GP Dr Paddy McLisky answers commonly asked questions about how skin cancer is treated, and how you can prevent it and protect yourself.

VIDEO TRANSCRIPTION

My name is Patty McClisky and I’m a GP working at Cape Byron Medical Centre. I run the Skin Clinic here. We do skin cancer checks, head-to-toe checkups looking for anything suspicious that might have grown on people’s skin. We also take biopsies into excisions flaps and skin grafts if needed in the clinic.

How is skin cancer treated?
Skin cancer in the early stages can be treated, sometimes just with cryotherapy by freezing the spot, which kills off the epidermal layers and you shed off those shallow layers of the skin and the cancer will go off with it. That can be used for various shallow skin cancers. There are also the options of using various creams or photo therapy. So, we can use light therapy to kill off skin cancers that are shallow.
For the deeper skin cancers, we use surgical excision, so we would cut out the piece of skin, stitch it closed and we would always send away that piece of skin to the pathology lab to make sure we’ve gotten all of the cancer out.
If cancer has spread through the body, unfortunately this is a much more serious situation which sometimes requires chemotherapy or radiotherapy.
Fortunately, in recent years there have been massive advances in the chemotherapy options for melanoma, in particular. People who have had spreading melanoma are now surviving much longer than they used to, however it is always a much better idea to get in early and try and get melanomas off your skin before they spread.

How can we protect our skin?
The most important thing in Australia, living on the coast or living anywhere in Australia, for that matter, is really to be sun safe.
Technology once again is helping us in this area. There are some great apps on your phone that you can you can get, or you can look on the internet. The Bureau of Meteorology will tell you the UV rating each day (it may also be published in your local newspaper), but with the apps, you can sort of see how strong the UV is going to be at any hour of the day, and you can plan your day around that. If you want to go surfing, you could choose to do that when the UV is 3 or less (this is generally in the morning or the afternoon.
Something that a lot of people don’t realise is that in the middle of summer, in the middle of the day, the UV may be as high as 14. And in the winter, the UV might peak at 4 in the middle of the day, so it’s going to be more than three times harsher in summer than it is in winter in Australia.
The UV level at which we believe that people start to burn is between two and three. So, you can imagine in winter, for a good portion of the day you can go out enjoy yourself, get some vitamin D get some sunshine, but you’ve got to be a lot more careful in summer. I would advise people to use the app to guide them on the best hours.

How does sunscreen work?
There are a variety of sunscreens available. Some of them absorb the energy of the of the sun, so the ultraviolet rays, the UVA and the UVB and other sunscreens actually reflect this energy.
The most important thing to do is to draw the energy away from your DNA, which is damaged by the UV radiation. So, you can either absorb that into the molecules of the sunscreen or you can reflect that away.

Can moles turn into melanoma?
Traditionally, we wouldn’t say that moles turn into melanoma, but melanoma can arise within a mole. There have been various theories over history as to where melanoma comes from. Some doctors used to think that melanoma was a mole which sort of turned bad.
Other doctors would say that a mole was always a mole and a melanoma was always a melanoma, but about half of melanomas arise within a mole, and roughly half of them arise in normal skin where there was no mole before.
Darker moles are not particularly more prone to melanoma than lighter moles. People often ask me ‘what about this dark mole?’ ‘is there something wrong with that?’.  Certainly, people with darker hair darker eyes and a darker skin tone do seem to have darker moles generally so if a person with blue eyes, red hair and fair skin comes in and has a single black mole, that would be flagged as being quite different to the others and that would that would attract a lot more attention and review.
However if somebody has a very olive skin type and dark eyes and dark hair they might have twenty dark moles and they may all be completely normal.

Does a sun tan protect us from skin cancer?
Most people seem to be aware that tanning is the body’s response to getting a little bit too much sun. So, certainly, when we talked about the sunscreens some of the sunscreens absorb the UV radiation to prevent it from damaging their DNA.
Melanin is like a natural sunscreen, so melanin is of a dark color and it will absorb the UV radiation and this will then draw that energy away from damaging the DNA. So when your body produces a suntan it is trying to protect you from skin cancer, but sadly that response is often not adequate to do the job.
I think if we look at the migration of people over time many Australians have very fair skin their ancestry may be in Northern Europe, Scotland, Ireland or England and of course their ancestors would never have been exposed to such UV radiation that they are now. So their bodies really through evolution haven’t been able to adapt a good enough response to protect them. So getting a tan is your body’s attempt to stop skin cancer, just like when you get a fever your body’s trying to stop you from having a cold but your cold doesn’t always just go away – it’s the same idea.

By Cape Byron Medical Centre Team