DISCOVERY HEALTH MATTERS. Spot skin cancer, stop skin cancer

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1 DISCOVERY HEALTH MATTERS Spot skin cancer, stop skin cancer Vol

2 Discovery Health Matters Discovery Health Matters is a layman s guide to important, but often misunderstood topics in healthcare. The information contained in this document is for informational purposes only, and should not be used to replace professional medical advice, or be used to diagnose or treat a medical condition. Skin cancer dashboard The skin is the body s largest organ. Even a single sunburn increases your risk of developing melanoma, the deadliest form of skin cancer. 5 or more sunburns double your lifetime risk. More than 90% of the visible changes commonly attributed to skin ageing are caused by the sun. Daily sunscreen use by adults younger than 55 can reduce skin ageing. 90% of skin cancer is caused by the sun s ultraviolet rays. Skin cancer is the most common of all cancers. It is also the easiest to cure, if diagnosed and treated early. The amount of time that you can spend outdoors unprotected without damaging your skin in southern Africa in the middle of summer is 10 minutes! Regular sunscreen use in children can decrease cancer risk by 80%. Source: SA Melanoma Advisory Board, Annals of Internal Medicine June 2013, The Skin Cancer Foundation (US), the Journal of the American Academy of Dermatology, CA: A Cancer Journal for Clinicians, JAMA Dermatology, The Cancer Association of South Africa, Cansa. People who use sunscreen daily show 24% less skin ageing than those who do not use sunscreen daily. The number of people developing melanoma is increasing each year. In South Africa, the number has more than doubled in the past 20 years. Increased melanoma is related to increased sun exposure. South Africa has the second highest incidence of skin cancer in the world after Australia.

3 What is skin cancer? Skin cancer is the uncontrolled growth of abnormal skin cells. It occurs when damage to skin cells DNA, caused by ultraviolet radiation from sunshine, triggers genetic defects. This leads to the skin cells multiplying rapidly and forming malignant tumours. There are three main types of skin cancer: 1. Basal cell carcinoma 2. Squamous cell carcinoma (these are the so-called non-melanoma skin cancers) 3. Melanoma Because each has many different appearances, it is important to know the early warning signs. Look especially for change of any kind, and don t ignore a suspicious-looking spot because it doesn t hurt: Skin cancer can be painless. If you notice one or more of the warning signs, see a doctor right away, preferably a dermatologist, who specialises in diseases of the skin. Causes Skin cancer warning signs: Know your ABCDE Asymmetry: If you draw an imaginary line through a mole and the two sides don t match. Common moles are round and symmetrical. Border: Uneven or poorly defined borders. Common moles are smooth and have even borders. Colour: Having a variety of colours in one spot is another warning sign. A number of different shades of brown, tan or black could appear. Diameter: Larger than 6mm in diameter. Evolving: Any change in size, shape, texture, colour, height or any other characteristic or any new symptoms such as bleeding, itching, or crusting is cause for concern. An open sore that does not heal within three weeks should also be investigated. Skin cancer is caused by ultra violet (UV) radiation from the sun. Southern Africa has amongst the highest UV levels in the world, along with Australia and some parts of South America. Sub-Saharan Africa has a higher UV-concentration because of geographical location, as well as the depletion of the protective ozone layer. The ozone layer absorbs high energy UV-rays, and a 10% depletion in ozone leads to a 20% increase of UV radiation, and a 40% increase in skin cancer, according to the SA Melanoma Advisory Board. The skin never forgets any sunburn (an overdose of UV) causes damage, which accumulates over the years. Most skin damage happens in the first 20 years of our lives. 80% of the total lifetime UV exposure is acquired in childhood.

4 Take care of your skin; take care of your health Preventing skin cancer To enjoy what the sun has to offer without risking your health, follow these simple rules: Stay out of the sun, especially between 10am and 3pm. Do not burn. Avoid sunbeds and tanning booths. Wear protective clothing; wide brimmed hats and UV protective clothes and swimsuits. Wear sunglasses with a UV protection rating of UV400. >Use a broad-spectrum (UVA/UVB) sunscreen with an SPF of 20 or higher every day. SPF 30 is best for those with fairer skins and anyone planning prolonged sun exposure, like at the beach. Apply a two-tablespoon amount of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating. Some of the protective ingredients in all sunblocks degrade after this time. Keep newborns and young children out of the sun completely. Sunscreens should be used on babies over the age of six months. Examine your skin head-to-toe every month: 80% of all melanomas are detected by patients and not doctors. See your dermatologist or physician every year for a professional skin examination. Some high-pressure sunlamps used in tanning salons emit UV radiation in doses as much as 12 times that of the sun. When unprotected skin is overexposed to UVR, DNA is damaged; a tan is the skin s attempt to prevent further damage by creating a wall of darker pigment. Damage that has already occurred can lead to changes (mutations) in skin cell DNA. People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma. Even occasional sunbed use almost triples your chances of developing melanoma. Young people including teenagers are especially sensitive to the UVR emitted from tanning booths. The Cancer Association of South Africa has petitioned to ban the use of sunbeds in South Africa.

5 How sunscreens work SPF, or Sun Protection Factor, measures how long unprotected skin can be exposed to the sun s shortwave, ultraviolet B (UVB), rays before burning, compared with how long it takes to burn without protection. If used correctly, sunscreen with an SPF of 15 would allow you to be in the sun 15 times longer without getting burned than if the product weren t used. Sunscreen with an SPF of 15 effectively filters out about 93% of all incoming UVB rays, while SPF 30 keeps out 97% and SPF 50, 98%. Most of us don t use enough sunblock, which means we do not get enough protection use at least two tablespoon for your body. But high SPF alone is not enough. SPF measures protection against UVB, but not against the sun s long-wave, ultraviolet A (UVA) rays, and new research shows that UVA penetrates the skin more deeply than UVB, possibly causing even more damage. UVA is also the key cause of sun-induced skin ageing (photoageing). The best sun protection products offer broad spectrum or UVA/ UVB protection. Check the label for one or more of these UVA-filtering ingredients: titanium dioxide, zinc oxide, oxybenzone, or stabilised avobenzone. Remember; use sunscreen every day, year-round, in every kind of weather. Here s why: Sunlight reflects off concrete, wet roads, ice, sand and water and snow, intensifying UVR effects by up to 80%. Even on overcast days, 70-80% of UVR travels through clouds, mist and fog. Treatment of skin cancer Skin cancer, when caught early, is nearly always curable. So don t delay if you have any concerns seek medical attention as soon as possible. The removal of the entire mole or a sample of tissue for examination under a microscope is called a biopsy. If possible, it is best to remove moles by an excisional (removing the entire tumour) biopsy, rather than a shave biopsy (removing the top layers of skin). If the biopsy returns a positive diagnosis of skin cancer, you and your doctor will discuss your treatment options. Glossary of skin cancer terms Basal cell carcinoma: The most common type of skin cancer, which often appears as a raised, translucent, pearly nodule, which may crust, ulcerate and sometimes bleed. Basal cell carcinoma often occurs on the face and neck, where the skin is exposed to sunlight. Benign: A tumour that will not spread beyond the tissue of origin. Biopsy: The removal of a sample of tissue for examination under a microscope to check for cancer cells or other abnormalities. Carcinoma: A tumour that arises from epithelial tissue. These are tissues that form the coverings and linings of the body such as the skin or intestine. Chemotherapy: Treatment of cancer with drugs. Dermatologist: A qualified medical specialist who has obtained postgraduate qualifications to specialise in the diagnosis, treatment and prevention of skin disease including skin cancer.

6 Glossary of skin cancer terms Dysplastic naevi: About one out of every ten people has at least one unusual (or atypical) mole that looks different from an ordinary mole. The medical term for these unusual moles is dysplastic naevi. Doctors believe that dysplastic naevi are more likely than ordinary moles to develop into skin cancer. Because of this, moles should be checked regularly by a dermatologist. Immunotherapy: Treatment using different methods to manipulate the body s immune system to address a tumour. Malignant: Refers to a tumour that has the ability to spread to other parts of the body. Melanoma: One of the most serious types types of skin cancer because advanced melanomas have the ability to spread to other parts of the body. This life-threatening disease is curable if detected and effectively treated in the earliest stages. Moles: Growths on the skin. Doctors call moles naevi (one mole is a naevus). These growths occur when cells in the skin, called melanocytes, grow in a cluster with tissue surrounding them. Moles are usually pink, tan, brown, or flesh-coloured. Oncology: The study of tumours. Radiotherapy: Treatment using radiation or x rays. Solar keratosis: An abnormal skin growth which is a pre-cancer that can develop into skin cancer. Squamous cell carcinoma: A type of skin cancer that can take on the form of a persistent scaly red patch that sometimes crusts or bleeds; an open sore that does not heal; or a raised or wart like growth that may bleed. Tumour: An abnormal growth of tissue, which, if near the surface, may produce a lump. Useful skin cancer resources CANSA: The Cancer Association of SA The South African Melanoma Advisory Board Dermatology Society of SA The Skin Cancer Foundation (USA) American Cancer Society American Melanoma Foundation Melanoma International Foundation

7 How Discovery Health Medical Scheme covers skin cancer The removal of a benign skin lesion or biopsy in hospital is evaluated against specific criteria, and paid from your Hospital Benefit once approved. Don t forget to get preauthorisation for any hospital procedures. Contact DiscoveryCare on for preauthorisation and confirmation of how and if they will fund your request. If the procedure is not done in hospital (but rather in your doctor s rooms), the treatment will be covered by your day-to-day benefits, unless your diagnosis forms part of the Prescribed Minimum Benefits, which is a legislated set of conditions for which the Scheme is obliged to cover. For more information, visit www. discovery.co.za/portal/individual/manage-your-condition If your healthcare provider does not send claims directly to Discovery Health Medical Scheme, submit your claims by: Post: Discovery Claims, PO Box , Sandton, 2146 Fax: 0860 FAX CLAIMS ( ) Scan and them to claims@discovery.co.za When you have been diagnosed with a malignant melanoma, your doctor will send your treatment plan to Discovery Health Medical Scheme, and you can register on the DiscoveryCare Oncology Programme for Discovery s Oncology Benefit, which entitles you to cover for cancer treatment. If your biopsy returns a positive diagnosis, the cost of the diagnostic tests will be paid from the Oncology Benefit. You will have cover for a 12 month rolling period of between R and R , depending on your plan choice (excluding KeyCare). After this limit is used up, Discovery Health will continue to pay 80% of the treatment costs. For more information, visit

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