Skin Cancer Diagnosis & Treatment in Singapore
What are Skin Cancer Treatments in Singapore?
There are several skin cancer treatments available in Singapore.
Skin cancer is a type of cancer that develops in the cells of the skin. There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma.
The appropriate treatment for skin cancer depends on the type, location, and stage of the cancer.
Skin Cancer Treatment: Surgery
Surgery is one of the most common treatments for skin cancer, and it involves removing the cancerous tissue from the skin. Depending on the type, size, and location of the skin cancer, different surgical techniques may be used. Some of the common surgical procedures for skin cancer include:
(A) Excisional surgery: This involves removing the entire cancerous tissue along with a margin of healthy tissue to ensure all cancer cells are removed.
(B) Mohs surgery: This is a specialized surgical technique used for skin cancers that have a high risk of recurrence or are in areas where tissue preservation is important, such as the face. The surgeon removes the cancerous tissue layer by layer, examining each layer under a microscope until no cancer cells are found.
(C) Curettage and electrodessication: This involve scraping the cancerous tissue from the skin with a curette, followed by using an electric needle to destroy any remaining cancer cells.
After surgery, the removed tissue is usually sent to a laboratory for examination to ensure all cancer cells have been removed. Recovery time and follow-up care will depend on the type of surgery performed and the individual’s overall health.
Skin Cancer Treatment: Radiation Therapy
Radiation therapy is a treatment for skin cancer that uses high-energy radiation to kill cancer cells. It is usually recommended for patients who are not good candidates for surgery, or for those who have larger or more aggressive skin cancers. Radiation therapy may also be used after surgery to destroy any remaining cancer cells.
There are two main types of radiation therapy for skin cancer:
(1) External beam radiation therapy: This involves directing radiation from a machine outside the body onto the skin cancer. The radiation is carefully targeted to minimize damage to healthy tissue surrounding the cancer.
(2) Brachytherapy: This involves placing small radioactive seeds or sources directly into or near the skin cancer to deliver radiation to the cancer cells. This technique may be used for smaller skin cancers or for those located in sensitive areas where preservation of normal tissue is important.
Radiation therapy is usually given in several sessions over the course of several weeks. During each session, the patient lies on a table while the radiation is delivered.
Radiation therapy is a highly effective treatment for skin cancer, with cure rates similar to surgery.
Skin Cancer Treatment: Chemotherapy
Chemotherapy is a treatment for skin cancer that involves using drugs to kill cancer cells. It is typically used for advanced or metastatic skin cancer that has spread to other parts of the body. Chemotherapy may also be used in combination with other treatments, such as surgery or radiation therapy, to treat certain types of skin cancer.
There are two main types of chemotherapy for skin cancer:
(1) Systemic chemotherapy: This involves taking chemotherapy drugs orally or through injection, which circulate throughout the body to target cancer cells. This type of chemotherapy is usually used for skin cancer that has spread to other parts of the body.
(2) Topical chemotherapy: This involves applying chemotherapy drugs directly to the skin cancer in the form of a cream or gel. This type of chemotherapy is usually used for early-stage skin cancers that are confined to the skin.
Chemotherapy is typically used for advanced or metastatic skin cancer, which means the cancer has spread to other parts of the body. It may also be used in combination with other treatments, such as surgery or radiation therapy, to treat certain types of skin cancer.
Skin Cancer Treatment: Targeted Therapy
Targeted therapy is a type of treatment that is used for some types of skin cancer, particularly advanced melanoma. Targeted therapy is a relatively new approach to cancer treatment that uses drugs to specifically target and attack cancer cells while minimizing damage to healthy cells.
Targeted therapy drugs work by targeting specific molecules or proteins that are involved in the growth and spread of cancer cells. In the case of skin cancer, some targeted therapy drugs target the BRAF gene, which is mutated in about half of all melanoma cases. By targeting this gene, these drugs can help slow or stop the growth of melanoma cells.
Targeted therapy for skin cancer is typically administered in pill form and is usually taken daily.
Skin Cancer Treatment: Immunotherapy
Immunotherapy is a type of skin cancer treatment that uses the body’s own immune system to fight cancer cells. It works by stimulating or enhancing the immune system to recognize and attack cancer cells.
There are several types of immunotherapies that may be used for skin cancer treatment, including:
(1) Checkpoint inhibitors: These drugs target certain proteins on immune cells that help keep them from attacking normal cells. By blocking these proteins, checkpoint inhibitors can help the immune system recognize and attack cancer cells.
(2) Interleukin-2 (IL-2) therapy: IL-2 is a type of protein that helps activate the immune system. In high doses, it can stimulate the immune system to attack cancer cells.
Immunotherapy can be used to treat several types of skin cancer, including melanoma, squamous-cell and Merkel cell carcinoma. It is often used for advanced or metastatic skin cancer that has not responded to other treatments.
Are there any Side Effects of Skin Cancer Treatment?
Side Effects of Skin Treatment: Surgery
Surgery is often a long and complex operation. Serious short-term side effects are not common, but they can include reactions to anesthesia, excess bleeding, blood clots, and infections. Pain is common after the operation, and strong pain medicines might be needed for a while after surgery as the site heals.
The specific side effects that a patient may experience depend on the type of surgery they undergo, the extent of the surgery, and other factors such as their overall health and medical history.
Some common side effects of skin cancer surgery may include:
- Pain and discomfort: Patients may experience pain and discomfort in the area where the surgery was performed. This can usually be managed with pain medication prescribed by the doctor.
- Swelling: Swelling may occur in the area where the surgery was performed. This is usually temporary and should resolve on its own.
- Scarring: Surgery can result in scarring, which may be more or less noticeable depending on the location and extent of the surgery.
- Bleeding and bruising: Patients may experience some bleeding and bruising in the area where the surgery was performed.
- Infection: There is a risk of infection with any surgical procedure. Patients should follow their doctor’s instructions for wound care to reduce the risk of infection.
- Numbness or tingling: Surgery can sometimes cause nerve damage, which can result in numbness or tingling in the area where the surgery was performed.
Side Effects of Skin Cancer Treatment: Radiation Therapy
Radiation therapy is a common treatment option for skin cancer, but it can have side effects, which may vary depending on the type and location of the cancer, as well as the dose and duration of radiation treatment. Some possible side effects of radiation therapy for skin cancer may include:
- Skin changes: Radiation can cause changes in the skin in the area where the treatment is delivered. This can include redness, itching, dryness, blistering, and peeling. The skin may also become darker or lighter in color.
- Fatigue: Radiation therapy can cause fatigue or tiredness, which can range from mild to severe. This can be due to the energy used by the body to heal the tissues that have been exposed to radiation.
- Hair loss: Depending on the area of the skin being treated, radiation therapy can cause temporary hair loss in the treatment area.
- Radiation recall: Sometimes, radiation therapy can cause an inflammatory reaction in the skin in the area where a chemotherapy drug was given, even if the drug was given in the past. This is known as radiation recall and can cause redness, swelling, or blistering in the area.
- Radiation toxicity: High doses of radiation therapy can cause damage to the surrounding normal tissues and organs, leading to toxicity and potential long-term side effects.
- Infection: Radiation can weaken the immune system and make the skin more susceptible to infections.
Side Effects of Skin Cancer Treatment: Chemotherapy
Chemotherapy is a type of skin cancer treatment that uses drugs to kill cancer cells. While it can be effective, chemotherapy can also have side effects, which can vary depending on the type and dose of chemotherapy drugs used, as well as the individual’s overall health and medical history. Some possible side effects of chemotherapy for skin cancer may include:
- Nausea and vomiting: Chemotherapy drugs can cause nausea and vomiting. Anti-nausea medications can be prescribed to help manage these side effects.
- Hair loss: Chemotherapy can cause hair loss in the treated area or all over the body.
- Fatigue: Chemotherapy can cause fatigue or tiredness, which can range from mild to severe.
- Mouth sores: Chemotherapy can cause sores or ulcers in the mouth, making it difficult to eat or drink.
- Weakened immune system: Chemotherapy can weaken the immune system, making it more difficult for the body to fight off infections.
- Anemia: Chemotherapy can cause a decrease in red blood cells, leading to anemia, which can cause fatigue, weakness, and shortness of breath.
- Skin changes: Some chemotherapy drugs can cause changes in the skin, such as redness, dryness, or peeling.
Side Effects of Skin Cancer Treatment: Targeted Therapy
Targeted therapy is a type of skin cancer treatment that uses drugs to target specific molecules or genes involved in the growth and spread of cancer cells. While it can be effective, targeted therapy can also have side effects, which can vary depending on the type of drug used, as well as the individual’s overall health and medical history. Some possible side effects of targeted therapy for skin cancer may include:
- Skin changes: Targeted therapy can cause changes in the skin, such as rash, dryness, or redness. Some drugs can also cause hand-foot syndrome, which is characterized by redness, swelling, and pain in the hands and feet.
- Fatigue: Targeted therapy can cause fatigue or tiredness, which can range from mild to severe.
- Gastrointestinal problems: Targeted therapy can cause gastrointestinal problems, such as nausea, vomiting, diarrhea, or constipation.
- High blood pressure: Some targeted therapy drugs can cause an increase in blood pressure.
- Liver toxicity: Some targeted therapy drugs can cause liver toxicity, which can lead to liver damage.
- Bleeding problems: Some targeted therapy drugs can cause bleeding problems, such as easy bruising or bleeding.
Side Effects of Skin Cancer Treatment: Immunotherapy
Immunotherapy is a type of skin cancer treatment that uses drugs to stimulate the immune system to recognize and attack cancer cells. While it can be effective, immunotherapy can also have side effects, which can vary depending on the type of drug used, as well as the individual’s overall health and medical history. Some possible side effects of immunotherapy for skin cancer may include:
- Skin changes: Immunotherapy can cause changes in the skin, such as rash, dryness, or redness. Some drugs can also cause vitiligo, which is characterized by patches of skin that lose their color.
- Fatigue: Immunotherapy can cause fatigue or tiredness, which can range from mild to severe.
- Gastrointestinal problems: Immunotherapy can cause gastrointestinal problems, such as nausea, vomiting, diarrhea, or constipation.
- Immune-related adverse events: Immunotherapy works by stimulating the immune system, which can lead to immune-related adverse events. These can include inflammation of the lungs, liver, or kidneys, as well as autoimmune disorders, such as thyroiditis, colitis, or diabetes.
- Endocrine problems: Some immunotherapy drugs can cause endocrine problems, such as thyroid dysfunction, hypophysitis, or adrenal insufficiency.
- Infusion reactions: Some immunotherapy drugs are given through intravenous infusion, which can cause infusion reactions, such as fever, chills, or shortness of breath.
What Do I Need to Do If I have Skin Cancer?
It is important to remember that skin cancer can be treated successfully if caught early. If you have any concerns about your skin or notice any changes, do not hesitate to see a healthcare professional for evaluation.
If you suspect that you or your loved one have skin cancer, it is advisable to get the support you need. Early detection and diagnosis of skin cancer is key to treating the disease.
Regardless of what stage your skin cancer may be at, you should schedule an appointment to see an oncologist specialising in skin cancer as soon as possible. With the speed of developments in skin cancer diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.
Our cancer specialists at OncoCare specialise in treating late stage and advanced stages of skin cancer, as well as earlier stages of the disease.
Who are the Skin Cancer Specialists in Singapore?
Senior Consultant, Medical Oncologist
MBBS (Singapore) – ABIM Int. Med (USA) – ABIM Med Onc(USA) – FAMS (Medical Oncology)
Dr. Kevin Tay is a Senior Consultant Medical Oncologist with the OncoCare Cancer Center and also a Visiting Consultant at the National Cancer Center Singapore. Dr. Tay received his medical degree from the National University of Singapore, School of Medicine and did his post-graduate training in Internal Medicine at the University of Hawaii and his Medical Oncology fellowship at the National Cancer Institute (NCI), National Institute of Health (NIH) in USA. Dr. Tay was also appointed Chief Resident and Chief Fellow during both his residency and fellowship program respectively. He currently holds American Board certifications for the practice of Internal Medicine and Medical Oncology.
During his time at the National Cancer Institute (NCI) and the National Institute of Health (NIH) in USA, Dr Tay trained under several renowned oncologists, including Dr Sandy Swain, a world expert on breast cancer and the previous President of the American Society of Clinical Oncology, and Dr Giuseppe Giaccone, the previous Chair of the EORTC’s Lung Cancer Cooperative Group and also the Associate Director for Clinical Research at the Lombardi Comprehensive Cancer Center, Georgetown University. Dr Tay also spent two years doing research at the NIH with an internationally renowned translational research group, under the mentorship of Dr Wyndham Wilson, Dr Louis Staudt and Dr Elaine Jaffe.
Upon returning to Singapore in early 2010, Dr. Tay joined the Department of Medical Oncology at National Cancer Center. He continued to be active in translational research and is part of the core group at the National Cancer Center Singapore. He was recognized as one of top cancer doctor doing research, that was awarded the prestigious center grant by the National Medical Research Council of Singapore. In addition, Dr Tay is actively collaborating with other leading Asian researchers from Korea, Taiwan and Hong Kong as well with his former colleagues at the National Institute of Health in USA in genomic oncology research. Dr Tay has also published widely in numerous journals, including the Nature Genetics, the Journal of Clinical Oncology, The Lancet Hematology, American Journal of Medicine, Leukemia & Lymphoma and Seminars in Hematology.
Dr Tay’s subspecialty interest is in women related cancers such as breast cancers & gynaecological cancers, melanoma, brain cancers, soft tissue & bone sarcomas and also hematological malignancies such as lymphoma, multiple myeloma and leukemia.
- Graduated from the National University of Singapore in 1998.
- Board Certified, Internal Medicine, American Board of Internal Medicine, 2006
- Board Certified, Medical Oncology, American Board of Internal Medicine, 2009
- Chief Resident, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, 2006
- Chief Fellow, Medical Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, 2008
What is Skin Cancer?
Definition of Skin Cancer
Skin cancer is a type of cancer that develops in the cells of the skin. There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma.
Basal cell carcinoma is the most common type of skin cancer and typically appears as a raised, pearly bump on the skin. It usually develops on sun-exposed areas, such as the face and neck.
Squamous cell carcinoma is the second most common type of skin cancer and typically appears as a red, scaly patch or sore on the skin. It can also develop on sun-exposed areas of the body, including the face, ears, and hands.
Melanoma is the least common type of skin cancer, but it is the most dangerous because it can spread to other parts of the body. It often appears as a dark, irregularly shaped mole or spot on the skin.
Exposure to ultraviolet (UV) radiation from the sun or tanning beds is the most common cause of skin cancer. Other risk factors include having fair skin, a history of sunburns, a weakened immune system, and a family history of skin cancer.
Skin cancer is a common type of cancer worldwide, and its incidence has been increasing in many countries. In Singapore, skin cancer is the sixth most common cancer in men and the seventh most common cancer in women, according to the Singapore Cancer Registry. The latest data from the registry shows that there were 3781 cases of skin cancer diagnosed in Singapore between 2016 – 2020.
Globally, the incidence of skin cancer varies depending on the region and population. According to the World Health Organization (WHO), skin cancer is the most common cancer worldwide, accounting for about 20% of all newly diagnosed cancers. In 2020, it was estimated that there were over 1.2 million new cases of melanoma and over 3 million new cases of non-melanoma skin cancer worldwide.
What are the Signs and Symptoms of Skin Cancer?
The most common symptoms of Skin Cancer include:
- A new growth or mole on the skin: This can appear as a bump or a patch of skin that is discolored, raised, or rough.
- Changes to an existing mole: This can include changes in color, shape, size, or texture.
- Irregular borders: The edges of a mole or growth may be irregular or notched.
- Itching, bleeding, or crusting: A mole or growth that is itchy, bleeding, or developing a crust should be evaluated by a healthcare professional.
- Scaly or red patches: A patch of skin that is scaly, red, or irritated may be a sign of skin cancer.
It is important to note that not all skin cancers present with symptoms, and some may only be detected through routine skin exams. Regular skin checks can help detect skin cancer early when it is most treatable.
Screening for Skin Cancer
In Singapore, the Health Promotion Board (HPB) recommends that individuals perform regular self-exams of their skin to check for any changes or abnormalities. The HPB also recommends that individuals who are at higher risk of developing skin cancer, such as those with fair skin, a family history of skin cancer, or a history of significant sun exposure, undergo regular skin exams by a healthcare professional.
During a skin exam, a healthcare professional will visually inspect the skin for any suspicious growths or lesions. If an abnormality is detected, a biopsy may be performed to determine if it is cancerous.
In addition to regular skin exams, the HPB recommends taking steps to protect your skin from the sun, such as wearing protective clothing and sunscreen, and avoiding tanning beds. It is also important to be aware of the early signs of skin cancer and to seek medical attention if you notice any changes or abnormalities on your skin.
How Skin Cancer is Diagnosed
Skin cancer can be diagnosed through a combination of physical examination and biopsy.
During a physical exam, a healthcare professional will visually inspect the skin for any suspicious growths or lesions. They may use a dermatoscope, a handheld device that provides a magnified view of the skin, to closely examine any areas of concern.
If an abnormality is detected, a biopsy may be performed to determine if it is cancerous. A biopsy involves removing a small sample of skin tissue from the area of concern and examining it under a microscope. There are several types of biopsies that can be performed depending on the size and location of the abnormality, including shave biopsies, punch biopsies, and excisional biopsies.
In some cases, imaging tests such as CT scans, MRI scans, or PET scans may be ordered to help determine the extent of the cancer and whether it has spread to other parts of the body.
It is important to note that not all abnormal skin growths or lesions are cancerous, and not all skin cancers present with symptoms. Regular skin exams can help detect skin cancer early when it is most treatable. If you notice any changes or abnormalities on your skin, it is important to see a healthcare professional for evaluation.
What are the Causes and Risk Factors of Skin Cancer?
The primary cause of skin cancer is damage to the DNA in skin cells, usually caused by exposure to ultraviolet (UV) radiation from the sun or tanning beds. When the DNA in skin cells is damaged, the cells can grow and divide uncontrollably, leading to the development of cancer.
Some common risk factors for skin cancer include:
Sun exposure: People who spend a lot of time in the sun or who have had repeated sunburns are at higher risk of developing skin cancer.
Tanning beds: Tanning beds emit UV radiation that can cause skin damage and increase the risk of skin cancer.
Fair skin: People with fair skin, light eyes, and blond or red hair are at higher risk of developing skin cancer.
Family history: Individuals with a family history of skin cancer may be at higher risk of developing the disease.
Age: The risk of skin cancer increases as people age.
Weakened immune system: People with weakened immune systems, such as those with HIV or who have received an organ transplant, are at higher risk of developing skin cancer.
Exposure to certain chemicals: Exposure to certain chemicals, such as arsenic, can increase the risk of skin cancer.
It is important to protect your skin from the sun, including wearing protective clothing and sunscreen, and avoiding tanning beds. If you have risk factors for skin cancer, it is important to undergo regular skin exams and to be vigilant about checking your skin for any changes or abnormalities.
What are the Types of Skin Cancer?
There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma.
- Basal cell carcinoma (BCC): This is the most common type of skin cancer, accounting for approximately 80% of all cases. BCC typically develops in areas that have been exposed to the sun, such as the face, neck, and arms. It usually appears as a small, waxy bump or a flat, flesh-colored or brown scar-like lesion.
- Squamous cell carcinoma (SCC): SCC is the second most common type of skin cancer, accounting for approximately 16% of all cases. SCC typically develops in areas that have been exposed to the sun, such as the face, neck, and arms. It usually appears as a firm, red nodule or a flat lesion with a scaly, crusty surface.
- Melanoma: Melanoma is a less common but more dangerous type of skin cancer. It develops in the cells that produce pigment in the skin (melanocytes) and can appear anywhere on the body, even in areas that have not been exposed to the sun. Melanoma can appear as a new or existing mole that changes in size, shape, or color, or as a dark, irregularly shaped patch.
Other rare types of skin cancer include Merkel cell carcinoma, dermatofibrosarcoma protuberans, and Kaposi sarcoma. It is important to have any unusual or changing skin lesions evaluated by a healthcare professional to determine if they are cancerous.
What are the Stages of Skin Cancer?
The stages of skin cancer are typically determined by the size and depth of the cancerous cells, whether the cancer has spread to nearby lymph nodes or other organs, and the overall health of the patient. The stages of skin cancer are as follows:
- Stage 0: This stage is also known as melanoma in situ, and it refers to cancer cells that are present only in the top layer of skin and have not yet spread.
- Stage I: At this stage, the cancer is still confined to the skin and has not spread to nearby lymph nodes or other organs.
- Stage II: In this stage, the cancer has grown deeper into the skin and may have spread to nearby lymph nodes, but not to other organs.
- Stage III: At this stage, the cancer has spread to nearby lymph nodes and may have also grown into nearby tissues.
- Stage IV: This is the most advanced stage of skin cancer, in which the cancer has spread to distant organs, such as the lungs or liver.
It is important to note that not all types of skin cancer follow this staging system. For example, basal cell carcinoma and squamous cell carcinoma are typically staged based on their size and location rather than how far they have spread. Our Skin Cancer Specialists can help determine the stage of your skin cancer based on a variety of factors, including your medical history, physical examination, and diagnostic tests.
