Brigitte
This is a West Wimmera Health Service podcast.
Presented by me Brigitte Muir.
One of the most successful health campaigns in Australia was launched by the Cancer Council in 1981. Remember, Sid the seagull, sitting bare chested on a tractor at the start of the video clip. He sang to us the three easy ways to protect against skin cancer.
*Portion of song Cancer Council song*
Slip on a shirt, slop on sunscreen and slap on a hat.
*Portion of song Cancer Council song*
The campaign certainly made us Aussie’s, more aware of the importance of protecting our skin from the sun. But why is it, that 80% of newly diagnosed cancers, are still skin cancers?
*Portion of song Cancer Council song*
I asked Dr. David Lester, a Horsham GP, specialising in skin cancer more about it.
Dr. David Lester
Basal cell cancer makes up the vast majority of skin cancers. Australia has an extraordinary incidence of, of skin cancer full stop, but particularly that one. But in Australia incidence of skin cancer leads the world incidence, really it isn't going down, it's going up really as we're aging.
Brigitte
Is it really?
Dr. David Lester
Yeah, a little bit, the demographics are a little bit different when it comes to melanoma. Where melanoma and rates in young people are dropping, but as the aging population, as baby boomers get older… there's so many aspects of their health get complicated so does their skin.
Brigitte
Okay, right. And of course we do have a lot of sun in this country, the sunburnt country, and the people who are listening to us, the farmers spend a lot of time outside in the sun. What would you recommend people to do …to make sure that they don't end up… with deadly skin cancer.
Dr. David Lester
The most important thing is …to protect skin everywhere you can, in the way that you find the least disagreeable. A lot of farmers I talk to, push back pretty strongly against sunscreen, because of dust and perspiration. But if you can find a way of… just lessening your exposure, your risk will drop. And one of the things I find is particularly problematic, is that a lot of farmers will wait until summer… to …take protective… protection and that's really a bit too late. We know that one third of the dose it takes to burn your skin, or damage DNA in the skin. So, all those minor exposures that you get the don't burn your skin, are still doing some damage. So, a lesson in trivial exposures helps, so SunSmart’s advice is make a protective effort in some form or rather, when the UV is gonna be three or greater.
Brigitte
I used to be a mountaineer and we always… used to wear long sleeves and a hat of course, and even a mask to diminish the, the exposure to the sun, which of course at high altitude is pretty *chuckles* nasty.
Dr. David Lester
Exactly right. So in an ideal world, farmers would be taking precautions every day of the year. That’s tough when it's freezing, but it helps and there's some fantastic fabrics now that you don't need much sunscreen if any sunscreen.
The farmers tan is a classic thing, as I'm sure you've seen, shorts, short sleeve shirt with a lot of forearm exposure, leg exposure. And so those sites… are particularly dangerous. We don’t see much melanoma on the hand which is interesting, but we've seen everywhere else pretty much
Brigitte
And I've seen a farmer… a very old farmer, once without a nose.
Dr. David Lester
Yeah, it's it's the grimm thing
Brigitte
Yes
Dr. David Lester
And when noses get cancer, it's often basal cell cancer and they can be very aggressive. So, I think… one of the things that is very important is that whatever is happening on your skin, it gets diagnosed and put into the right pigeonhole. So, is it a basal cell cancer? Is it some other type of cancer? Ah…Is it a potentially life endangering type of cancer? But your right to lose a nose, we see a lot of cancers on noses and ears. Baseball caps… have made discussing this point with farmers almost every consultation, because baseball caps were pretty hopeless form of protecting skin. Wearing a proper hat has merit, I’m somewhat mindful when I say that, that a lot of the old farmers who have worn Akubra’s their whole life still have very damaged facial skin, and that's really just ‘cause there's so much reflected UV off the environment, and they just get… these huge exposures, six, eight, ten hours a day.
Brigitte
At the same time you've got to get your D3 into your body which means a little bit of sun exposure, but not too much, it's a balancing act isn't it?
Dr. David Lester
Yeah…that's right. And, and how much sun do you need? Very little to get your D, the guidelines are along the lines of… five to ten minutes, face…
Brigitte
Is that all?
Dr. David Lester
Face and forearms, in the middle of the day. You only get vitamin D from UVB spectrum light. So, if you go for a walk early in the morning… and think I'm getting a bit of exposure, you're not really getting vitamin D generation, but you need these very small exposures. And actually, the more exposure you get, you actually start to down regulate your vitamin D generation. So, more exposure, doesn't produce more vitamin D. But really, it's a trip to the clothesline. One of the things we, we know as a risk factor when you shade skin, and this has been proven in study in Queensland, but when you shade skin, your risk of dropping vitamin D goes up. So, I think if you're very effective at protecting your skin, we know that this is a potential problem, and from time to time you need to measure it.
Brigitte
Okay… right… I guess that's why we have blood tests
Dr. David Lester
From time to time, I think that's… that's really worthwhile doing if you think I'm very careful and protecting my skin… measuring that's a good idea.
Brigitte
We're talking about tests here. How often, or when do you recommend, that farmers and people in general, should have their skin checked for potential skin cancers?
Dr. David Lester
There's not …clear recommendations from expert bodies …as to how to answer that question. We don't have this… the data, that there is about breast screening, and pap smearing, and all of that type of screening. I think if you're …if your burning history has been fairly bad, and you've had some severe sunburns, or you've got a fairly high mole count, we know your risk of melanoma is significantly elevated. There'll be people whose more count… average more count stops at about 20. So, if you have more moles than that, your of interest in getting your skin looked at. If you've had a …high occupational exposure, your roadside worker, farmer, tradesperson you'd consider getting your skin checked, even in your mid 30s. Melanoma predominantly, in skin cancer predominately, effects older Australians. But melanoma is, is the… most common cancer in 29-to-45-year old’s, so they don’t get much types of cancer full stop, but it does affect them, this type of cancer. I've seen basal cell cancer… on a 23-year-old, so you, you can be quite young. So, I think if, if your exposures pretty high, you're a bit of a moley person, had some bad burnings, those patients should consider and people have a family history of melanoma, so, if you've had a parent with a melanoma, of have a sibling with melanoma, your risk is roughly double the background risk, so, you'd consider it for those people. Once you've had a skin cancer, the convention is that, we'll look at once a year.
The main thing I, I think is we know that, so melanoma for instance, patients find about half their melanomas and doctors find the other half. And so, one of the, one of the useful things about seeing, a skin cancer practitioner, is that we would strip you off you get down to underpants, if you're a female we give you a gown to put on just with your bra and underpants. So, we know that getting you down to a significant level of undress, helps you find stuff. Where if someone comes in for face check, I, I almost always look at their back as well, just out of concern that we're missing something on the back, and pretty much every doctor working in my field, finds stuff on backs the patient wasn't aware of.
Brigitte
I look at the cancer.org,au website, and stated that often …the skin cancers are in places which are not exposed to the sun's, …you know between toes or …in places where the sun never goes.
Dr. David Lester
That's very true, they can really occur on any aspect of your skin. But your skin, that’s had the most sun is most at risk. So, for women that's below the knee, mens traditionally been the back.
We see an enormous number of cancers on the head and neck, and that's …to get a cancer on your head and neck is …confronting its… potentially disfiguring… they're more dangerous.
Brigitte
Well, why are they more dangerous, cause they're closer to your brain?
Dr. David Lester
That's a great question. We…
Brigitte
Arteries, veins…?
Dr. David Lester
Well… we know they metastasize more easily. So, if you were to get a squamous carcinoma which has a travel potential on your forearm, they just don't seem to move nearly as quickly as, as if they're on your head. The squamous carcinomas, are the ones that farmers… quite frequently get and that's, that's correlated with a high lifetime exposure, whereas melanoma has the biggest risk factor of being …infrequent bad burns. Squamous carcinoma goes through that higher lifetime exposure, and they just frequently on the head and neck.
Brigitte
If I want to come and see you do I need to get a referral from my GP?
Dr. David Lester
No the, the doctors that work at Australian Skin Face Body, are predominantly, come from general practice backgrounds. And we've trained in skin cancer medicine and surgery. So, to see me you don’t need a referral, to see Mr. Holton, to see a GP, that can be your own GP. If I see something on you, which is too severe and complicated for my level of skill, I would write a referral, so, no you don't need one.
Brigitte
And it's also very important to have that service available in the Wimmera, which is really… a long way from the big centres, where you usually get this kind of service.
Dr. David Lester
Yes, well I've…I’ve been working for Australian Skin Face Body in Ballarat and Warrnambool and a little bit in Geelong, and certainly my …detection of skin cancer is, is considerably greater in the Wimmera, than it was in Warrnambool and Ballarat and it's all… to do… the jobs, pretty much all rural trades, and it's hot as you know, so people are exposed. So yeah, there's, there’s more cancer here than further south.
Brigitte
If you spot something that needs further attention, what happens then?
Dr. David Lester
If it's, clearly …looks suspicious, we will arrange to biopsy it. If it, if it clearly looks like a skin cancer… we can often avoid biopsying it and just cut the thing out in toto and we arrange a time to do it. We will try and avoid procedures where we don't really have to do them, some spots are just a little bit, bending of the rules, where they're just minimally suspicious, but we don't want to just dismiss it for a year. And I'll ask you to come back, I’ll photograph it using our magnification system and rephotograph it three months and compare the two images.
Brigitte
Okay. And then if it changes, you can take measures then.
Dr. David Lester
That's right. That's right. But I think the suspicious things are.. we can biopsy on the spot, or bring you back to biopsy. When things are clearly cancerous…we try to avoid giving you unnecessary procedures.
Brigitte
If I've got a little cancer on my finger, you're not going to remove it straight away. I'll have to make another appointment and come back to do that.
Dr. David Lester
That's not necessarily true, for those patients who …have travelled a significant distance. So, if you've come from Edenhope or Hopetoun, or somewhere, you think ‘I've come all this way, do I really have to come back for a biopsy’, we will try and biopsy on the day, so that you get an answer pretty quickly. And your next step can be planned and we… I sometimes have pictures of things sent to the practice, and I'll occasionally be able to give you some guidance via email, do I need to see you? how quickly do I need to see you? So, we're open to receiving pictures. We can't make clear diagnosis just from pictures, but we can get an idea of planning time that you might need. We use Melbourne pathology which picks up a couple of times a week from here. Melbourne pathology has a very expert team in particular skin diagnosis, so you can be confident you get a, highly expert pathology service.
Brigitte
We are in good hands here in the Wimmera now, and all we need to do is to make an appointment and get that skin checked.
Dr. David Lester
Just, perhaps, to mention a couple things about spotting dangerous lesions. Most melanomas don't happen in moles they’ll, they'll just happen straight away in a normal patch of skin. And by that I mean about 75% of melanomas really, just emerge in non-pigmented skin. The thing that I encourage patients to look for, when they're just doing their own surveillance, is looking for the new odd lesion. So, we talk about the ugly duckling, the bad apple, so you're really trying to spot something on your skin which just looks out of place. So, if you see a, a spot you think, well, that's new, that's of interest, if it's a spot, particularly if it's got poor symmetry, and you think I just don't think it looks like the other things, that's of great interest. It doesn't mean it's melanoma, it just means it's of great interest. So, being on the lookout for the new strange thing, and then by strange generally they're often too coloured and, and your seeing lopsided lesion, where you think gee, I seem to be seeing a second thing happening in this spot. The other thing I encourage patients to do, particularly if they have a partner, is to have their partner look at their back from time to time because it's clearly your blind spot. They may well spot something on you that you may just completely unaware of. So, you can do a lot of surveillance yourself, where you're paying attention to what's happening on the front of your body. Hopefully there's somebody that can look at the back of your body, and you're particularly looking for the new thing. But, but a new odd thing.
Brigitte
That was Dr. David Lester skin cancer specialist in Horsham.
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Transcribed by https://otter.ai edited by WWHS Health Promotion