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