A man who has spent twenty years on lease roads, drilling sites, roofs or equipment has accumulated more ultraviolet exposure than almost anyone who deliberately sunbathes. It arrives in small daily instalments rather than in obvious burns, and the northern latitude and long summer daylight here do not reduce it — the working day simply lasts longer. Snow and water reflect it, cloud cover barely filters it, and the parts of the body that receive the most are the ones nobody looks at: the back of the neck, the tops of the ears, the forearms, the scalp under thinning hair, and the left arm of anyone who drives a truck with the window down.
Skin cancer is the most common cancer in Canada, and outdoor workers carry disproportionate risk. Men are also more likely than women to be diagnosed at a later stage, largely because the lesions appear in places that are hard to see without help and easy to ignore when they do not hurt.
What to Watch For
Most skin cancers fall into three groups. Basal cell carcinoma is the most common and the least dangerous; it typically appears as a pearly or waxy bump, a persistent shiny patch, or a small sore that scabs, heals and reopens in the same spot for months. It does not spread through the body, but left alone it grows locally and can be destructive, particularly on the face and ears.
Squamous cell carcinoma often looks like a rough, scaly, red patch or a firm nodule, sometimes tender, sometimes crusted. It is strongly linked to cumulative occupational sun exposure and it can spread if neglected. It is frequently preceded by actinic keratoses — small sandpapery patches that many outdoor workers have across the forehead, scalp and forearms and assume are simply weathered skin.
Melanoma is less common but accounts for most skin cancer deaths. The usual guide is a change in an existing mole or a new pigmented spot that is asymmetric, has an irregular border, contains more than one colour, is larger than about six millimetres, or is evolving in any way. In men, melanoma appears most often on the back — the one area you cannot inspect yourself.
The single most useful signal, across all three, is persistence. A spot that has not resolved in a month, a sore that will not heal, or a lesion that bleeds when caught by a collar or a razor deserves a look. Pain is not required and is usually absent.
What a Skin Check Involves
It is a short, unremarkable examination. A physician looks at the skin in good light, sometimes with a dermatoscope, which is a handheld magnifier that shows structures beneath the surface. Areas of concern are recorded so that change over time can be judged. If something is suspicious, the usual next step is a small biopsy taken under local anaesthetic in a matter of minutes, and most of what is removed turns out to be benign.
Treatment for lesions caught early is generally minor: a local excision, a topical treatment, or freezing for pre-cancerous patches. The difference between a straightforward procedure and a serious one is almost entirely a matter of how long the lesion has been there.
Reducing What Accumulates
Occupational exposure cannot be avoided, but it can be reduced. A wide-brim attachment for a hard hat protects the ears and neck, which sunscreen on a work site rarely reaches reliably. Long sleeves in lightweight fabric are more practical than repeated application. Sunglasses reduce eyelid and ocular exposure. None of this undoes past exposure, but past exposure is precisely why the periodic check is worth doing.
Dr. Raymond Nash provides skin assessment as part of general preventive care at Grande Prairie Men’s Medical Clinic. To have something looked at, book through gpmm.clinic or call (587) 416-8296. The above is general information and is not a substitute for having a lesion examined in person.