Awareness of malignancy in flesh coloured lesions highlighted

Ill-fitting masks and glasses may be incorrectly blamed for symptoms of BCC

Only four in 10 people would seek attention for less well-understood skin cancer signs like lumps, spots and rough, scaly patches on the skin, a survey by the Irish Cancer Society has revealed.

“Most patients are aware that a new or changing mole should warrant advice from their GP however many are surprised when a flesh-coloured lesion is diagnosed as a malignancy,” Dr Bláithín Moriarty, Consultant Dermatologist at St Vincent’s University Hospital in Dublin told Irish Medical Times.

“Cutaneous squamous cell carcinoma (SCC) typically presents as a tender, enlarging nodule which may ulcerate or develop abnormal keratinisation may cause a cutaneous horn. Lesions which are >2cm or located on the ear, hands or mucosal surfaces are most likely to metastasise. These are most likely to occur on sun-damaged skin, particularly in the elderly, outdoor workers or those with a history of actinic change.

“Current or past immunosuppression is a significant risk factor. Beware a tender nodule within an area of actinic keratosis,” she advised.

“By contrast basal cell carcinoma (BCC) presents with slow growing pearly or scar-like change which may not become symptomatic until central ulceration or local neurological destruction occurs.

“Both ill-fitting masks and glasses may be incorrectly blamed for symptoms of basal cell carcinoma.

“A variety of less frequent and usually more aggressive cutaneous malignancies present with less defined features. Any lesion, particularly if new or changing for which a confident diagnosis cannot be made may require review and/or histological assessment,” added Dr Moriarty.

Although much of what we read correctly emphasised caution regarding changes in existing moles, 65 per cent of melanomas presented de novo as a new pigmented lesion at a site of previously normal skin. Moles normally developed from early childhood until 30 to 35 years and any new mole after this should be assessed with caution.

She said the ABCDE criteria succinctly highlighted characteristics of melanoma; Asymmetry, Border irregularity, Colour variation, Diameter >6mm and Evolution.

Naevi with these features should be assessed. The most frequent superficial spreading malignant melanoma often presents with a history of asymmetrical change over weeks to short months, border irregularity and three colours on inspection.

However, she added that this sensitive ABCDE acronym may exclude nodular melanoma for which ‘EFG’ Elevated, Firm and Growing had been proposed.

“These tumours may bleed. Mucosal, acral and subungal melanomas carry a less favourable prognosis than cutaneous lesions and at these sites any new lesion, lesion for which the patient cannot provide a history or lesion meeting ABCDE criteria should be referred.”

Dr Moriarty’s advice on detecting skin cancers follows publication of a survey of 1,000 adults conducted by Core Research on behalf of the Irish Cancer Society during Skin Cancer Awareness Month in May, which found that three in 10 people never checked their skin for signs of cancer.

And the number of people who were ‘not at all worried’ about skin cancer increased to four in 10 among some groups who were actually at higher risk, including males and those aged over 55.

The survey also found that people mostly associated skin cancer signs with moles, with over half of those queried saying they would seek attention within a matter of days if they noticed a worrying sign with a mole.

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