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Facts about skin cancer
- Skin cancers are divided into two main types: melanoma and non-melanoma
- Non-melanoma skin cancer is the most common cancer in Ireland, with melanoma being the fourth most common
- There are over 10,069 non-melanoma skin cancers and over 1,289 melanomas diagnosed every year
- More men than women are diagnosed with non-melanoma skin cancer
- Being SunSmart is vital to preventing skin cancer
For information on melanoma skin cancer, visit our melanoma page.
What is the skin?
The skin is an organ, like your heart and kidneys. The skin is the biggest organ in the body and does several important jobs such as acting as a barrier and protecting everything inside your body.
The skin is made up of two main layers: the epidermis on the outside and the dermis underneath. New cells are made in the deep layers of the epidermis and are pushed towards the surface. The epidermis is mainly made up of flat, scale-like cells called squamous cells. These cells make a substance called keratin, a tough, waxy substance that helps make the skin strong enough to protect the body. At the base of the epidermis are cells called melanocytes which make a pigment called melanin. This pigment gives your skin its colour and protects it from ultraviolet (UV) rays in sunlight. Under the squamous cells are round cells called basal cells. These cells constantly divide to form new keratin-producing cells to replace the ones that wear off the skin’s surface.
Different types of skin cancer
There are different types of skin cancer. The type of skin cancer depends on the skin cells that are affected.
- If the cells affected are the basal or squamous cells, it is called non-melanoma skin cancer (NMSC)
- If the melanocytes are affected, it is called melanoma skin cancer. Read about melanoma here.
Skin cancer (non-melanoma)
Non-melanoma skin cancer is the most common cancer in Ireland. There are several different types of non-melanoma skin cancer. The most common types are basal cell cancer (BCC) and squamous cell cancer (SCC). Sometimes these cancers are called ’carcinomas.’
Basal cell cancer (BCC)
The most common type of skin cancer, this develops from basal cells which are in the deepest layer of the epidermis and around the hair follicle. It develops mostly in areas of skin exposed to the sun, including parts of the face such as the nose, forehead and cheeks. It can also develop on your back, particularly in men, or lower legs. It is most often diagnosed in people of middle or old age.
Basal cell cancer may start as a small lump that gets bigger slowly over months and years. The edges usually have a shiny or pearly look and the middle is usually sunken. Sometimes the middle becomes crusty or an ulcer develops. It usually will not hurt unless knocked but it can be itchy and may bleed if scratched.
It is very rare for basal cell skin cancer to spread to another part of the body to form a secondary cancer. It is possible to have more than one basal cell cancer at any one time. Having had one increases your risk of getting another.
Squamous cell cancer (SCC)
This cancer begins in cells called keratinocytes, which are the cells nearest the surface of your skin, lying just above the basal cells. Squamous cell cancer most often develops in areas that have been exposed to the sun, including parts of the head, neck, and on the back of your hands and forearms. Rarely, it can develop around your vulva or anus. It can also develop in scars, areas of skin that have been burnt in the past or areas of skin that have been ulcerated for a long time.
Squamous cell skin cancer can look like a crusty, scaly ulcer. Or it may be bumpy and hard and develop into an ulcer. This type of cancer is generally faster growing than basal cell cancer though it does not usually spread.
Risks and causes of skin cancer
- Sunbeds- Using sunbeds greatly increases your risk
- Skin types- People who have fair skin; lots of moles or freckles; or red or fair hair have a greater risk
- Age- Non-melanoma skin cancers develop very slowly. As you get older you have more time to build up sun damage. However, young people can get skin cancer too
- Having had skin cancer before- If you have had a non-melanoma skin cancer, you have about a 10 times higher risk of a second non melanoma skin cancer
- Other skin conditions-People with certain skin conditions or skin treatments can be more likely to develop skin cancer. These include: psoriasis, scarring; solar keratosis; and atopic dermatitis
- Family history- If someone in your family has had any type of skin cancer, this increases your risk
- Sun exposure- Most skin cancers are caused by sun exposure, either long-term or short periods of intense sun exposure and burning, perhaps while on holiday. Remember even on a cloudy day, UV rays can be strong enough to cause skin damage that can lead to skin cancer
UV – What you should know
UV or Ultraviolet Radiation is a form of electromagnetic radiation that comes from the sun and man-made sources like tanning beds and welding torches. This source of radiation is incredibly harmful to unprotected skin and can greatly increase a person's risk of developing skin cancer.
The two main types of UV that affect the skin are UVA waves and UVB. These types of radiation are emitted from the sun and can cause long term skin damage such as pigmentation and wrinkling if the skin is left unprotected. These types of rays are also known the damage the skins DNA structure, drastically increasing a person's risk of developing skin cancer later in life. UV rays are responsible for sunburns and as we know, even one bad sunburn can damage your skin and increase in your risk of developing skin cancer in the future.
The UV Index:
The Global Solar UV index is a scale developed by the World Health Organisation to help measure the UV radiation level on the surface of the Earth, and give an indication of the potential for skin damage on any particular day.
The UV index helps us to determine how high the risk is each day so we can plan ahead to protect our skin from damage throughout the day.
The scale is based on 1 to 11+ number scale and as the UV rating climbs, so does your risk.
How do I prevent skin cancer?
Nearly all cases of skin cancer can be prevented by being SunSmart. It just takes a few simple steps:
Always wear sunscreen
Apply sunscreen 20-30 minutes before going out into the sun. Apply thickly and evenly every 2 hours no matter how high the SPF is. Apply the equivalent of a shot glass full of sunscreen to each limb and to your body and about half this much to your face. Always reapply after swimming or sweating. Remember no sunscreen gives 100% protection from the sun.
Sunscreen with UVA protection
Choose a sunscreen that has good protection against UVA and UVB rays as well as a high SPF. This is because both UVB and UVA rays can cause skin cancer. In Ireland, the level of UVA protection might be shown in one of two ways
- Star rating
- A symbol with the letters UVA inside a circle
Avoid the sun between 11am and 3pm
This is when the sun's rays are strongest. This applies all year round, not just in summer. It is important to remember that the sun's rays are present even on a cloudy day.
Wear protective clothing
Clothing should be dark and tightly woven and cover your arms and legs. Wear a broad-brimmed hat that provides lots of shade. Remember to protect your eyes too by wearing sunglasses. Choose a wraparound pair that give UV protection. Check the sunglass tags to ensure that they give good protection. You can look out for these quality marks:
- European Standard EN1836
- British Standard BS 27241987
Never, ever use sunbeds
Sunbeds are not a safe alternative to tanning outdoors. Some sunbeds use UV rays that are 10 to 15 times more intense than those that come from the midday sun. Using a sunbed, even just once, increases your risk of melanoma skin cancer by 20%.
What are the signs of skin cancer?
Skin cancers do not all look the same but it’s important to keep an eye on your moles and freckles. Check them regularly to see if any of them have changed. Use the ABCDE checklist to look for any of the following signs:
Asymmetry
If you draw a line through a melanoma, the two sides will not match
Border
The border of an early melanoma tends to be uneven. The edges may be scalloped or notched.
Colour
Most healthy moles are all one colour. A mole with a number of different shades of brown, black or tan is a warning sign. Melanomas may also be blue, red or some other colour
Diameter
Melanomas are usually larger in size than the rubber at the top of a pencil (¼ inch or 6mm)
Evolving
Any change in shape, colour, size, elevation (height), or any other trait, or a new symptom like bleeding, itching or crusting is a warning sign. If you see any of the above signs in your moles, see your GP. Remember that skin cancer can be deadly but it’s very treatable if it’s caught early.
What will happen if I notice that one of my moles has changed?
If you notice any of these changes, you should see your GP without delay. Your GP will look at the mole and ask you what you have noticed about it. He or she will examine your skin and if they think that your mole looks as if it might be melanoma, they will arrange for you to see a skin specialist, called a dermatologist. You should be seen within 2 weeks.
When you have your appointment with the dermatologist, they will examine your skin again. He or she may ask you about your family history of melanoma as well as other questions about your health and especially your skin. The dermatologist might use two different tests to establish if you have melanoma:
- A skin exam, which is also called a dermascopy
- An excision biopsy, where the doctor will take a sample of cells from the mole to look at under a microscope
Once the dermatologist knows if your mole has cancerous cells in it or not, he or she can talk to you about the next steps. Most melanomas in Ireland are found at an early stage when they are treatable.
Where are you most likely to get a melanoma?
Men are most likely to develop a melanoma on the chest or back. Women are most likely to get it on the legs.
Should I stay out of the sun?
Some sunlight is good for you - it boosts vitamin D - but sun-bathing should be kept to a minimum. Most dermatologists say that you can get enough Vitamin D from 30 minutes in the sun so there is no need to lie on a beach or pool when on holiday.
Think about other places you might be exposed to the sun:
- driving (80% of UV gets through the average car window)
- walking
- playing sport
- gardening
- at work, depending on your job
Make sure you protect your skin while you are at these places by covering up and by wearing sunscreen.
What are the risk factors for skin cancer?
Besides the way you treat your skin in the sun, using a sun bed or tanning devices also increase your risk. Sun beds can be even worse for your skin than sitting out in the sun. Using a sun bed just once can increase your risk of melanoma, the most deadly type of skin cancer, by 20%.
Your family history also affects your risk of developing skin cancer. If someone in your family has had melanoma, it doubles your risk of developing the disease in people with a family history of the same disease.
Your skin and hair type also play a role.
- The risk of melanoma is 57% higher in people with blue eyes than with brown eyes, for example.
- It is 200% higher in red/red-blonde hair, compared with dark-haired people.
As a rule, the more freckles/moles you have the lighter your skin type and the more you should stay out of the sun.
How do I know what sunscreen to buy?
Everyone should use sunscreen every day, even when you are in Ireland and it is cloudy as the sun’s damaging UV rays are still getting through the clouds. Make sure that you are using a sunscreen that blocks both ultraviolet A (UVA) and ultraviolet B (UVB) radiation. It is also important to use a sunscreen with a high SPF- at least SPF 30. Look for bottles that have either a five star rating symbol on them or else a symbol with the letters UVA inside a circle.
Reapply every two hours and use waterproof sunscreen if in the water.
What’s the treatment?
Most skin cancers in Ireland are treated with surgery. The cancerous mole and the skin around it is removed. While for many people this means that they can then move on with their lives, it can be a traumatic experience, may leave them with a scar and is also costly for the health service so it would be better for everyone in Ireland if we were all more SunSmart and looked after our skin in the sun so as to avoid developing skin cancer in the first place.
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