what do we need to know about skin cancer and how do you recognize it?

The sun has already shone, the terrace and the beach beckon and yes, there is already the first article about skin cancer. What else do we need to know about that? A lot, because average Almost 67,000 people are diagnosed with skin cancer every year, about one-tenth of whom have melanoma, the most aggressive form of skin cancer. Usually the disease can be cured well, but a melanoma can have a bad end if it has metastasized. In 2020, nearly 800 people died from this.

A major cause of skin cancer is well known: sunlight, or rather the invisible ultraviolet part, can damage the DNA in our skin cells. This happens to us millions of times a day, explains dermatologist Klara Mosterd of Maastricht UMC. ‘Our body’s DNA repair mechanisms can repair most damage. It only works if certain repair genes are destroyed.’

The more often this happens, the greater the chance that the DNA will change permanently. In this way, the skin cells become disrupted and they can proliferate.

Children

Sunburn is harmful at any age, but even more so for children than for adults. ‘Adults have a greater risk of skin cancer if they were often burned as a child,’ says Remco van Doorn, dermatologist at the LUMC.

It is not entirely clear why, but it is clear that baking in the sun is bad. The fact that avoiding the sun can lead to a lack of vitamin D is a misconception that he likes to get rid of. ‘We also absorb vitamin D from foods, such as fish, and short exposure to sunlight is sufficient for the production of vitamin D in the skin.’

aging

The number of people with skin cancer has approximately quadrupled between 1989 and 2018† This is partly due to the aging population: the chance that cells derail due to lifelong UV damage is simply greater in older people. Another reason is that holidaymakers are increasingly seeking sunny places. Especially unprotected light skins can’t handle it well.

In the Netherlands, the mortality from melanoma is more than twice as high as in Mediterranean countries such as Greece and Spain. ‘Dark skin contains more pigment (melanin), which can absorb more UV radiation. As a result, the DNA in the cell nucleus is less likely to be damaged,’ explains Van Doorn. ‘For that reason, people with tinted skin are less likely to suffer from skin cancer.’

Of the many types of skin cancer, three types predominate: basal cell carcinoma, squamous cell carcinoma, and melanoma. The first two are the most common, grow slowly and rarely lead to metastasis. Melanoma is rarer (1 or 2 percent of the Dutch population develops melanoma), but is more often accompanied by metastases to internal organs.

It is therefore important to treat a tumor at an early stage. Much has changed in this area in recent years, especially for melanoma, says Mosterd. ‘Ten years ago there was nothing against metastatic melanoma. People who had that were given up. There are now effective immune therapies and targeted therapy that intervenes on the mutated DNA of the tumor cells.’

Therapy

In terms of treatment, there is also more distinction between the different types of skin cancer. In the past, the doctor would cut out any type of skin tumor as widely as possible, nowadays the treatment is much more subtle. ‘Superficial skin cancer can often be treated well with medicinal ointment,’ says Mosterd.

‘In recent years there has also been a discussion about whether we still need to treat basal cell carcinoma in old and vulnerable people. These tumors grow slowly, so people rarely die from them. Sometimes you can leave that stain alone. On the other hand, you often don’t know exactly how long someone has left to live.’ Anyway, go to the doctor with the stain.