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Understanding Skin Cancer

In this article:

Incidence and Mortality Statistics
Common Symptoms
Causes of the Disease
Risk Factors
Diagnostic Methods
Treatment Methods
Personal Care
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Hong Kong Skin Cancer Incidence and Mortality Statistics

Skin cancer is a common cancer in Hong Kong, with non-melanoma skin cancers accounting for 90% of all skin cancers. In 2022, there were 1 006 new cases of non-melanoma skin cancer, accounting for 2.8% of all new cancer cases in Hong Kong. The crude annual incidence rate of non-melanoma skin cancer per 100 000 Hong Kong population was 14. Although the incidence rate in Hong Kong is much lower than that in the West, the number of local new cases due to non-melanoma skin cancer has significantly increased by 12% from 2012 to 2022.

While the incidence of skin cancer is high, its mortality rate is not that high. Since skin is the most visible organ, it is easy for us to detect any abnormalities on the skin. Hence, skin cancer can be treated early. If any unusual changes in skin is noticed, please visit a doctor as soon as possible. Early detection increases the chance of successful treatment.

Physical Reactions

What Are The Common Symptoms Of Skin Cancer?

Non-melanoma and melanoma skin cancers present different symptoms. For non-melanoma skin cancer, it can generally be divided into two types. The first type is called basal cell carcinoma, accounting for approximately 70% of all skin cancer cases. It typically appears on the head, neck, or upper body as small, smooth, pearl-like patches with shiny surfaces or as raised red lumps that may occasionally bleed. Flat, scaly red crusts may also develop. Additionally, patients may experience itching in the affected area. This type of skin cancer usually grows slowly and rarely spreads to other parts of the body. If detected early, it is generally treatable.

The second type of non-melanoma skin cancer is called squamous cell carcinoma, accounting for approximately 30% of all skin cancer cases. Patients may develop raised, scaly, hard lumps on the face, neck, forearms, backs of hands, lower legs and other areas, which may occasionally bleed. Unless the symptoms appear on the ears or lips, the cancer cells grow slowly and are typically not difficult to treat.

Regarding melanoma skin cancer, patients typically develop new dark spots on their skin, or existing moles/freckles may gradually enlarge, change shape, or alter colour over several weeks to months. Unlike regular pigmented spots, melanomas exhibit irregular borders, uneven surfaces, and variable colouration, potentially appearing brown, black, white, blue, red, or grey.

Some patients may develop nodular melanoma, characterised by raised, dome-shaped lesions in black, red, or pink hues. This aggressive variant demonstrates rapid growth and high metastatic potential, necessitating prompt surgical excision.

Prolonged Sun Exposure

What Are The Causes Of Skin Cancer?

Skin cancer is typically associated with long-term ultraviolet (UV) radiation exposure. While the skin requires UV absorption to produce vitamin D for bone development, excessive sun exposure during peak hours can cause visible damage (including redness, burning pain, and subsequent peeling). More critically, it may induce genetic mutations in skin cells by damaging their DNA. These mutations can trigger uncontrolled cellular growth, ultimately leading to skin cancer development.

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What Are The High-Risk Factors For Skin Cancer?

While no one should underestimate the threat of skin cancer, individuals with the following characteristics generally face higher risks:

  • Having numerous moles on the body
  • Family history of melanoma in close relatives
  • History of prolonged sun exposure
  • Fair skin that burns easily but doesn’t tan
  • Red or blonde hair
  • Blue or green eye colour
  • Weakened immune system (e.g. Organ transplant recipients or HIV-positive individuals)
  • Occupational exposure to arsenic [Note 1], tar, coal oil, and other petroleum-based chemicals
  • Previous history of skin cancer or radiation therapy

Avoiding prolonged sun exposure is the most effective way to prevent skin cancer. At the same time, regular self-examination is another important preventive measure – begin by photographing your entire skin as a baseline, then periodically re-examine and compare with the initial photos, paying special attention to often-missed areas like the soles of feet, between toes, and toenails; if you notice any new skin spots that look different from others, existing spots that change in size/shape/color, or wounds that won’t heal, photograph them with dates, and if they persist beyond one month, seek medical attention immediately.

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Suspicious Skin Lesions? What Are The Diagnostic Methods For Skin Cancer?

The diagnostic approach for skin cancer varies depending on the type. Melanoma, characterised by its darker pigmentation and typical growth in the epidermis (the outermost skin layer), can often be preliminarily identified through visual examination. However, a biopsy is necessary when visual assessment cannot definitively distinguish between benign and malignant cells.

Since most skin cancers appear on the skin’s surface, grow relatively slowly, and rarely spread to other parts of the body, further testing for cancer staging is usually unnecessary; however, if a previously treated skin cancer recurs, indicating a higher likelihood of metastasis, the doctor will physically examine nearby lymph nodes for swelling and may perform additional biopsies if necessary.

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Latest Treatment Trends for Skin Cancer

The treatment approach depends on the type, location, size, and extent of spread of the cancerous growth. For example, non-melanoma skin cancers are typically curable, with surgical removal being the most common method, sometimes combined with radiation therapy to enhance effectiveness.

  • Surgery
    • If the biopsy didn’t completely remove the cancerous tissue or if the cancer has spread from the epidermis deeper into the body, additional surgical removal of surrounding tissue may be necessary. The doctor will determine whether local or general anaesthesia is required based on the size of the affected area. Small lesions may only need local anaesthesia, allowing patients to go home the same day to care for the wound themselves. Larger areas may require general anaesthesia and possible skin grafting to repair the surgical site.
  • Mohs Micrographic surgery
    • Also known as ” Margin-controlled Excision”, this minimally invasive procedure under local anaesthesia is primarily used for large skin cancers, recurrent basal cell carcinomas, or cancers showing signs of spread. The surgeon removes tissue layer by layer, examining each under a microscope until no cancer cells remain at the margins. The larger wound often requires skin grafting from another body part for proper healing.
  • Cryotherapy
    • Major for small, superficial cancers, this treatment uses liquid nitrogen or carbon dioxide to freeze and destroy cancerous tissue. Patients may feel a stinging sensation during the procedure and pain for 1-2 minutes afterwards, with possible blistering. The area typically scabs over and heals within two weeks, though scarring may occur. Multiple sessions might be needed for complete removal.
  • Curettage and Electrodessication
    • Mainly for superficial cancers like basal cell carcinoma, this involves local anaesthesia, scraping out the tumour and using electric current to stop bleeding and destroy remaining cancer cells. Healing takes several weeks, with varying degrees of scarring.
  • Laser Surgery
    • Laser beams instead of scalpels are used during tissue removal to minimise bleeding.
  • Photodynamic Therapy
    • For cancers attached to bone structures, this involves applying or injecting a light-activated drug to the area, then using laser light to activate it and attack cancer cells.
  • Radiation Therapy
    • For non-melanoma skin cancers, especially in delicate areas like the face, eyes, nose or forehead, where surgery is complex, or to eliminate residual cancer cells after surgery. High-energy X-rays destroy cancer cells and prevent their division.
  • Topical Chemotherapy
    • Unlike systemic chemotherapy, skin cancer chemotherapy uses medicated creams applied directly to the affected area. Patients can self-administer at home once or twice daily for several weeks. Treated areas must be protected from sunlight; treatment should stop if pain or discharge occurs.
  • Topical Immunotherapy
    • For small superficial basal cell carcinomas, Imiquimod cream stimulates the immune system to fight cancer cells. Suitable for areas where surgery is complex or for multiple lesions. Patients apply daily for several weeks, with possible redness, pain, crusting and peeling during treatment, but minimal permanent scarring.
  • Retinoids
    • A vitamin A-related medication is occasionally used to treat squamous cell carcinomas.

Healthy Living

Skin Care During Skin Cancer Treatment: How to Protect Sensitive Skin?

After surgical removal of basal cell carcinoma or early-stage squamous cell carcinoma, patients should attend regular follow-up appointments while self-examining their skin and practising proper skincare, particularly by avoiding sun exposure and skin trauma. However, since cumulative sun damage to the skin is irreversible, survivors face an elevated risk of developing new cancerous lesions either at the original site or elsewhere on the body. Any observed changes in skin condition warrant immediate medical consultation.

Further Understanding

Recommended Reading

Note 1: Arsenic is commonly used in industries such as semiconductor manufacturing and harms human health.

Sources:

Centre for Health Protection

Cancer Foundation

Hong Kong Anti-Cancer Society

Mayo Clinic

Cancer Online Resource Hub



▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.

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