Seek and Ye Shall Find

"I was very surprised. Maybe I will see two or three [incidences of melanoma] in a week when practising, but we saw ten in one day."

"We probably have a large group of people not seeing primary caregivers for a long time."

"It is not uncommon to hear about patients who used mineral oil or baby oil [decades earlier] and went out tanning."

"That cohort is now who we see in the clinic."

Dr. Mark Kirchhof, head of dermatology, The Ottawa Hospital 

"Ultraviolet radiation (UVR) is an established cause of skin cancer and most skin cancers are caused by exposure to UVR from the sun or other sources, such as tanning beds. Exposure to UVR can have additional serious effects on human health, such as premature skin damage, cancer of the eye, cataracts and increased susceptibility to infections."

"The increase in skin cancers seen since the early 1990s may be related to an increase in sun exposure. National surveys conducted in 1996 and 2006 found that Canadians spent more time in the sun, such as through more time outdoors and vacations in sunny climates without increasing their sun protection. Sixty percent of Canadians surveyed in 2006 who took a winter vacation in a sunny climate were age 44 and older."

"UVR levels are also higher than in the past. Over northern midlatitudes, current levels of UVR are 2% to 3% higher than in the 1970s and early 1980s. For comparison, UVR increases 2 times when travelling from southern Ontario to the Caribbean in spring. Increases in UVR levels seen from the 1970s to 1990s were caused by decreases in ozone. The ozone layer is recovering after a ban on ozone-depleting substances."

Cancer Care Ontario

Rates of melanoma, a deadly form of skin cancer, are on the rise in Canada. Those living in southern and coastal areas are most at risk, according to a new study led by McGill University.

In the hope of increasing awareness of skin cancer as well as to raise funds for the expansion of treatment, Ottawa dermatologists held a pop-up skin check clinic. Doctors, residents and students who had volunteered their time and expertise examined hundreds of people, some arriving from towns other than Ottawa to take advantage of the free skin-clinic check-up. Of the total of 300 people who had come out, 60 were diagnosed with some form of skin cancer, ten were melanomas, the deadliest form of skin cancer.

 

The balance remaining were basal cell carcinoma -- skin cancer's most common form, not quite as severe as melanoma, but requiring monitoring and treatment. Dr. Mark Kirchhof, who led the clinic, mentioned that one of the melanoma cases identified at the clinic was in such an advanced stage, the patient was sent to the hospital the day following the clinic to receive expedited treatment. Normally it can take between three and nine months for an appointment to see a dermatologist.

 

Dr. Kirchhof hazarded the opinion that the pandemic along with a shortage of family physicians in all likelihood contributed to the high numbers who attended the clinic. Along with an exhibited level of interest in the proffered service. Between 150,000 and 200,000 residents of the city lack the services of a general practitioner, a reflection of the situation pertaining across the province, highlighting the lack of timely access to family physicians.

 

And then of course the pandemic played a role in the rates of undiagnosed skin cancers, as it did in all manner of medical conditions going undetected, given that hospitals and medical staff were focused on an infusion of patients suffering from COVID-19, resulting in cancellation of thousands of medical appointments and scheduled surgeries. At the same time hospitals became infection points for the SARS-CoV-2 virus, and people hesitated to visit doctors or hospitals; in fact the majority of doctors took to shunning in-person consultations in favour of telephoned 'examinations'.

 

Cutaneous melanoma is the cause of more deaths than any other skin cancer, accounting for some 1.9 percent of all cancer deaths in men and 1.2 percent in women in Canada, according to a 2022 study from Dr. Ivan Litvinov, associate professor, department of Medicine, McGill University. All forms of skin cancer are on the increase, noted Dr. Kirchhof, in part caused by a population, now aging, when sun exposure was a common leisure activity.

The fundraising part of the free clinic was for an expansion of the hospital's specialized Mohs skin cancer surgery -- a surgical technique that involves cutting away thin layers of skin for microscopic examination, to provide doctors with accurate information on where the cancer stops. This enables avoidance of taking excess amounts of skin, a technique used for skin cancer surgery on parts of the body where no excess skin exists.

• In the U.S., more than 9,500 people are diagnosed with skin cancer every day. More than two people die of the disease every hour.
• More than 5.4 million cases of nonmelanoma skin cancer were treated in over 3.3 million people in the U.S. in 2012, the most recent year new statistics were available.
• More people are diagnosed with skin cancer each year in the U.S. than all other cancers combined.
• At least one in five Americans will develop skin cancer by the age of 70.
• Actinic keratosis is the most common precancer; it affects more than 58 million Americans.
  
• The annual cost of treating skin cancers in the U.S. is estimated at $8.1 billion: about $4.8 billion for nonmelanoma skin cancers and $3.3 billion for melanoma.

^{The Skin Cancer Foundation}

Melanoma affects different areas of the body in males versus females. Figure adapted from: https://www.frontiersin.org/articles/10.3389/fmed.2022.830254/full

"Skin cancer risks increase as you age, likely due to accumulated exposure to ultraviolet radiation from sunlight or other artificial sources."

"But skin cancers may also be found in younger people. Factors like genetics, personal history, where you live, all play into the risk of exposure."

"Sometimes melanoma can happen in a sixty-year-old due to sunburns that they had in their teens, twenties, and thirties."

"Globally there was a 44 per cent increase in melanoma rates over the years, with a corresponding surge in mortality rates of 32 per cent. Rates of melanoma are likely to increase with climate change and the thinning of the Earth’s ozone layer."

"We need to encourage women to protect their legs and arms from the sun, while for men sun exposure on the torso, head and neck is the main problem."

"Cutaneous melanoma causes more deaths than any other skin cancer, accounting for 1.9 per cent of all cancer deaths in men and 1.2 per cent in women in Canada. Globally, there were 290,000 new cases of this form of skin cancer in 2018."

Dr. Ivan Litvinov, Assistant Professor, Department of Medicine, McGill University