Management of Keloids

MELANOMA – CONTROVERSIES IN SCREENING

Your Ultimate Guide to Mole Checks and Skin Cancer Screenings with a Dermatologist in Singapore

Table of Contents

    SKIN CANCER IN SINGAPORE 

    Skin cancer is relatively rare in Singapore with an incidence rate of 0.3 to 0.5 per 100,000 people annually. However, frequent headlines [1] continue to highlight the disbelief of many Singaporeans who are caught off-guard by a skin cancer diagnosis. The prevalence of the myth that Asians are safe from skin cancer has created a complacent society, especially in Singapore where levels of ultraviolet radiation are strikingly high throughout the year [2]. In fact, the UV index hit “extreme” levels in March 2024, and this is likely to happen again on the backdrop of global climate change [3]. It is important to note that;

    •  Skin cancer is the sixth most common and the seventh most common cancer type among men and women respectively [4] in Singapore.
    • Skin cancer incidence is increasing among Asians in Singapore [5] with fairer-skinned Chinese having higher incidence rates of skin cancer compared with Malays and Indians.
    • There remains a gap in data regarding the incidence of skin cancer among expatriates in Singapore particularly those of Caucasian descent where the incidence of skin cancer is higher compared to other ethnicities [6]. 
    • Almost 100% of patients with stage 1 melanoma skin cancer will survive their cancer for 5 years or more after they are diagnosed – further emphasising the need for early intervention.

    In this article, we aim to provide a comprehensive guide on all matters related to moles, skin cancers, screenings, treatment options, and prevention strategies. By raising awareness about the prevalence of skin cancer in Singapore, we hope to cultivate the habit of undergoing routine checks and screening among Singaporeans and expatriate communities. 



    HOW DOES SKIN CANCER DEVELOP 

    The sun is a great source of vitamin D [7], a vital nutrient that helps maintain and strengthen your bones, on top of optimising your brain health [8]. Although it is ill-advised to stay indoors for an extended period, too much sun exposure can damage your skin by inducing photocarcinogenesis, a process that encourages the development of skin cancers. 

    The driving factor of skin cancer is overexposure to sunlight,  particularly if one is prone to sunburns. UV rays from the sun induce damage to the skin’s DNA, catalysing the formation of abnormal cells that divide and mutate rapidly. In fact, intermittent severe sun exposure caused by acute sunburns is a major risk factor for the development of skin cancers [9]. 

    skin cancer singapore
    Too much UV radiation from the sun causes sunburns that damage the DNA in our skin cells.

    Types of skin cancer 

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    The type of skin cancer is typically classified by where the cancer begins.

    skin cancer singapore.
    There are 3 main types of skin cancer, with melanoma being the most advanced type, often requiring immediate medical intervention.

    There are three primary types of skin cancer, which are:

    • Basal cell carcinoma: develops in the basal cells of the lower part of the epidermis– the outer layer of the skin. It is the most common form of cancer and manifests as a flesh-coloured round growth, pearly bump, or a rough pink patch of skin.
    • Squamous cell carcinoma: develops in the squamous cells in the epidermis. Squamous cell carcinoma typically presents as a red firm bump, scaly patch, or a sore that heals and then reopens.
    • Melanoma: melanoma is a serious type of cancer that is formed in the melanocytes, which are the pigment-producing cells in the skin. It is also notorious for the likelihood of spreading to other parts of the body.  Melanoma requires immediate treatment and accounts for more than 0.5 per cent of all skin cancers in Singapore.
    There are 3 main types of skin cancer, with melanoma being the most serious type, often requiring immediate medical intervention.

    Stages of Skin Cancer

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    Identifying the stage of skin cancer is crucial in determining the appropriate treatment and prognosis. The stages of skin cancer are broken into the following stages:

    StagesDescription
    Stage 0: Carcinoma In SituThe cancer cells are located in the epidermis (outermost layer) of the skin and have not penetrated deeper
    Stage 1: LocalisedThe cancer cells are small and confined to the initial area. It has extended beyond the epidermis but often remains localised to the upper layer of the dermis.
    Stage 2: Localised with higher riskThe cancer is larger and accompanied by certain high-risk features. However, it has yet to spread to the lymph nodes or grow beyond the initial area
    Stage 3: Regional spreadThe cancer has spread to nearby lymph nodes, and tissues, but not to different parts of the body
    Stage 4: MetastaticThe cancer has metastasised to other organs and lymph nodes of the body
    skin cancer stages
    Early detection is crucial in treating skin cancer as certain types of skin cancer can progress in mere months.

    SKIN CANCER RISK FACTORS

    Although skin cancer is arguably rare in Singapore, several risk factors increase your likelihood of developing it, especially when it is combined with excessive sun exposure. These risk factors include:

    Lifestyle HabitsHistorySkin Condition
    Frequent sun exposureFrequent use of tanning bedsSpending time outdoors without sun protective measuresA family history [10] of skin cancerA history of blistering sunburns in childhood [11]History of previous skin cancer or precancerous skin changesFamily history of skin cancersA history of previously having received chemotherapy or radiation Presence of multiple Actinic keratoses [12]Moles, especially irregularly shaped and coloured molesExtensive frecklingHave more than 50 moles throughout the bodyLight skin types Prone to sunburn

    3.1 Skin Tones and Skin Cancer: What is the Relationship?

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    Another risk factor that contributes to the risk of developing skin cancer is skin type. In fact, fair-skinned individuals are more at risk of developing skin cancer – specifically melanoma – than people with naturally dark skin tones. This is because fair-skinned individuals have less melanin [13] in their skin, compared to individuals with darker skin tones. Due to the limited melanin, individuals residing in tropical-climate countries are more at risk [14] of developing skin cancer in their lifetime.

    expats singapore
    Individuals residing in tropical-climate countries are more at risk of developing skin cancer.

    To understand the risk factors associated with skin tones, we need to understand the Fitzpatrick skin types, which essentially classify the skin’s reaction to sunlight among individuals. 

    Skin Type 1
    • Pale white skin, freckling
    • Light coloured eyes
    • Reddish or strawberry blonde hair
    • Exposure to UV radiation burns the skin without tanning
    Skin Type 2
    • Fair skin, often with freckling
    • Blue, green, hazel eye colours
    • Blonde or brown hair
    • Exposure to UV radiation burns the skin easily but hardly tans
    Skin Type 3
    • Light or light brown skin and rarely with freckles
    • Dark blue, hazel, brown eye colours
    • Dark blonde or brown hair
    • Exposure to UV radiation will sometimes burn and tans gradually
    Skin Type 4
    • Light brown or olive-coloured skin
    • Brown or dark brown eyes
    • Dark brown hair
    • Exposure to UV radiation hardly ever burns and tans easily
    Skin Type 5
    • Dark brown skin
    • Dark brown eyes
    • Dark brown or black hair
    • Exposure to UV radiation rarely ever burns and tans very easily
    Skin Type 6
    • Dark brown or black skin
    • Dark brown eyes
    • Black hair
    • Exposure to UV radiation seldom burns the skin but tans very easily and becomes deeply pigmented
    skin cancer singapore
    The risk of skin cancer increases the lighter your skin tone is.

    However, being Asian or having a darker skin tone should not make you complacent about sun protection, as skin cancer does not discriminate based on skin tone. A 2009 study [15] revealed that fairer-skinned Singaporean Chinese were three times more likely to develop skin cancer compared to their Malay and Indian compatriots. Despite being a skin phototype 4 to 6,  it is important to remember that skin tone is not the sole driving force behind this highly preventable disease. Beyond skin tone, factors such as hormones, genetics, lifestyle habits, age and environmental exposures all contribute to the development of skin cancer.


    MOLES AND SKIN CANCER 

    Skin moles are formed because of abnormal skin cell growth and are often developed between early childhood and 20 years old. It is common for an adult to have between 10 and 40 moles throughout their body. 

    Overexposure to sunlight can stimulate the development of new moles in adulthood, thereby increasing the risk of melanoma. Moles progress into melanoma [16] when melanocytes divide uncontrollably due to excessive sunlight exposure, causing genetic changes inside the mole cells. While there is no definitive rate for how quickly or slowly melanoma progresses, it is believed that melanoma can develop within a few months. 

    moles singapore
    Benign moles usually do not progress to skin cancer, however, it is still encouraged to undergo routine skin checks to be sure.

    4.1 Types of moles 

    There are several types of moles, including:

    4.2 Differentiating Moles from Other Skin Conditions

    Because moles are common, it is easy to mistake moles for other skin conditions such as freckles, melasma and pigmentation. But each skin condition is unique with distinctive features, as per the table below:

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    FeatureMolesFrecklesSolar Lentigenes or Sun spotsMelasma
    AppearanceRaised or flat and may be round or ovalDiscrete, Flat, small, tan to brown spotsDiscrete, flat brown spots Vague brown patches resulting in an uneven skin tone
    ColourBlack, brown, tan, pink, or skin-colouredLight brown to dark brownLight brown to dark brownBrown to grey-brown
    SizeVaries but can be larger than frecklesSmall, typically 1-2 mmVaries but usually larger than frecklesOften larger patches
    LocationAnywhere on the bodySun-exposed areas (face, arms)Sun-exposed areas (face, arms)Face (forehead, cheeks, upper lip)
    CauseClusters of pigmented cellsGenetics, Intermittent sun exposureGenetics, cumulative lifetime sun exposureHormonal changes, sun exposure, photoaging, genetics
    Gradual ChangesCan change in size, shape, or colourMay fade with sun avoidance and appear with sun exposureMay darken with sun exposure but does not lighten much with sun avoidanceBecomes more pronounced with sun exposure
    Risk of Skin CancerSome moles can become cancerousNot cancerousNot cancerousNot cancerous
    Treatment OptionMonitoring, and removal of suspicious or evolving molesSun avoidance, topical lightening agents, lasersSun avoidance, Topical lightening agents, lasersSun avoidance, topical lightening agents, chemical peels, lasers, oral medications

    Understanding and being aware of these differences will aid you in distinguishing between moles from other skin conditions. This will inherently help you in being more aware of any changes to your skin, with regards to mole development.


    SELF-EXAMINATION FOR SKIN CANCER AT HOME

    The key step to preventing skin cancer is to monitor the possible changes in your moles, especially if you have a higher risk of developing the disease. One of the methods for monitoring these changes is by routinely practising a skin self-examination by relying on the ABCDE guide. It entails:

    If you managed to identify at least two changes, then it is time to have it properly and thoroughly examined by a dermatologist.

    As melanoma has distinctive features, skin-self examination can be performed by individuals and their loved ones at one to three-monthly intervals. Many new and recurrent melanomas could potentially be detected, especially if there is access to previous photographs taken of the moles that are being monitored [17]. A thorough skin-self examination involves looking at often overlooked sites such as the fingerwebs, toewebs, scalp, retroauricular skin, natal cleft, back and back of the legs. Do bear in mind that the back is the most commonly affected area in men, and the back of the legs is the most commonly affected area in women. 

    skin cancer self screening
    By routinely examining your moles by referring to the ABCDE guide, you will be a step ahead at preventing skin cancer.

    MOLE CHECKS AND SKIN CANCER SCREENING IN SINGAPORE

    When it comes to skin cancer, early detection and treatment are crucial in treating the disease. That is why individuals who pose an increased risk of developing skin cancer, especially expatriates residing in tropical-climate countries, are advised to undergo routine skin cancer screening.

    6.1 Preparing for the Procedure

    As daunting as it sounds, skin cancer screening is a non-invasive and quick procedure. A full-body skin examination typically lasts between 15 to 20 minutes. Make a mental note of the moles that you are concerned about prior to your appointment, so we can discuss them with you in detail. In addition, it would be useful for you to bring any previous clinical photographs of your skin (if applicable) so we can assess your skin changes longitudinally over a period of time. 

    Before the appointment, it is recommended that you do the following steps to save time and improve efficiency during the procedure:

    mole check singapore
    Mole screening typically lasts anywhere between 25-45 minutes

    6.2  Skin Cancer/ Mole Check Screening Guide 

    Skin cancer screening involves examining your skin for possible signs of precancerous conditions or skin cancer. Here is a step-by-step guide to what the procedure entails:

    Step 1:Private and Comfortable EnvironmentAs your comfort is our priority, Dr. Evelyn Tay, who is a fellowship-trained dermatological surgeon, will conduct skin checks in a private and comfortable setting.
    Step 2:Meeting with Dr. EvelynDr. Evelyn will manage your care with extensive experience in detecting and managing skin cancers. At this stage, Dr. Evelyn will assess your medical history and ask about your lifestyle habits along with your sun protection measures to understand your risks of developing skin cancer.
    Step 3: Skin Cancer Screening ProcedureAfterwards, Dr. Evelyn will perform a detailed skin screening by using a dermatoscopy and polarised light to identify any suspicious lesions. Skin checks will involve a thorough examination of the skin from the top of your scalp to the bottom of your feet.
    Step 4: Photographic Documentation of Skin Moles and LesionsAfter the procedure,  our staff will take photographs of your skin lesions.. This will allow us to monitor and track their progress over time, thereby ensuring early detection and effective monitoring, while reducing the need for unnecessary biopsies. We will also be sending you a copy of those photographs, which will come in handy for your skin self-examination.
    skin cancer screening
    A dermatoscope is used to examine if a mole shows any risk of becoming cancerous.

    6.3 Benefits of Skin Cancer Screening/ Mole Check Screenings

    Studies have shown that skin cancer screening performed by trained specialists has a higher rate of detection of skin cancers [18]. Beyond early detection, mole checks and skin cancer screening offer a list of benefits, including;

    mole removal singapore
    Moles can be removed with a simple punch biopsy procedure if they are deemed unsuitable for laser treatment. This confers the additional benefit of sending the removed mole for histological analysis to exclude malignancy.

    TREATMENT OPTIONS FOR POSITIVE SKIN CANCER DIAGNOSIS

    Identifying the stage of skin cancer is crucial in determining the appropriate treatment and prognosis. The table below details the types of treatments available depending on your diagnosis; 

    StagesTreatment
    Stage 0: Carcinoma In SituTopical treatment, surgical excision, curettage and cautery, cryotherapy, photodynamic therapy
    Stage 1: LocalisedExcision, curettage and cautery (in suitable cases), topical treatment (in suitable cases), photodynamic therapy (in suitable cases)
    Stage 2: Localised with higher riskSurgical excision with close surveillance
    Stage 3: Regional spreadSurgical excision with close surveillance may require radiation therapy, targeted therapy or chemotherapy
    Stage 4: MetastaticTreatment often involves a combination of surgery, radiation therapy, chemotherapy, immunotherapy or targeted therapy. However, this will depend on the location and extent of the cancer spreading

    Although there is an array of treatment options available for treating skin cancer, it is important to understand that each treatment plan is unique to every patient. While a singular treatment may suffice for some, others may require a combination of treatments. This will be determined by how progressive the cancer is. Below are some of the treatment options that are available at Lumine Dermatology;

    MOHS Micrographic Surgery

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    MOHS micrographic surgery is a highly precise and specialised dermatological surgery that is mainly used to treat skin cancers, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). It involves systematically removing thin layers of cancerous tissue and immediately examining them under a microscope, continuing this process until no cancer cells are detected. Additionally, MOHS surgery is designed to conserve as much healthy tissue as possible. This not only helps to minimise scarring but, will achieve better cosmetic results too. MOHS surgery also offers excellent cure rates for non-melanoma skin cancer, specifically up to 99% for new cases and 94% for recurrent cases [20].  Similarly, it is particularly suitable for treating skin cancers in cosmetically sensitive areas, recurrent skin cancer cases and aggressive tumours with unclear boundaries.

    skin cancer surgery
    Visualisation of MOHS micrographic surgery performed in Lumine Dermatology
    STEPSDESCRIPTION
    PreparationThe area around the skin cancer is cleaned and a local anaesthetic is applied to numb the area.
    Tissue RemovalThe surgeon removes the visible tumour along with a thin layer of surrounding tissue. This tissue is also marked and mapped to indicate its orientation.
    Mapping and SectioningThe removed tissue is divided into sections and colour-coded to correspond to the specific areas of the surgical site. A detailed map of the tissue is created to guide further removal if needed.
    Microscopic ExaminationThe tissue sections are frozen, cut into very thin slices and examined under a microscope. Afterwards, the surgeon looks for cancer cells at the margins of each section.
    Additional Tissue RemovalIf cancer cells are found at the margins, the surgeon removes another thin layer of tissue from the precise area where the cancer cells were detected. This step is repeated until cancer cells are no longer present.
    Wound ReconstructionOnce all cancer cells have been removed, the surgeon closes the wound usually within the same day. Some of the options include allowing the wound to heal naturally, stitching it closed, or using a skin graft or flap.
    Follow-upThe patient is scheduled for follow-up appointments to monitor the healing process and check for any signs of recurrence. The surgeon may also provide care instructions and information on how to protect the skin.

    Wide Local Excision

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    A wide local excision indicates the removal of the entire cancerous area, including a 4–10-millimetre margin of the surrounding tissue. It is often used to treat BCC, SCC and early-stage melanomas. Wide local excision boasts at least a 90 to 94% cure rate for low-risk skin cancers, [21]  aside from being one of the most cost-effective forms of treatment. Additionally, the treatment options are also beneficial for specific skin cancers that exhibit unpredictable growth patterns, like melanoma and extramammary Paget's disease.

    skin cancer surgery 
    Elliptical excision is advantageous for certain skin cancers characterised by unpredictable growth patterns, such as melanoma and extramammary Paget’s disease.
    STEPSDESCRIPTION
    Marking the AreaThe surgeon will begin by marking the boundary around the skin lesion. This will also include the surrounding tissue, measuring roughly between a margin of 4 – 10 millimetres, depending on the diagnosis.
    Administering the AnesthesiaAfterwards, local anaesthesia will be administered to numb the surgical area. However, if the surgical area is extensive, then the surgeon may opt for sedation or general anaesthesia to minimise discomfort throughout the procedure.
    Incision and ExcisionThe surgeon proceeds to make an incision around the marked area to remove the lesion and its surrounding tissue. Additionally, the surgeon may mark the excised tissue for orientation to help pathologists assess the margins.
    Bleeding ControlBefore closing the wound, the surgeon will inspect the surgical area for any bleeding. If bleeding is found, the surgeon may opt to control the bleeding by cauterization or suturing.
    Wound ClosureThe wound is closed either with sutures, skin grafts, or flaps. This will depend on the size of the treated area.
    Dressing and Postoperative CareA sterile dressing is applied to prevent the wound from getting infected. This will also entail post-operative care instructions, including follow-up appointments.
    Pathological ExaminationThe excised tissue is sent to a pathology lab to confirm the complete removal of cancer cells and confirm clear margins.
    Follow-upAs soon as the pathology results come back, the patient is briefed of the results and the surgeon will advise on the next course of action. This will possibly include timely monitoring or additional therapies, depending on the results.

    Curettage and Cautery (C&C)

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    Although curettage and cautery (C&C) are less precise compared to MOHS surgery and wide local excision, C&C is often used to treat premalignant skin cancer and superficial basal cell carcinomas. Similarly, it offers a 98% cure rate [22] for suitable skin lesions. 

    STEPSDESCRIPTION
    Pre-procedure PreparationPrior to the procedure, the surgeon will inform the patient of the procedure, including the risks, benefits and aftercare. Once the patient has been briefed, local anaesthesia will be administered to minimise discomfort.
    Curettage ProcedureThe lesion is scrapped off using a spoon-shaped instrument called a curette. During this step, the abnormal cells in the epidermis and superficial dermis are removed.
    Cautery ProcedureThe area is then cauterised using an electrocautery device to help remove any remaining cancerous cells and halt any bleeding.
    Wound DressingOnce the procedure is complete, the surgeon will proceed to cover the area with a sterile dressing.
    Follow-UpThe surgeon will schedule a follow-up appointment to monitor how the wound is healing and determine if additional treatment is necessary.

    Beyond MOHS surgery, wide local excision and C&C, some of the additional treatment options include:

    • Creams: certain creams, such as imiquimod and 5-fluorouracil (5-FU), are prescribed to boost the immune system. This encourages the immune system to attack cancer cells. Depending on the location and type of skin cancer, imiquimod or 5-FU may be prescribed. Although these creams are used for certain non-melanoma skin cancers, their effectiveness depends on the type, size and location of the skin cancer.
    • Chemotherapy: chemotherapy involves the use of drugs to target and kill cancer cells by hindering the cells’ ability to multiply. It is often used when cancer cells have spread extensively. However, it is similarly recommended in the event patients are unsuitable to undergo surgical procedures or radiation therapy.
    • Photodynamic Therapy: photodynamic therapy involves injecting light-sensitive medication (photosensitizers) into the bloodstream and later accumulating in the cancer cells. Once the area is exposed to a specific wavelength, the medication reacts and produces a form of oxygen that destroys these cancer cells. Photodynamic therapy is commonly used to treat superficial skin cancers or pre-cancerous lesions without damaging the surrounding healthy tissue too much.
    • Lasers: fractional and non-ablative fractional lasers may also be used to minimise widespread field changes due to chronic sun exposure
    • Immunotherapy: immunotherapy is a form of cancer treatment that harnesses the body’s immune system to fight cancer cells. For melanoma skin cancer, immunotherapy functions by stimulating the immune system to identify and attack cancer cells more effectively.
    • Radiation Therapy: radiation therapy involves the use of high-energy radiation to target and destroy cancer cells. It is often used for non-melanoma skin cancers or when surgery is not an option for the patient. Radiation therapy works by damaging the cancer cells’ DNA, thereby preventing them from multiplying and spreading. However, radiation therapy involves multiple sessions and may cause side effects like skin irritation.


    PREVENTING SKIN CANCER

    Whether you are a local or an expatriate residing in Singapore, it is imperative to improve your sun protective measures as doing so will lower the likelihood of you developing skin cancer. We have come a long way from applying olive oil on the skin of our children when they go to the beach, and blistering sunburns are becoming a thing of the past. Here are some of the steps that you can take to protect your skin from the harmful damage of UV rays. Remember the 5s: Slip, Slop, Slap, Seek and Slide.

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    Slip: Choosing the right clothing The clothes you choose to put on are one of the easiest and most effective ways to protect your skin from harmful UV rays. Look for UV protection clothing, which usually comes with a UV protection factor (UPF) rating.
     A UPF of 25 means that only 1/25 th of UV (~4%) is allowed to penetrate clothing, while a UPF of 50 means that 1/50 th of UV (~2%) is allowed to go through. A white cotton T-shirt that does not come with a UPF rating typically has a UPF of 5, which means that 1/5 th of UV (~20%) is allowed to pass through. This UPF drops even further if the white T-shirt is wet. Hence, it is important to select appropriate clothing as some clothing may give a false sense of protection when out in the sun.
    Opt to discard or recycle old and worn fabrics, as the UPF drops with repeated washes. Dark-coloured clothing (e.g black, navy) are generally better at absorbing UV rays than light-coloured clothing, conferring a higher degree of protection.
    Slop: Applying sunscreen Sunscreen acts as the first line of defence against harmful UV rays. Whether you will be out the whole day or running a quick errand, it is advisable to apply sunscreen. When it comes to sunscreen, do remember the following tips:
    • Choosing at least SPF 30+
    • Reapply sunscreen every 2 hours
    • Do not forget behind your ears, the top of your feet and the back of your hands too
    Slap: Wearing the right hats On top of applying sunscreen, it is encouraged for you to put on hats. It is effective at protecting your face, head, neck and ears from harmful UV rays. So, when choosing your hat, pay attention to the following criteria:
    • A high UPF factor which reflects the appropriate weave and material
    • Shades the whole face from the sun
    • A wide-brimmed surrounding
    Seek: Go to where the shade is The strength of the sun’s UV radiation is measured in the form of UV index (UVI). In sunny Singapore, the average maximum UVI ranges from 8 to 10, which is very high. In fair-skinned individuals and those prone to developing skin cancers, it helps to check the UVI before heading out and to dress appropriately, walk in the shade or bring an umbrella. It is helpful to even avoid being outdoors when the UVI is very high. UVI can be checked on the NEA website (https://www.nea.gov.sg/weather/ultraviolet-index) or by downloading various apps on one’s handphone.Reflection off snow and water can also significantly increase UV exposure and this should be taken into account when planning the relevant activities. 
    Slide: Protect your eyes too UV radiation not only puts you at risk of developing skin cancer around the eyes, but it also brings about a host of eye-related concerns, such as cataracts [23]. The next time you step outside, do not forget your sunglasses. If you are planning on purchasing new sunglasses, consider these criteria:
    • Choose sunglasses that offer a 95% UV radiation absorption rate
    • Choose sunglasses that offer at least 9 Eye Protection Factors (EPF)

    Secondary prevention of skin cancers

    In high-risk individuals, we routinely prescribe nicotinamide [24] and Polypodium leucotomos extract [25]. Nicotinamide, which is an active form of vitamin B3, boosts cellular energy and enhances DNA repair on a molecular level and has been shown in clinical trials to reduce the amount of actinic keratosis and NMSCs in susceptible individuals. Polypodium leucotomos has been found to neutralize free radicals and reduce mutations associated with UV exposure, also known as UV signature mutations. It has been purported to not just reduce photodamage, but also delay photoaging. These oral agents hold much promise and more research needs to be done in how they can be used to complement, but not replace,  traditional photoprotection strategies such as behaviour modifications, clothing and sunscreen use.


    CONCLUSION 

    Ensuring your skin’s health is paramount, especially when residing in a sunny country like Singapore. As skin cancer often develops silently, it is imperative for you to schedule regular screenings as early detection of skin cancer is crucial for improving the treatment success and survival rates. It is equally important to choose a highly skilled and experienced dermatologist who is proficient in identifying subtle changes in your skin as it can make significant differences in the management and treatment outcomes. Prioritising these steps, not only helps in early intervention but contributes to better overall health. 

    At Lumine Dermatology and Laser Clinic, Dr. Evelyn Tay offers expert mole checks and skin cancer screenings for early detection to provide her patients with peace of mind. Armed with her wealth of knowledge and extensive years of experience offering dermatological services and sound assessment, Dr. Evelyn understands the unique dermatological needs of her patients, making her the ideal and go-to choice for your skin health. Schedule an appointment today at  Lumine Dermatology and Laser Clinic to take a proactive step towards healthier skin.

    References

    1. Gan, E. (2020) Skin cancer doesn’t just hit those with fair skin; young adults with constant sun exposure at risk, TODAY. Available at: https://www.todayonline.com/singapore/skin-cancer-doesnt-just-hit-those-fair-skin-young-adults-constant-sun-exposure-risk (Accessed: 16 July 2024).
    2. National Environmental Agency (no date) UV Radiation & UV Index. Available at: https://www.nea.gov.sg/corporate-functions/weather/ultraviolet-index/uv-radiation-uv-index (Accessed: 16 July 2024).
    3. Health Promotion Board (2015) Singapore Cancer Registry Annual Registry Report 2015, Singapore Cancer Registry . Available at: https://www.nrdo.gov.sg/docs/librariesprovider3/Publications-Cancer/cancer-registry-annual-report-2015_web.pdf?sfvrsn=10 (Accessed: 16 July 2024).
    4. Sng, J. et al. (2009) Skin cancer trends among Asians living in Singapore from 1968 to 2006, Journal of the American Academy of Dermatology. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0190962209003867#:~:text=Skin%20cancer%20incidence%20is%20increasing,compared%20with%20Malays%20and%20Indians  (Accessed: 16 July 2024).
    5. American Cancer Society (no date) Cancer Facts & Figures 2024. Available at: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2024/2024-cancer-facts-and-figures-acs.pdf (Accessed: 16 July 2024).
    6. Wacker, M., & Holick, M. F. (2013). Sunlight and Vitamin D: A global perspective for health. In Dermato-endocrinology (Vol. 5, Issue 1, pp. 51–108). Dermato-endocrinology. https://doi.org/10.4161/derm.24494 
    7. Kent, S. T., McClure, L. A., Crosson, W. L., Arnett, D. K., Wadley, V. G., & Sathiakumar, N. (2009). Effect of sunlight exposure on cognitive function among depressed and non-depressed participants: a REGARDS cross-sectional study. In Environmental health : a global access science source (Vol. 8, pp. 34–34). Environmental health : a global access science source. https://doi.org/10.1186/1476-069X-8-34 
    8. Asgari, M. M., Warton, E. M., & Whittemore, A. S. (2015). Family history of skin cancer is associated with increased risk of cutaneous squamous cell carcinoma. In Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] (Vol. 41, Issue 4, pp. 481–486). Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. https://doi.org/10.1097/DSS.0000000000000292 
    9. Wu, S., Eunyoung Cho, Li, W.-Q., Weinstock, M. A., Han, J., & Qureshi, A. A. (2016). History of Severe Sunburn and Risk of Skin Cancer Among Women and Men in 2 Prospective Cohort Studies. In American journal of epidemiology (Vol. 183, Issue 9, pp. 824–833). American journal of epidemiology. https://doi.org/10.1093/aje/kwv282
    10. Actinic Keratosis (A Precancerous Condition). (2023). https://www.hopkinsmedicine.org/health/conditions-and-diseases/actinic-keratosis 
    11. Skin cancer by race and ethnicity: Images and statistics. (2021). In www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/skin-cancer-by-race 
    12. Ezzedine, K., Guinot, C., Mauger, E., Pistone, T., Rafii, N., Receveur, M.-C., Galan, P., Hercberg, S., & Malvy, D. (2007). Expatriates in high-UV index and tropical countries: sun exposure and protection behavior in 9,416 French adults. In Journal of travel medicine (Vol. 14, Issue 2, pp. 85–91). Journal of travel medicine. https://doi.org/10.1111/j.1708-8305.2007.00108.x
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