Skin Cancer Screening in Singapore

What are Skin Cancers?

Skin cancer occurs when abnormal skin cells grow in an uncontrolled way. Ultraviolet (UV) radiation from sunlight is an important risk factor, although skin cancers can also develop on areas that receive little or no sun exposure.

Skin cancer is relatively common in Singapore. According to the latest Singapore Cancer Registry data for 2019–2023, non-melanoma skin cancer is the 6th most common cancer in men and 8th most common in women.

What Does Skin Cancer Look Like?

Skin cancer can have many different appearances. It may present as a new growth, a changing mole, a persistent scaly patch, a lump or a sore that does not heal. Some skin cancers may bleed, crust or repeatedly break down.

The surface may appear smooth, pearly, waxy, scaly, crusted or firm, depending on the type of skin cancer.

What Colour Can Skin Cancer Be?

Skin cancers are not always dark or obviously abnormal. They may be skin-coloured, pink, red, brown, black or occasionally blue-grey. Some may contain several different colours within the same lesion.

How Large Are Skin Cancers?

Skin cancers vary considerably in size and can initially be very small. Rather than size alone, a lesion that is growing or changing over time can be an important warning sign.

Early assessment is particularly important because skin cancers are generally easier to treat when they are small.

Where Do Skin Cancers Commonly Appear?

Many skin cancers occur on areas with significant sun exposure, particularly the face, scalp, ears, neck, arms, hands and legs.

However, skin cancer can develop anywhere on the body, including areas that are not regularly exposed to the sun. It is therefore important not to dismiss a suspicious lesion simply because it is in a covered area.

Are Skin Cancers Dangerous?

The three main types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma.

BCC and SCC are generally highly treatable, particularly when diagnosed early. However, if left untreated, they can grow into and damage surrounding tissues, and some SCCs can spread to other parts of the body.

Melanoma is less common but more serious because it has a greater potential to spread to lymph nodes and other organs. Early diagnosis and treatment significantly improve outcomes.

What are the Symptoms of Skin Cancer?

Skin cancer can look very different from person to person. An important early warning sign is any new, changing or unusual spot or growth on the skin, particularly one that looks different from your other skin lesions.

Signs to look out for include:

• A spot that looks different: A mole or growth that stands out from the other spots on your skin — sometimes called the “ugly duckling” sign.
• A sore that does not heal: A wound or ulcer that persists, repeatedly crusts or bleeds, or does not heal normally.
• A changing mole: Any mole that changes in size, shape, colour or appearance should be assessed.
• A persistent scaly patch: A rough, crusted or scaly area that does not resolve and may occasionally bleed.
• A pearly or shiny growth: A skin-coloured or pink bump that appears shiny or pearly and may contain visible small blood vessels, a characteristic appearance of some basal cell carcinomas.
• Repeated bleeding: A spot that bleeds easily or repeatedly without significant trauma should be examined.
• A growing lump: A firm or enlarging growth, particularly one that continues to change over weeks or months.

Skin cancers are not always painful or symptomatic, particularly in their early stages. For this reason, a lesion should not be assumed to be harmless simply because it does not hurt or itch.

Any new, changing, persistent or unusual skin lesion should be assessed by a dermatologist, particularly if it continues to evolve or does not heal.

What are the Causes of Skin Cancer?

Skin cancer develops when DNA within skin cells becomes damaged, allowing abnormal cells to grow and multiply in an uncontrolled way. In most skin cancers, this results from a combination of environmental exposure and individual susceptibility.

Important causes and risk factors include:

• Ultraviolet (UV) Radiation: UV radiation from the sun and tanning devices is the most important preventable cause of skin cancer. UV exposure damages DNA within skin cells, and this damage can accumulate over many years.
• Repeated or Intense Sun Exposure: People who spend significant time outdoors without adequate sun protection have a greater lifetime exposure to UV radiation. A history of severe or blistering sunburns, particularly earlier in life, can also increase the risk of certain skin cancers.
• Fair Skin: People with fair skin have less protective melanin and are therefore more susceptible to UV-induced skin damage. However, skin cancer can occur in all skin types, including Asian and darker skin.
• Genetic Factors: A family history of melanoma or certain other skin cancers can increase an individual's risk. Some inherited genetic conditions also significantly increase susceptibility to skin cancer.
• Weakened Immune System: People who are immunosuppressed, such as organ-transplant recipients or patients taking long-term immunosuppressive medication, have an increased risk of skin cancer, particularly squamous cell carcinoma.
• Increasing Age: Skin cancer becomes more common with age because UV and other DNA damage accumulate over time, although skin cancer can also occur in younger people.
• Previous Skin Cancer: Someone who has previously developed a skin cancer has a higher risk of developing another skin cancer in the future.
• Other Exposures: Less commonly, previous radiation treatment, chronic wounds or scars, and exposure to certain carcinogenic chemicals can increase the risk of particular skin cancers.

Importantly, not all skin cancers are caused by sun exposure. Melanoma and other skin cancers can develop in areas that receive little sunlight, so any new, changing or unusual skin lesion should be assessed regardless of its location.

What are the Types of Skin Cancers?

The three main types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. They arise from different types of skin cells and vary in their appearance, behaviour and potential to spread.

1. Basal Cell Carcinoma (BCC)

Basal cell carcinoma is the most common type of skin cancer. It usually grows slowly and is highly curable when detected and treated early. If left untreated, BCC can continue to grow and damage surrounding tissues, although it very rarely spreads to other parts of the body.

BCC may appear as a pearly or shiny pink bump, a persistent scaly patch, or a sore that repeatedly bleeds, crusts or does not heal. Small blood vessels may sometimes be visible on its surface. In Asian and darker skin types, BCC may contain more pigment and appear brown, blue-grey or black.

2. Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma is the second most common type of skin cancer. Most SCCs are successfully treated when detected early. However, some can behave more aggressively, growing into surrounding tissues and potentially spreading to the lymph nodes or other parts of the body.

SCC may appear as a firm pink or red lump, a thickened scaly or crusted patch, or a persistent sore that does not heal. Some lesions may become tender or bleed easily. SCC commonly develops on sun-exposed skin but can also occur within longstanding scars or chronic wounds.

3. Melanoma

Melanoma is less common than BCC and SCC but is potentially more serious because it has a greater tendency to spread to the lymph nodes and other organs. When detected early and confined to the skin, melanoma is often highly curable.

Melanoma may develop from an existing mole or appear as a new pigmented spot or growth. Warning signs include changes in size, shape or colour, asymmetry, irregular borders, multiple colours, or a lesion that looks noticeably different from the other moles on your skin — sometimes referred to as the “ugly duckling” sign.

In Asian patients, melanoma can also occur on the palms, soles and around or beneath the nails, so new or changing pigmented lesions in these areas should also be assessed.

What are the Risk Factors for Skin Cancer?

Anyone can develop skin cancer, but certain factors increase the risk. These include:

• Excessive sun exposure, particularly over many years
• Fair skin that burns easily
• A history of severe blistering sunburn, especially during childhood
• A personal history of skin cancer
• A family history of skin cancer, particularly melanoma
• Multiple or atypical (dysplastic) moles
• A weakened immune system, including from certain medical conditions or medications
• Exposure to arsenic
• Increasing age, although melanoma can also occur in younger individuals

If you notice a new, changing or unusual mole or skin lesion, it is important to seek prompt assessment by a dermatologist. Early detection greatly improves the chances of successful treatment.

Individuals with an increased risk of skin cancer, or those who have previously been diagnosed with skin cancer, should undergo regular skin examinations, typically every 6–12 months, or as recommended by their dermatologist.

How to Prevent Skin Cancer?

The leading cause of skin cancer is damage to skin cells from ultraviolet (UV) radiation, primarily from the sun. Protecting your skin from excessive UV exposure can significantly reduce your risk of developing skin cancer.

You can help protect your skin by:

• Limiting sun exposure, especially during the middle of the day when UV levels are highest.
• Seeking shade whenever possible when outdoors.
• Applying a broad-spectrum sunscreen (SPF 50 or higher) every day. Reapply every 2 hours, and after swimming, sweating or towel drying.
• Wearing protective clothing, including a wide-brimmed hat, sunglasses and long-sleeved clothing when outdoors.
• Avoiding tanning beds, which emit harmful UV radiation and increase the risk of skin cancer.
• Performing regular self-skin examinations to look for new or changing moles and skin lesions.
• Scheduling regular skin checks with a dermatologist, particularly if you have a personal or family history of skin cancer, multiple atypical moles, or other risk factors.

Early detection is just as important as prevention. If you notice a new, changing or non-healing skin lesion, arrange an assessment with your dermatologist as soon as possible.

How to Check for Skin Cancer Using the ABCDE Rule?

The ABCDE rule is a simple guide to help identify the early warning signs of melanoma, the most serious type of skin cancer. Regularly examining your skin and moles can help detect suspicious changes early, when treatment is most effective.

Look for the following signs:

• A – Asymmetry: One half of the mole does not match the other half in shape or appearance.
• B – Border: The edges are irregular, ragged, blurred or poorly defined.
• C – Colour: The mole has multiple colours or uneven shades of brown, black, tan, red, white or blue.
• D – Diameter: The mole is larger than 6 mm (about the size of a pencil eraser), although melanomas can sometimes be smaller.
• E – Evolving: The mole is changing in size, shape, colour, elevation or symptoms such as itching, bleeding or crusting.

Remember, not all skin cancers follow the ABCDE rule. A new, changing or non-healing skin lesion, or a mole that looks different from your other moles (the “ugly duckling” sign), should also be assessed by a dermatologist.

If you have any concerns about a mole or skin lesion, your dermatologist can perform a thorough skin examination and, if necessary, recommend further investigations or treatment to establish an accurate diagnosis.

How is Skin Cancer Diagnosed?

Skin cancer is diagnosed through a thorough skin examination (also known as a skin check or mole check) performed by a dermatologist. If a suspicious lesion is identified, further investigations may be recommended to confirm the diagnosis and guide treatment.

Clinical Examination

Your dermatologist will examine your skin using specialised magnification tools, such as dermoscopy, to assess suspicious moles and skin lesions.

Skin Biopsy

If a lesion appears suspicious, a biopsy or complete excision may be performed under local anaesthesia. The tissue is then sent to a laboratory to be examined by a dermatopathologist to determine whether skin cancer is present and, if so, the type, thickness and other important pathological features.

Additional Investigations

For certain skin cancers, particularly higher-risk melanoma, additional tests such as sentinel lymph node biopsy, imaging or other investigations may be recommended to determine the stage of the cancer and guide further management.

How to Treat Skin Cancers?

Treatment depends on the type, size, location and stage of the skin cancer. The primary goal is to completely remove the cancer while preserving as much healthy tissue and function as possible. Your dermatologist will recommend the most appropriate treatment based on your diagnosis.

Prescription Creams

Certain precancerous lesions (solar keratoses) and selected superficial skin cancers may be treated with prescription creams. These medications work by destroying abnormal cells or stimulating the body's immune system to eliminate them.

Cryotherapy (Freezing Treatment)

Cryotherapy uses liquid nitrogen to freeze and destroy precancerous lesions such as solar keratoses. It is a quick and effective treatment that allows the abnormal cells to gradually die and shed as the skin heals.

Surgical Excision

Surgical excision is the most common treatment for basal cell carcinoma, squamous cell carcinoma and melanoma. The skin cancer is removed together with an appropriate margin of surrounding healthy skin to maximise the likelihood of complete removal. The excised tissue is then examined by a dermatopathologist to confirm the diagnosis, assess important pathological features, and determine whether the margins are clear of cancer.

At Stephanie Ho Dermatology, most skin cancer excisions are performed under local anaesthesia as a day procedure, allowing patients to return home shortly after treatment. If MOHS micrographic surgery is considered the most appropriate treatment, we can arrange a referral to a trusted MOHS surgeon.

Other Treatments

In selected cases, other treatment options such as radiotherapy, immunotherapy, targeted therapy or chemotherapy may be recommended.

Why Choose Us for Skin Cancer Treatment

Skin cancer can present differently across different skin types, making early recognition and accurate diagnosis particularly important. Dr Stephanie Ho's experience practising dermatology in both the United Kingdom and Singapore provides extensive experience in assessing and treating skin cancers in both Caucasian and Asian patients. Our approach combines careful diagnosis, individualised treatment and appropriate long-term surveillance, with procedures and follow-up care available within the clinic.

Summary

Early detection is the key to successful treatment of skin cancer. While basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are highly curable when diagnosed early, melanoma has the potential to spread and requires prompt diagnosis and treatment.

Protecting your skin from excessive UV exposure, understanding your personal risk factors, and performing regular self-skin examinations all play an important role in prevention and early detection. If you notice a new, changing or non-healing skin lesion, it is important to have it assessed by a dermatologist.

At Stephanie Ho Dermatology, we provide comprehensive skin examinations, dermoscopic assessment, AI-assisted mole mapping, accurate diagnosis, and personalised treatment for all types of skin cancer.

If you have any concerns about a mole or skin lesion, or would like a routine skin check, we welcome you to schedule a consultation. Early diagnosis offers the best chance of successful treatment.