The skinny on skin cancer

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Skin cancer is the most common cause of cancer in Australia. In fact, we diagnose and treat so many skin cancers that the non-melanoma skin cancers are not even included in the Australian Cancer Database, so we aren’t even exactly sure of the true prevalence.

Even though Summer is over, skin cancer can develop at any time. Read on for the “skinny” on skin cancer.

What is skin cancer?

As I’ve already alluded to, there are two different types of skin cancer- melanoma and non-melanoma skin cancers. Non-melanoma skin cancers were previously known as benign skin cancers, but this was a bit of a misnomer, as not all non-melanoma skin cancers are completely benign. While it is true that the vast majority do not cause death, certain subtypes of these cancers, in certain locations, can definitely cause harm or health complications. According to the Cancer Council, in 2015 there were 642 deaths from non-melanoma skin cancers. These skin cancers include most commonly squamous cell carcinomas (SCCs) and basal cell carcinomas (BCCs).

Basal cell carcinoma. Image from dermnetnz.org
Squamous cell carcinoma. Image from dermnetnz.org
Melanoma. Image from dermnetnz.org

The other, more scary skin cancer is melanoma. Melanoma is a true cancer in the sense that it can grow rapidly and spread, causing metastatic deposits in other parts of the body. Melanoma is the cancer that can kill, and the one that we try to pick up as early as possible, before it has spread.

What are risk factors for skin cancer?

The most important risk for skin cancer is UV (ultraviolet) radiation exposure. Not just “sun exposure” but UV exposure. The difference is important because you can still have UV light exposure even on a cloudy day, without the sun shining.

Studies seem to suggest that high, intermittent exposure to UV radiation increases the risk of malignant melanoma. This means excessive tanning or cases of sunburn, especially at a youthful age. Cumulative, lifelong exposure to UV radiation increases the risk of non-melanoma skin cancers.

Skin type and family history also have a role to play. Skin cancer, like all other cancers, has an element of heredity, whether that is due to inherited skin type or through other mechanisms (such as differences in the immune system). Having a strong family history of melanoma is a red flag for keeping a closer eye on your skin.

Other risk factors for skin cancer include the same risk factors for many other cancers such as age, diseases and medications affecting the immune system.

How do we prevent skin cancer?

The best way to prevent skin cancer is to prevent overexposure to UV radiation. This means staying out of the sun during the hottest hours of the day, which on the East Coast in summer during daylight savings is 10am-4pm. The best way to check for the UV rating for the day is on your Bureau of Meteorology weather app, or on the website here. If you are out in the sun, then make sure you cover up with UV resistant clothing, you wear sunscreen over sun exposed areas, and you wear a hat.

Photo by Jedd on Unsplash

If you choose to wear a baseball cap rather than a broad brimmed hat, then please make sure you apply sunscreen to your ears.

A note about sunscreen: make sure you apply it at least 20 minutes before you go out in the sun, and reapply every 30 minutes if you’re swimming (even if the bottle says it is 4 hours water resistant!).

How do we check for skin cancer?

It’s really important to be regularly checking your own skin. I advise all patients in Australia to have an annual skin check by a doctor, but I also remind my patients that a skin check is like a “snapshot” in time- we can only see how the skin lesion is at that very moment. So it’s important to still be vigilant and keep an eye out for anything concerning- this means looking out for changes in your skin, like changes in colour, shape, size or symptoms- especially if it becomes itchy or starts bleeding. I usually tell my patients to look out for any mole that looks different from the other moles on their body- skin cancer is like any cancer- abnormal cells. This means they will look different from the benign moles.

Who should we go to if we are concerned?

The first place is always your GP. Depending on their level of experience, they will either examine you themselves with something called a dermatoscope, or they will refer you to a skin specialist or a skin cancer GP for a check. A skin cancer GP, like myself, have done extra studies in diagnosing and treating skin cancers.

A dermatoscope is a handheld device that acts as a magnifying glass to help the user see patterns in the skin lesions. My advice? Always make sure your doctor is examining your skin with one of these.

If you would like a bulk billed skin check, you can book an appointment here with me in Brookvale’s Warringah Mall.

Stay sun safe!

I’m always tired, Doc

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“I’m always tired, Doc.”
Well, join the club, I’m always tempted to say. It doesn’t seem like a day goes by without at least one poor patient slumping down in their chair and telling me about their permanent fatigue.

Feeling tired is such a common symptom in today’s busy society that it’s almost a badge of honour. And there are many different causes of fatigue, things like iron deficiency, low thyroid, viral illness, chronic fatigue syndrome, mental health issues. But today I want to discuss sleep apnoea.  I have a sneaky suspicion that a lot more of my tired patients have it than I previously realized. The Healthy Sleep Foundation is a great resource for further information. This is their fact sheet on Sleep Apnoea.

What is sleep apnoea

Sleep apnoea occurs when there is some sort of airway obstruction during sleep. When this happens, the patient actually stops breathing, and their sleep is interrupted as their body automatically wakes them up to start breathing again. Obviously, with this constant sleep disturbance, sleep quality is affected.

Why does it occur

Your airway is maintained by nerves to the muscles around your airway that keep it open. When you are awake, these muscles are always activated, working to keep the otherwise soft and floppy pharynx (since it has no cartilage or bone) open. However, when you sleep, the nerves that keep these muscles activated reduce in their activity, and this can allow your airway to collapse. This is more likely with the following:

  • Being obese- this can cause fat deposition in the soft tissues of the airway, narrowing it further. Being obese can also reduce lung volumes in the lying down position, which reduces the traction on the pharynx and makes it even more likely to collapse
  • Have nasal issues- like nasal polyps or a septal deviation. This can result in mouth breathing at night, causing the tongue to flop back over the airway and block it. Increased nasal resistance also increases the likelihood of the pharynx collapsing due to negative pressures.
  • Certain anatomical features of the jaw shape and position can also reduce the airway
  • Family history- there is definitely a genetic predisposition to the condition

What are the symptoms?

Patients are often snorers, but not always. Sometimes their partners might report sudden gasping or snorting, which can be a sign their body waking up to breathe again. But the most common reported symptom is excessive tirednessfatigue, or sleepiness. There is a questionnaire called the Epworth Sleepiness Scale which can be done to assess daytime sleepiness and consider testing for sleep apnoea. Essentially it is a propensity to dozing which is out of the ordinary- for example, falling asleep while driving or eating. But some patients may score normally on this scale and still have sleep apnoea.

What complications can it cause?

 Untreated sleep apnoea can cause a whole host of problems outside of simply feeling tired (although that is pretty significant!). Otherwise it can contribute to, or is a risk factor for:

  • Hypertension
  • Coronary artery disease
  • Heart failure
  • Cardiac arrhythmias
  • Stroke
  • Diabetes
  • Depression
  • Injuries due to fatigue (for example, car accidents and workplace injuries)

What tests can be done? 

Aside from standard tests to exclude other causes of sleepiness, the most important diagnostic test for sleep apnoea is a sleep study. This can be done in a lab or at home. You wear sensors and equipment, and a computer records a number of readings while you sleep. You have an EEG done, which traces the electrical activity of your brain to detect your different sleep stages, and sensors check your oxygen saturations in your blood, changes in airflow, muscle movements, and cardiac rhythms. Using this data, the lab can calculate whether you have having apnoeas (referring to a cessation in breathing), and how many.

How is it treated? 

If you are identified as having sleep apnoea (generally considered when you are recorded has having more than 15 episodes per hour of sleep), then treatment is twofold- treating the cause(s) and treating the symptoms. Obviously, if it is largely genetic/anatomical there is not a lot that can be done to treat the causes, but if you are overweight or have nasal congestion issues, these can be addressed. To treat the symptom, we generally rely on CPAP machines, although there are some oral appliances such as mandibular splints which apparently can reposition the jaw to prevent pharyngeal collapse.

How does a CPAP machine work?

CPAP stands for Continuous Positive Airway Pressure, which is exactly what it does- it delivers positive pressure that acts as a mechanical splint to keep the airway open. Air is delivered through the mask, and this air creates the pressure. There is no oxygen delivery.

So, if this sounds like you, or you would simply like to check if there are any underlying medical causes for your constant tiredness (not just the stresses of modern living!), then see your GP for testing. Of course, you are also welcome to see me to discuss your symptoms, or if you already have sleep apnoea and would like to discuss weight loss management.

Reference:
In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 20e Chapter 291: Sleep Apnea New York, NY: McGraw-Hill;  Accessed October 15, 2018.

Antibiotics: friend or foe?

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Spring is a strange time, isn’t it? One day it’s 30 degrees and we’re grabbing our summer clothes and getting ready for beach days, the next it’s plunged to 18 degrees and the jumpers are back on. With this temperamental weather, as well as the advent of hayfever symptoms, I’ve been seeing a lot of coughs and colds lately. So I thought I’d write a little about antibiotics.

Continue reading “Antibiotics: friend or foe?”

Chronic Pain: What can we do about it?

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Last week, I wrote about the definition of pain, and some of the physiology behind it.

Today, I’m going to talk a little about some of the management strategies for chronic pain. Continue reading “Chronic Pain: What can we do about it?”

My Health Record: is it safe?

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There has been a lot of furor in the media over the past few weeks over the security of My Health Record, which is an initiative by the government to keep all of your medical records and details in a central database, linked to your Medicare number. Continue reading “My Health Record: is it safe?”