In South Africa, we’re blessed with loads of warm weather and sunshine. But all that sun, if we’re not careful, can be dangerous.

According to the World Health Organisation (WHO), the incidence of skin cancers has been increasing over the past decades. The estimated 10% decrease in ozone levels has led to an additional 304,500 skin cancer cases globally. Let’s dive into what skin cancer is, the risk factors, and what you can do to protect yourself.

Different types of skin cancer

There are two main categories of skin cancer, melanoma and non-melanoma skin cancers (NMSCs), which are made up of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and other rare skin cancers (RSC). Non-melanoma skin cancers are rarely fatal, but surgical treatment is painful and often disfiguring. Melanoma is less common, but if it spreads, it’s the most dangerous and the leading cause of death from skin cancer.  

The National Cancer Registry (NCR) reports that in 2019, 22 712 South Africans were diagnosed with NMSCs, and more than 2 166 were diagnosed with melanoma. Among South African men and women, melanoma is ranked as the 5th and 6^th most prevalent cancers, respectively, and is showing an overall increase in numbers. 

Risk factors for skin cancer

• Fair skin
• Blue, green or hazel eyes
• Light-coloured hair
• Tendency to burn rather than suntan
• History of severe sunburns
• Many moles
• Freckles
• A family history of skin cancer

Common sites and prevention:

A study conducted in South Africa showed that the most common sites for cutaneous melanoma are the lower limbs, the trunk and the upper limbs (Tod B et al., 2019). Non-melanoma skin cancer is often found in the sun-exposed areas of the body, so minimise your time spent in direct sunlight or wear a hat or umbrella if outside. Sunscreen should be applied on all body sites exposed to the sun, including the scalp, ears, and neck.

Screening and diagnosis

The main screening methods are examination of the skin to detect any suspicious lesions or growths, such as moles, and removal (biopsy) of the growth for laboratory testing.

The ABCDE method is often used when looking at suspicious skin growths and can help determine whether you should seek medical attention. As always, if you’re unsure, seek medical attention.

The most common types of biopsy are:

• Shave biopsy: The top layer of the lesion is shaved off for testing
• Punch biopsy: Removal of a deeper layer of skin but not the whole growth
• Excisional biopsy: Removal of the entire growth. This can sometimes be sufficient to treat skin cancer as well.

Most skin cancers remain localised and do not spread to distant organs, but melanoma is more prone to spread. This is why your doctor may send you for medical imaging procedures like an x-ray, CT scan, or MRI to determine whether cancer cells have spread to your internal organs and bones.

Treating Skin Cancer

Treatment will depend mainly on the stage and location of the skin cancer. Factors such as the stage of the cancer, the risk of the cancer returning after treatment, if the cancer cells have certain genetic changes, and your overall health are essential to determining treatment options. Common treatment options include:

• Surgery: this is often used in the early stages of skin cancer if the tumour has not spread to other areas of the body.
• Radiotherapy (radiation): this helps shrink the tumour and may also alleviate the symptoms of the disease in the advanced setting.
• Chemotherapy: helps to shrink the tumour and can be used during treatment and maintenance therapy if a patient has responded well.
• Targeted therapy: If a biopsy confirms that the cancer is caused by a genetic mutation for which there is targeted treatment, this therapy can work especially on cancer cells to stop their growth and survival.
• Immunotherapy: works by using the body’s own immune system to fight the cancer. This is based on the information from the biopsy and is not appropriate for all patients.

Skin cancer treatment often requires a multidisciplinary team for the best outcomes, including a dermatologist, surgeon, oncologist, psychologist, and allied workers like social workers, physiotherapists, and dieticians.

What do medical aid schemes cover?Nearly 75% of all melanoma cases originate in the private sector. This may be a result of early intervention and detection.

Most skin cancers are prescribed minimum benefit diagnoses (PMB), meaning their diagnosis, treatment and care are covered by medical schemes. Skin cancers that are not covered as PMB are metastatic cancers like malignant melanoma. For this type of cancer, if supportive care and palliation are needed, they could be considered a PMB.

If you need more info on how we cover skin cancers, reach out to our Oncology Disease Management team:

Call: 0860 100 572

Email: cancerinfo@fedhealth.co.za

Key points/takeaways:

Skin Cancer can affect all races.

Check your skin regularly for suspicious growths.

Always wear a hat and sunblock when exposed to the sun.

Early detection can save lives and result in less invasive treatment.

References

• Skin cancer statistics: World cancer research fund international. WCRF International. (2022, December 5). https://www.wcrf.org/cancer-trends/skin-cancer-statistics/
• gov.za. (n.d.). https://www.statssa.gov.za/?p=16217
• @CANSA, D. (2023, February 22). Melanoma – cansa – the cancer association of south africa. CANSA. https://cansa.org.za/melanoma/#:~:text=The%20National%20Cancer%20Registry%20(NCR,166%20were%20diagnosed%20with%20melanoma.
• Ndlovu, B., Kellett, P., Kuonza , L., Sengayi , M., & Singh, E. (2019). HISTOLOGICAL SUBTYPES, ANATOMICAL SITES, AND  INCIDENCE TRENDS OF NON-MELANOMA SKIN CANCERS IN  SOUTH AFRICA, 1993-2014, 17(3), 155–167.
• Tod, B. M., Kellett, P. E., Singh, E., Visser, W. I., Lombard, C. J., & Wright, C. Y. (2019). The incidence of melanoma in South Africa: An exploratory analysis of National Cancer Registry data from 2005 to 2013 with a specific focus on melanoma in black Africans. South African Medical Journal, 109(4), 246. https://doi.org/10.7196/samj.2019.v109i4.13565
• World Health Organization. (n.d.). Radiation: Ultraviolet (UV) radiation and skin cancer. World Health Organization. https://www.who.int/news-room/questions-and-answers/item/radiation-ultraviolet-(uv)-radiation-and-skin-cancer?gclid=EAIaIQobChMI8r339KiegwMVpo1QBh1bvAAVEAAYASAAEgIxJvD_BwE#
• https://www.cancer.org/cancer/types/melanoma-skin-cancer/treating.html