The risk factors for skin cancer

Lesions that change in size, shape and colour over time, wounds that take longer than six weeks to heal may be a sign that one has skin cancer. 

Many people believe in the myth that skin cancer only affects those with fair skin since black people have melanin that protects them. However, Dr Abraham Mukalazi, a dermatologist at Mildmay Hospital in Lweeza, says there are some types of cancer that also affect those with a black complexion. 

“The challenge is that we do not have many dermatologists in the country and there has not been a lot of research done in this field. So, there are no particular statistics about the number of people who suffer from this type of cancer,” he says.

The cancers that commonly affect black or brown people include kaposi’s sarcoma, a type of cancer that affects people with immune suppression such as HIV (but can affect other parts of the body other than the skin), Bowen’s disease which is triggered by the Human Papilloma Virus (HPV), Acral lentiginous melanoma, cutaneous T-cell lymphoma as well as a cancer that grows from wounds that do not heal and bleed from time to time.

What is skin cancer?

Skin cancer can be described as an uncontrolled growth of abnormal cells in the skin. It is broadly categorised into two types; melanoma and non- melanoma cancers, depending on the cell of origin within the skin from which they develop. 

Dr Malik Ssempereza, a dermatologist at Unity Skin Clinic in Kampala, says non-melanoma skin cancer are a group of cancers that develop in the upper layers of the skin. They arise from the damage of the outer layer of the skin and include basal cell carcinoma (BCC) as well as squamous cell carcinoma (SCC).

These rarely spread to other parts of the body but only eat the skin locally causing deformation, especially around the face. 

“Melanoma cancers on the other hand develop in the skin’s melanocytes and arise from the destruction of the melanin which is responsible for skin pigment (colour). These are dark, more serious and are very aggressive,” Dr Ssempereza says.

“Basal cell carcinoma is the most common type of skin cancer among albinos because their skins lack melanin pigment. They are common on sun-exposed areas of skin such as the nose, ears and lower lips,” says Dr Mukalazi.
 
Risk factors

If you have black or brown skin, you have a lower chance of getting melanoma, but you can still get it.

Others at risk are those who have a large number of moles on your skin, have a history of skin cancer in your family or you have had skin cancer before. 

“People exposed to chronic sun damage, scars as a result of burns, arsenic exposure, chronic inflammation as seen in longstanding skin ulcers, and spots of previous x-ray therapy are predisposed to the development of squamous cell carcinoma,” Dr Mukalazi says, adding that risky behavior such as bleaching, smoking and alcohol use can also predispose someone to skin cancer. 

Exposure to ultraviolet radiations from the sunrays is the leading cause of most skin cancers. Although the radiation cannot be felt or seen, they can only be exhibited through sunburn, skin and eye damage, premature ageing of the skin and damage to the skin cells which leads to cancer.

“Several exposures to x-ray, especially during medical tests is another risk factor that makes skin cells prone to cancers. People who work in industries and are exposed to coal and arsenic compounds are also prone to developing skin cancers,” Dr Ssempereza warns.

Signs and symptoms

Dr Ssempereza recommends that you see a dermatologist if you have a lesion which develops a border that is not uniform and is irregular, varies in colour such as black, red, brown or red, increases in diameter and evolves over time.

“The cancer may appear as a pearly lump or a scaly or dry area that is pale or bright pink and shiny, which may bleed or be inflamed and the dead tissue may become an ulcer. The wound may heal but may break down again,” Dr Mukalazi says.

Moles and dark black birthmarks, which later become itchy or painful could also be a sign that you have skin cancer.

Diagnosis

If you have a lesion, wound or mole that is suspicious, the dermatologist will do mole mapping or dermoscopy, an examination of a mole. 

“To confirm skin cancer,” Dr Ssemperza says, “a biopsy sample has to be taken off for observation and it takes about two to three weeks for one to get their results, depending on where they have the test done.” 

Management and treatment 

In the early stages, skin cancer is not dangerous and can easily be treated. In the last stage, however, the cancer, especially the melanoma type, can spread to different parts of the body such as the lymph nodes, bones, spine and brain. 

Treatment for skin cancer depends on the stage and type. Melanoma skin cancer can often be treated. The treatment you have will depend on where the cancer is, if it has spread and your general health.

“Surgery usually involves removing the melanoma and an area of healthy skin around it, swollen lymph nodes if the cancer has spread to them and other parts of the body if it has spread to them,” Dr Ssempereza.

If a large part of skin has to be removed, a skin graft will be taken from another part of the body to cover the area where the melanoma was.

Radiotherapy is sometimes used to reduce the size of large melanomas and help control and relieve symptoms. Chemotherapy, which kills cancer cells, is sometimes used to treat advanced melanoma when it has spread to another part of the body.