For 10 years now, John Bagole (not real name) has lived with skin cancer. He is 32 years old. It all started with a small painful swelling on an area near his ear. “At the time, I went to a nearby clinic and got medication and became fine. But after one year, the swelling reappeared,” says Bagole.
“My left side head and toes were swollen and before I could get proper treatment, the skin on my entire body had been affected. I developed moulds on my skin and people could not easily identify who I was at that point. I did not know what had happened to me,” he adds.
Bagole says he got aice from different people on what to do about his condition, with some offering local herbs. “The herbal medicines were so many yet not a single one worked to cure my condition. I was in too much pain, and my body felt heavy,” says Bagole.
It is at this point that he decided to go to Jinja hospital, where a dermatologist cut off skin from part of his swollen body that was then tested for skin cancer.
“I got the results after one week, and the doctor told me I had skin cancer. I was not surprised because I have known that cancer can affect anyone, at any time. The doctor, however, explained to me that it was because of the blood clots that remained in my body following an accident I had suffered a year earlier,” explains Bagole.
Dr Henry Manson Ngobi, a dermatologist at Jinja hospital, who had diagnosed Bagole’s condition, then referred him to the Uganda Cancer Institute at Mulago hospital.
“The pain on my skin was unbearable yet the treatment I received for the first five months did not make any difference on my health,” says Bagole.
He was then started on another form of treatment that involved extracting excess water from his body.
“The doctor told me that I had to continue with this type of treatment twice a month, which I adhered to but then it became costly for me. I could not afford to get money for transport from Jinja to Mulago hospital a month. Instead, I have been using herbal medicine but when I get money, I will return to get proper treatment from Mulago,” he says.
Doctors say one of the biggest challenges is people not knowing what skin cancer exactly is. Many do not know the warning signs and symptoms, and when they are affected, they take long to seek medical help.
What is skin cancer?
“A skin cancer can be described as uncontrolled growth of abnormal cells in the skin, and are broadly categorised into two types as melanoma and non- melanoma caners, depending on the cell of origin within the skin from which they develop,” explains Dr Kafeero.
Melanoma cancers arise from the destruction of the melanin which is responsible for skin pigment (colour). These are more serious and normally spread fast.
Non-melanoma cancers on the other hand, arise from the damage of the outer layer of the skin, and they include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC.
“Basal cell carcinoma is the most common type of skin cancer among albinos because their skins lack melanin pigment. They are common on sun-exposed areas of skin such as the nose, ears and lower lips,” says Dr Ogwang.
He adds: “basal cell carcinoma BCCs are composed of cells derived from the basal cell layer of the epidermis. They are slow-growing, however, they can result in serious deformation of the skin. It can also be hard to treat.
People exposed to chronic sun damage, scars as a result of burns, arsenic exposure, chronic inflammation as seen in longstanding skin ulcers, and spots of previous x-ray therapy are predisposed to the development of squamous cell carcinoma.
Other types of skin cancers may arise from damage of the sweat glands and blood vessels known as kaposi’s, sarcoma, which is a common type of skin cancer in Uganda. This type of cancer, however, can affect any other part of the body besides the skin.
Signs that you have skin cancer.
Dr Ngobi says, “The cancer may appear as a pearly lump or a scaly or dry area that is pale or bright pink and shiny, which may bleed or be inflamed and the dead tissue may become an ulcer. The wound may heal but may break down again.”
The typically red, scaly patches which appear on areas of chronically sun-exposed skin may be a warning sign for the cancer.
“Moles and dark black birthmarks, which later become itchy or painful could also be a sign that you have skin cancer,” explains Dr Kafeero.
“When skin cancer is in the early stage, it is not dangerous and can easily be treated. In the last stage however, the cancer is hard since it has already spread to different parts of the body. Affected body parts could include the lymph nodes, bones and spine,” notes Dr Ogwang.
“Because the symptoms are usually painless, you need a skin specialist to diagnose it. That is why it is recommended that people undergo regular skin check-ups. This will help the dermatologist to establish if you are developing a skin condition or not,” says Dr Kafeero.
“A dermatologist can only conclude that a person has skin cancer by doing a biopsy where a part of the suspected cancer cells is taken by a dermatopathologist for examination,” he adds.
Exposure to ultra violet radiations from the sunrays is the leading cause of most skin cancers. Although the radiations cannot be felt or seen, they can only be exhibited through sunburn, skin and eye damage, premature ageing of the skin and damage to the skin cells which leads to cancer.
Several exposures to x-ray, especially during medical tests is another risk factor that makes skin cells prone to cancers. People who work in industries and are exposed to coal and arsenic compounds are also prone to developing skin cancers.
“Although these factors can increase a person’s chances, they do not necessarily cause the cancer,” Dr Ogwang warns.
“Chronic scars from diseases and burns predispose the skin to melanoma cancers. Uganda, among other countries being near the equator, receives sunshine throughout the year, which increases the risk of skin cancers because the sun rays are strongest near the equator,” adds Dr Ogwang.
At higher altitudes, Dr Ogwang notes, the UV light is strong as elevation increases because the thinner atmosphere at higher altitudes cannot filter UV as effectively as it does at lower altitudes.
On the other hand, a person’s family history can also be a risk factor for skin cancer, especially for melanomas. Health experts say if you have a first degree relative (this includes parents, brothers and sisters) with a history of skin cancer, then you are also likely to develop it.
How to find out
Dr Ngobi says “We should always be vigilant with whatever happens to our skin. When you develop moles and patches, or see an increase in the size of birthmarks that change colour, you should not ignore it.”
“Melanomas should be checked by identifying irregularly shaped moles on our skins. They may have irregular borders, change in colour and size. They are sometimes itchy and may start bleeding. Once you find out that your skin is dry and has scaly patches whose cause you are not sure of, seek the services of a dermatologist as soon as possible,” says Dr Ogwang.
“Once skin cancer is detected at an early stage, it is easier to treat than one reported at a late stage, which could have spread to other parts of the body,” Dr Ogwang says.
Lack of awareness
“There is little knowledge about skin cancers in Uganda because 80 per cent of patients come at the institute when the disease is in the late stages, or has spread to other parts of the body,” says Dr James Kafeero, a community cancer awareness personnel, at the Cancer Institute, Mulago hospital.
Dr Kafeero says general awareness of all types of cancers also remains low, and people only realise the seriousness of the disease when a public figure succumbs to the disease.
“Not so many people are aware of skin cancers and often times, they associate it with witchcraft. Although few people are aware of skin cancer, it is as dangerous as other cancers,” says Dr Ngobi.
Skin cancer, Dr Edward Ogwang, another dermatologist at The Skin Specialist Clinic in Wandegeya, a Kampala suburb says the cancer cuts across all age groups, depending on the risk factors.
For instance, he says it is common among albinos, people living with HIVAids and children with genetic defects.
“Dr Dr Edward Ogwang, a dermatologist at The Skin Specialist Clinic, in Wandegeya, a Kampala suburb says chronic scars from diseases and burns predispose the skin to melanoma cancers. Uganda, among other countries being near the equator, receives sunshine throughout the year, which increases the risk of skin cancers because the sun rays are strongest near the equator.
Dr Ogwang notes the UV light is strong as elevation increases because the thinner atmosphere at higher altitudes cannot filter UV as effectively as it does at lower altitudes.
•Always see a dermatologist at least once a year even when you believe your skin is fine. However, if you have a different cancer, you also need to check for skin cancer as your risk is higher than that of a person who does not have cancer.
•Dr Edward Ogwang, a dermatologist in Kampala, also aises eating foods rich in Vitamin E, such as avocado because they are antioxidants which help in growth of healthy skin cells.
“Treatment for skin cancer is quite expensive as any other type of cancer. It may also depend on the stage at which it is detected. Early detection would, however, save a patient a lot of money because it will be easier to treat,” says Dr Kafeero. Management of skin cancer is done in two. Minor surgery may be done for early stage cancers where the affected cells are completely removed.
Radiotherapy can also be administered where fast moving radiations are directed onto the cancer cells to prevent them from spreading to other parts of the body.
Dr Kafeero explains that for late stage skin cancer, chemotherapy may be used where drugs are administered into blood vessels.
In some cases, he says the cancer may be too aanced to be treated.
Who is at risk of skin cancer?
Here are the conditions that could increase your risk of developing skin disease.
1. People with fair skins and red hair are more susceptible to developing skin cancer than their dark-skinned and haired counterparts.
2. If you have brown spots (freckles), this increases your chance of developing skin cancers,although this is more common among white people.
3. Because albinos usually lack melanin, which is responsible for the formation of skin colour, frequent exposure to the sun exposes them to melanoma cancers.
4. People with lowered immunity such as those living with HIVAids, whose white blood cells are too weak to fight diseases and germs may develop skin cancers from wounds which take long to heal.
5. Genetic factors especially for people who suffer from conditions that impair their DNA mechanism may find it difficult to fight skin cancer.
6. People with Human Papillomavirus (HPV), a sexually transmitted disease also stand high risk of developing skin cancer.
7. People who use bleaching creams can also develop skin cancer, because most of the ingredients used in such creams, such as hydroquinone and cojic acid act by blocking the formation of melanin, which is responsible for protecting the skin from sunburn. A person can also lose pigment of their skins.
SOURCE: Daily Monitor