Farm Doctor: Sun exposure and skin cancer symptoms
© Adobe Stock Even though it seems we’re still waiting for summer to start, the normally sunnier months of the year are a good time to take a look at our bodies and note any changes in our skin or moles.
In this month’s Farm Doctor, farmer’s daughter and qualified doctor Camilla Baker explains the signs and symptoms of skin cancer and the importance of staying out of the sun.
See also: Farm Doctor: How to spot signs of poor mental health
“As one of the biggest risk factors for developing skin cancer is exposure to sun, people working in the outdoors and in agriculture should be aware of the signs and symptoms of skin cancer and know when to seek help,” says Camilla.
Skin cancer is one of the most common forms of cancer, with malignant melanoma being the second most common cancer in people aged 15-34.
Skin cancers are broadly divided into two groups:
- Melanomas Cancers that come from the cells in your skin that give a tan – melanocytes.
- Non-melanomas Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Non-melanomas are more common and generally spread more slowly than melanomas.
Basal cell carcinoma
This is the most common type of skin cancer in the UK, accounting for about 80% of cases.
“It is normally slow growing and generally does not spread to other parts of the body. It is more common in older people and typically develops in sun exposed areas, such as the head, face and neck,” says Camilla.
They start off as small red, pink or pearly lumps on previously normal skin, and the lump may appear dome like.
If your GP suspects BCC, they may refer you to a dermatologist. As BCC typically grows slowly, this may not be a rapid referral and most basal cell carcinomas can be managed by the GP.
Squamous cell carcinoma
This is the second most common type of skin cancer and, like basal cell carcinoma, is more common in older people who have been exposed to the sun.
“An SCC will typically develop on the face, nose or ears, and may start as a small red patch which can grow into a hard, wart-like lump,” says Camilla.
They tend to grow slowly, but can erode into the surrounding tissue. If your medical professional or doctor suspects SCC, they may refer you to a specialist under the suspected cancer pathway.
Malignant melanoma
This is a cancer that starts in the skin, affecting about 16,000 people in the UK every year.
“It is less common than the other types, but is the most serious, and can spread to other parts of the body. Malignant melanoma can start in a mole or in normal looking skin,” says Camilla.
“A change in the shape, size or colour of a mole or skin lesion is normally the first sign and it is important to get a medical professional to review any changing mole.”
If your GP or medical practitioner suspects malignant melanoma, they will refer you on to a skin specialist. This referral normally happens quickly, and as always, the outcome is better the earlier cancers are detected.
ABCDE Checklist
Camilla recommends using the ABCDE checklist for moles:
A – Asymmetry The shape may be uneven, unlike a mole that is normally circular.
B – Border The edge may be jagged, blurred and not smooth.
C – Colour The colour may not be uniform and may be a mix of two to three colours, or shades of brown or black.
D – Diameter Melanomas are normally more than 6mm wide and typically change in size quickly.
E – Evolving Any change in size, shape, colour, elevation or any new symptom such as bleeding, itching or crusting may be due to a melanoma.
Who is at risk, and how do I reduce my risk?
“The main cause of skin cancers is damage to the skin by the sun, either over time or from sunburns,” Camilla explains.
About nine in 10 non-melanoma skin cancers and about six in 10 melanomas are thought to be caused by excessive sun exposure.
“It is important to limit our exposure to the sun, though I appreciate this can be hard for farmers who mainly work outside,” says Camilla.
“If you can, try to avoid working in direct sun between the hours of 11am and 3pm. Try to cover up with long-sleeved shirts, trousers and wide-brimmed hats.
“It is also important to regularly apply sun cream, making sure it contains protection from UVA rays.”
Investigations and treatment
If your doctor is concerned about skin cancer, they may refer you on to a dermatologist.
The specialist will take a more detailed look at the skin and may ask you questions about any family history of skin cancers and history of sun exposure. They may need to do a biopsy of this skin.
Treatments can include surgery, different types of creams, chemotherapy and radiotherapy.
“If you are worried about any part of your skin, or if you notice a change in the size, colour or shape of a mole, it is important to get it checked out quickly,” says Camilla.
“You may notice a skin change in one of your older friends or family members, and if so, encourage them to see their doctor. And remember prevention is key, so stock up on sun cream and keep in the shade.”
Case study – counting the cost of sun exposure
Somerset beef farmer Judith Denning was diagnosed with a basal cell carcinoma, which she says had developed over a number of years.
“I can’t pinpoint when it came, but I started checking photos back because I told myself it was an old scar,” she explains.
“I had knocked it a couple of times and it bled profusely, and the last time it happened I thought I’d better check it out.”
Judith describes the area on her chin as about half the size of a five pence piece, jaggedy-round in shape, and white in colour.
After an initial trip to the doctor where her concerns had been dismissed, Judith persisted and was sent for further examination.
“I saw the specialist, and I didn’t even sit down in the seat. As I walked in the door he looked at me and said I can tell you straight away what that is, and he instantly gave me a name for it.”
The specialist also confirmed that the basal cell carcinoma was definitely a result of sun exposure.
After having the affected area removed, Judith says that it has left a scar on her face, but that this is better than the alternative.
As for wearing sun cream, she says that for many busy farmers it can easily be forgotten, but shouldn’t be.
“I think as farmers, you just get up in the morning and go. If you get up really early, the sun’s not really up so sun cream isn’t a priority.” It should be.