Cork woman issues warning about skin cancer

AS a pale-skinned person, I’ve long been aware of the risk of skin cancer.

But as I’ve never been a tanner (in fact, I really hate lying out in the sun), I presumed that once I wore SPF on holiday or when it was very sunny outside, my risk would be diminished.

In late 2018, I noticed a small patch of red, flaky skin on my face, about half an inch under my right eye, near my nose. Thinking it might be dermatitis, I made sure the area was clean and well moisturised.

Then, one day I noticed a perfectly round dot of blood on the patch. Hmm, I thought — that’s strange. The bleeding happened on and off over a period of months, then stopped.

A few months later, I was on holidays in New York when I took a good look at the patch on my face. It had started bleeding again, and even when I put on make-up I could see the red raised patch. It was about the size of a 2 cent coin, but I felt like it was getting bigger.

Part of me wondered if the patch could be something like skin cancer, but I thought the chance was low — after all, it wasn’t a mole or freckle, and it didn’t really look like anything I’d seen pictured on skin cancer warning leaflets.

Back home, I booked an appointment with my doctor and showed her the patch under my eye.

After looking with an illuminated magnifying glass at my face, she told me I needed to see a dermatologist.

Ireland has a two-tier health system, and health insurance isn’t affordable for a lot of people. I was very lucky to have access to health insurance through my boyfriend, and decided to go privately to a dermatologist as my doctor felt speed was of the essence. Still, the entire process took months.

My dermatologist had a brisk manner, and after looking at my face said she wanted to take a biopsy, which is when a small bit of the skin is removed for analysis. A few weeks later, I had the biopsy, which was a strange but not very painful experience. My face was numbed, including my right eyelid. Then I felt a punching sensation in my face and the weird sensation of someone sewing up my skin. Just a tiny bit of skin was removed (I have a fairly imperceptible scar now). I spent a few weeks with a bandage on my face, but I didn’t mind — it’s funny how vanity leaves you in such a situation.

It took about four weeks before I got another letter from my dermatologist, asking me to visit her a month later.

Great, I thought: It’s not cancer, then.

But it was cancer. Thankfully, it turned out I had basal cell carcinoma (BCC), one of the most common skin cancers in Ireland (over 10,000 people are diagnosed with it every year). It’s a non-melanoma cancer, meaning it is a ‘good cancer’ to have, relatively speaking. If I treated it early, my chances of it going malignant were almost non-existent.

I’ve since learned that BCC can in some people turn malignant. In addition, the treatment for it can involve skin grafts. So it’s a ‘good cancer’ but that doesn’t mean that for some people it’s not an incredibly difficult or frightening one to get.

I was told I had two choices for treatment: surgery, or using a cream. I was advised to see a plastic surgeon about whether surgery would suit, but he told me it wasn’t the right route for me. He seemed to base this on my age and being female, and worries about scarring — not something that really bothered me.

So the cream route it was. I was given a prescription for Aldara, also known as Imiquimod. This cream stimulates your immune system to kill off the cancer cells, and I had to apply it Monday to Friday for six weeks.

Nothing happened until three weeks in, when the patch bloomed into a red area that looked like sunburn. This turned into a scab, which was itchy and hot, and could be uncomfortable. During the day I’d apply cooling antiseptic creams to relieve the itchiness.

It took another three weeks after finishing the cream before the redness began to go down. That period was a strange one, as I’d sometimes notice people looking at the angry scab on my face when I was out and about.

I decided when I started treatment to give updates on my Instagram account, which ended up being a really cathartic experience. People got back to me to say they’d never heard of BCC, and a few people went to their doctor for check-ups after hearing my story.

Sharing what was happening helped normalise it for me, and let my friends and family abroad know how I was doing.

Six months after the cream treatment, I got the all-clear. I have to go back to my dermatologist every year for a full-body check, and be extremely vigilant, wearing SPF daily and keeping out of the full glare of the sun during the summer.

The likelihood is my BCC began years ago, when I was younger and we all weren’t as educated in using sun cream.

What I learned from this experience (besides how lucky I was to be able to afford treatment — Aldara costs over €100) was that SPF is an essential, and that even if you ‘just’ get a BCC, the surgery for it can be quite invasive.

If you’re spending time out in the sun, do your skin and health a favour and use a good quality SPF, and cover up as much as you can.

My chances of skin cancer are now higher than they were before, given my history, and the potential of melanoma is in the back of my mind. There are plenty of good fake tans on the market, if you do want to tan.

There’s no need to bake yourself — it’s really not worth it.

BE SUN SMART SAYS IRISH CANCER SOCIETY

Skin cancer is the most common cancer in Ireland, with more than 11,000 new cases diagnosed in 2015, according to the Irish Cancer Society. The National Cancer Registry of Ireland (NCRI) expects this number to double by 2040.

Skin cancer is a disease of skin cells. Nine out of every ten cases are caused by UV rays from the sun or sunbeds.

There is a huge volume of information and supports on the Irish Cancer Society website, in relation to skin cancer.

See https://www.cancer.ie/cancer-information-and-support/cancer-types/skin-cancer

SKIN CHANGES TO LOOK OUT FOR

According to the Irish Cancer Society, skin cancers do not all look the same. They can appear in a number of ways including any of the following:

A small lump

Flat, red spot

Firm, red lump

A lump or spot that is tender to touch

An ulcer that will not heal

A lump with a scaly or horny top

Rough, scaly patches

A new or changing mole

Non-melanoma often appears as one of the following:

A new growth or sore that does not heal in a few weeks.

A spot or sore that continues to itch, hurt, crust, scab or bleed.

A skin ulcer not explained by other causes.

Melanoma mainly develops from a new mole or a change to an existing mole. The changes to watch out in existing moles are:

Change in shape: From a round and regular shape to ragged edges or an irregular shape with one half unlike the other.

Change in size: From the size of the top of a pencil and getting bigger.

Change in colour: From one colour to many shades of tan, brown or other colours. Some melanomas can also lose colour

The mole looks red or inflamed around the edges

The mole is bleeding, oozing or crusting

The mole starts to feel different, for example, slightly itchy or painful.

As not all melanomas develop from moles, it is important to speak to your doctor if you spot other skin changes that are unusual for you.