Hydrochlorothiazide: Cause Of Non-Melanoma Skin Cancer?

There has been plenty of research linking blood pressure and the common medication prescribed for the treatment of it with non-melanoma skin cancer (NMSC).

Known as hydrochlorothiazide (HCTZ) – 2 recent Danish studies involving 1.7 million people has concluded that the long-term use of the diuretic drug is closely associated with cases of NMSC.

In the study, people who took HCTZ for at least 6 years were 29% more likely to develop basal cell carcinoma (BCC), and almost 4 times more likely to get squamous cell carcinoma (SCC) than individuals who didn’t take the medication.

A staggering revelation – what is worrying is that the risks increased the longer the patients were exposed to the drug, as well as the higher the dosage prescribed.

HCTZ is also commonly used to treat various other diseases including heart problems, and is one of the most frequently used anti hypertensive medications in the United States and Western Europe.

So, how will this affect you, and should you be worried? Let us delve deeper by first understanding what is non-melanoma skin cancer:

What is non-melanoma skin cancer (NMSC)?

In Singapore, skin cancer is one of the top 10 most frequent cancers.

Different from melanoma – the deadlier and more aggressive form of skin cancer – non-melanoma skin cancer is actually a much more common condition that starts in the cells of the skin.

There are 3 types of NMSC – consisting of mainly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), the most common being BCC that makes up roughly 75% – 80% of all skin cancer cases.

Slowly developing in the upper layers of the skin, it usually appears first as a growth, lump, mole, or discolored patch on the skin that doesn’t go away. The condition is mainly caused by being overexposed to harmful ultraviolet (UV) rays from the sun, artificial sunbeds and sun lamps.

In addition, there are certain other factors that increase the probability of developing NSMC, including:

– a family history of the condition
– fair skin and light hair that burns easily
– a high number of moles or freckles present on the skin
– immunosuppression caused by medication
– previous non-melanoma skin cancer

Since taking HCTZ increases skin’s photosensitivity – this means that the patient’s immune system is more easily triggered by sunlight, causing inflammation of the skin.

In order to treat skin cancer – treatments such as excision of the lesion (type of mole removal), cryotherapy, electrosurgery, photodynamic therapy and radiation therapy can be done.

The goal of treatment is to remove the cancer completely with the least possible cosmetic damage. When diagnosed early, NMSC can be easily treated and has a very low mortality rate.

What does this mean for doctors and patients

The Health Sciences Authority (HSA) has recently released an update informing health professionals on the outcomes of the Danish study, and how it impacts their decisions on treatment methods moving forward.

The use of HCTZ should be carefully considered, despite limitations of the studies not being fully applicable to the local context.

What this means for you – in the case that you are of a higher risk of skin cancer, be sure to schedule regular check-ins with our doctors to conduct a thorough skin examination, or learn how to complete a self-assessment at home.

A useful tool that you can use to do a self-exam at home is to use the ABCDE method:

Asymmetry: both sides of the mole look different from each other.

Border: the mole’s border is crooked, jagged or irregular.

Color: the mole is discolored or multi-colored.

Diameter: the width is more than 6 mm (about the size of a pencil eraser)

Evolution: the mole has changed in size, shape or feeling in a short amount of time.

The Skin Cancer Foundation in the U.S. advises everyone to examine their whole body at least once a month for any new moles or present moles that demonstrate any of these symptoms.

Either way, always consult a doctor first before you completely stop your medication – they should be able to advise you further, and prescribe a similar medication that provides no risks.

Should you remove your moles? 

A mole is simply a bump or spot on the skin that is usually brown or pink in color, with a smooth a regular border.

Most people have 10 to 40 moles somewhere on their skin – and while it isn’t necessary to remove all of them, should you notice any new or changed spots, lumps, sores, or moles that are painful – it may be time to head down to a clinic to have it checked and undergo mole removal treatment.

Furthermore, certain moles are more likely to turn into melanoma – removing a suspicious mole and examining it for cancer cells is a key step in catching and treating the condition early.

There are several ways to go about mole removal in Singapore; namely:

– Laser Removal: for smaller moles that doesn’t appear above the surface of the skin. Using powerful light energy to break down pigment in the mole, 2 to 3 treatments is needed to fully get rid of the mole. A minimally-invasive technique for eliminating multiple moles at the same time with zero scarring.

– Shave Removal: for smaller moles that protrude from the skin. Using a scalpel to shave off the mole and some tissue beneath it, this is a relatively straightforward and painless way to remove a mole. However, the root remains in the skin, meaning that the mole can grow and resurface again in the future.

– Punch Biopsy: a punch tool is placed over the mole and used to “punch” out the mole. The preferred and best mole removal method with no recurrence. Takes just a few minutes to complete.

– Excision Removal: mostly used for larger moles and flat mole removal that cannot be removed with previous methods. Performed under local anesthetic, the mole is cut away and removed entirely via an excision. Stitching is required after the surgery, and a small scar will be left. However, it will eventually fade over time.

While excision and shave removal are the most common methods for removing moles – laser removal can be useful for harder to reach areas such as facial mole removal.

We have partnered up with the pathology labs at Singapore General Hospital to effectively analyze, detect and diagnose skin cancer in its early stages.

During your initial consultation, our doctors will conduct a full body screening and biopsy to determine the characteristic of the mole and if its cancerous. If it is, it needs to be quickly removed in order to get rid of the dangerous cells. Best case scenario is if we are able to remove the entire tumor during the biopsy so that no further mole removal treatment is needed.

Depending on the type of mole and end result you are looking to achieve, our doctors will choose a method that is best for you to ensure minimal scarring.

Even if the mole is benign – many patients still undergo the procedure for cosmetic mole removal reasons. If you are worried about pain, not to worry! Our surgical mole removals are done under local anesthesia, and can be combined with laser mole removal to hasten the process and help to prevent scarring.

It is always better to be safe than sorry. If you are thinking about removing your mole, we have a multi-disciplinary team including a pathologist, radiologist, medical-oncologist and dermatologist to cater to your specific needs. You can rest assured that you will be provided with the best care possible – all at an affordable cost!

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