Staying out of the sun, or covering up, is the best way to avoid skin cancer
Skin cancer is increasing at an alarming rate in Hong Kong and the lack of awareness is a major concern
With summer temperatures often hovering around 40-plus degrees Celsius, it's little wonder Australia is known as the sunburnt country. But it's not just the land that gets scorched - its inhabitants also suffer. Melbourne-born Danielle Stutterd was one of them.
For Stutterd, summers were less about fun under the sun, and more about painful blisters and peeling skin. While her tan-seeking friends soaked up the rays - "they'd smother themselves in oil and even sit near a tin roof to get a more intense heat" - Stutterd sought out the shade.
"I'd fry in the sun. My skin would go red and sometimes bubble up if I got really burnt," says Stutterd, who has lived in Hong Kong for 14 years.
With her fair hair, blue eyes and sprinkling of freckles, Stutterd also fits the high-risk skin-cancer profile. In 2006, when she was 29 and fresh from a year-long overseas trip, she discovered a lump on the top of her head.
That lump was diagnosed as a basal cell carcinoma (BCC), the most common form of skin cancer, which makes up 70 per cent to 85 per cent of all skin cancers, according to the Hong Kong Cancer Fund.
Most basal cell carcinomas develop on areas exposed to the sun such as the head, neck and upper body, although some appear on the arms and legs.
Skin cancer is the fastest-growing cancer globally. It falls into two groups - non-melanoma, the most common, and melanoma, which is less common but faster growing and most vicious, says Dr Winston Lee, a skin cancer specialist based in Hong Kong.
Australia has one of the highest rates of skin cancer in the world - one in three people will be diagnosed with the disease, according to Cancer Council Australia.
While the rate is relatively low in Hong Kong, the disease has increased by almost 100 per cent in the past 10 years. According to the Hospital Authority, non-melanoma skin cancer is the eighth-most common cancer in Hong Kong.
Dr Anthony Ying Chi-ho, chairman of the cancer detection and prevention subcommittee of the Hong Kong Anti-Cancer Society, says the incidence of non-melanoma skin cancer in Hong Kong has increased rapidly in the past decade. In 1990, there were 346 new cases; the number jumped to 774 in 2011.
"The risks of excessive sun exposure, and importance of adequate sun protection, should be made known to the general public," says Ying.
Lee, who is on a mission to raise awareness about the disease, says people should always be sun savvy - even in winter. "Winter can be more intense, because we let our guard down. We spend more time outside, and don't apply sunscreen. We're just unprepared," he says.
Lee says it's a misconception that only fair-skinned people get skin cancer. "Chinese people have more melanin to protect the skin but Chinese people get skin cancer — people with dark skin do get skin cancer. [Reggae star] Bob Marley died of skin cancer," says Lee.
Leaning forward, Stutterd parts her hair to reveal a white scar about three centimetres long. "It's quite big but luckily not in a place that's visible … I continue to check my skin for any changes or new or suspicious markings. My doctor in Australia says it's highly likely that I'll develop more."
Today, Stutterd - who recently set up her own social enterprise Community& - lives the beach life in Shek O. But her relationship with the sun is different to before.
Beachwear today is not just a bikini but a light, long-sleeved shirt, hat and sunglasses. She tries to stay out of the sun between 11am and 3pm, when the sun's UV rate is at its highest - and most dangerous. Only 30+ sunscreen will do.
With genes playing a big role in skin cancer, she also applies these rules to her three-year-old son, Oliver. "I keep him out of the sun when it's at its peak, and I make sure he wears a hat and a rashie [rash vest]. He's lucky he's got his father's olive skin colouring, but I still apply sunscreen."
Danielle's mother Christine, visiting from Melbourne, also has some sun-related horror stories. Arms dotted with freckles, like a dangerous game of join the dots, she points out the places where suspicious spots have been removed.
"Almost every inch of my hands has had sun spots frozen off. It's a generational thing," Christine says. "There just wasn't the awareness when I was growing up."
Early detection is also vital in the fight against the disease, a reason Quality HealthCare now offers the latest technology for mole screening called SIAscopy, short for Spectrophotometric intracutaneous analysis.
Approved by the US Food and Drug Administration and EU Mark, SIAscopy easily identifies problematic moles and lesions, and Lee proves this by picking up what looks like a small hairdryer and places the machine's "nozzle" over a small spot on his hand.
After a few seconds, a computer has "diagnosed" the mole, breaking it down into different components following the ABCDE rule of skin cancer classification (see sidebar).
Lee says the non-invasive and pain-free technology provides confirmation of non-suspicious moles, therefore reducing the number of biopsies and unnecessary excisions of benign moles.
Lee says people should stay out of the sun in the middle of the day, and never use sunlamps or sunbeds, devices that emit ultraviolet radiation to produce a cosmetic tan. "Each time a person uses a sunbed, they increase their risk of melanoma by 20 per cent," he says.
Sunscreen is also important. "A broad spectrum, water-resistant SPF 30+, applied 20 minutes before going outdoors and every two hours afterwards … and be generous."
This year, researchers from Hong Kong, Macau and Taiwan reported promising results in using a chemical compound to treat skin cancer that could be used in sun cream.
Laboratory trials by scholars from Baptist University, University of Macau and Kaohsiung Medical University found that injections of the compound, rhodium (III) metal complex, can inhibit the development of skin cancer.
Lee says babies and children are at a high risk of sunburn as their young skin is delicate and easily damaged by the sun. "Most skin cancers result from sun damage at a young age so teaching kids to be sun aware is a good idea."
Jessica Leary, who moved to Hong Kong from Sydney this year, says she could not find solar suits - sun protective clothing - in the city for her four- and six-year-old boys this summer, so had to buy them online. "The selection of sunscreen is poor, and confusing labels are also a problem," she says.
The Hong Kong Cancer Fund recently partnered with Cancer Council Australia to launch high-quality sunscreen products in the city.
As a final bit of doctor's advice, Lee says it pays to be vigilant. "The earlier a skin cancer is identified and treated, the better the outcome. The most common question I get is 'is this mark a dangerous mole?' The best thing to do if you have any concerns is to get that mark checked by a doctor," he says.
For details, go to cancer-fund.org or call the hotline on 2191 3191
Know your ABCDEs
If you notice any of the following signs, see your doctor immediately
Asymmetry: the two halves of your mole do not look the same
Border: the mole's edges are irregular, blurred or jagged
Colour: the colour is uneven, with more than one shade
Diameter: your mole is more than 6mm in diameter
Evolving: any change in size, shape, colour, elevation, or another trait, or any new symptom such as bleeding, itching, or crusting points to danger
Source: Hong Kong Cancer Fund