Non-Melanoma Skin Cancer (NMSC) is the world’s most common cancer. As a Dermatologist in private practice in South Africa, skin cancer is the most common condition I deal with every day.
There are generally two broad groups of skin cancer namely Malignant Melanoma and Non-Melanoma Skin Cancer. I am only going to write about Non-Melanoma Skin Cancer in this article.
Actinic Keratoses (AK) and Non-Melanoma Skin Cancers (NMSC) are caused by chronic sun exposure over your whole life i.e. it is as if you have a meter on your forehead at birth that registers 000 and every time you go out into the sun, throughout your life, that meter ticks over and depending upon your skin type, the higher the total amount of sun exposure, the more likely you are to develop AK and NMSC. It is estimated that two-thirds of your total lifetime sun exposure occurs before the age of 20 years.
Actinic Keratoses are also known as Solar Keratoses are generally small red, scaly, pre-cancerous bumps usually on the sun-exposed areas of the body. They feel like sharp little thorns in the skin. If left untreated, approximately one in ten Actinic Keratosis will develop into a Squamous Cell Carcinoma (SCC). This type of skin often presents with a larger, wart-like bump that may be painful and that may grow rapidly. If an SCC is not treated timeously, cancer may spread to your regional lymph nodes and may be fatal.
The other type of Non-Melanoma Skin Cancer is Basal Cell Carcinoma (BCC). This usually presents with a pink pearly growth that bleeds easily. Of all the skin cancers, Basal Cell Carcinoma is the least dangerous but if neglected it can be locally destructive. The other name for a BCC is a Rodent Ulcer i.e. it looks like a rat has eaten a hole in your skin.
So, what can we do to prevent AK and NMSC? The general principles are:
- Avoid the 11 am to 4 pm sun and seek the shade.
When outdoors, apply a high factor, broad-spectrum sunscreen to all the exposed areas on a regular basis and re-apply after swimming or heavy sweating. Always choose a sunscreen recommended for your skin type.
Wear an appropriate UV protective broad-brimmed hat and clothing. The hat should have a tight weave that does not allow ultra-violet radiation through the fabric.
For those in the high-risk category of AKs and NMSC i.e. If you have been diagnosed with Actinic Keratoses or Non-Melanoma Skin Cancer in the past, you should ideally only use one of the more modern, advanced sunscreens often referred to as photoimmunoprotection.
They not only block out UVB and UVA radiation but also High Energy Visible Light and Infrared radiation. These sunscreens should also contain antioxidants for added protection against free radicals and most importantly, the more advanced sunscreens also contain enzymes that can repair DNA damage in the cells.
Oral supplements that contain Polypodium Leucotomos (Fernblock), a potent antioxidant from a tropical Central American fern, Vitamin C, Vitamin E, and Niacinamide are recommended to complement topical sunscreens especially in people who have more sun exposure during the summer months.
A recent addition is Oral Nicotinamide (Vitamin B3) which at a dosage of 500mg twice a day has been shown to reduce Actinic Keratosis by 35% after only two months of treatment. It has also been shown to reduce the incidence of Non-Melanoma Skin Cancers by approximately 23%. These studies have been published in well-established, peer review journals.
Nicotinamide orally boosts cellular energy in UV-damaged skin, helping to repair damaged DNA. It also has anti-inflammatory actions and enhances local cutaneous immunity.
To achieve these results the dosage has to be Nicotinamide 500mg twice a day i.e. 1 gram a day. The problem in South Africa is that Nicotinamide is only freely available in the form of a 25mg tablet – therefore, to achieve 1 gram a day with a 25mg tablet, you would have to take 40 tablets a day! Dermastore has recently had 500mg capsules made up specially by a registered compounding pharmacy.
Nicotinamide does not cause flushing (as opposed to Nicotinic Acid which does cause flushing) and at a dosage of 1 gram a day there have been virtually no side-effects or drug interactions reported. For those people who have AK or NMSC, the Nicotinamide should be taken indefinitely. If all the AKs disappear, then one can consider stopping the Nicotinamide.
It is important to note that the above recommendations for prevention and treatment of Actinic Keratoses and Non-Melanoma Skin Cancer should be complementary or in addition to the usual treatments offered by your General Practitioner or Dermatologist. The usual treatments could include cryotherapy, topical 5 fluorouracil ointment, imiquimod cream and surgery.
We’ve also combined some of our most-recommended adjunctive treatment products into an easy to get-going Dermastore Skin Cancer Prevention Box.