Skin Cancer

By Kylie Alexander

In the early 20th century, the causes of cancer were much debated. For example, an MOH Deptford 1927 report indicated that some people believed cancer was caused by an infective agent while others believed it was caused by a lasting alteration in the nutrition of somatic cells. The medical officers of health were fairly confident that cancer was not contagious, but they still advised their communities to disinfect things used by people suffering from cancer.

The presentation of skin cancer is fairly consistent in the MOH reports. According to a MOH Camberwell 1923 report and a MOH Fulham 1931 report, the first sign of skin cancer is a tumor of the skin and may be described as a pimple or flat-topped nodule with discolored skin surrounding it. Eventually this nodule transforms into a firm ulcer, which will last for a considerable amount of time if cancerous, and then scabs over. Skin cancer was not believed to have affected the glands, like other types of cancers, and was considered to be completely curable when treated early.

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The image displays the classic appearance of melanoma on the skin of a patient, reported by The National Cancer Institute in 1985. 

SKIN CANCER DEVELOPMENT

There were many ideas as to how skin cancer developed. The MOH Fulham 1931 report claims that cancer starts as a mole, usually as a result of irritated skin caused by the razor while shaving, and blames beauty doctors’ use of electricity to remove moles as the cause of skin cancer. The report states that this method is insufficient and fails to completely remove the deepest parts of the mole, thus, the remains of the original mole are consistently irritated by the pull of the scar that is produced by this treatment, leading to skin cancer. Overall, medical observers have come to agree that chronic irritation of the epidermis leads to skin cancer (MOH Harrow 1911).

All of the Medical Officer of Health reports, except for the MOH Fulham 1933 report, claim that cancer in the skin is more common in men than in women, and this may be due to their occupations. Men with specific occupations such as mule spinners, chimney sweeps, and patent fuel workers often developed “occupational cancer” which was essentially cancer on the skin covering the testicles. Occupational cancer was caused by consistent irritation of the skin from substances that the workers were exposed to during work including oil, soot, tar, or pitch (MOH Fulham 1931 Pg. 17). Skin cancer was also common in tar and paraffin workers, hairdressers who consistently handled hair lacquer, and x-ray workers, due to the excessive exposure to radiation (MOH Harrow 1911,MOH Deptford 1926, MOH Hounslow 1970). Because men were typically the primary source of income for their families,  it may be justified that men developed skin cancer more often than women, especially if their occupations were the primary cause of skin cancer. Therefore, the MOH Hounslow 1970 report, emphasized occupational health as a pressing matter for employees of various work forces.

TREATMENT OPTIONS

Medical Officers of Health asserted that immediate recognition of moles that could indicate skin cancer was very important to the treatment process (MOH Camberwell 1923). In the MOH Harrow 1911 report, an officer describes an instance of skin cancer suffered by his first school master. The officer noted that his master had a wart on one side of his nose, which he tugged at when irritated. When the officer saw his master many years later, half of his face had been eaten away by cancer. All of this damage started out as a wart. Stories like this enforced the importance of early recognition of the disease. Skin cancer may be easily detected with the naked eye, so the officers put an emphasis on educating the public on how to prevent, and recognize the early symptoms of skin cancer (MOH Fulham 1931 Pg. 15).  

Preventative measures for the disease include protection from irritating substances, x-ray examinations for suspected growths, and immediate removal of simple tumors, moles, warts, naevi (strawberry marks) and papillomata, especially in middle aged people (MOH Deptford 1926MOH Harrow 1911). In contrast, a MOH Fulham 1931 Pg. 18 report stated that it was best to leave brown or black moles alone when they were not actively growing. General treatment for cancerous moles was simply cutting them out, preferably by a surgeon, and according to the MOH Fulham 1931 Pg. 15 report, patients typically sought out advice about moles between the age of fifty-five and sixty.

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The image is found in the Atlas of Clinical Surgery and identifies the skin condition as Carcinoma Planum Faciei in 1908. 

Dr. Butlin, a Victorian physician, established a skin cancer treatment, in place of surgery, that included zinc chloride as the key ingredient during his career between 1864 and 1911. The treatment took place in two phases: the first included the application of a paste, which was composed of sixty-five percent zinc chloride, and the second phase included an additional layer of a well-known Bougard’s paste, which was also mixed with zinc chloride. The first paste was applied to the healthy skin surrounding the ulcer, and ultimately destroyed the skin for the purpose of enhancing the skins absorbency so that the second paste would work to destroy the cancer. The second paste was applied directly onto the ulcer. After twenty-four hours later, Dr. Butlin removed the dead epithelial tissue via cutting. The patient endured fourteen two-phase treatment sessions, and after sixteen months, was reported cancer free and pain free (Victorian Pharmacology XI). Dr. Butlin’s treatment for skin cancer was a very different approach than the typical treatments advised by the Medical Officers of Health. A MOH East Ham 1953 statistic taken in 1954 reporting only one skin cancer death may indicate that the officers did a very good job of educating their communities on the early signs and symptoms of this particular disease.

MODERN CAUSES OF SKIN CANCER

While risky occupations for the lower class seemed to be the cause of skin cancer in the early twentieth century, the opposite is true for the cause of the disease today. According to Robert Jackson, factors such as leisure time, excess money for vacations, better health for outside activities, and skimpier clothing are important contributions to the development of the disease. This is because ultraviolet light, which is a component of sunlight, has been identified as a major cause of skin cancer. Studies show that one-hundred and sixty-five people out of every one-hundred thousand people report having a non-melanoma skin cancer in the United States, and susceptibility to skin cancer is related to paleness and chronic exposure to sunlight (“Concepts of Cancer,” pp. 107-108). Statistics like this have provoked research on the areas of the body that are most exposed to the ultraviolet element of sunlight, and these studies have shown that the tops of the ears, nose, scalp, and posterior lower neck receive the most radiation (Jackson).

FINAL THOUGHTS

Understandings of the causes of skin cancer have shifted significantly throughout history as it was originally presented as “occupational cancer” on men’s scrota, then showed up on other parts of people’s bodies who worked with radiation and hair lacquer, and now is most commonly found on the head and neck area due to leisure activities in the sun. However, the presentation of skin cancer and the idea to protect the skin from harmful substances/ultraviolet light in order to avoid acquiring the disease has remained relatively constant.

REFERENCES

MOH REPORTS

SECONDARY SOURCES

IMAGES