A scar on the skin, even one that has been present for decades, can significantly increase the risk of developing skin cancer, including potentially deadly forms. TV presenter Mike Parry discovered this firsthand when a scar above his eyebrow, present for 53 years, began to bleed and form an open wound, which was later diagnosed as basal cell carcinoma (BCC).
Parry, a regular on Channel 5's Jeremy Vine show and GB News, initially dismissed the persistent bleeding from the 53-year-old scar as a slow-healing cut. However, by March of this year, the wound had grown to 2cm, prompting him to seek medical attention. A private hospital examination revealed not only the tumor on his eyebrow but also a smaller cancer on his nose and another 1cm cancer on his right arm, which resembled a vaccine scar.
This experience was particularly surprising for Parry, who described himself as someone who actively avoids sun exposure. He stated that he always seeks shade, wears hats, and uses long-sleeved shirts, even on holiday. His case illustrates that skin cancer risk is not solely tied to excessive sunbathing, and other factors can play a crucial role.
Having a scar elevates the risk of any skin cancer, including malignant melanoma, the most dangerous type, which is responsible for nearly 3,000 deaths in the UK annually. Research published in the Journal of Plastic Surgery and Hand Surgery indicates that skin cancers developing in scars may exhibit more aggressive clinical behavior.
Even casual sun exposure can increase risk. Parry had previously been advised to take Vitamin D supplements due to low levels, even during summer, suggesting limited sun exposure.
BCCs develop in the skin's outermost cells, which are responsible for regeneration. Over time, UV radiation can damage the DNA of these cells, leading to cancer. Dr. Adil Sheraz, a consultant dermatologist and spokesperson for the British Association of Dermatologists, explained that BCCs are linked to cumulative sun exposure from daily activities.
Dermatologists emphasize the importance of wearing sunscreen when the UV index exceeds three, advising daily application between April and September, even in the UK. While often underestimated because they are not typically life-threatening, BCCs can be highly destructive, eroding surrounding skin. They are sometimes referred to as 'rodent ulcers' due to their destructive nature, and in severe cases, can lead to the removal of parts of the nose or impact vision.
BCCs commonly appear on the head and face, often along 'fault lines' like smile lines. They can initially present as a shiny nodule or pearly lump that grows and may ulcerate, or as a non-healing cut or injury. Their slow growth and lack of pain can cause them to go unnoticed in their early stages, particularly when they begin in scars, where they might be mistaken for the scar reopening.
Scar tissue is more vulnerable to cancer due to several factors. It is paler, containing fewer melanocytes, which provide pigment and UV protection. Additionally, scar tissue may have fewer immune cells patrolling the area, potentially hindering the early detection and response to cancerous changes. Dr. Justine Hextall, a consultant dermatologist, advises extra care in protecting scars and burns from the sun and seeking medical attention for any signs of ulceration or bleeding.
Parry's fair skin, which produces more pheomelanin, also contributed to his risk. Fair skin is less adept at protecting itself from UV rays and can produce free radicals that damage cells, promoting tumor formation. Approximately 30% of individuals in the UK with fair skin develop at least one BCC in their lifetime, a figure rising due to sun exposure and the use of sunbeds.
Experts also caution against misinformation on social media that promotes tanning beds and discourages sunscreen use. The UVA radiation in sunbeds can be up to ten times stronger than the sun and penetrates deeply into the skin layers where BCCs develop.
Treatment for BCCs varies depending on their size and depth. Small, superficial BCCs can be treated with freezing or anti-cancer creams. Deeper or more invasive cancers may require surgical removal or radiotherapy. Parry recently began a five-day course of radiotherapy for the cancer on his eyebrow and will undergo further treatment for the cancer on his nose. The cancer on his arm has already been surgically removed.
Parry noted that the radiotherapy causes dizziness and a sensation of being hit in the eye, but expressed relief that the outcome could have been far worse and potentially led to more extensive scarring.