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  • Q&A with Australian Health Practitioners

    How can I avoid any further skin cancers?

    Related Topics
    Cancer Skin Cancer
    I am 47 years old.

    I have a Squamous Cell Carcinoma on my face and will get it removed next week.

    Can I avoid any more of these, or are more inevitable assuming all the damage was done when I was young? I also have a family history.

    • 2 answers
    • Prof Rodney Sinclair
    • Dr John Mahony
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    Prof Rodney Sinclair

    Dermatologist (Skin Specialist)

    Professor Sinclair is a Professor of Dermatology at the University of Melbourne and Director of Sinclair Dermatology. He is past-president of the Australasian Society for … View Profile

    There are 3 things thay may help. The first is daily application of sunscreen. The second is regular skin surveilance to treat precancerous lesions and to also detect any emerging skin cancers early, and the third is oral retinoid tablets. These can only be prescribed by specialist dermatologists. Finally there is some early research data to suggest nicotinamide could also ne of benefit. Clinical trials are currently underway to ascertain if nicotinamide is useful.
    Prof Rod Sinclair
    Epworth Dermatology

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    Dr John Mahony

    Cosmetic Physician

    Dr John Mahony studied Medicine at Sydney University 1980-1984 graduating early 1985. Internship and residency years followed in the Illawarra, covering general medical and surgical … View Profile

    Couple of points:

    1)

    Most people, when they buy a sunscreen, go off to the chemist (if they are serious, and you are) and buy something with the maximum SPF they can see. More the better, right? And then they see that some sunscreens are water resistant and some are not. Hey, you never know when you might want to go for a swim, right? More is better, so they buy the water-resistant one.

    Then they apply it and, lo and behold, they don't like it, because it is a bit sticky and a bit white on their skin. They keep at it for a while but, one day, it's a bit overcast and they won't be going out that much and, you know how it is, that stuff is so gooey anyway, let's skip it today. And pretty soon, other priorities seem to crowd out their heads and the sunscreen just ends up sitting in the bathroom vanity.

    Here's a tip: if you are going to use this stuff every day forever, get something comfortable! That means getting something that is primarily a moisturiser, with added zinc oxide or titanium dioxide to make it SPF 30. If it is confortable and not gooey, there's a chance you'll actually use it long term.

    Secondly, for every day, get somethig that is *not* water resistant, which means the base will be more cream-like rather than ointment-like and thus more comfortable and less likely to block pores etc.

    Thirdly, don't get *too* hung up over whether it's SPF 30 or 50. SPF 30+ blocks at least 96.66% of UVB (assuming correct dose), and SPF 50+ blocks at least 98% of UVB. What's the difference? In absolute terms, just 1.33 percentage points. Hardly anything. Put another way, an hour spent in the sun under SPF 30  protection is equivalent to 2 minutes without protection, and an hour spent in the sun under SPF 50 protection is equivalent to 1 minute 12 seconds without protection. Both excellent.

    What's *much* more important than whether your SPF is 30 or 50 is *putting on enough*. Most people apply their sunscreen or moisturiser-with-SPF far too thinly. To cover your face, you should use more-or-less one gram of moisturiser (roughly 1 ml) each time.

    Of course, you should also decide that hats are groovy, and wear one.

    2)

    Controversy point (and maybe Prof Sinclair will comment?): rather than wait until non-melanoma skin cancers arise and get detected at a doctor's consultation before treating them, why not diminish them or possibly eliminate some at the preclinical stage with 5aminolevulinic acid photodynamic therapy(5ALA-PDT)? Or, if preferred, efudix/solarase/aldara (if tolerated)?

    Here's a recent trial suggesting this idea has some merit:

    http://www.ncbi.nlm.nih.gov/pubmed/19863513

    And here is the conclusion from the abstract

    Conclusions: The results obtained showed that field therapy with ALA-PDT confers a significant preventive potential against the formation of new NMSCs in patients with field changes.

    PDT comes at some cost and is associated with some down-time. It isn't for everyone, but surely it is better to know about it than not know about it?

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