Save your skin

Some good news and bad this week. Bad that last week's skin biopsy tested positive for cancer, then good that it is Basal Cell Carcinoma (BCC), which seems to be just about the most harmless cancer out there. Still, on Friday this week I have to get another six little lumps cut out - I can think of things I'd rather be doing.  Read on for seven tips to keep your skin safe...

1. Know what to look for. Most skin cancers, even Melanoma, will be treated successfully if caught early enough. I paid ttention to a new spot on my thigh after seeing a picture in a magazine article about skin cancer, and thinking 'Hmm, that looks familiar'. Here are pictures of common types of BCC, to give you an idea of what to look for.

2. A little paranoia never hurt. If you see changes in your skin, pay a visit to the doctor to get them checked out. The dermatologist I spoke to this week seemed most interested in
  • recent changes in my skin
  • spots that didn't itch
  • old features that were changing significantly, eg a mole that seemed to be changing appearance.
But in any case, if you see changes it's time to see your doctor, or maybe a dermatologist...

3. Doctor doesn't always know best. I first asked my doctor about this almost exactly a year ago. He said it was probably eczema, and sent me off with a cream to try. After two more visits and different creams we agreed that once I got back from my summer holiday we'd cut it out and send it to be tested. On the second of the visits he told me 'not to get paranoid' about skin problems, though it turns out it was a good job I kept following up. I guess the problem is that BCC is so rare among Asians, a local GP (General Practitioner) with mainly Chinese customers won't get much practice at recognising the warning signs.

I visited a dermatologist for the first time this week, and got a very different reaction. In future I'll visit my GP for general health matters, but visit the dermatologist when I have questions about my skin.

4. Can you say Keratosis? During the visit to the dermatologist, he found patches of keratosis on my back and shoulders. Their full name is Actinic Keratosis, or Solar Keratosis. They aren't harmful in themselves, but over time around 2-5% may develop into squamous cell carcinoma (SCC), which is nastier than BCC. Fortunately treatment at this early stage is easy - the dermatologist squirts a drop of liquid nitrogen on the affected skin. The keratosis freezes, dies and drops off!

Looking at the mirror today I can see he squirted about 15 little spots. There was a mild sting at the time, but nothing very painful. You can see pictures of Actinic Keratosis here, and that same article describes them as 'Actinic Keratosis is skin cancer's warning signal.  Heed that signal.' So, that's one more thing to watch out for when checking your skin.

5. How much does your tan protect you? I thought that most of the UV damage to skin happened when it got sunburnt, ie red and painful. And that this year being the brownest I've been in a long time (go figure!), I was relatively safe from sun damage. The WHO's document put me straight on that, saying 'A dark tan on white skin offers only limited protection equivalent to an SPF of about 4.' The UV damage comes from the accumulated exposure of skin to UV, so a tan reduces the exposure by a factor of four, but that damage is still accumulating.

Since the tan doesn't give enough protection, time to follow the WHO guidelines on ways to limit exposure to UV:
  • Limit exposure during midday hours.
  • Seek shade.
  • Wear protective clothing.
  • Wear a broad-brimmed hat to protect the eyes, face and neck.
  • Protect the eyes with wrap-around design sunglasses or sunglasses with side panels.
  • Use and reapply broad-spectrum sunscreen of sun protection factor (SPF)15+ liberally
  • Avoid tanning beds.
  • Protect babies and young children: this is particularly important.
6. Avoid the strongest Hong Kong sunshine. The Hong Kong Observatory's daily UV index shows it peaked at a value of  7.5, at midday today (Wednesday 20th Sep, a cloud-free but smoggy day). The same website's 'What is the UV index' page has another chart of the index on 14th August 2001, which has the daytime peak at 14. It must have been a clear sky that day. Is this the good news about pollution at last, that it blocks out UV and reduces the chance of skin cancer?

What do those UV Index numbers mean? Here's the World Health Organisation (WHO) chart on the subject:
UV Index 
Exposure Level
0 - 2 
3 - 5 
6 - 7 
8 - 10 
Very High 
> 11 

Then how should we interpret 'Low', 'Moderate', etc.? The WHO again: 'Even for very sensitive fair-skinned people, the risk of short-term and long-term UV radiation damage below a UV Index of 3 is limited, and under normal circumstances no protective measures are needed.' The UK's Met Office gives further information about the relationship between skin type and damage, which I've summarised below. The first column shows skin type, then the UV index level at which 'moderate' damage to skin begins, then the times of day the HK UV index exceeds that level (based on the clear-day readings given earlier). During those times skin should be protected - ie hat, clothing & sunscreen.

Skin type UV index  start end
fair, burns 3 8:30am 4:30pm
fair, tans 5 9:30am 4:00pm
brown 6 9:30am 3:30pm
black 7 10:00am 3:30pm

7. Will it happen to you? Here is the incidence of new cases per 100,000 people per year in different countries:

Where Incidence Year of study
Hong Kong (Chinese) 0.92 1999
UK (Caucasian) 116 1998
US (Caucasian) 339 1994
Australia (Caucasian) 1,626 1998

So if you are Hong Kong Chinese, congratulate yourself on your good fortune. The incidence rate for Hong Kong Chinese is increasing (the incidence in 1990 was just 0.32 per 100,000), but remains a tiny fraction of the incidence among caucasians.

For us pale-skinned gweilos, 'The lifetime risks were estimated to be 28% to 33% for BCC and 7% to 11% for SCC'. Those are figures are for the US, here nearer the equator we can expect the risks to be greater. So yes it can certainly happen to you. It's worth taking a little extra care now to reduce that risk.



skin checks

Very informative post!

In Australia, where I'm from, there are skin cancer centres where you can drop in and get checked all over by an experienced doc. Do you know if the equivalent exists here in HK? I don't like the idea of going to a GP, convincing him I need a referral for a dermatologist, booking in at the dermatologist, waiting...

Failing that, can you recommend a good dermatologist :-)?

Those centres sound great,

Those centres sound great, but I'm not aware of anything like that here. I thought the doctor or dermatologist would suggest a check like you describe, but they were mostly interested in checking any spots that I brought to their attention. Maybe they didn't fancy foraging through the gweilo body hair!!

For the dermatologist, I just asked at Quality Healthcare (one of the big local medical groups - and was introduced to Dr Ku. He seems to know his stuff.


Doctor Ku

If you're having trouble getting an appointment to see Dr. Ku at Quality Healthcare, you can also see him at his own clinic : 1504 Melbourne Plaza, 33 Queens Rd C, Tel: 2525-2212.

I'd been trying to get an appointment to see him at Quality Healthcare, but there's a wait of over a month. With our recent vacation, and a cancellation on his part, it was looking like a total wait of over four months from my first attempt to get an appointment. To their credit, they offered me the option to see him at his clinic. I could get an appointment there in just two days, so that's where I went for my checkup this morning.

He explained that people that must pay with health insurance cards go to the big chain, those paying by cash or credit card go to his clinic.


And look out for your parents too

While the doctor (not Dr Ku) was cutting a couple of dodgy moles out of my thigh today, I asked if he saw many cases. "Not many" he said, as most of his patients are local chinese, and as we saw above, the incidence of skin cancer among chinese people is much lower than caucasians.

BUT, he said when he did see one, it tended to be an elderly person, and usually on their face. (Makes sense, as if you don't go in for sunbathing, the face is what gets most sunlight). Unfortunately, he said that by the time the patient reached him, it was usually at a late stage. Given that there's not a lot of spare skin or flesh on the face, he says the result was usually very disfiguring. In his words, "I hate those cases".

His view was that the older generation of Chinese were very reluctant to go and see a doctor when they first noticed the problem. So, if you see any of the signs of cancer on your parents' face, get to work on having them visit a dermatologist for a checkup.