Interview about skincancer
‘People nowadays have several types of skin cancer on their bodies’
The incidence of skin cancer has reached epidemic proportions. More and more people have different types of skin cancer and even some children already have melanoma. Why is this? How dangerous is this? How is this treated? And can you do anything to prevent it? Dermatologist Francis Wu tells more about it in an interview.
Francis, what’s going on?
There is no denying that the number of skin cancer cases is increasing. I remove a lot of skin cancers, cautiously estimated about 50 skin cancers per month. We see an increase in basal cell carcinoma in particular, but melanoma, the most dangerous form of skin cancer, is also on the rise. Eleven years ago I removed a melanoma every month, now it’s weekly.
Multiple species at once
‘You also increasingly see multiple types of skin cancer in one person. For example, if you have had a basal cell carcinoma, you have a 50% chance of developing a new one within five years, and you are three times as likely to develop squamous cell carcinoma and more than twice as likely to develop a melanoma.
Risk of recurrence on sun-damaged skin
‘That doesn’t mean that the basal cell carcinoma wasn’t removed properly, that’s because the entire piece of skin around it has been damaged by UV radiation. If you have had squamous cell carcinoma, you have a 30% chance that it will come back within five years and if you have had melanoma, you have a 10% chance that it will return. And it’s all because the skin is damaged.
The Netherlands in the European top 3 for melanoma
‘Based on figures in 2012, the Netherlands is now in the top three of melanomas in Europe. We are in the top five for basal cell carcinoma and squamous cell carcinoma. Basal cell carcinoma is the most common in our country, but we also see a large increase in squamous cell carcinoma, especially in men. In 2000, KWF Cancer Control had diagnosed about 3,200 cases, in 2015 there were 9,000.
People in their forties: paying attention
Melanoma, the most dangerous and aggressive form of skin cancer, is also on the rise. There were almost two and a half times as many cases in 2015 as in 2000. Melanoma is most common in people over forty. Als je er niet op tijd bij bent kun je er dood aan gaan.Melanoma, the most dangerous and aggressive form of skin cancer, is also on the rise. It can spread to your intestines, your lungs and your lymph nodes, all over your body.
If melanoma metastasizes, it is deadly
‘Basal cell carcinoma and squamous cell carcinoma must also be removed, but you can grow very old with them. A melanoma is a different story, you can die from it as a result of metastases.
How does skin cancer develop? Because of too much UV radiation, right?
‘UV radiation certainly plays a very important role, but skin cancer can have many causes. It can be caused by the sun, but also by your lifestyle, tanning bed, smoking, stress, air pollution. All this leads to DNA damage.
Behavioral change in genes
‘Another cause may also be that the epigenetics of the DNA have changed and no longer work properly. Epigenetics literally means above the DNA and can turn genes on or off. They control how a body cell reads the genes without physically changing the DNA sequence.
The DNA can no longer read itself very well, which weakens the repair system
‘The DNA is otherwise completely normal and not damaged, but it can no longer read itself properly, so that your own DNA repair system is not activated. It is possible that this epigenetic system malfunction due to, for example, poor nutrition in childhood and possibly also generations before. As a result, the DNA itself cannot be read properly and you may have a higher risk of skin cancer, among other things. Whether there is actually a link between epigenetics and skin cancer remains to be investigated.
‘There are various lines of research into the role of nutrition and recovery of your epigenetics, the so-called epigenetics diet. We need to look into that further.
“There is more recognition that melanomas have to do with the amount of UV radiation that the skin receives. We now know that sunburn and sunbed use can indeed contribute to the development of melanoma.
Why is skin cancer so common in the Netherlands these days?
“One reason is our behavior. It is quite easy to travel to a sunny area with a cheap plane ticket. This problem occurs throughout Northwest Europe. The Netherlands, Norway, Denmark, Switzerland, we are all in the top ten with the most skin cancers.
We detect skin cancer faster
“In addition, there is much more awareness. That means that there is not so much more skin cancer, but that we discover it more often and faster because people have a skin check done more often. I notice that it is very much alive among my patients. They tell me that they hear more often in their environment that someone has skin cancer. Many people also come by themselves for a skin check, also because they more often experience that a known person has skin cancer.
Shouldn’t there be a regular check that you are called for?
They already do that in Australia, where people are checked once a year and that also falls under the basic fee. However, this is not yet discussed in the Netherlands. We did have the ‘Skin Cancer Day’ initiative here, where people were encouraged to check themselves for skin cancer. However, that did not happen this year.
The Skin Cancer Day missed its target….
“It had missed its target, it was intended as an awareness campaign where people were given a free check for “suspicious” spots and blemishes on the skin. In addition to a skin check, they also receive advice on how the skin can best be protected and controlled. A lot of people saw it as a dermatological consultation and that was not the intention. That can have a lot of consequences and that’s why it didn’t happen this year. It was a good campaign but it needs to be reviewed.
What can you do yourself to prevent skin cancer? Stay out of the sun?
Protect your skin well. Sun products will help a bit, but clothing, sunglasses and a hat are better. Staying in the shade is deceptive, even in the shade your skin gets quite a bit of UV radiation.
Can you see for yourself the difference between basal cell carcinoma and squamous cell carcinoma?
“There are certain features. Classically, a basal cell carcinoma is a pearlescent bump. Very small vessels often run through it. A squamous cell carcinoma is a somewhat less glistening, rough-feeling skin-colored bump with a crust in the center or a wound.e.
And a melanoma? Can you find out for yourself?
“Birthmarks that look ‘weird’, multiple shades/colors, irregular shapes and generally larger than 5mm. Most melanomas also arise spontaneously, so not from a mole, which many people still think. You also barely feel it. Melanoma is more common on the trunk/back in men and more on the legs in women. A regular skin check is certainly helpful.
What about the various treatment techniques?
‘Surgery, cutting out the cancer, is of course the most important treatment. A special way of operating is the Mohs surgery. It is especially effective in the treatment of basal cell carcinoma, but sometimes also in the treatment of squamous cell carcinoma. With this technique, all cutting walls are checked immediately, so that you know for sure that everything has been removed.
‘I do a variant of this technique myself, in which I apply a skin graft, with a piece of skin from the neck or near the collarbone or a skin plastic. This is also a very effective technique, especially if the skin cancer is in a very visible area such as the face.
But there are also other treatment methods. You can also work with chemo cream for superficial basal cell carcinomas, or irradiate the tumor. Laser treatment is also possible. However, laser, radiation and chemo cream (Efudix, ed.) have disadvantages. You have little control over it and are never quite sure if everything is gone. The chance of the tumor returning is high with these treatments. Superficial basal cell carcinoma, by the way, is fairly treatable with chemotherapy or liquid nitrogen.
And now even children already have skin cancer
‘That’s right and that scares me. A colleague had a six-year-old patient, a girl with melanoma. My youngest patient is eleven, a boy with a basal cell carcinoma on his forehead. Another boy I saw was 15 and had melanoma so thick I had to send him for a sentinal lymph node surgery. There, too, they were amazed that this could occur at such a young age. They finally did a PET scan and it was thankfully negative.
‘Fortunately, this is very rare. Research has been done but there are too few cases to arrive at official figures. But nevertheless, it is worrisome. You didn’t see this before and now I’ve seen two cases in half a year.
What is the role of sun products in the huge increase in skin cancer? Do they aid in the prevention of or do they merely provide a false sense of security and unwittingly contribute to the skin cancer epidemic?
The big problem is that sunscreen products are designed to prevent sunburn. They therefore protect mainly against UV B radiation and less well against UV A radiation. While UVA radiation also plays a major role in the development of skin cancer. It causes free radical formation in the dermis, which is normally neutralized by your own body.
The more often you get burned in the sun, the greater the risk
“But if it accumulates, it affects your DNA and can lead to skin cancer. In addition, you destroy fibroblasts and your collagen, something you don’t immediately notice. In the longer term, this leads to premature skin aging such as wrinkles and pigment spots. UV-A rays are present with relatively equal intensity during all daylight hours throughout the year, and can penetrate clouds and glass.
‘UVA rays make up the largest part of the ultraviolet radiation, so more than UVB. There is now a lot of talk about this. Of course it is also very important to protect yourself against sunburn from UVB radiation. Burning damages your DNA and that sets off a chain reaction that can lead to a lot of problems, including skin cancer.
Will sunscreen become a medical device?
‘There are now discussions to no longer see sun products as cosmetics but as a medical device, a self-care medication. However, that has quite a few consequences. The rules for self-care medicines are much stricter. Stricter testing is needed, for example to prove that you actually live up to the SPF indicated on the packaging.
‘Nevertheless, it remains important to use sunscreen products because they do provide good protection against sunburn and therefore against damage to the DNA. Provided you lubricate well and most people don’t. They use far too little product and do not lubricate often enough. So lubricate well and always wear protective clothing, sunglasses and possibly a hat.
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