Skin cancer affects 65,000 people in the UK every year. Rachel Hanslope explains what underwriters take into account when looking at this area
Skin cancer is a disease where malignant cells form on the outer layer of your skin.
Most cases are caused by damage from ultraviolet (UV) rays in sunlight.
Skin cancer is one of the most common types of carcinoma and accounts for half of all new cancers in Western populations.
The high incidence of this type of cancer can be in part linked to the current trend for people wishing to get a sun tan for cosmetic reasons.
This has also been affected by the level of UV light today, which is higher than it was 50 or 100 years ago.
The intensity of UV light is due to a reduction of ozone in the earth's atmosphere.
Ozone serves as a filter to screen out and reduce the amount of UV light that we are exposed to.
With less atmospheric ozone, a higher level of UV light reaches the earth's surface.
There are three types of skin cancer; the two most common are basal cell and squamous cell carcinomas.
They are easily treated and rarely fatal.
The third and most dangerous is the malignant melanoma.
Basal cell cancer is the most common and least dangerous non-melanoma skin cancer.
It grows quite slowly and usually starts as a small round or flattened lump.
The lump may be red, pale or pearly in colour.
Sometimes it appears as a scaly, eczema-like patch on the skin.
Curative treatment for most of these types of lesions entails either surgery or radiotherapy, but if lesions are neglected and become advanced, reconstructive plastic surgery may be needed.
Squamous cell cancer is more serious than basal cell cancer as it can spread to other parts of the body if left untreated.
Squamous cell cancers appear as persistent red scaly spots, lumps, sores or ulcers, which may bleed easily.
Excision of squamous cell carcinoma leads to cure in over 80% of patients, but this is dependent on the differentiation of the tumour and whether or not lymph node metastases have occurred.
The lesions are also responsive to radiotherapy.
Malignant melanoma, also known as melanoma, is the most serious type of skin cancer.
It usually develops in cells in the outer layer of the skin.
The first visible signs of this may be a change in the normal look or feel of a mole.
Malignant melanoma occurs clinically in four forms:
• Lentigo maligna (Hutchinson's freckle)
• Superficial spreading melanoma
• Nodular melanoma
• Acral lentiginous melanoma Melanoma is a malignant tumour that originates in melanocytes, the cells that produce the pigment melanin that colours skin, hair, and eyes and is heavily concentrated in most moles.
The majority of melanomas, therefore, are black or brown.
However, melanomas occasionally stop producing pigment.
When that happens, the melanomas may no longer be dark, but are skin-coloured, pink, red, or purple.
Like most cancers, melanoma is best treated when it is diagnosed early.
Melanoma can spread or metastasise quickly to other parts of the body through the lymph system or through the blood.
Lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells.
Melanoma is described as either 'in situ' or invasive.
In situ is Latin and means 'in one site' or localised.
Melanomas in situ occupy only the uppermost part of the epidermis, the top layers of the skin.
Malignant melanomas Invasive melanomas are more serious, as they have penetrated more deeply into the skin and may have travelled from the original tumour through the body.
Surgery to remove the tumour is the primary treatment for all stages of melanoma.
It may be removed using the following operations: °Ω Local excision - which involves taking out the melanoma and some of the normal tissue around it.
• Wide local excision - with or without removal of lymph nodes.
• Lymphadenectomy - which is a surgical procedure in which lymph nodes are removed and examined to see if they contain cancer.
• Sentinel node biopsy - which is the removal of the sentinal lymph node, the first lymph node the cancer is likely to spread to from the tumour during surgery.
A radioactive dye is injected near the tumour.
The substance or dye flows through the lymph ducts to the lymph nodes.
The first node to receive the dye is removed for biopsy.
A pathologist views this through a microscope to look for cancer cells.
If cancer cells are not found, it may not be necessary to remove more lymph nodes Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.
When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells.
There are two types of radiation therapy.
External radiation therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Biologic therapy is a treatment that uses the patient's immune system to fight cancer.
Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defences against cancer.
This type of cancer treatment is also called biotherapy or immunotherapy.
Rachel Hanslope is a life and disability underwriter for Scottish Equitable Protect
Underwriting implications In order to underwrite this condition it is important to establish the type of skin cancer.
For non-malignant types such as basal cell carcinoma and squamous cell carcinoma, these would usually be given standard rates for life cover, total and permanent disability, waiver of premium and income protection (IP).
Also, standard rates would be given for critical illness (CI) benefit, providing skin cancer other than malignant melanomas are excluded from the list of specified illnesses covered.
For underwriting malignant melanomas the staging of the tumour needs to be established.
To do this, the underwriter would initially obtain a tumour questionnaire from the GP and the hospital specialist reports.
There are generally two types of classification for the staging of the disease, which are the Breslow system (thickness of the lesion) or Clark's system (level of invasion).
Should the underwriter also be given information on the presence of ulceration, this also needs to be taken into consideration and rated more severely.
The type of rating usually applied to life cover and IP for cases of malignant melanoma is a temporary per mille rating, where an extra annual charge is applied per each £1,000 of cover.
These can be as high as £20 extra per £1,000 of life cover per year.
They are usually temporary ratings for a number of years ranging from two to seven.
After this time, if there is no recurrence, the premium can then often reduce to standard rates.
This rating method is to reflect the increased likelihood of recurrence for a number of years following diagnosis and treatment.
Dependent on the staging of the malignant melan oma, life cover and IP could also be postponed for as long as five years following treatment, at which time rated terms may be offered.
CI benefit would usually be declined with a history of malignant melanoma.
Facts and figures °Ω There are around 65,000 new cases of skin cancer in the UK every year.
• About 1,500 people die from melanomas in Britain every year.
• Melanoma affects adults of all ages.
It is one of the few cancers to affect young adults and is the third commonest cancer among 15-39 year olds.
Risk increases with age.
• More women than men develop malignant melanoma.
In women they are most common on the legs and in men they are most common on the back.
• By 2001, one in every 90 people in the US were diagnosed with malignant melanoma.
The UK figure is one in every 150-200.
• Melanomas can spread in two ways.
Horizontally, which gives rise to the superficial spreading melanoma, or they can grow downwards and the cells will invade the lymph glands, which is much more dangerous.
• There is strong evidence that melanomas occur on sun-damaged skin and that people are particularly at risk when they have sudden, short bursts of sunlight on holidays in places where the sun is very strong.
• People most at risk from melanoma include those with, a high number of moles, red or fair hair, blue eyes, fair skin and freckles, who tan with difficulty and burn in the sun, and those with a history of the disease in two or more family members.
• Over the past 60 years, damage to the planet's ozone layer has increased the amount of harmful radiation that reaches your skin.
• UV radiation is made up of UVA and UVB rays.
UVA ages the skin and UVB burns the skin.
Both can cause skin cancer.
• UV radiation is not felt as heat on the skin, so even on a cool and cloudy day, it may be just as high and just as damaging as on a clear and sunny day.
• If detected early, skin cancer has a 99% cure rate.
