Cleveland Clinic Florida

Leading specialists warn dark skin no guarantee against skin cancer

Dermatologists promote skin checks for prevention.

Radiation oncologists offer brachytherapy for skin cancer treatment.

It’s the world’s most common cancer but Bahamians aren’t taking it seriously. That’s the conclusion of leading skin specialists both locally and abroad, including a pioneer in an advanced form of treatment at one of Florida’s premier health care institutions.

People of colour aren’t immune to skin cancer, reports Dr Richelle Ramnarine-Knowles, the chief dermatologist at the Skin Cancer and Allergy Testing Centre in Sandyport, noting that while darker skin is somewhat less susceptible to UV damage from the sun, persons of colour need to be especially careful to check for moles and anything that looks out of the ordinary in certain areas of the body.

“I see dark skinned patients who have skin cancer, melanoma, which occurs in areas of the body such as ears, hands and feet. Bob Marley had a melanoma and that’s what he died from,” said Dr Knowles, a member of the American Society of Mohs Surgery (ASMS).

“All races have moles, so if you know you have moles on your body and live in a tropical country where you have exposure to sun on a daily basis, then you are at risk of developing skin cancer. It is very important for all races to avoid the midday sun, wear protective clothing and use sunscreen when outdoors.”

Nothing covers The Bahamas better than the sun and with school out for the summer, maintaining healthy skin through beach days and an outdoor lifestyle in this tropical climate is no easy feat. Not surprisingly, Dr Knowles recommends an annual skin check.

“Every day I diagnose one of the three types of skin cancers,” reported the dermatologist who has spent the last 13 years in private practice delivering full service dermatology care and a suite of other services through her laser and cosmetic centre.

Through full body dermoscopy – a 90-minute procedure spent checking every spot, from head to toe, on a patient’s body – she is able to identify skin cancers early, mostly basal cell and squamous cell cancers.

Nonmelanoma skin cancer may appear as a pimple, a patch of eczema, she explains, red scaly skin with crusting, or a sore that doesn’t heal. Melanoma, the most serious type of skin cancer, appears as a flat mole that has increased in size or changed its shape, colour, edges and could itch or bleed.

For non-melanoma tumors, specialists at Cleveland Clinic Florida offer the cancer cell destroying brachytherapy by placing a high dose radiation pellet near the cancer using specialize catheters, providing highly conformal, precise radiation treatment.

“Brachytherapy is well-suited to treat skin cancer patients,” said Dr. John Greskovich, chairman of Radiation Oncology at Cleveland Clinic Florida’s Maroone Cancer Center. “We use brachytherapy to treat non-melanoma skin cancers that are too large for surgery or located on the central face in areas where cosmesis is important.”

At the Maroone Cancer Center, an optimized treatment plan with HDR brachytherapy can vary from one to three weeks, depending on the extent of the skin cancer.

“HDR brachytherapy has been shown to control over 95 percent of the non-melanoma skin cancers treated,” said Dr. Greskovich who specializes in a wide-range of radiation therapy. “Brachytherapy may also be more suitable for people taking blood thinners or who have problems with wound healing.”

Larger tumors treated with surgery often require tissue reconstruction using a skin graft or bringing in tissue from other parts of the body. By contrast, no reconstructive surgery is necessary when using brachytherapy.

“After radiation with brachytherapy, the appearance of the skin goes back to normal,” said Dr. Greskovich. “HDR brachytherapy using the Freiburg Flap, a flexible mesh-style surface mold that can be sized and shaped to match the contour of the area being treated, augments the treatment ‘toolbox’ that our specialists use to achieve optimal results for non-melanoma, skin cancer patients.

In addition to brachytherapy, Cleveland Clinic Florida patients have an expanded array of treatment options, including immunotherapy drugs for advanced basal cell carcinoma and Merkel Cell Carcinoma.

“We are excited to offer these innovative treatments, guided by a multidisciplinary team of researchers,” said Dr. Greskovich.

And while methods of treatment vary, both skin specialists urge Bahamians to take extra care when out in the sun and pay special attention to early warning signs, including changes on the skin’s surface, which could indicate a type of skin cancer.